Non-alcoholic fatty liver disease （NAFLD） is a chronic liver disease closely related to metabolism， which is mainly characterized by abnormal lipid deposition in hepatocytes. In recent years， with the increasing prevalence of obesity and metabolic syndrome， NAFLD has become one of the most common chronic diseases in the world. The pathogenesis of NAFLD is complex and varied， involving the cross-regulation of multiple signaling pathways such as glucose-lipid metabolism， oxidative stress， and inflammation. The TLR4 signaling pathway plays a key role in the development and progression of NAFLD， and abnormal activation of this pathway accelerates the deterioration of NAFLD by promoting the release of pro-inflammatory cytokines， inducing oxidative stress， and exacerbating insulin resistance. Studies have shown that traditional Chinese medicine （TCM） can regulate the TLR4 signaling pathway to alleviate the symptoms and pathological features of NAFLD. The present review summarizes the experimental research progress in the TCM regulation of the TLR4 signaling pathway in treating NAFLD in the past 5 years， covering a wide range of TCM active ingredients （such as polysaccharides， terpenoids， alkaloids， flavonoids） and compound prescriptions. The active ingredients and compound prescriptions of TCM can effectively ameliorate lipid metabolism disorders， reduce insulin resistance， regulate intestinal flora， and inhibit inflammation and oxidative stress by regulating the TLR4 signaling pathway via multiple targets and pathways， thus slowing down the progression of NAFLD. Through in-depth analysis of the pathological mechanisms of NAFLD and exploration of the potential of TLR4 signaling pathway as a therapeutic target， we can provide theoretical support for the application of TCM in the treatment of NAFLD， as well as new perspectives and directions for future clinical research and new drug development， thereby promoting the innovation and development of therapeutic strategies for NAFLD.

Objective To investigate the effect of intravenous lidocaine on postoperative fatigue syndrome(POFS)in patients undergoing laparoscopic resection for gastric carcinoma.Methods A total of 80 patients who underwent elective laparoscopic resection for gastric carcinoma at Xuzhou Central Hospital between September 2023 and June 2024 were enrolled.Inclusion criteria included age 18～75 years,ASA physical status classificationⅠ～Ⅲ,body mass index(BMI)of 18.5～27.9 kg/m2,preoperative Christensen score≤4,and estimated operation time≤4 hours.Patients were randomly allocated into either the lidocaine group(Group L)or the saline group(Group C)using a random number table,with 40 patients in each group.Group L received an intravenous infusion of lidocaine at a dose of 1.5 mg·kg?1 over 15 minutes,initiated 30 minutes before anesthesia induction.If no adverse reactions occurred,lidocaine was maintained at a rate of 1.5 mg/(kg·h)throughout the surgery until its conclusion.Group C received an equivalent volume of normal saline administered in the same manner.The Christensen score and Visual Analogue Scale(VAS)scores were recorded on postoperative days 1,3,5,and 7,and the time-weighted average(TWA)of the Christensen score was calculated.Postoperative inflammatory markers were measured,and additional outcomes including extubation time,post-anesthesia care unit(PACU)stay duration,postoperative nausea and vomiting(PONV),consumption of rescue analgesics,time to first flatus and defecation,and length of hospital stay were also documented.Results Compared with Group C,the TWA of the Christensen score in Group L decreased by 0.44 points(95％CI:0.11～0.76;P<0.05).The VAS scores were significantly lower in Group L on postoperative days 1 and 3(P<0.05).Levels of IL-6 and TNF-α at the end of surgery and 24 hours after surgery were also lower in Group L(P<0.05).The time to first flatus and defecation was significantly shorter in Group L(P<0.05).There were no significant differences between the two groups regarding extubation time,PACU stay duration,incidence of PONV,postoperative consumption of remedial analgesic drugs,or length of hospital stay(P>0.05).Conclusion Intravenous lidocaine may improve POFS in patients following laparo-scopic resection for gastric carcinoma by attenuating inflammatory responses,alleviating pain,and facilitating gastrointestinal function recovery,while maintaining a favorable safety profile.

