The medicinal use of Malvae Semen has a long history. In this paper， by consulting the ancient materia medica， prescription， agronomy， literature and other aspects of the classics， the name， origin， evolution of scientific name， quality， harvesting and processing， functions and indications and others of Malvae Semen were systematically sorted out and verified， so as to provide a basis for the development and utilization of famous classical formulas containing this herb. According to the textual research， Shennong Bencaojing began to use Dongkuizi as the correct name， which was used in the past dynasties， and there were also aliases such as Kuicaizi， Huacai， and Kuizi. Through the original research， it can be seen that Kuicai is the mainstream original plant of Malvae Semen， that is， Malva verticillata var. crispa， the Alcea rosea and M. cathayensis are also used. In modern times， the seeds of Abutilon theophrasti have been passed off as Malvae Semen， while the seeds of M. verticillata var. crispa have rarely been used in medicine. And Abutili Semen has been another medicinal material with different efficacy since the collection of Newly Revised Materia Medica in the Tang dynasty. Since the Ming and Qing dynasties， the cultivation of Kuicai has been decreasing， while A. theophrasti is more common and easy to obtain， and Abutili Semen and Malvae Semen are similar in morphology and confused， which should be corrected. In addition， Malvae Fructus is a Mongolian customary medicinal herb， which is different from the traditional use of seeds in traditional Chinese medicine. Kuicai， as an important vegetable in history， was widely cultivated and gradually shrunk after the Song dynasty， it is now mainly produced in southern provinces. The quality evaluation of Malvae Semen is better for those with dry bodies， full grain， grayish brown color， no mud， and no impurities. The harvesting is generally in the autumn and winter. After drying， it is seeded， sieved peel and impurities， mashed， or slightly stir-fried to yellow-white color with gentle fire. It is sweet， cold and slippery in nature and taste， with the main effects of laxation， diuresis， lactation and elimination of swelling. The efficacy of Abutili Semen is clearing heat and removing toxicity， promoting diuresis and removing nebula， the efficacy is quite different from that of Malvae Semen. Based on the results of textual research， it is suggested that M. verticillata var. crispa should be used as the medicinal source of Malvae Semen in the development of famous classical formulas， the corresponding processing methods should be selected according to the requirements of drug processing in the formulas， while the raw products are recommended to be used if the processing is not specified.

The medicinal use of Malvae Semen has a long history. In this paper， by consulting the ancient materia medica， prescription， agronomy， literature and other aspects of the classics， the name， origin， evolution of scientific name， quality， harvesting and processing， functions and indications and others of Malvae Semen were systematically sorted out and verified， so as to provide a basis for the development and utilization of famous classical formulas containing this herb. According to the textual research， Shennong Bencaojing began to use Dongkuizi as the correct name， which was used in the past dynasties， and there were also aliases such as Kuicaizi， Huacai， and Kuizi. Through the original research， it can be seen that Kuicai is the mainstream original plant of Malvae Semen， that is， Malva verticillata var. crispa， the Alcea rosea and M. cathayensis are also used. In modern times， the seeds of Abutilon theophrasti have been passed off as Malvae Semen， while the seeds of M. verticillata var. crispa have rarely been used in medicine. And Abutili Semen has been another medicinal material with different efficacy since the collection of Newly Revised Materia Medica in the Tang dynasty. Since the Ming and Qing dynasties， the cultivation of Kuicai has been decreasing， while A. theophrasti is more common and easy to obtain， and Abutili Semen and Malvae Semen are similar in morphology and confused， which should be corrected. In addition， Malvae Fructus is a Mongolian customary medicinal herb， which is different from the traditional use of seeds in traditional Chinese medicine. Kuicai， as an important vegetable in history， was widely cultivated and gradually shrunk after the Song dynasty， it is now mainly produced in southern provinces. The quality evaluation of Malvae Semen is better for those with dry bodies， full grain， grayish brown color， no mud， and no impurities. The harvesting is generally in the autumn and winter. After drying， it is seeded， sieved peel and impurities， mashed， or slightly stir-fried to yellow-white color with gentle fire. It is sweet， cold and slippery in nature and taste， with the main effects of laxation， diuresis， lactation and elimination of swelling. The efficacy of Abutili Semen is clearing heat and removing toxicity， promoting diuresis and removing nebula， the efficacy is quite different from that of Malvae Semen. Based on the results of textual research， it is suggested that M. verticillata var. crispa should be used as the medicinal source of Malvae Semen in the development of famous classical formulas， the corresponding processing methods should be selected according to the requirements of drug processing in the formulas， while the raw products are recommended to be used if the processing is not specified.

