ObjectiveTo investigate the mechanism of action of modified Chaihu Shugan Powder in the treatment of abnormal gallbladder relaxation in gallbladder cholesterol stone （CS） with liver depression syndrome， and to provide a basis for clinical medication. MethodsMice were given a high-fat lithogenic diet combined with chronic unpredictable mild stress （CUMS） to establish a model of CS. A total of 45 male C57BL/6 mice were randomly divided into blank group （6 mice fed a normal diet） and CS group （39 mice fed a high-fat lithogenic diet）. After CS modeling， the CS group was further randomly divided into four subgroups of CS group， CS liver depression group， traditional Chinese medicine group （treated with modified Chaihu Shugan Powder）， and Western medicine group （treated with ursodeoxycholic acid）， with 9 mice in each group. All subgroups were fed with the high-fat lithogenic diet， and all mice except those in the CS group were given 21 days of CUMS for modeling. Samples were collected after intervention. The serum levels of cholecystokinin （CCK）， liver function parameters， and blood lipid profiles were measured； HE staining was performed for liver and gallbladder tissue； qPCR and Western blot were used to measure the mRNA and protein expression levels of G protein-coupled bile acid receptor 1 （TGR5） and glucagon-likepeptide-1/2 （GLP-1/2） in the intestine and TGR5 and glucagon-like peptide-2 receptor （GLP-2R） in gallbladder； metabolomics methods were used to determine bile acid composition in intestinal contents. The independent-samples t-test was used for comparison of continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test or the Games-Howell method was used for further comparison between two groups. ResultsCompared with the blank group， the CS group showed significant gallstone formation， bile turbidity， hepatic steatosis， abnormal gallbladder wall structure， and significant increases in anxiety- and depression-like behaviors based on behavioral tests； significant increases in the level of total cholesterol in bile and the serum levels of alanine aminotransferase， aspartate aminotransferase， and low-density lipoprotein and significant reductions in the level of total bile acid （TBA） in bile and the serum levels of CCK and high-density lipoprotein （HDL） （all P<0.05）； significant increases in the mRNA expression levels of GLP-1/2 and TGR5 in the intestine and the protein expression levels of GLP-2R and TGR5 in the gallbladder and significant reductions in the mRNA expression levels of GLP-2R and TGR5 in the gallbladder （all P<0.05）； significant changes in multiple bile acid components in intestinal contents （all P<0.05）. Compared with the CS group， the CS liver depression group had further aggravation of pathological and behavioral manifestations， changes in bile acid composition， significant increases in the protein and mRNA expression levels of TGR5 and GLP-1/2 in the intestine， and significant increases in the protein and mRNA expression levels of TGR5 and GLP-2R in the gallbladder （all P<0.01）. Compared with the CS liver depression group， both treatment groups had an improvement in gallbladder morphology， alleviation of stones and liver injury， and recovery of liver function and blood lipid levels， as well as significant reductions in the protein and mRNA expression levels of TGR5 and GLP-1/2 in the intestine and TGR5 and GLP-2R in the gallbladder （all P<0.05）； the traditional Chinese medicine group showed significant increases in glycodeoxycholic acid （GDCA）， tauro-α-muricholic acid （T-α-MCA）， and taurochenodeoxycholic acid （TCDCA） （all P<0.05）， while the Western medicine group showed significant increases in taurohyodeoxycholic acid， T-α-MCA， TCDCA， GDCA， and glycoursodeoxycholic acid （all P<0.05）. Compared with the Western medicine group， the traditional Chinese medicine group had significantly greater behavioral improvements， significantly higher levels of TBA in bile and serum HDL （both P<0.01）， significant reductions in the protein expression levels of TGR5 and GLP-1/2 in the intestine and TGR5 and GLP-2R in the gallbladder， and a significant reduction in the mRNA expression level of TGR5 in the intestine （all P<0.01）， as well as a significant increase in tauroursodeoxycholic acid and significant reductions in glycoursodeoxycholic acid， taurohyodeoxycholic acid， TCDCA， and taurolithocholic acid （all P<0.05）. ConclusionModified Chaihu Shugan Powder can improve liver function and abnormal gallbladder relaxation in CS with liver depression syndrome by regulating the bile acid-TGR5 axis， thereby exerting the therapeutic effect of soothing the liver， resolving depression， moving Qi， and promoting bile flow.

