ObjectiveTo construct a comprehensive evaluation indicator system for clinical practice guidelines of traditional Chinese medicine （TCM） that is scientific， systematic， and reflects the characteristics of TCM. MethodsA systematic search was conducted in Chinese and English databases， including CNKI， Wanfang， VIP， SinoMed， PubMed， Embase， and Cochrane Library， to include literature on domestic and international guideline evaluation tools and TCM-related research. Document analysis and CiteSpace were utilized for keyword co-occurrence and clustering analysis. ResultsA total of 65 relevant studies were included， from which seven core thematic domains were identified. Based on the research objectives， a two-step construction strategy was adopted： first， an external evaluation framework was established by referencing international tools to cover methodological rigor and procedural standardization； second， an internal evaluation framework was developed to reflect the distinctive features of TCM clinical practice， including syndrome differentiation and efficacy feedback. Through expert consensus， the indicator system was refined， resulting in a dual-layered structure comprising 8 primary indicators， 22 secondary indicators， and 62 evaluation criteria. ConclusionThe comprehensive evaluation system for TCM clinical practice guidelines， based on bibliometric analysis and core element extraction， integrates both theoretical integrity and practical applicability. This study provides a preliminary research foundation for further optimization， validation， and development of a refined comprehensive evaluation system.

Objective To investigate the mechanism underlying the inhibitory effect of Buyang Huanwu Decoction(BYHWD)on vascular aging.Methods Eighteen male SD rats were randomized into young group,intraperitoneal D-galactose injection-induced aging group,and BYHWD gavage group.The changes in pulse wave velocity(PWV),vascular SA-β-gal activity,and expressions of p16,p21 and SA-β-gal of the rats were examined.Serum exosomes were isolated from the rats,and after characterization using NTA and TEM and for surface markers and vascular cell markers,were examined for miR-590-5p expression using qRT-PCR.The M1/M2 macrophage ratio and cytokine levels were evaluated using immunofluorescence staining and qRT-PCR.Bioinformatics analysis and dual-luciferase reporter assays were carried out to predict the potential target genes of miR-590-5p and validate its targeting relationship with SLC8A3,whose expressions were detected in the vascular tissues of the rats by Western blotting.Results Compared with the young rats,the aging rats exhibited significantly increased PWV in the abdominal aorta with elevated vascular expressions of p16,p21 and SA-β-gal,which were all reversed by BYHWD treatment.The isolated serum exosomes were positive for CD63,CD81,CD31 and SM-22,and the exosomes from aging rats showed significantly downregulated expression of miR-590-5p,which was upregulated after BYHWD treatment.The aging rat vessels showed an increased M1/M2 macrophage ratio with elevated M1-specific cytokines and reduced M2-specific cytokines,and BYHWD treatment effectively inhibited M1 polarization of the macrophages.Pearson analysis revealed a negative correlation between exosomal miR-590-5p upregulation and the M1/M2 ratio.Bioinformatics analysis and dual-luciferase assays confirmed that miR-590-5p targets SLC8A3.Western blotting demonstrated increased SLC8A3 expression in aging rat vessels,which was downregulated after BYHWD treatment.Conclusion BYHWD attenuates vascular aging in rats by modulating macrophage M1 polarization and suppressing vascular inflammation via exosomal miR-590-5p-mediated downregulation of SLC8A3.

Objective To explore the applicability of four risk assessment methods in evaluating occupational health risks associated with low-level benzene homologues exposure in key work sites within the automobile manufacturing industry. Methods The work sites (paint mixing and spray painting) with exposure to benzene homologues among six automobile manufacturing enterprises in Guangdong Province were selected as the study subjects using the judgmental sampling method. Qualitative risk assessment, exposure index method, non-carcinogenic risk assessment, and the International Council on Mining and Metals risk rating method were independently applied to evaluate the occupational health risks of benzene homologues at these work sites. Accuracy, consistency, and correlation of the four methods were compared. Results The air levels of benzene, toluene, xylene, and ethylbenzene in work sites of paint mixing and spray painting across all six enterprises met national occupational health standards. The median ratios of occupational exposure limits for benzene and toluene in spray painting site were higher than those in paint mixing site (0.017 vs 0.010, P<0.05). Using this ratio as a reference for evaluating method accuracy, the non-carcinogenic risk assessment method could distinguish paint mixing site from spray painting site in terms of risk level (P<0.05), whereas the other three methods could not (both P>0.05). The result of consistency testing revealed that the Kappa coefficients between the four methods ranged from -0.13-0.26, indicating poor consistency. The result of Spearman correlation analysis showed that the non-carcinogenic risk assessment and exposure index methods had higher correlation with occupational exposure limits ratios (Spearman correlation coefficients were 0.501 and 0.656, respectively, all P<0.05). Conclusion Occupational health risk assessment can serve as a supplementary tool to evaluate the hazard level of key work sites in the automobile manufacturing industry. Non-carcinogenic risk assessment shows higher accuracy.

