Postprandial drowsiness is a clinical condition characterized by pronounced drowsiness after meals， while The Inner Canon of Yellow Emperor （《黄帝内经》） associates this condition with wei qi （defensive qi）. By analyzing the original texts of The Inner Canon of Yellow Emperor and perspectives from many medical professionals， it is found that the transition between wakefulness and sleep depends on the mutual induction of yin and yang， and that the two pathways of wei qi circulation intersect at the spleen and stomach. Based on this， the core pathogenesis of postprandial drowsiness is proposed to be either upper jiao obstruction or spleen-stomach dysfunction， leading to the stagnation of wei qi internally， then the mutual induction of yin and yang causes inward invasion of wei qi in the body， resulting in drowsiness； at this stage， the stagnated and inward invasive wei qi converges at the spleen and stomach， then merges into the circulation of zang-fu organs， rerouting through the Foot Taiyang Meridian， forming a circulation pattern described as "circulating from yin to yang". Treatment should focus on the root and branch simultaneously， with the primary goal of regulating the circulation of wei qi； facilitating its transition from yin to yang to restore the sleep-wake cycle. By proposing the model of wei qi circulating from yin to yang， this study offers novel insights on the understanding of postprandial drowsiness.

Addressing the enduring challenge of evaluating traditional Chinese medicines (TCMs), the integrated evidence chain-based effectiveness evaluation of TCMs (Eff-iEC) has emerged. This paper explored its capacity through a demonstration study that evaluated the effectiveness evidence of six commonly used anti-hepatic fibrosis Chinese patent medicines (CPMs), including Biejiajian Pill (BP), Dahuang Zhechong Pill (DZP), Biejia Ruangan Compound (BRC), Fuzheng Huayu Capsule (FHC), Anluo Huaxian Pill (AHP), and Heluo Shugan Capsule (HSC), using both Eff-iEC and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The recognition of these CPMs within the TCM academic community was also assessed through their inclusion in relevant medical documents. Results showed that the evidence of BRC and FHC received higher assessments in both Eff-iEC and GRADE system, while the assessments for others varied. Analysis of community recognition revealed that Eff-iEC more accurately reflects the clinical value of these CPMs, exhibiting superior evaluative capabilities. By breaking through the conventional pattern of TCMs effectiveness evaluation, Eff-iEC offers a novel epistemology that better aligns with the clinical realities and reasoning of TCMs, providing a coherent methodology for clinical decision-making, new drug evaluations, and health policy formulation.

Fabry disease, a rare genetic disorder affecting multiple organs, has understudied correlations among enzyme activity, genotype, and clinical manifestations in patients of different sexes with classical and late-onset phenotypes. In this study, clinical data, α-Gal A activity, and GLA gene test results of 311 patients, who were categorized by classical and late-onset phenotypes, ⩽5% and > 5% of the normal mean value of enzyme activity, and truncated and nontruncated mutation groups, were collected. The common clinical manifestations of Fabry disease included acroparesthesia, hypohidrosis/anhidrosis, neuropsychiatric system, and renal and cardiovascular involvement. Multiorgan involvement was higher in males and classical phenotype patients. In both sexes, classical patients commonly presented with acroparesthesia and multiorgan involvement, whereas late-onset patients showed renal, neuropsychiatric, and cardiovascular involvement. Male and classical patients had lower enzyme activity than female and late-onset patients, respectively. Classical males with enzyme activity of ⩽5% of the normal mean level showed higher multiorgan involvement frequency than those with enzyme activity of > 5%, whereas no significant difference was observed among females. Ninety-five gene mutation sites were detected, with significant phenotype heterogeneity in patients with the same mutation. No significant difference in enzyme activity or clinical manifestations was observed between truncated and nontruncated mutations. Overall, male patients with Fabry disease, regardless of classical or late-onset phenotype, have a higher frequency of multiple-organ involvement and lower α-Gal A activity than female patients. α-Gal A activity was closely correlated with clinical symptoms in males but weakly correlated with clinical manifestations in females. The clinical manifestations of patients with the same mutation are heterogeneous, and the correlation between gene mutation and enzyme activity or clinical manifestation is weak.
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Age of Onset ; alpha-Galactosidase/metabolism* ; China ; Fabry Disease/enzymology* ; Genotype ; Mutation ; Phenotype ; Sex Factors ; East Asian People/genetics*

