ObjectiveTo investigate the clinical effects and safety of Shuhe Granules （舒和颗粒） in patients with rheumatoid arthritis （RA） comorbid with insomnia. MethodsA single-arm prospective exploratory design was adopted. Thirty RA patients comorbid with insomnia and diagnosed with the traditional Chinese medicine （TCM） syndrome of kidney-heart deficiency and qi-blood disharmony were enrolled. On the basis of maintaining their original RA treatment regimens， all patients received oral Shuhe Granules， one dose per day， for 12 consecutive weeks. The outcomes were assessed before treatment and at weeks 4， 8， and 12 after treatment. Sleep and related psychosomatic function were evaluated using the insomnia severity index （ISI）， Pittsburgh sleep quality index （PSQI）， fatigue severity scale （FSS）， patient health questionnaire-9 （PHQ-9）， generalized anxiety disorder-7 （GAD-7）， and Montreal cognitive assessment （MoCA） scores. RA-related assessments included the 28-joint disease activity score based on C-reactive protein （DAS28-CRP）， pain visual analog scale （VAS）， tender joint count （TJC28）， swollen joint count （SJC28）， morning stiffness duration， and health assessment questionnaire （HAQ） score. Laboratory parameters included erythrocyte sedimentation rate （ESR）， serum C-reactive protein （CRP）， anti-cyclic citrullinated peptide antibody （anti-CCP）， and rheumatoid factor （RF） levels. A literature-based historical control group was established through literature retrieval and meta-analysis. The ISI， PSQI， DAS28-CRP， and pain VAS scores were compared between the treatment group in the present study and the historical control group. Safety assessments were also performed. ResultsCompared with baseline before treatment， ISI and PSQI scores decreased at weeks 4， 8， and 12， while MoCA scores increased at weeks 4， 8， and 12. FSS scores decreased at weeks 4 and 12. At weeks 8 and 12， GAD-7 scores， DAS28-CRP scores， duration of morning stiffness， TJC28， and SJC28 were reduced. At week 12， PHQ-9， pain VAS， and HAQ scores significantly decreased （P＜0.05）. FSS and DAS28-CRP scores at week 12 were lower than those at week 4， and CRP levels at week 8 were lower than those at week 4 （P＜0.05）. Compared with the historical control group， the treatment group showed superior improvement in ISI and PSQI scores （P＜0.001）； however， no statistically significant differences were observed between the two groups in DAS28-CRP or pain VAS scores （P＞0.05）. No serious adverse events occurred during the study， and the 4 reported mild adverse events were all considered unrelated to the study medication. ConclusionShuhe Granules significantly improve sleep quality， fatigue， emotional status， cognitive function， RA-related symptoms， and joint function in patients with RA comorbid insomnia， with good safety and tolerability.