OBJECTIVES: To investigate the mechanism underlying the inhibitory effect of Buyang Huanwu Decoction (BYHWD) on vascular aging. METHODS: Eighteen male SD rats were randomized into young group, intraperitoneal D-galactose injection-induced aging group, and BYHWD gavage group. The changes in pulse wave velocity (PWV), vascular SA-β-gal activity, and expressions of p16, p21 and SA‑β‑gal of the rats were examined. Serum exosomes were isolated from the rats, and after characterization using NTA and TEM and for surface markers and vascular cell markers, were examined for miR-590-5p expression using qRT-PCR. The M1/M2 macrophage ratio and cytokine levels were evaluated using immunofluorescence staining and qRT-PCR. Bioinformatics analysis and dual-luciferase reporter assays were carried out to predict the potential target genes of miR-590-5p and validate its targeting relationship with SLC8A3, whose expressions were detected in the vascular tissues of the rats by Western blotting. RESULTS: Compared with the young rats, the aging rats exhibited significantly increased PWV in the abdominal aorta with elevated vascular expressions of p16, p21 and SA-β-gal, which were all reversed by BYHWD treatment. The isolated serum exosomes were positive for CD63, CD81, CD31 and SM-22, and the exosomes from aging rats showed significantly downregulated expression of miR-590-5p, which was upregulated after BYHWD treatment. The aging rat vessels showed an increased M1/M2 macrophage ratio with elevated M1-specific cytokines and reduced M2-specific cytokines, and BYHWD treatment effectively inhibited M1 polarization of the macrophages. Pearson analysis revealed a negative correlation between exosomal miR-590-5p upregulation and the M1/M2 ratio. Bioinformatics analysis and dual-luciferase assays confirmed that miR-590-5p targets SLC8A3. Western blotting demonstrated increased SLC8A3 expression in aging rat vessels, which was downregulated after BYHWD treatment. CONCLUSIONS BYHWD attenuates vascular aging in rats by modulating macrophage M1 polarization and suppressing vascular inflammation via exosomal miR-590-5p-mediated downregulation of SLC8A3.
Animals ; MicroRNAs/genetics* ; Rats, Sprague-Dawley ; Drugs, Chinese Herbal/pharmacology* ; Male ; Macrophages/drug effects* ; Rats ; Exosomes/metabolism* ; Aging/drug effects* ; Signal Transduction

Objective:To assess the long-term risk of relapse in patients with Crohn's disease (CD) who discontinued infliximab (IFX) monoclonal antibody and to identify risk factors associated with relapse.Methods:A single-center retrospective observational study was conducted from February 2006 to October 2016. The study included CD patients who were treated with scheduled IFX infusions at the First Affiliated Hospital of Sun Yat-sen University and assessed in corticosteroid-free clinical remission at the time of withdrawal were included. The primary outcome was clinical relapse. We evaluated the risk of relapse using Kaplan-Meier method. Factors associated with time to relapse was identified using the multiple Cox proportional hazards regression analysis.Results:We included 97 eligible patients, and 75 (77.3%) experienced a relapse after a median follow-up time of 124 months. Among them, 45 patients (46.4%) relapsed within 3 years after IFX withdrawal. The 1-, 2-, 3-, 5-, and 10-year relapse-free survival were 79.4%, 59.8%, 52.6%, 42.0% and 22.6%, respectively. Risk factors for relapse included age ≤ 16 ( HR = 2.62, 95% CI: 1.30-5.31; P = 0.007) and failure to achieve biological remission (CRP > 3 mg/L, HR = 2.37, 95% CI: 1.29-4.36; P = 0.006) at drug withdrawal. Induction with biologics or systemic steroids were both effective (89%-100% relieved) in relapsers. Conclusions:Nearly half of CD patients relapsed within 3 years after discontinuation of IFX treatment. Early age of discontinuation and failure to achieve serum biological remission at the time of discontinuation are independent predictors of clinical relapse.