ObjectiveTo investigate the distribution of traditional Chinese medicine （TCM） syndromes in intrahepatic cholestasis of pregnancy （ICP） and its association with perinatal outcomes， and to provide a basis for precise treatment based on TCM syndrome differentiation. MethodsA cross-sectional study was conducted among 275 patients with ICP who were admitted to The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from April 2023 to April 2025. A hierarchical cluster analysis was used to summarize TCM syndromes. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. A multivariate Logistic regression analysis was used to identify the clinical features significantly associated with TCM syndrome. ResultsThe cluster analysis identified three core TCM syndromes among the 275 patients with ICP， i.e.， liver-gallbladder damp-heat syndrome （45.8%）， syndrome of blood deficiency generating wind （30.9%）， and liver depression and spleen deficiency syndrome （23.3%）. There was a significant difference in the distribution of TCM syndromes between different groups stratified by maternal age at delivery， parity， history of ICP recurrence， gestational weeks at disease onset， total bile acid （TBA）， alanine aminotransferase （ALT）， and comorbidity with gestational diabetes mellitus （GDM） （all P<0.05）. The multivariate Logistic regression analysis showed that<34 gestational weeks at disease onset was significantly associated with all three syndromes （damp-heat： odds ratio ［OR］=3.769， P<0.001； blood deficiency： OR=4.031， P<0.001； liver stagnation： OR=3.552， P<0.001）. Liver-gallbladder damp-heat syndrome was associated with maternal age ≥35 years at disease onset （OR=2.048， P=0.014）， parity ≥2 times （OR=1.921， P=0.034）， history of ICP recurrence （OR=2.404， P=0.030）， ALT ≥200 U/L （OR=2.051， P=0.018）， comorbidity with GDM （OR=1.944， P=0.029）， and TBA ≥40 μmol/L （OR=2.542， P=0.024）. The syndrome of blood deficiency generating wind syndrome was associated with maternal age ≥35 years （OR=2.939， P=0.003）， parity ≥2 time （OR=3.222， P=0.003）， history of ICP recurrence （OR=3.809， P=0.010）， ALT ≥200 U/L （OR=2.889， P=0.006）， comorbidity with GDM （OR=3.711， P=0.001）， and comorbidity with hypertensive disorders of pregnancy （OR=4.472， P=0.011）. Liver depression and spleen deficiency syndrome was associated with TBA ≥40 μmol/L （OR=2.995， P=0.044）. The analysis of perinatal outcomes showed that there were significant differences in mode of delivery， gestational weeks at the time of delivery， postpartum blood loss， and neonatal birth weight between the three groups with different TCM syndromes （all P<0.05）. ConclusionLiver-gallbladder damp-heat syndrome， syndrome of blood deficiency generating wind， and liver depression and spleen deficiency syndrome are the main TCM syndrome types in ICP， and the distribution of TCM syndromes is closely associated with clinical factors and perinatal outcomes， which provides a basis for precise TCM syndrome differentiation and individualized treatment.

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective:To explore the repair mechanism of bone marrow stromal cells(BMSCs)transfected with miR-21 in rat sciatic nerve injuries.Methods:In vitro,rat BMSCs were transfected with miR-21 agonist(agomir-21)or blocker(antagomir-21)and their respective empty vectors,respectively,and divided into Control group,agomir-21 group,agomir-NC group,antagomir-21 group and antagomir-NC group.A 12 mm rat sciatic nerve injury model contai-ning decellularized nerve area was prepared,and the cells in each group were labeled with Hoechst33342 for postopera-tive implantation of decellularized nerve area.At 14 d after operation,the recovery of neuromotor function was evaluated by footprint test and the wet weight ratio of gastrocnemius.Immunofluorescence staining was applied to detect the expression of neurofilament protein 200(NF200),myelin basic protein(MBP),S100 calcium binding protein β(S100β)and glial fibrillary acidic protein(GFAP)within the regenerating nerve.Results:Compared with Control group,the sciatic nerve function index(SFI)and the wet weight ratio of gastrocnemius were significantly increased in agomir-21 group(P<0.05);and the density of regenerated nerve fibers and the expression of myelin marker proteins were increased,and the differentiation rate of BMSCs into Schwann cell-like cells(SCLCs)was elevated significantly(P<0.05).Conclusion:miR-21 significantly promotes peripheral nerve regeneration by enhancing the differentiation of BMSCs into SCLCs in vivo.

Objective To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application.Methods and Results Recommendations were formulated based on literature review and expert group discussion,and consensus was reached following expert consultation.The consensus recommendations are comprehensive,covering the entire treatment procedures from preoperative assessment and preparation,surgical operation process,postoperative management and traditional Chinese medicine treatment to individualized treatment planning.The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain,reduced the use of opioid drugs,and significantly improved the quality of life and enhanced immune function of the patients.Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.Conclusion The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy.The combined treatment has a high clinical value with a good safety profile for management of cancer pain.