Chronic atrophic gastritis （CAG），as a key stage of precancerous lesions of gastric cancer，has an increasing incidence year by year，and it can gradually develop into gastric invasive cancer and mucosal cancer. At present，the main treatment focuses on the eradication of Helicobacter pylori （Hp），drug therapy， and pathological follow-up by gastroscopy，which can alleviate some symptoms，but it is difficult to curb the pathological progress，and the recurrence rate is high. Phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway is involved in the regulation of cell growth，differentiation，proliferation，apoptosis，autophagy， and other responses，and abnormal activation of this pathway can promote the progression of precancerous lesions of CAG. Traditional Chinese medicine is effective in the treatment of precancerous lesions of CAG through multi-component and multi-target comprehensive regulation. By regulating the PI3K/Akt pathway，the active ingredients and compounds of traditional Chinese medicine play therapeutic roles，such as inhibiting inflammation，glycolysis，angiogenesis， and epithelium-mesenchymal transformation，promoting autophagy，and regulating the balance of cell proliferation and apoptosis. This paper systematically reviewed the mechanism of traditional Chinese medicine intervention in the PI3K/Akt pathway in the treatment of precancerous lesions of CAG，so as to provide references for further understanding of the pathogenesis of precancerous lesions of CAG and search for potential therapeutic targets，and it provided new ideas for further research and drug development of precancerous lesions of CAG.

Oxidative stress due to aberrant metabolism is considered as a crucial contributor to diabetes and its complications. Hyperglycemia and hyperlipemia boost excessive reactive oxygen species generation by elevated mitochondrial respiration, increased nicotinamide adenine dinucleotide phosphate oxidase activity, and enhanced pro-oxidative processes, including protein kinase C pathways, hexosamine, polyol, and advanced glycation endproducts, which exacerbate oxidative stress. Oxidative stress plays a significant role in the onset of diabetes and its associated complications by impairing insulin production, increasing insulin resistance, maintaining hyperglycemic memory, and inducing systemic inflammation. A more profound comprehension of the molecular processes that link oxidative stress to diabetes is crucial to new preventive and therapeutic strategies. Therefore, this review discusses the mechanisms underlying how oxidative stress contributes to diabetes mellitus and its complications. We also summarize the current approaches for prevention and treatment by targeting the oxidative stress pathways in diabetes.
Oxidative Stress/physiology* ; Humans ; Diabetes Mellitus/physiopathology* ; Diabetes Complications/metabolism* ; Reactive Oxygen Species/metabolism* ; Glycation End Products, Advanced/metabolism* ; Animals

OBJECTIVE: To explore the epidemiological characteristics of knee osteoarthritis (KOA) among the elderly in the community, and its correlation with bone mass loss. METHODS: A cross-sectional study was conducted on elderly community population over 50 year old from 12 community health service centers in Zhejiang province. Their gender, age, body mass index (BMI), T value and KOA diagnosis were collected using face to face questionnaire survey. Univariate regression was used to analyze the influence of age, gender, BMI and bone loss on KOA. Logistic multivariate regression model was used to analyze the independent effect of bone mass loss on KOA. RESULTS: Among 4 173 subjects in this study, 1 710 of them were had a KOA. The prevalence rate was 40.9%. The mean age, the proportion of females and the mean BMI in KOA patients were (65.5±3.8) years old, 67.7%(1 158/1 710) and(24.59±1.28) kg·m^-2, respectively, which were significantly higher than (58.5±3.2) years old, 51.3%(1 263/2 463), and (23.48±1.25) kg·m^-2 in non-KOA subjects (P<0.001). In the population aged from 60 to 69 years old, the influence of osteopenia and osteoporosis on the prevalence of KOA was[OR=1.21, 95%CI(1.00, 1.46), P=0.053 2], [OR=1.42, 95%CI(1.14, 1.78), P=0.002 2]. The influence of male and female osteoporosis on the prevalence of KOA was [OR=1.52, 95%CI(1.16, 1.99), P=0.002 7] and [OR=1.87, 95%CI(1.51, 2.32), P<0.000 1], respectively. In the population of 24 kg·m^-2≤BMI<28 kg·m^-2, the influence of osteopenia and osteoporosis on the prevalence of KOA was [OR=1.47, 95%CI(1.21, 1.80), P=0.000 1], [OR=2.69, 95%CI(2.11, 3.42), P<0.000 1], respectively. After controlling the confounding factors of age, gender and BMI, compared with people with normal bone mass, the effect of osteopenia on the prevalence of KOA was [OR=1.34, 95%CI(1.08, 1.67), P=0.009 2], and the effect of osteoporosis on the prevalence of KOA was [OR=1.38, 95%CI(1.06, 1.79), P=0.017 9]. CONCLUSION Elderly overweight women are more likely to develop KOA. Bone mass loss is an independent risk factor for KOA, which will significantly increase the prevalence of KOA in people overweight or aged 60 to 69 years old.
Humans ; Female ; Male ; Aged ; Osteoarthritis, Knee/etiology* ; Middle Aged ; Cross-Sectional Studies ; Bone Density ; Aged, 80 and over ; Incidence ; Body Mass Index ; China/epidemiology* ; Osteoporosis/epidemiology*