Objective:To assess the long-term risk of relapse in patients with Crohn's disease (CD) who discontinued infliximab (IFX) monoclonal antibody and to identify risk factors associated with relapse.Methods:A single-center retrospective observational study was conducted from February 2006 to October 2016. The study included CD patients who were treated with scheduled IFX infusions at the First Affiliated Hospital of Sun Yat-sen University and assessed in corticosteroid-free clinical remission at the time of withdrawal were included. The primary outcome was clinical relapse. We evaluated the risk of relapse using Kaplan-Meier method. Factors associated with time to relapse was identified using the multiple Cox proportional hazards regression analysis.Results:We included 97 eligible patients, and 75 (77.3%) experienced a relapse after a median follow-up time of 124 months. Among them, 45 patients (46.4%) relapsed within 3 years after IFX withdrawal. The 1-, 2-, 3-, 5-, and 10-year relapse-free survival were 79.4%, 59.8%, 52.6%, 42.0% and 22.6%, respectively. Risk factors for relapse included age ≤ 16 ( HR = 2.62, 95% CI: 1.30-5.31; P = 0.007) and failure to achieve biological remission (CRP > 3 mg/L, HR = 2.37, 95% CI: 1.29-4.36; P = 0.006) at drug withdrawal. Induction with biologics or systemic steroids were both effective (89%-100% relieved) in relapsers. Conclusions:Nearly half of CD patients relapsed within 3 years after discontinuation of IFX treatment. Early age of discontinuation and failure to achieve serum biological remission at the time of discontinuation are independent predictors of clinical relapse.

Objective To investigate and analyze the current status and challenges of infant and toddler nutritional services in urban and rural medical facilities in Sichuan Province.Methods In 2022,a questionnaire survey was conducted to collect data on infant and toddler nutritional services,including feeding guidance,physical growth assessment,and micronutrient deficiency screening,as well as information on personnel and tools in medical facilities throughout Sichuan Province.The provision of nutritional services was analyzed and the urban-rural disparities were assessed.Results A total of 2206 medical facilities(29.1%from urban areas and 70.9%from rural areas)were investigated.Only 35.8%of medical facilities provided all three types of nutritional services.Specifically,the overall service provision rates were high for feeding guidance(94.6%)and physical growth assessment(85.0%),but lower for micronutrient deficiency screening(37.4%).Rural facilities exhibited significantly lower rates than their urban counterparts for both physical growth assessment and micronutrient deficiency screening(P＜0.05).The provision rates of feeding guidance ranged from 70.6%to 93.2%,with responsive feeding guidance being the least implemented(70.6%),particularly in rural areas compared to urban areas(P＜0.05).Rates for physical growth assessment and micronutrient deficiency screening ranged from 75.3%to 81.8%and 23.6%to 30.8%,respectively,both showing lower rates in rural settings compared to urban ones(P＜0.05).Nutrition service providers were predominantly nurses(52.3%)and clinical practitioners(43.4%).The availability of dietary assessment tools ranged from 7.7%to 15.9%,significantly lower in rural areas compared to urban areas(P＜0.001),while physical measurement tools were widely available at rates of 94.6%to 98.5%.Conclusion At present,the infant and toddler nutritional service provisions of medical facilities in Sichuan Province are incomplete,particularly so in the implementation of feeding guidance,physical growth assessment,and micronutrient deficiency screening.There is a notable shortage of personnel and necessary tools,with rural areas facing more significant challenges.Enhancing the overall capacity of infant and toddler nutritional services in Sichuan Province is essential,with specific attention needed for rural healthcare settings.