Objective:To observe the effects of moxibustion at Shenshu(BL23)and Zusanli(ST36)on Toll-like receptor 4(TLR4)-myeloid differentiation factor 88(Myd88)signaling pathway-mediated inflammatory factors in the synovial tissue of ankle joints of rats with rheumatoid arthritis(RA),and to explore the molecular and biological mechanisms underlying the anti-inflammatory and analgesic effects.Methods:A total of 24 male Sprague-Dawley(SD)rats were randomly divided into a normal group,a model group,and a moxibustion group,with 8 rats in each group.The RA model was established with exposure to wind,cold,and damp environmental factors,along with Freund's complete adjuvant.After three days of modeling,mild moxibustion was applied to bilateral Shenshu(BL23)and Zusanli(ST36)in the moxibustion group using moxa sticks of 0.9 cm in diameter for 30 min each time,once a day for 14 d.Structural changes in the synovial tissue and cells were then observed using hematoxylin-eosin staining and transmission electron microscopy,while immunohistochemistry analysis was used to detect tumor necrosis factor(TNF)-α,interleukin(IL)-17,IL-1β,and IL-6 levels.Moreover,the protein expression levels of Myd88,TLR4,and transient potential receptor vanilloid type 1(TRPV1)in the synovial tissue were detected using Western blotting,while their mRNA expression levels were detected using reverse transcription-polymerase chain reaction.Finally,the levels of IL-1β,IL-2,IL-6,IL-17A,and TNF-α in rat serum were detected using enzyme-linked immunosorbent assay.Results:Compared to the normal group,the model group exhibited notable pathological synovial tissue damage,along with significantly higher IL-1β,IL-6,and TNF-α levels(P<0.01)and a slightly higher IL-17 content(P>0.05).Furthermore,the Myd88,TLR4,and TRPV1 protein and mRNA expression levels and serum IL-1β,IL-2,IL-6,IL-17A,and TNF-α levels were all significantly higher in the model group than in the normal group(P<0.01).Compared to the model group,the moxibustion group exhibited a lower degree of synovial tissue pathological damage,along with significantly lower IL-1β,IL-6,and TNF-α levels(P<0.05 or P<0.01)and a lower IL-17 content without statistical significance(P>0.05).Moreover,the Myd88,TLR4,and TRPV1 protein and mRNA expression levels,and serum IL-1β,IL-2,IL-6,IL-17A,and TNF-α levels were all significantly lower in the moxibustion group than in the model group(P<0.01 or P<0.05).Conclusion:Mild moxibustion at Shenshu(BL23)and Zusanli(ST36)can effectively inhibit TLR4-MyD88 signaling pathway-mediated inflammatory factor expression in the synovial tissue of ankle joints of RA rats.Furthermore,the effect of moxibustion on synovial tissue inflammation in RA rats may be attributed to TRPV1 channel activation.

This paper introduces chief physician of traditional Chinese medicine WANG Yigang's clinical experience in treating peripheral facial palsy in the acute stage with acupuncture-medication-combined therapy.Professor WANG believes that the pathogenesis of facial paralysis in the early stage is mostly the external invasion of wind and pathogenic toxins and the internal disturbance of dampness and toxins,resulting in the obstruction of collaterals and muscle regions of meridians.The treatment should be guided by the"unity of form(body)and spirit(Shen)",paying attention to the movement of the spirit,dispelling evils,and regulating the spirit.Professor WANG believes that when the spirit initiates,the healthy Qi is strong,and the pathogen subsides.In the treatment,he is good at combining acupuncture and medication for a synergistic effect,stresses the use of scalp points,and coins the empirical point Miandong(Extra).At the same time,he does not restrict himself to the traditional needling method and treats facial paralysis with"dynamic retention acupuncture".

