Acute-on-chronic liver failure （ACLF） is a syndrome of multiple organ failure on the basis of underlying chronic liver disease and has an extremely high short-term mortality rate， while there is still a lack of unified diagnostic criteria around the world. Radiology plays an important role in the evaluation and prognostic prediction of ACLF， constituting a multi-dimensional assessment system covering morphology， function， and hemodynamics. Computed tomography can be used for the measurement of liver volume and the diagnosis of sarcopenia by providing key morphological and nutritional parameters. Magnetic resonance imaging （MRI）， especially gadobenate dimeglumine-enhanced MRI， enables quantitative assessment of liver function and has critical significance for predicting short-term survival rate. Ultrasonography and elastography techniques facilitate the early warning of ACLF onset and the dynamic monitoring of its progression through noninvasive measurement of liver stiffness and hemodynamic parameters. This article systematically reviews the pivotal role of these three imaging modalities in the diagnosis and monitoring of ACLF， and integrating the strengths of multiple imaging techniques with clinical indicators to construct diagnostic and prognostic models may become a key future direction for achieving early intervention and improving clinical outcomes in ACLF.

ObjectiveTo investigate the therapeutic effects and potential mechanisms of Atractylodes chinensis volatile oil microemulsion in relieving depression， thus establishing a theoretical foundation and a new approach for developing it as a novel adjunctive antidepressant. MethodsSixty SD male rats were assigned into four groups： control， model （chronic unpredictable mild stress）， positive drug （flupentixol hydrochloride， 1.8 mg·kg^-1）， and low-， medium-， high-dose （16.2， 32.4， 64.8 mg·kg^-1） A. chinensis volatile oil microemulsion. The sucrose preference test， open field test， tail suspension test， and forced swimming test were conducted to measure the sucrose preference rate， total exercise distance， average speed， resting time， tail suspension time， and swimming immobility time before and after treatment. The morphology of the rat brain tissue was visualized by hematoxylin-eosin （HE） staining. The levels of 5-hydroxytryptamine （5-HT）， norepinephrine （NE）， and cortisol （CORT） in the hippocampal tissue were measured by enzyme-linked immunosorbent assay （ELISA）. Real-time PCR was used to detect mRNA level differences of cyclic adenosine monophosphate （cAMP）， protein kinase A （PKA）， cyclic adenosine monophosphate response element-binding protein （CREB）， brain-derived neurotrophic factor （BDNF）， and tyrosine kinase B （TrkB） in the hippocampus. Western blot was employed to assess protein level variations of cAMP， PKA， CREB， BDNF， and TrkB in the same tissue samples. ResultsCompared with that in the blank group， the body mass of rats in low-， medium-， high-dose A. chinensis volatile oil emulsion groups decreased （P<0.05）， indicating that the modeling was successful. Compared with the model group， medium-， high-dose A. chinensis volatile oil emulsion shortened the tail suspension time， swimming immobility time， and resting time （P<0.05， P<0.01）， while increasing the sucrose preference rate， total exercise distance， and average speed （P<0.01）. No significant changes were observed in the low-dose A. chinensis volatile oil emulsion group. ELISA results indicated that CORT concentrations in the hippocampal tissue of medium and high-dose A. chinensis volatile oil emulsion groups decreased （P<0.01）. In the high-dose group， 5-HT and NE concentrations increased （P<0.05， P<0.01）， while they had no significant changes in the low-dose group. Real-time PCR results revealed that the mRNA levels of cAMP， PKA， and CREB in the hippocampus of the medium-dose Beicangzhu volatile oil emulsion group increased （P<0.05， P<0.01）， and those of cAMP， PKA， CREB， BDNF， and TrkB were upregulated in the high-dose Beicangshu volatile oil microemulsion group （P<0.01）. Western blot and immunofluorescence results demonstrated that the protein levels of cAMP， PKA， and TrkB in the hippocampal tissue of the low-dose A. chinensis volatile oil microemulsion group were up-regulated （P<0.05）. The medium-dose Beicangzhu volatile oil emulsion group exhibited increases in protein levels of cAMP， PKA， BDNF， and TrkB （P<0.05， P<0.01）， while the high-dose group showed elevationsin protein levels of cAMP， PKA， CREB， BDNF， and TrkB （P<0.05， P<0.01）. ConclusionBeicangzhu volatile oil emulsion demonstrates certain antidepressant efficacy by inhibiting CORT expression， upregulating the expression of 5-HT， NE， cAMP， PKA， CREB， BDNF， and TrkB， activating the CREB/BDNF signaling pathway to improve the cerebral protection.