Objective To investigate the predictive value of labor progress angle (AOP), fetal head descent distance (HPD) and their change rates in the outcome of vaginal trial of cesarean scar uterus. Methods A total of 170 pregnant women who underwent vaginal trial production of scar uterus after cesarean section were selected as study subjects, and were divided into successful group and failed group based on the trial production outcomes. Advanced oxidation processes (AOP) and head-perineum distance (HPD) were measured by ultrasound during the active phase of the first stage of labor when the cervix dilated to 4 cm and at 1 hour after the cervix dilated to 4 cm, respectively. The AOP change rate and HPD change rate after 1 hour of progress were calculated. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of AOP, HPD and their change rates in the outcome of vaginal trial production of scar uterus after cesarean section. Delong test was used to compare the differences in area under curves (AUCs). Results Among 170 pregnant women with scarred uterus after cesarean section who were pregnant again, 139 cases (success group) were succeed in transvaginal delivery, while 31 cases failed trial delivery, and transferred to cesarean section (failure group). The AOP of the successful group was significantly larger than that of the failed group when the cervix was opened to 4 cm, and the HPD was significantly shorter than that of the failure group (P < 0.05). The AOP change rate and the change rate of HPD of the successful group were significantly higher than that of the failed group when the cervix dilated to 4 cm and at 1 hour (P < 0.05). The AUC of AOP and HPD in predicting the outcome of vaginal trial delivery of scar uterus after cesarean section were 0.846 and 0.812 respectively, and AUC predicted jointly by AOP and HPD showed no significant differences compared with AUC predicted separately (P>0.05). The AUC of the change rate of AOP and HPD in predicting the outcome of vaginal trial delivery of scarred uterus after cesarean section was 0.899 and 0.852 respectively, and the combined prediction of AOP change rate and HPD change rate had a higher AUC value than the AUC predicted separately. Its AUC value was higher than that of AOP combined with HPD (P < 0.05). Conclusion The AOP, HPD and their change rates when the uterine orifice expands to 4 cm in the active phase of the first stage of labor have predictive value for the outcome of vaginal trial production of scarred uterus after cesarean section.

ObjectiveTo investigate the menstrual conditions of women infected with COVID-19 in Shanghai and analyze the influencing factors. MethodsFrom December 2022 to March 2023， menstrual data from 281 women infected with COVID-19 in Shanghai were collected with a questionnaire survey， including usual menstrual characteristics， the most recent menstrual period post-infection， symptoms of infection， and medication usage. According to the crossover period between the menstrual period and the infection period of the respondents， the samples were divided into two groups for comparative analysis： those whose menstrual and infection periods overlapped （positive group） and those whose menstruation started after conversion to virus-negative （negative conversion group）. ResultsAmong the 281 respondents， 196 （65.8%） experienced menstrual changes. Among them， 145 （51.6%） had changes in menstrual volume， color and texture， and 109 （38.8%） had changes in menstrual duration or cycle. Decreased menstrual volume （22.1%）， darker color （23.49%）， thicker texture （21.0%）， increased blood clots （16.7%）， and prolonged duration （21.8%） were observed in both groups. The rate of changes in menstrual volume， color， and texture was higher in the positive group （56.8%， 69/110） than that in negative group （37.3%， 76/171） （P<0.05）. Regarding the menstrual cycle changes， the rate of early onset was higher in the positive group （14.5%） compared to the negative conversion group （3.5%）（P<0.05）， while the rate of delayed menstruation was higher in the negative conversion group （25.1%） than that in the positive group （5.5%） （P<0.05）. Correlation analysis showed a weak association between sore throat and menstrual changes （r=0.154， P<0.05）. ConclusionSome women infected with COVID-19 experience short-term changes in their menstrual conditions， characterized by reduced volume， darker color， thick texture， increased clots， and prolonged menstrual duration， reflecting a pathogenesis of blood stasis. Menstruation during the infection period tends to occur earlier， while delayed menstruation is more prevalent at post-conversion.

ObjectiveTo analyze the research status and trends in low-level occupational benzene exposure. Methods Articles on low-level occupational benzene exposure from Chinese and English journals from January 1st, 2000, to December 31th, 2022 were retrieved using the Web of Science and the China National Knowledge Infrastructure, and a bibliometric analysis was conducted. Results A total of 327 articles were included in the analysis, comprising 216 English articles and 111 Chinese articles. i) The number of articles published in English fluctuates greatly over the years, without a trend of continuous growth or decline. Authors from 359 research institutions in 45 countries and regions have published relevant English articles in 97 kinds of journals, involving 281 grants from 226 foundations. The top three countries in terms of articles amount were the United States, Italy, and China, with 81, 46, and 43 papers, respectively. The English articles mainly focused on mechanistic research at the genetic level, such as hematotoxicity, oxidative stress, and DNA damage. ii) The number of Chinese articles increased gradually after 2012, with the growth peak in 2017. Authors from 127 research institutions in 26 provinces, autonomous regions, and municipalities published Chinese articles in 51 kinds of journals, involving 154 grants from 78 foundations. Chinese articles tended to focus on benzene-induced hematotoxicity and occupational health damage. Conclusion Most studies on low-level occupational benzene exposure were conducted in China, the United States and Italy, focused on hematotoxicity. Monitoring international research topics and hotspots of the field has certain reference value for related research in China.