Objective:To evaluate whether there is a difference between the lesion volumes detected by 18F-FDG PET/CT imaging and 11C-choline PET/CT imaging based on different threshold delineation methods in patients with nasopharyngeal carcinoma, and to recommend a more clinically appropriate threshold method with reference to lesion volume detected by enhanced MRI. Methods:A retrospective study was conducted on 37 patients(27 males, 10 females, age (51.2±11.9) years) with nasopharyngeal carcinoma diagnosed in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between October 2015 and May 2017. All patients underwent nasopharyngeal enhanced MRI, 18F-FDG PET/CT and 11C-choline PET/CT scans. Advantage Workstation 4.6 software was used to fuse images of the 3 imaging examinations. The lesion contour was sketched manually based on enhanced MRI sequences to obtain VMRI, and the lesion was sketched in PET images to obtain the corresponding metabolic tumor volume (MTV) by absolute threshold method, relative threshold method and background threshold method respectively. The correlation between ROIs sketched by different threshold methods and ROI in MRI was evaluated by using the Dice similarity coefficient (DSC). Friedman test or repeated measures analysis of variance (corrected by Greenhouse-Geisser) was employed to analyze the differences of MTV or DSC obtained by using 3 threshold methods. Wilcoxon signed-rank test or paired t-test was used to compare the data of different imaging methods. Results:In 18F-FDG PET/CT results, MTVs obtained by using the absolute threshold method, relative threshold method, and background threshold method were 13.21(5.47, 23.16), 10.13(5.67, 16.81), and 13.68(5.77, 25.52)mm 3, respectively, with significant differences ( χ2=17.89, P<0.001). The corresponding DSC differences for the 3 methods were also significant (0.43±0.19, 0.38±0.17 and 0.44±0.17; F=16.35, P<0.001). In 11C-choline PET/CT results, MTV differences based on the 3 threshold methods were significantly different (14.96(6.80, 32.27), 16.28(12.23, 32.47) and 18.97(14.38, 37.02)mm 3;χ2=10.45, P=0.005), and the DSC differences were also significant (0.52±0.21, 0.58±0.13 and 0.62±0.13; F=16.37, P<0.001). The differences in MTV and DSC between FDG and choline groups were also significant ( Z=-3.87, t=-5.57, both P<0.001). The differences between MTVs of 18F-FDG imaging/ 11C-choline imaging and VMRI (24.35(14.48, 36.89)mm 3) were all significantly different ( Z values: from -5.03 to -2.59, all P<0.05). Conclusions:Compared with 18F-FDG PET/CT, the preoperative 11C-choline PET/CT imaging in patients with nasopharyngeal carcinoma is closer to enhanced MRI (gold standard) in the lesion delineation. Compared with ROIs of the other 2 threshold delineation methods, the ROI obtained by the background threshold method is closer to that in enhanced MRI.

Objective:To evaluate the clinical value of 11C-methyl- L-methionine (MET) PET/MR in the differential diagnosis between neoplastic and non-neoplastic brain lesions. Methods:From July 2017 to May 2022, a total of 34 patients (19 males, 15 females, age 8-81 years) who received 11C-MET PET/MR imaging for suspected brain tumors in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively enrolled. Postoperative pathological or clinical follow-up results were used as the gold standard. Diagnostic performance of 11C-MET PET/MR and contrast-enhanced MRI was evaluated by ROC curve analysis and Delong test, as well as the diagnostic performance of PET metabolic parameters (SUV and target to background ratio (TBR)), MRI multi-sequence parameters (cerebral blood flow (CBF), relative CBF (rCBF), apparent diffusion coefficient (ADC), relative ADC (rADC), choline/creatine (Cho/Cr) and choline/ N-acetylaspartate (Cho/NAA)) and their combination. Results:A total of 35 lesions of 34 patients were enrolled, including 12 (34.3%) non-neoplastic lesions and 23(65.7%) neoplastic lesions. The diagnostic sensitivity, specificity, and accuracy for 11C-MET PET/MR were 91.3%(21/23), 12/12, and 94.3%(33/35), in contrast to 16/18, 2/10, and 64.3%(18/28) for contrast-enhanced MRI. Maximum TBR (TBR max) showed the highest discriminative value (AUC=0.877, 95% CI: 0.692-1.000). The combination of TBR max, minimum ADC (ADC min), rCBF, and Cho/NAA could achieve a higher diagnostic performance (AUC=0.918, 95% CI: 0.816-1.000), although the difference was not statistically significant ( Z=-0.42, P=0.676). Conclusion:Multiple quantitative parameters of 11C-MET PET/MR are beneficial to distinguish neoplastic from non-neoplastic brain lesions, and their combination may improve the diagnostic confidence.