OBJECTIVE: To investigate the relationship between the weight-adjusted waist index (WWI) and acute, subacute pain or chronic pain among American adults. METHODS: There was a cross-sectional study. Data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) concerning waist circumference, weight, pain status and covariates (age, gender, race, marital status, education level and income, physical activity, alcohol consumption, smoking status, and diabetes) were extracted for analysis. Multinomial Logistic regression was conducted across the three models to investigate the associations between WWI and acute, subacute and chronic pain. Model 1 did not involve any adjustments. Model 2 involved adjustments for age, gender, race, marital status, education level, and income. Model 3 was further adjusted for physical activity, alcohol consumption, smoking, and diabetes status. RESULTS: This study involved 12 694 participants with an average age of (50.6±18.7) years. Among all the participants, 9 614 people (75.74%) had no pain, 870 people (6.85%) experienced acute pain, 354 people (2.79%) suffered from subacute pain, and 1 856 people (14.62%) experienced chronic pain. The WWI of all the participants was (10.95±0.85) cm/$\sqrt{\mathrm{kg}}$, divided into four groups based on quartiles: Group Q1 (7.90-10.36) cm/$\sqrt{\mathrm{kg}}$, group Q2 (10.37-10.94) cm/$\sqrt{\mathrm{kg}}$, group Q3 (10.95-11.53) cm/$\sqrt{\mathrm{kg}}$ and group Q4 (11.54-15.20) cm/$\sqrt{\mathrm{kg}}$. With the increase of WWI, the analysis revealed a significant statistical difference in the participants' acute and chronic pain status (all P < 0.001). In Model 1, the prevalence of acute pain was lower in group Q2 and group Q4 compared with group Q1 (group Q2: OR=0.765, 95%CI: 0.615-0.953, P=0.017; group Q4: OR= 0.648, 95%CI: 0.503-0.835, P < 0.001). Compared with group Q1, the prevalence of chronic pain increased in group Q2, group Q3, and group Q4 (group Q2: OR =1.365, 95%CI: 1.149-1.622, P < 0.001; group Q3: OR=1.291, 95%CI: 1.082-1.541, P=0.005; group Q4: OR=1.874, 95%CI: 1.579-2.224, P < 0.001). In Model 2, compared with group Q1, an increase in chronic pain prevalence was still associated with an increase in WWI in other three groups (group Q2: OR=1.359, 95%CI: 1.137-1.624, P=0.001; group Q3: OR=1.260, 95%CI: 1.039-1.528, P=0.019; group Q4: OR=1.735, 95%CI: 1.413-2.132, P < 0.001). In Model 3, group Q4 had a 49.2% increased prevalence of chronic pain compared to group Q1 (OR = 1.492, 95%CI: 1.208-1.842, P < 0.001). However, in Models 2 and 3, no significant relationship was observed between acute pain and WWI (all P>0.05). And none of the three models identified a significant association between subacute pain and WWI (all P>0.05). CONCLUSION For American adults, there was no significant correlation between WWI and acute pain or subacute pain. However, as WWI increases, so does the prevalence of chronic pain. Further validation of this conclusion through large-scale prospective studies is warranted.
Humans ; Cross-Sectional Studies ; Middle Aged ; Male ; Female ; Adult ; Waist Circumference ; Chronic Pain/epidemiology* ; Aged ; Nutrition Surveys ; Pain/epidemiology* ; Body Weight ; Logistic Models ; Body Mass Index