Background Air pollution is a major environmental factor threatening respiratory health. Different pollutants exhibit varying degrees of lag effects on respiratory diseases, and synergistic effects may exist among multiple pollutants. There is an urgent need to identify the key air pollutants influencing respiratory diseases and their interactive effects at specific lags. Objective To identify key pollutants affecting hospital admissions for respiratory diseases, to analyze their lag effect characteristics, and to quantify the impact of multi-pollutant synergistic effects on respiratory disease admissions. Methods Daily air pollution data, meteorological data, and respiratory disease hospitalization records were collected from multiple national monitoring stations in Hefei City from 2019 to 2024. A two-stage analytical framework was employed. First, a distributed lag model (DLM) was used to construct pollutant lag matrices, followed by least absolute shrinkage and selection operator (LASSO) regression to select key variables among fine particulate matter (PM_2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃). Second, a generalized additive model (GAM) was established, incorporating product interaction terms and excess relative risk (ERI) to quantitatively assess synergistic effects among the selected pollutants. Results Through LASSO regression, 24 pollutant lag terms with non-zero coefficients were identified, among which NO₂, PM_2.5, and SO₂ accounted for 66.7% of the total positive effects and exhibited distinct lag patterns. Exposure to NO₂ showed acute risk, with a relative risk of 1.040 (95%CI: 1.023, 1.057) at lag0. Conversely, PM_2.5 and SO₂ exhibited delayed effects, with peak impacts observed at lag7 (RR=1.012, 95%CI: 1.0002, 1.024) and lag3 (RR=1.015, 95%CI: 1.0004, 1.03), respectively. Short-term NO₂ exposure (lag0–1) exhibited a significant positive interaction with medium-term PM_2.5 exposure (lag4–7). When both pollutants coexisted at high exposure levels, the combined health risk exceeded the sum of their independent effects by 4.40%. Stratified analysis showed that the interaction effects of pollutants were higher in females (ERI=5.00%), children (<18 years, ERI=5.50%), and older adults (≥65 years, ERI=3.90%)Conclusion There are significant lag heterogeneity and synergistic mechanisms in the health effects of air pollution in Hefei. It is recommended to implement real-time early warning responses for NO₂, prioritize medium-to-long-term management for PM_2.5 and SO₂, and adopt coordinated emission reduction measures when NO₂ and PM_2.5 concentrations rise simultaneously. Concurrently, enhanced health protection should be provided for sensitive populations such as women, children, and the elderly.

The current clinical treatment of bladder cancer (BCa) is mainly surgical treatment，supplemented by postoperative chemotherapy and immunotherapy.However，due to the lack of specificity，targeting and other reasons，the therapeutic effect is not satisfactory.In recent years，it has been found that metal nanoparticles (MNPs) prepared by gold，silver，and so on，as bladder infusion drugs or drug carriers，can not only accurately target BCa cells，but also have high stability and drug release rate，thereby reducing the side-effects of chemotherapy drugs.Based on domestic and foreign studies，this paper reviews the progress of MNPs in the treatment of BCa，including gold，silver，copper and other MNPs，and prospects the trend of bladder perfusion combined with nanomedical drugs.