Objective:To investigate the operation of water improvement projects in villages affected by drinking-water-borne endemic arsenic poisoning in Shaanxi Province, the arsenic level in both internal and external environments, the trend of disease development and patient management, and evaluate the effectiveness of prevention and control measures.Methods:From March to December 2023, in accordance with the requirements of the "Notice of the Office of Shaanxi Provincial Health Commission on Issuing the Monitoring Plan for Key Endemic Diseases such as Kashin-Beck Disease" and the "Monitoring Plan for Endemic Fluorosis and Arsenism in Shaanxi Province", all villages affected by drinking-water-borne arsenic disease were monitored. Water arsenic testing was carried out in accordance with the "Standard Test Methods for Drinking Water Inorganic Nonmetallic Indicators" (GB/T 5750.5-2006), and the evaluation of whether water arsenic exceeded the standard was conducted based on the "Sanitary Standards for Drinking Water" (GB 5749-2022). According to the "Diagnosis of Endemic Arsenism" (WS/T 211-2015), the arsenic poisoning status of all population in the disease affected areas was investigated. In 5 villages of 3 monitoring counties, 358 people were randomly selected to determine the urinary arsenic level, and the determination was made according to the "Safety Guideline Value of Urinary Arsenic for Human Population" (WS/T 665-2019). According to the "Notice of the National Health Commission on Issuing the Evaluation Measures for Control and Elimination of Key Endemic Diseases (2019 Edition)", elimination evaluation was conducted.Results:A total of 2 cities, 3 counties, 9 towns, and 13 endemic villages were monitored, with a water improvement rate of 100% (13/13), and all were operating normally. The arsenic level in residents' drinking water was < 0.01 mg/L. A total of 12 688 people were examined, and 338 cases of arsenic poisoning were detected, all of whom were historical cases. There were no new cases of arsenic poisoning or skin cancer patients. The geometric mean of urinary arsenic was 0.026 0 mg/L, which was lower than the safety guideline value of 0.032 mg/L for urinary arsenic in the population. All 338 existing arsenic poisoning patients had received family doctor contract services and implemented follow-up management. The drinking-water-borne endemic arsenic poisoning areas counties in Shaanxi Province have reached the elimination standard.Conclusions:The water improvement project in drinking-water-borne endemic arsenic poisoning areas in Shaanxi Province is operating normally. The arsenic content in both the internal and external environments of the population meets the standard. The condition is stable and no new cases have been detected. Follow up management has been implemented for all current cases. All affected counties have reached the elimination standard.

Objective To investigate clinical therapeutic value of combined posterior nasal nerve and anterior ethmoidal nerve ablation in patients with nasal septal deviation and moderate to severe persistent allergic rhinitis.Methods A total of 47 patients diagnosed with nasal septal deviation and moderate to severe persistent allergic rhinitis from April to December 2024 were divided into two groups.The control group(n=22)underwent septoplasty and bilateral inferior turbinate out-fracture,with postoperative symptom control managed by budesonide nasal spray.The experimental group(n=25)received the same septoplasty and turbinate surgery,supplemented by bilateral posterior nasal nerve and anterior ethmoidal nerve ablation.Symptom improvement was compared between groups by using the Visual Analogue Scale(VAS)and Rhinoconjunctivitis Quality of Life Questionnaire(RQLQ)scores preoperatively and3 months postoperatively.Results The operation time of the control group was(36.3±5.9)min,significantly shorter than that of the experimental group[(59.4±6.6)min,t=12.496,P=0.000].Both groups of patients showed significant improvement in VAS and PQLQ scores for nasal symptoms such as nasal congestion,runny nose,sneezing,and itching at 3 months after surgery compared to preoperative levels(all P=0.000).The mean VAS score of the four symptoms in the control group was(4.6±0.9)points at3 months after surgery,which was significantly lower than that before surgery[(6.3±1.1)points,t=9.796,P=0.000].The mean VAS score of the four symptoms in the experimental group was1.0(0.3-4.3)points at3 months after surgery,which was significantly lower than that before surgery[7.0(4.5-9.0)points,Z=-4.376,P=0.000].The improvement rate of the VAS score in the experimental group was(82.4±14.2)%,significantly higher than that in the control group[(26.9±11.7)%,t=14.510,P=0.000].At3 months after surgery,the RQLQ score of the control group[(2.3±0.8)points]was significantly lower than that before surgery[(3.3±0.8)points,t=10.055,P=0.000].The RQLQ score of the experimental group after surgery was 1.4(0.8-3.5)points,which was significantly lower than the preoperative score[3.6(1.5-6.1)points,Z=-4.373,P=0.000].The improvement rate of RQLQ score in the experimental group was(53.0±14.6)%,significantly higher than that in the control group[(30.2±13.4)%,t=5.555,P=0.000].Conclusion Postnasal nerve and anterior ethmoidal nerve ablation combined with nasal septal deviation correction can significantly improve nasal symptoms and quality of life in patients with nasal septal deviation complicated with moderate to severe allergic rhinitis compared with simple nasal septal deviation correction,but the operation time is prolonged.