Objective:To investigate the efficacy and safety of a new airway opening device with automatic position adjustment.Methods:From January 4 to March 15,2021,the purposive sampling method was used to select 360 patients who underwent bronchoscopy exami-nation or treatment.According to the random sequence generated by a computer,the research assistant adjusted the position angle(PA)as 90°(90° PA group),95°(95° PA group),and 100°(100° PA group),respectively,to open the airway of subjects,and the bron-choscope entered the airway to obtain the image of the best glottic view.All subjects were followed up immediately after study and at 0.5,1,3,6,12,and 24 hours after study to observe device-related adverse events.The primary outcome measure was the Cormack-Lehane(CL)grade for glottic exposure,and the secondary outcome measures were the incidence rate of adverse events and Visual Ana-logue Scale(VAS)score.Results:More than 80.0%of the subjects had CL grade I glottic exposure,and there was no significant difference in CL grade between the three PA groups(x2=1.942,P>0.05).The CL grade of some subjects was optimized at an angle of 100°.No device-related adverse events were reported,and the VAS score was 0.Conclusion:The device can effectively and safely open the air-way of subjects undergoing bronchoscopy at a PA of 90°-100°,and although it has no obvious advantage in improving glottic exposure at different levels of PA,it is recommended to select the PA of 100° to open the airway.

Integrated traditional Chinese and Western medicine refers to a clinical diagnosis and treatment model that incorporates the essence of traditional Chinese medicine in regard to treatment decisions based on syndrome differentiation and a reliance on modern western medicine as the basis of diagnosis and treatment.It is an organic combination of the two,with each bringing its own strengths into full play and complementing those of the other.After the founding of the People's Republic of China,the development of the integrated traditional Chinese and Western medicine has been increasingly valued.The unique advantages of the integration of traditional Chinese and Western medicine have been continuously utilized,resulting in fruitful achievements in theoretical inheritance and innovation and in the prevention and treatment of major diseases.Furthermore,integrated traditional Chinese and Western medicine has become a unique system of medicine of China.This article provides a review and elaboration of the entire process of the integration of traditional Chinese and Western medicine,including its significance,status of development,and achievements.It is suggested that,in the field of integrated traditional Chinese and Western medicine,efforts should made to delve into classic theories,identify the right entry points for integration,reconstruct and improve the theoretical system of integrated traditional Chinese and Western medicine by combining the cutting-edge achievements of modern medicine,and focus on enhancing clinical efficacy.

Objective To compare the analgesic effect, duration and incidence of adverse reactions of liposome bupivacaine (LB) and bupivacaine hydrochloride after intercostal nerve block in single-port thoracoscopic lung surgery. Methods In Department of Thoracic Surgery of the First Affiliated Hospital of Xinxiang Medical University between September 2023 and March 2024, 228 patients who needed to undergo thoracoscopic lung surgery were selected and divided into two groups by random number table method: a group B with bupivacaine hydrochloride (n=118), and a group LB with LB (n=110). Intraoperative intercostal nerve block was performed under endoscopy, and the time of first use of analgesic drugs after surgery, cumulative use of opioids 72 h after surgery, incidence of postoperative nausea and vomiting, length of stay and other indicators were evaluated and recorded. Results Visual analogue scale (VAS) scores at 4 h, 8 h, 12 h, 24 h, 48 h and 72 h in the LB group were significantly lower than those in the group B (P<0.05). The total number of activities within 48 h after surgery in the group B was significantly lower than that in the LB group (P<0.05), and the postoperative hospitalization stay in the LB group was shorter than that in the group B, but the difference was not statistically significant. There was no statistical difference between the two groups in postoperative adverse reactions. Conclusion Intercostal nerve block with LB during single-port thoracoscopic lung surgery can significantly reduce postoperative pain, improve quality of life, and promote recovery of the patients. It is worthy of clinical application.

Humans ; Blood Pressure/physiology* ; Renal Insufficiency, Chronic ; Hypertension/drug therapy* ; Antihypertensive Agents/therapeutic use*

Chronic hepatitis B virus (HBV) infection is one of the major public health issues of ongoing global concern. Due to inadequate understanding of the HBV life cycle, there is a lack of effective drugs to cure chronic hepatitis B. During HBV replication, covalently closed circular DNA (cccDNA) serves as the template for viral replication and can be transcribed to produce five viral RNAs of 3.5, 2.4, 2.1 kb and 0.7 kb in length, which are translated to produce HBeAg, core protein, polymerase (P) protein, HBsAg and HBx proteins, respectively. Among them, the 3.5 kb pregenomic RNA (pgRNA) is also the template for viral reverse transcription. Polymerase protein recognizes and binds to the capsid assembly signal on the pgRNA to initiate capsid assembly and reverse transcription. Recent studies have revealed that the processes of splicing, nuclear export, stability, translation, and pgRNA encapsidation of HBV RNAs are regulated by a post-transcriptional regulatory network within the host cell and depend on unique post-transcriptional regulatory elements in the HBV RNA structure. The aim of this review is to overview the post-transcriptional regulatory mechanisms of HBV RNA and their applications in the study of HBV antiviral therapeutics, with the aim of providing new ideas for the development of new drugs targeting HBV RNA.