Objective To investigate and analyze the association between serum microRNA-141-3p(miR-141-3p)and miR-223-3p levels and neonatal necrotizing enterocolitis.Methods Eighty neonates with necrotizing enterocolitis admitted to our hospital between January 2019 and January 2022 were enrolled as subjects.According to the disease stage,they were divided into the stage Ⅱ group(n=43)and the stage Ⅲ group(n=37).Additionally,80 healthy newborns born during the same period were recruited as the control group.General clinical data were collected and analyzed systematically.The expression levels of miR-141-3p and miR-223-3p were detected using quantitative real-time PCR(qRT-PCR).Spearman's correlation analysis was performed to evaluate the relationship between miR-141-3p,miR-223-3p,and the severity of the disease.Multivariate logistic regression analysis was conducted to assess the impact of miR-141-3p and miR-223-3p on the severity of pediatric illness.Furthermore,a Receiver Operating Characteristic(ROC)curve was plotted to determine the diagnostic value of miR-141-3p and miR-223-3p in predicting the severity of the patient's condition.Results Compared with the control group,the rela-tive expression levels of miR-141-3p and miR-223-3p in the diseased group were significantly decreased(P<0.05).Similarly,compared with the stage Ⅱ group,the relative expression levels of miR-141-3p and miR-223-3p in the stage Ⅲ group were also markedly reduced(P<0.05).Furthermore,miR-141-3p and miR-223-3p exhibited a nega-tive correlation with disease severity(r=-0.489,-0.496,P<0.05).Increased relative expression of miR-141-3p and miR-223-3p was identified as a protective factor influencing disease severity in children(P<0.05).The AUC values for diagnosing the severity of necrotizing enterocolitis using miR-141-3p,miR-223-3p,and their combination were 0.806,0.783,and 0.885,respectively.Combined diagnosis demonstrated significantly better performance than miR-141-3p alone(Z=2.050,P=0.040)or miR-223-3p alone(Z=2.184,P=0.029).Conclusion In neonates with necrotizing enterocolitis,the relative expression levels of serum miR-141-3p and miR-223-3p are significantly decreased,which are closely associated with disease progression and provide potential auxiliary diagnostic value for assessing disease severity.

Objective:To analyze the clinical characteristics and outcomes of Haemophilus influenzae (Hi) meningitis in children. Methods:This is a retrospective case series study. This study included 34 Hi meningitis patients who admitted to Beijing Children′s Hospital, Capital Medical University, from January 1, 2010, to December 31, 2023. Data on clinical presentations, laboratory tests, hearing assessment and outcomes at discharge were collected. Patients were divided into 2 groups according to the outcome at discharge: favorable outcome group and unfavorable outcome group. Mann-Whitney U test and Fisher exact test was used to estimate the risk factors for an unfavorable outcome at discharge. Results:Thirty-four patients were enrolled. There were 16 males and 18 females. The age at onset ranged from 3 months to 12 years. Fever (34 patients (100%)), convulsions (17 patients (50%)), and coma (21 patients (62%)) were the common clinical presentations. Twenty-four patients (71%) developed complications. There were 15 patients (44%) needed treatment in the intensive care unit, 5 patients (15%) received intubation, and 4 patients (12%) had developed shock. The favorable outcome group included 23 patients, and the unfavorable outcome group included 11 patients. Female, patients with limb movement disability, dystonia, ventriculomegaly or hydrocephalus, and a concentration of glucose in the initial cerebrospinal fluid lower than 1 mmol/L were risk factors of unfavorable outcome at discharge (all P<0.05). Among the 23 patients (68%) in favorable outcomes group, 13 patients (57%) had data available on their long-term follow-up results, including 12 patients with favorable long-term outcomes and 1 patient with unfavorable long-term outcome. Among the 11 patients (32%) in unfavorable outcomegroup, 1 patient died, the other 10 patients (91%) had data available on their long-term outcomes. Eight patients had unfavorable long-term outcomes and 2 patients with favorable long-term outcomes. Patients who had unfavorable outcomes at discharge were at a greater risk of experiencing unfavorable long-term outcomes ( P=0.001). Conclusions:It is common for patients with Hi meningitis to have intracranial complications or develop into critical conditions. Patients who have limb movement disability, dystonia, ventriculomegaly or hydrocephalus, and who exhibit a concentration of glucose in the initial cerebrospinal fluid lower than 1 mmol/L tend to have unfavorable outcomes; they need to be assessed for sequelae.