Objective To study the relationship between serum insulin-like growth factor-1 (IGF-1) and resistin levels and osteoporosis in patients with type 2 diabetes mellitus (T2DM). Methods This study was conducted on 306 T2DM patients admitted to Baoding No.2 Central Hospital from January 2018 to January 2022. According to the detection results of bone mineral density, the patients were divided into osteoporosis group (T≤-2.5) and non-osteoporosis group (T>-2.5). The differences in IGF-1, resistin and bone mineral density were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between serum IGF-1 and resistin levels and bone mineral density in patients with osteoporosis. Receiver operating characteristic (ROC) curve was applied to evaluate the application value of IGF-1 and resistin in predicting osteoporosis in patients with T2DM. Patients with T2DM complicated with osteoporosis were followed up for 2 years, and the occurrence of fractures was assessed. After univariate analysis, multivariate logistic regression analysis was applied to screen the risk factors for fractures in T2DM patients with osteoporosis. Results The incidence rate of osteoporosis in patients with T2DM was 53.59% (164/306). The IGF-1 level and bone mineral density level in the osteoporosis group were lower than those in the non-osteoporosis group, while the level of resistin was higher than that in the non-osteoporosis group (P<0.05). Serum IGF-1 in patients with osteoporosis was positively correlated with bone mineral density, and serum resistin was negatively correlated with bone mineral density (P<0.05). The AUC, sensitivity and specificity of combination of IGF-1 and resistin in predicting osteoporosis were 0.888, 82.93% and 62.68% respectively, which were all higher than those of single factor prediction (P<0.05). The 164 T2DM patients with osteoporosis were followed up for two years, and 15 patients developed fragility fractures, with the incidence of fracture of 9.15% (15/164). Multivariate analysis showed that hypoproteinemia, high-intensity exercise, lack of nutritional management, low IGF-1, and high resistin were risk factors for fractures in patients with T2DM complicated with osteoporosis (P<0.05). Conclusion For patients with T2DM, the incidence rates of osteoporosis and fractures are high. The levels of IGF-1 and resistin are closely related to bone mineral density, which can be combined to predict osteoporosis. Hypoproteinemia, high-intensity exercise, lack of nutritional management, low IGF-1 and high resistin are risk factors for fractures in T2DM patients with osteoporosis. It is necessary to carry out targeted preventive measures in clinical practice to reduce the incidence rate of fractures.

The Chinese Pharmacopoeia 2025 Edition added the 9213 Guideline for validation,verification,and transfer of microbiological analytical methods.Based on the characteristics of pharmaceutical microbiological analyt-ical methods and practical applications,it specified definitions of relevant terms and application scenarios,estab-lished technical indicators and acceptance criteria for methodological evaluation,and introduced key statistical tools and evaluation principles.This article systematically elaborates on the drafting background and process of the Guideline,and interprets its key content,aiming to offer theoretical guidance and practical reference for relevant practitioners in applying this guideline.This guideline strengthens the foundation of pharmaceutical microbial analytical methods in China and enhances the scientificity and accuracy of the pharmaceutical microbial standards system.