Objective To investigate the effect of AU-rich element RNA-binding factor 1(AUF1)on the proliferation,apoptosis,and migration abilities of hepatocellular carcinoma(HCC)cells and possible mechanisms,and to clarify the role and molecular mechanism of AUF1 in the progression of HCC.Methods The UALCAN and TCGA-HCC databases were used to analyze the expression of AUF1 in pan-cancer and investigate the association of the expression level of AUF1 with the clinicopathological features and prognosis of HCC patients.CCK-8 assay,cell apoptosis assay,and Transwell chamber assay were used to investigate the function of AUF1 at the cellular level,and RNA-seq assay was used to investigate transcriptome changes in HCC cells after AUF1 knockdown.The t-test was used for comparison of continuous data between two groups;the Kaplan-Meier method was used to plot survival curves,and the log-rank test was used for comparison of survival rates.Results There were abnormal mRNA and protein expression levels of AUF1 in various tumor tissues compared with normal tissue(P<0.05).The mRNA expression level of AUF1 was positively correlated with the degree of HCC malignancy and the poor prognosis of early-stage HCC(P<0.05).Compared with the control group,the overexpression of exogenous AUF1 in HCC cells promoted the proliferation of HCC cells and inhibited the apoptosis and migration of HCC cells,while AUF1 knockdown inhibited HCC cell proliferation and promoted the apoptosis and migration of HCC cells.The RNA-seq analysis showed that AUF1 knockdown mainly affected the Wnt/β-catenin pathway and downregulated the protein expression level of β-catenin.Conclusion The abnormal expression of AUF1 is associated with the prognosis of early-stage HCC,and AUF1 may exert an oncogenic effect by activating the Wnt signaling pathway.

Objective:To study the clinicopathological features of Sjogren′s syndrome (SS) with liver injury and to improve the understanding of this disease.Methods:Forty-nine patients with SS complicated with liver injury were collected from Beijing Ditan Hospital, Capital Medical University from October 2008 to January 2022. All patients underwent ultrasound-guided liver biopsy, and all specimens were stained with HE. The histopathologic characteristics were observed and the pathologic indexes were graded. Immunohistochemical stains for CK7, CK19, CD38, MUM1 and CD10 were performed by EnVision method; and special histochemical stains for reticulin, Masson′s trichrome, Rhodanine, Prussian blue, periodic acid Schiff (PAS) and D-PAS stains were conducted .Results:The age of patients ranged from 31 to 66 years, including 3 males and 46 females. SS combined with drug-induced liver injury was the most common (22 cases, 44.9%), followed by autoimmune liver disease (13 cases, 26.5%, including primary biliary cholangitis in eight cases, autoimmune hepatitis in 3 cases, and PBC-AIH overlap syndrome in 2 cases), non-alcoholic fatty liver disease (NAFLD, 9 cases, 18.4%) and other lesions (5 cases, 10.2%; including 3 cases of nonspecific liver inflammation, 1 case of liver amyloidosis, and 1 case of porto-sinusoidal vascular disease). Among them, 28 cases (57.1%) were associated with obvious interlobular bile duct injury, mainly in SS combined with PBC group and drug-induced liver injury group. Twenty-three cases (46.9%) were associated with hepatocyte steatosis of varying degrees. In SS with autoimmune liver disease group, ISHAK score, degree of fibrosis bile duct injury, bile duct remodeling, lymphocyte infiltration of portal area, and plasma cell infiltration, MUM1 and CD38 expression; serum ALP and GGT, IgM; elevated globulin; positive AMA, proportion of AMA-M2 positive and IgM positive were all significantly higher than those in other groups(all P<0.05). Serum ALT, direct bilirubin and SSA positive ratio in SS combined with drug liver group were significantly higher than those in other groups(all P<0.05). The serum total cholesterol level in SS combined with PBC group ( P=0.006) and NALFD group ( P=0.011) were significantly higher than those in other groups ( P<0.05). Conclusions:The pathologic manifestations of SS patients with liver injury are varied. The inflammatory lesions of SS patients with autoimmune liver disease are the most serious, and the inflammatory lesions of SS patients with non-alcoholic fatty liver disease and non-specific inflammation are mild. Comprehensive analysis of liver histopathologic changes and laboratory findings is helpful for the diagnosis of SS complicated with different types of liver injury.