ObjectiveThe effects of two microbial fertilizers （Bacillus subtilis fertilizer and Trichoderma harzianum-Purpureocillium lilacinum compound fertilizer） on the growth and development， the accumulation of active ingredients， and the microbial community diversity of rhizosphere soil of Atractylodes chinensis were investigated. MethodsA field experiment was carried out with two-year-old Atractylodes chinensis as the test material. Plant samples were collected during the wilt stage （September 26， 2023） to determine the general agronomic traits of Atractylodes chinensis. High-performance liquid chromatography （HPLC） was utilized to evaluate the effects of microbial fertilizers on the synthesis and accumulation of four active ingredients （atractylodin， atractylon， β-eudesmol， and atractylenolide Ⅰ） in Atractylodes chinensi. PacBio Sequel sequencing technology was used to explore the differences in bacterial community structures and diversity in the rhizosphere soil of Atractylodes chinensis treated with different microbial fertilizers. ResultsThe two microbial fertilizers had significant growth-promoting effects on Atractylodes chinensis. Compared with those of the CK group， the stem diameter， stem and leaf dry and fresh weight， and rhizome dry and fresh weight of Atractylodes chinensis significantly increased by 0.47-1.07 times （P<0.05） after the application of the Bacillus subtilis fertilizer （16 kg/667 m²）， and those significantly increased by 0.62-0.96 times （P<0.05） after the application of the Trichoderma harzianum-Purpureocillium lilacinum compound fertilizer （1.5 kg/667 m²）. The effect on plant height was not significant. The application of two microbial fertilizers was beneficial to the accumulation of atractylodin， atractylon， β-eudesmol， and atractylenolide Ⅰ （P<0.01）， and the effect of the Bacillus subtilis fertilizer on the accumulation of active ingredients of Atractylodes chinensis was better than that of the Trichoderma harzianum-Purpureocillium lilacinum compound fertilizer. The results of high-throughput sequencing showed that compared with the CK group， the Bacillus subtilis fertilizer （8 kg/667 m²） could significantly increase the diversity of rhizosphere bacterial species by regulating the Simpson index and Shannon index （P<0.05）， and the Trichoderma harzianum-Purpureocillium lilacinum compound fertilizer significantly reduced the bacterial diversity （P<0.05）. The relative abundance of dominant bacteria was compared at the phylum and genus levels. The relative abundance of Proteobacteria （45.73%） and Burkholderia_Caballeronia_Paraburkholderia （9.98%） significantly increased after the application of the Bacillus subtilis fertilizer （P<0.01）， and the relative abundance of Acidobacteriota （20.53%） and Sphingomonas （3.63%） increased significantly （P<0.01） after the application of the Trichoderma harzianum-Purpureocillium lilacinum compound fertilizer. The relative abundance of beneficial bacteria in the Bacillus subtilis fertilizer was slightly higher than that in the Trichoderma harzianum-Purpureocillium lilacinum compound fertilizer. Pearson correlation analysis showed that Burkholderia_Caballeronia_Paraburkholderia and Sphingomonas were positively correlated with the content of atractylodin， atractylon， β-eudesmol， and atractylenolide Ⅰ （P<0.05）. ConclusionThe application of the Bacillus subtilis fertilizer and Trichoderma harzianum-Purpureocillium lilacinum compound fertilizer can increase the yield of medicinal materials and promote the synthesis and accumulation of active ingredients by regulating the rhizosphere microecological diversity of Atractylodes chinensis， and the application effect of the Bacillus subtilis fertilizer is better than that of the Trichoderma harzianum-Purpureocillium lilacinum compound fertilizer.

Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, plays a significant role in maintaining public health. In 2019, the Central Committee of the Communist Party of China and the State Council proposed for the first time the establishment of a TCM registration and evaluation evidence system that integrates TCM theory, "personal experience" and clinical trials (referred to as the "Three-in-One" System) to promote the inheritance and innovation of TCM. Subsequently, the National Medical Products Administration issued several guiding principles to advance the improvement and implementation of this system. Owing to the complexity of its implementation, there are still differing understandings within the TCM industry regarding the positioning of the "Three-in-One" Registration and Evaluation Evidence System, as well as the connotation and value orientation of the "personal experience." To address this, Academician WANG Qi, President of the TCM Association, China International Exchange and Promotion Association for Medical and Healthcare and TCM master, led a group of academicians, TCM masters, TCM pharmacology experts and clinical TCM experts to convene a "Seminar on Promoting the Implementation of the ′Three-in-One′ Registration and Evaluation Evidence System for Chinese Medicinals." Through extensive discussions, an expert consensus was formed, clarifying the different roles of the TCM theory, "personal experience" and clinical trials within the system. It was further emphasized that the "personal experience" is the core of this system, and its data should be derived from clinical practice scenarios. In the future, the improvement of this system will require collaborative efforts across multiple fields to promote the high-quality development of the Chinese medicinal industry.