BACKGROUND:The key to preventing the recurrence of intrauterine adhesions is to reconstruct the endometrium with normal function.The latest breakthrough in the treatment of recurrent intrauterine adhesions in and outside China is the use of degradable materials to prepare hydrogels to prevent the recurrence of adhesions. OBJECTIVE:To review the research advance in hydrogel-promoted endometrial repair in intrauterine adhesions. METHODS:PubMed,Web of Science,China National Knowledge Infrastructure(CNKI),and WanFang databases were searched systematically,with the keywords"intrauterine adhesions,endometrial injury,endometrium regeneration,hydrogel"in Chinese and English.Relevant articles published in each database from January 1990 to March 2023 were collected. RESULTS AND CONCLUSION:In recent years,research on hydrogel-promoted endometrial repair in uterine adhesions in and outside China has made some progress and plays an important role in the prevention and treatment of intrauterine adhesions and the promotion of endometrial repair:(1)As an important carrier in tissue engineering,hydrogel itself has excellent biocompatibility,biodegradability and three-dimensional network structure,which can be better applied in the treatment of intrauterine adhesions.(2)The hydrogel-based carrier system can promote the proliferation and differentiation of endometrial epithelial cells by transporting drugs/biologics/stem cells,and restore normal uterine morphology to prevent adhesion recurrence.(3)Hyaluronic acid hydrogels can not only meet good biocompatibility,but also promote the proliferation and differentiation of endometrial epithelial cells,and will be hydrolyzed by corresponding enzymes in utero,without affecting the normal metabolism of the body.They are currently commonly used uterine anti-adhesion agents in the clinic and are also the most commonly used hydrogel carriers in tissue engineering research.(4)Poloxamer hydrogel with excellent temperature-sensitive properties can rapidly gelate into the body,quickly form a physical barrier,and can play a slow-release effect on carrying substances and provide a platform for cell growth/adhesion.(5)There are broad prospects for the preparation of therapeutic hydrogels using materials with different characteristics,such as temperature-sensitive hydrogels,pH-responsive hydrogels and photosensitive hydrogels,but there are still many problems to be solved,such as the safety of the hydrogel system,whether the degradation products cause immune reactions,and whether they have an impact on the normal body's menstrual period.A large number of animal experiments and clinical trials are needed to verify its safety and efficacy,and continuously improve the treatment strategy.

Objective To explore the relationships of MRI manifestations of pericruciate ligament fat pad(PCFP)with the severity of knee osteoarthritis(KOA).Methods Fifty patients with MRI diagnosed KOA(KOA group)and 30 healthy subjects(control group)were retrospectively included.Signal intensity changes of PCFP,infrapatellar fat pad(IPFP),quadriceps fat pad(QFP)and prefemoral fat pad(PFP)were observed,and the maximum cross-sectional areas were obtained.The severity of KOA was assessed,including knee cartilage injury,anterior cruciate ligament tear,bone marrow lesion(BML),meniscal injuries and Park classification.MRI parameters of fat pad were compared between groups,and correlations of PCFP MRI parameter and other fat pad MRI parameters with the severity of KOA were analyzed.Results Signal change grade of IPFP and PCFP were significant different between groups(both P＜0.05),and the maximum cross-sectional area of IPFP and the thickness of PFP patellofemoral in KOA group were smaller than,while the maximum cross-sectional area of PCFP in KOA group was larger than that in control group(all P＜0.05).The signal change grade of PCFP was positively related to signal change grade of IPFP(rs=0.557)but negatively related to PFP interpatellofemoral thickness(rs=-0.651).The maximum cross-sectional area of PCFP was positively related to the maximum cross-sectional area of IPFP,PFP and QFP,also to the QFP occupancy effect(n=0.314 to 0.368).The signal change grade of PCFP was positively related to the cartilage injuries of knee compartments(medial and lateral patellofemoral joints,the femoral medial and lateral,the tibial medial and lateral)(rs=0.502 to 0.735),and the maximum cross-sectional area of PCFP was related to the lateral femoral cartilage injury(rs=0.305).In addition,the signal change grade of PCFP was positively related to tear of anterior cruciate ligament,BML,medial meniscus tears,lateral meniscus tears,medial meniscus extrusion,exudative synovitis and Park grading(rs=0.425 to 0.789),while the maximum cross-sectional area of PCFP was positively related to BML(rs=0.313).Conclusion MRI signal changes of PCFP could indicate KOA,and the grade of signal changes was correlated with the severity of KOA.