Objective To investigate and analyze the association between serum microRNA-141-3p(miR-141-3p)and miR-223-3p levels and neonatal necrotizing enterocolitis.Methods Eighty neonates with necrotizing enterocolitis admitted to our hospital between January 2019 and January 2022 were enrolled as subjects.According to the disease stage,they were divided into the stage Ⅱ group(n=43)and the stage Ⅲ group(n=37).Additionally,80 healthy newborns born during the same period were recruited as the control group.General clinical data were collected and analyzed systematically.The expression levels of miR-141-3p and miR-223-3p were detected using quantitative real-time PCR(qRT-PCR).Spearman's correlation analysis was performed to evaluate the relationship between miR-141-3p,miR-223-3p,and the severity of the disease.Multivariate logistic regression analysis was conducted to assess the impact of miR-141-3p and miR-223-3p on the severity of pediatric illness.Furthermore,a Receiver Operating Characteristic(ROC)curve was plotted to determine the diagnostic value of miR-141-3p and miR-223-3p in predicting the severity of the patient's condition.Results Compared with the control group,the rela-tive expression levels of miR-141-3p and miR-223-3p in the diseased group were significantly decreased(P<0.05).Similarly,compared with the stage Ⅱ group,the relative expression levels of miR-141-3p and miR-223-3p in the stage Ⅲ group were also markedly reduced(P<0.05).Furthermore,miR-141-3p and miR-223-3p exhibited a nega-tive correlation with disease severity(r=-0.489,-0.496,P<0.05).Increased relative expression of miR-141-3p and miR-223-3p was identified as a protective factor influencing disease severity in children(P<0.05).The AUC values for diagnosing the severity of necrotizing enterocolitis using miR-141-3p,miR-223-3p,and their combination were 0.806,0.783,and 0.885,respectively.Combined diagnosis demonstrated significantly better performance than miR-141-3p alone(Z=2.050,P=0.040)or miR-223-3p alone(Z=2.184,P=0.029).Conclusion In neonates with necrotizing enterocolitis,the relative expression levels of serum miR-141-3p and miR-223-3p are significantly decreased,which are closely associated with disease progression and provide potential auxiliary diagnostic value for assessing disease severity.

Objective:To explore the repair mechanism of bone marrow stromal cells(BMSCs)transfected with miR-21 in rat sciatic nerve injuries.Methods:In vitro,rat BMSCs were transfected with miR-21 agonist(agomir-21)or blocker(antagomir-21)and their respective empty vectors,respectively,and divided into Control group,agomir-21 group,agomir-NC group,antagomir-21 group and antagomir-NC group.A 12 mm rat sciatic nerve injury model contai-ning decellularized nerve area was prepared,and the cells in each group were labeled with Hoechst33342 for postopera-tive implantation of decellularized nerve area.At 14 d after operation,the recovery of neuromotor function was evaluated by footprint test and the wet weight ratio of gastrocnemius.Immunofluorescence staining was applied to detect the expression of neurofilament protein 200(NF200),myelin basic protein(MBP),S100 calcium binding protein β(S100β)and glial fibrillary acidic protein(GFAP)within the regenerating nerve.Results:Compared with Control group,the sciatic nerve function index(SFI)and the wet weight ratio of gastrocnemius were significantly increased in agomir-21 group(P<0.05);and the density of regenerated nerve fibers and the expression of myelin marker proteins were increased,and the differentiation rate of BMSCs into Schwann cell-like cells(SCLCs)was elevated significantly(P<0.05).Conclusion:miR-21 significantly promotes peripheral nerve regeneration by enhancing the differentiation of BMSCs into SCLCs in vivo.

Objective:To evaluate the clinical efficacy and the mid- and long-term follow-up outcomes of transanal anaplasty for treating rectovestibular fistula.Methods:The clinical data of 68 female infants diagnosed with rectovestibular fistula undergoing transanal anoplasty at the Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from Oct 2014 to Dec 2023 was collected. Postoperative complications, perineal and anal appearances, and defecation function of postoperative children aged 3 years or older were recorded.Results:After surgery 68 children followed-up for 6 months of recent with short-term complications in 6 cases, including 3 cases of incision infection, 2 cases of rectal mucosal prolapse, and 1 case of anal stenosis. Rintala score was (18.65±1.99). Twenty-five children underwent anorectal manometry, no significant differences were observed in the maximal systolic pressure of the anal canal( t=-0.596, P=0.563) and the maximum systolic time( t=-0.183, P=0.854). The resting pressure( t=-3.050, P=0.005), functional length( t=2.696, P=0.012), and positive rate of rectal anal inhibitory reflex( χ2=6.382, P=0.012) of the anal canal were significantly lower than those of the normal group( P<0.05). Conclusions:Transanal anaplasty for the treatment of rectovestibular fistula in girls has a low incidence of complications. It results in a normal perineal body appearance, good anal bowel control, and high quality of life.