The purpose of this study was to clarify the effect of Huotan Jiedu Tongluo Decoction on atherosclerosis(AS) injury in ApoE~(-/-) mice by regulating the ferroptosis pathway. Seventy-five ApoE~(-/-) mice were randomly divided into model group, low-, medium-, and high-dose of Huotan Jiedu Tongluo Decoction groups, and evolocumab group(n=15), and 15 C57BL/6J mice were selected as the blank group. Mice in the blank group were fed with a normal diet, and those in the other groups were fed with a high-fat diet to induce AS. From the 9th week, mice in Huotan Jiedu Tongluo Decoction groups were administrated with Huotan Jiedu Tongluo Decoction at corresponding doses by gavage, and those in the blank group and the model group were given an equal volume of distilled water. Mice in the evolocumab group were treated with evolocumab 18.2 mg·kg~(-1 )by subcutaneous injection every 2 weeks. After 8 weeks of continuous intervention, oil red O staining and hematoxylin-eosin(HE) staining were employed to observe the lipid deposition and plaque formation in the aortic root. Masson staining was used to evaluate the collagen content in the aortic root. The serum levels of total cholesterol(TC), triglycerides(TG), high-density lipoprotein cholesterol(HDL-C), and low-density lipoprotein cholesterol(LDL-C) were determined by biochemical kits. The levels of Fe~(2+), superoxide dismutase(SOD), malondialdehyde(MDA), and glutathione(GSH) in the aorta were measured by colorimetry. The protein and mRNA levels of nuclear factor erythroid 2-related factor 2(Nrf2), glutathione peroxidase 4(GPX4), solute carrier family 7 member 11(SLC7A11), and acyl-CoA synthetase long chain family member 4(ACSL4) in the aorta were detected by Western blot and RT-qPCR, respectively. The expression of Nrf2, GPX4, and SLC7A11 was localized by immunofluorescence. The results showed that low-, medium-, and high-dose Huotan Jiedu Tongluo Decoction reduced the plaque formation of aortic root and increased the collagen content in AS mice. At the same time, Huotan Jiedu Tongluo Decoction improved the lipid metabolism by lowering the levels of TC, LDL-C, and TG and elevating the level of HDL-C in the serum. Huotan Jiedu Tongluo Decoction enhanced the antioxidant capacity by elevating the levels of GSH and SOD and lowering the level of MDA in the aorta and inhibiting the accumulation of Fe~(2+) in the aorta. In addition, Huotan Jiedu Tongluo Decoction up-regulated the protein and mRNA levels of Nrf2, GPX4, and SLC7A11, while down-regulating the protein and mRNA levels of ACSL4. In summary, Huotan Jiedu Tongluo Decoction can effectively alleviate AS lesions in ApoE~(-/-) mice by activating the Nrf2/GPX4 pathway, reducing lipid peroxidation, and inhibiting ferroptosis.
Animals ; Ferroptosis/drug effects* ; Atherosclerosis/metabolism* ; Drugs, Chinese Herbal/administration & dosage* ; NF-E2-Related Factor 2/genetics* ; Mice ; Mice, Inbred C57BL ; Apolipoproteins E/metabolism* ; Male ; Phospholipid Hydroperoxide Glutathione Peroxidase/genetics* ; Signal Transduction/drug effects* ; Humans ; Mice, Knockout

OBJECTIVE: To evaluate the efficacy and safety of Shexiang Tongxin Dropping Pill (STDP) in treating stable angina patients with phlegm-heat and blood-stasis syndrome by exercise duration and metabolic equivalents. METHODS: This multicenter, randomized, double-blind, placebo-controlled clinical trial enrolled stable angina patients with phlegm-heat and blood-stasis syndrome from 22 hospitals. They were randomized 1:1 to STDP (35 mg/pill, 6 pills per day) or placebo for 56 days. The primary outcome was the exercise duration and metabolic equivalents (METs) assessed by the standard Bruce exercise treadmill test after 56 days of treatment. The secondary outcomes included the total angina symptom score, Chinese medicine (CM) symptom scores, Seattle Angina Questionnaire (SAQ) scores, changes in ST-T on electrocardiogram and adverse events (AEs). RESULTS: This trial enrolled 309 patients, including 155 and 154 in the STDP and placebo groups, respectively. STDP significantly prolonged exercise duration with an increase of 51.0 s, compared to a decrease of 12.0 s with placebo (change rate: -11.1% vs. 3.2%, P<0.01). The increase in METs was significantly greater in the STDP group than in the placebo group (change: -0.4 vs. 0.0, change rate: -5.0% vs. 0.0%, P<0.01). The improvement of total angina symptom scores (25.0% vs. 0.0%), CM symptom scores (38.7% vs. 11.8%), reduction of nitroglycerin consumption (100.0% vs. 11.3%), and all domains of SAQ, were significantly greater with STDP than placebo (all P<0.01). The changes in Q-T intervals at 28 and 56 days from baseline were similar between the two groups (both P>0.05). Twenty-five participants (16.3%) with STDP and 16 (10.5%) with placebo experienced AEs (P=0.131), with no serious AEs observed. CONCLUSION STDP could improve exercise tolerance in patients with stable angina and phlegm-heat and blood stasis syndrome, with a favorable safety profile. (Registration No. ChiCTR-IPR-15006020).
Humans ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Male ; Female ; Middle Aged ; Angina, Stable/physiopathology* ; Aged ; Syndrome ; Treatment Outcome ; Placebos ; Tablets