Background::Histological healing is closely associated with improved long-term clinical outcomes and lowered relapses in patients with ulcerative colitis (UC). Here, we developed a novel diagnostic criterion for assessing histological healing in UC patients.Methods::We conducted a retrospective cohort study in UC patients, whose treatment was iteratively optimized to achieve mucosal healing at Shanghai Tenth People’s Hospital of Tongji University from January 2017 to May 2022. We identified an inflammatory cell enumeration index (ICEI) for assessing histological healing based on the proportions of eosinophils, CD177 + neutrophils, and CD40L + T cells in the colonic lamina propria under high power field (HPF), and the outcomes (risks of symptomatic relapses) of achieving histological remission vs. persistent histological inflammation using Kaplan-Meier curves. Intrareader reliability and inter-reader reliability were evaluated by each reader. The relationships to the changes in the Nancy index and the Geboes score were also assessed for responsiveness. The ICEI was further validated in a new cohort of UC patients from other nine university hospitals. Results::We developed an ICEI for clinical diagnosis of histological healing, i.e., Y = 1.701X 1 + 0.758X 2 + 1.347X 3 - 7.745 (X 1, X 2, and X 3 represent the proportions of CD177 + neutrophils, eosinophils, and CD40L + T cells, respectively, in the colonic lamina propria under HPF). The receiver operating characteristics curve (ROC) analysis revealed that Y <-0.391 was the cutoff value for the diagnosis of histological healing and that an area under the curve (AUC) was 0.942 (95% confidence interval [CI]: 0.905-0.979) with a sensitivity of 92.5% and a specificity of 83.6% ( P <0.001). The intraclass correlation coefficient (ICC) for the intrareader reliability was 0.855 (95% CI: 0.781-0.909), and ICEI had good inter-reader reliability of 0.832 (95% CI: 0.748-0.894). During an 18-month follow-up, patients with histological healing had a substantially better outcome compared with those with unachieved histological healing ( P <0.001) using ICEI. During a 12-month follow-up from other nine hospitals, patients with histological healing also had a lower risk of relapse than patients with unachieved histological healing. Conclusions::ICEI can be used to predict histological healing and identify patients with a risk of relapse 12 months and 18 months after clinical therapy. Therefore, ICEI provides a promising, simplified approach to monitor histological healing and to predict the prognosis of UC.Registration::Chinese Clinical Trial Registry, No. ChiCTR2300077792.

Objective:To analyze the clinical application of different diagnostic methods for heart failure with preserved ejection fraction (HFpEF) in maintenance hemodialysis (MHD) patients.Methods:It was a single-center retrospective cohort study. Uremia patients who underwent hemodialysis at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2020 to June 2021 were enrolled. The demographic characteristics, laboratory indicators, and echocardiography parameters were collected. The 2016 European Society of Cardiology (ESC) criteria, H 2FPEF score [composite score based on weighted scores of heavy (H), hypertensive (H), atrial fibrillation (F), pulmonary hypertension (P), elder (E), and filling pressure (F)], and Heart Failure Association (HFA) -PEFF score [including pre-test assessment (P), echocardiography and natriuretic peptide score (E), functional testing (F) and final aetiology (F)] were used to diagnose HFpEF, respectively, and the difference of three diagnostic methods was compared. The association between HFpEF diagnosed by the three methods and poor outcomes (all-cause death, cardiovascular death) was analyzed. Results:A total of 160 MHD patients were included, whose age was (58.5±13.4) years, median dialysis age was 5.0 (2.3, 9.6) years, median H 2FPEF score was 2 (1, 3), median HFA-PEFF score was 4 (3, 5), and 92 (57.5%) were males. Of these patients, 118 patients (73.8%) met the 2016 ESC criteria for diagnosis of HFpEF, 4 (2.5%) met H 2FPEF score for diagnosis of HFpEF, and 56 (35.0%) met HFA-PEFF score for diagnosis of HFpEF. The consistency of three methods in diagnosing HFpEF was poor with κ values of 0.018 between ESC criteria and H 2FPEF score, 0.322 between ESC criteria and HFA-PEFF score, and 0.056 between H 2FPEF score and HFA-PEFF score. After a median follow-up of 2.6 years, 20 (12.5%) of the 160 MHD patients died. The Kaplan-Meier survival analysis showed a significant difference in mortality between patients diagnosed with HFpEF and those without using the H 2FPEF score (Log-rank test, χ2=6.95, P=0.008). After adjusting for demographic and clinical parameters, multivariate Cox regression analysis showed that HFpEF diagnosed by HFA-PEFF score was associated with all-cause mortality ( HR=2.73, 95% CI 1.07-6.98, P=0.036) and cardiovascular mortality ( HR=4.77, 95% CI 1.31-17.30, P=0.018). Conclusions:The 2016 ESC criteria, H 2FPEF score, and HFA-PEFF score have high heterogeneity and poor consistency in diagnosing HFpEF in MHD patients. Among the three diagnostic methods, only the diagnosis based on HFA-PEFF score is associated with the prognosis of MHD patients. The HFA-PEFF score can be used to assess the risk of HFpEF in MHD patients, and more clinical studies are needed to further verify it in the future.