Objective To explore the effect and mechanism of Gegen Qinlian decoction (GQD) on myocardial injury induced by high-fat diet combined with streptozotocin in type 2 diabetic mice through network pharmacology and animal experiments. MethodsNetwork pharmacology was applied to screen the potential signaling pathways of GQD in the intervention of diabetic heart disease (DHD). A total of 36 specific pathogen-free (SPF) male C57BL/6J mice aged 8 weeks were acclimatized for 1 week and randomly divided into a normal control group (n=6) and a model group (n=30). Mice in the model group were fed a 60% high-fat diet and 5% glucose water for 4 weeks, and were intraperitoneally injected with 100 mg/kg streptozotocin after 12 h of fasting to establish the type 2 diabetes model. Mice in the normal control group were given a conventional diet and drinking water, and were intraperitoneally injected with an equal volume of citrate buffer after 12 h of fasting at the same time point. After successful establishment of the diabetic mouse model, the model mice were randomly divided into five groups according to body weight: model control group, GQD low-dose group, GQD medium-dose group, GQD high-dose group, and metformin positive control group, with 6 mice in each group. After 6 weeks of intragastric administration of corresponding doses of GQD, metformin, and ddH₂O respectively, all mice in the six groups (one normal control group and five model groups) were anesthetized with inhaled 2% isoflurane, blood samples were collected via eyeball enucleation, and heart tissues were harvested after euthanasia by cardiac exsanguination. Hematoxylin-eosin (HE) staining and wheat germ agglutinin (WGA) staining were performed to observe the pathological damage of myocardial tissues and measure the cross-sectional area of cardiomyocytes. Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of pro-inflammatory cytokines in serum. Immunohistochemical staining was adopted to determine the protein expression levels of receptor for advanced glycation end products (RAGE), nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 (NLRP3), and phosphorylated nuclear factor-κB p65 (p-p65) in myocardial tissues. ResultsNetwork pharmacology analysis revealed that the targets of GQD against DHD were significantly enriched in inflammatory pathways, including the advanced glycation end products (AGEs)-RAGE axis, tumor necrosis factor (TNF) and interleukin-17 (IL-17) signaling pathways. HE and WGA staining results showed that, compared with the normal control group, the model control group exhibited myocardial fiber rupture, cardiomyocyte swelling, and significantly increased cardiomyocyte cross-sectional area (P<0.05). Compared with the model control group, GQD intervention significantly ameliorated the pathological changes, including myocardial fiber rupture, cell swelling, and cardiomyocyte hypertrophy. The results of immunohistochemical staining and ELISA indicated that compared with the model control group, GQD intervention markedly downregulated the protein expression of RAGE, NLRP3, and p-p65 in myocardial tissues, as well as the levels of serum pro-inflammatory cytokines (P<0.05). ConclusionGQD can effectively alleviate myocardial pathological injury in diet-induced type 2 diabetic mice, and its mechanism may be related to inhibiting the activation of the RAGE/p-p65/NLRP3 signaling pathway and reducing myocardial inflammatory response.

Ulcerative colitis(UC)is an inflammatory disease characterized by a continuous diffuse lesion in the colorectal mucosa.Macrophages,as key players in the inflammatory microenvironment,are significantly correlated with the development of UC.Based on the TCM pathogenesis of UC,this article reviewed the current research status of targeted regulation of macrophages in the treatment of UC using TCM,summarized the biological processes related to macrophages and their role in the progression of UC,and concluded the molecular mechanism of TCM treatment of UC targeting macrophages.It found that the active components of Chinese materia medica,TCM compounds,and TCM non-pharmacological therapies mainly regulate macrophage activity by regulating macrophage polarization,autophagy,pyroptosis,metabolic reprogramming,oxidative stress,and other processes,thereby delaying the progression of UC.This article aimed to provide references for in-depth exploration of the pathogenesis of UC and the TCM prevention and treatment of UC.

AIM:This study aims to investigate the mechanism by which Zhilianwan(ZLW)decoction affects dextran sodium sulfate(DSS)-induced ulcerative colitis(UC)in mice,focusing on the Toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD88)/nuclear factor-κB(NF-κB)signaling pathway.METHODS:Fifty male C57BL/6J mice were allowed ad libitum access to food for 1 week before the experiment.They were randomly divided into 5 groups:control group,model group,mesalazine(ME)group,high-dose ZLW(ZLW-H)group,and low-dose ZLW(ZLW-L)group,with ten mice in each group.All mice,except those in control group that received distilled water,were given a 3%DSS solution for seven consecutive days,starting the intervention on the first day of modeling.Each group re-ceived their respective treatments via gavage at volume of 20 μL/g for ten consecutive days.The mice in control and model groups received an equivalent volume of distilled water,while those in ME,ZLW-H,and ZLW-L groups were adminis-tered 0.2 g·kg-1·d-1 of ME,10.92 g·kg-1·d-1 of ZLW,and 2.73 g·kg-1·d-1 of ZLW,respectively.Body weight and dis-ease activity index(DAI)scores were recorded daily.At the end of the intervention,colon length was measured,and he-matoxylin-eosin staining was performed to assess pathological changes in colon tissues.ELISA and qPCR were employed to measure serum levels of interleukin-1β(IL-1β),IL-6,tumor necrosis factor-α(TNF-α)and IL-10,as well as the mRNA expression levels in colon tissues.Western blot analysis was conducted to evaluate the protein levels of TLR4,MyD88,cytosolic NF-κB and nuclear NF-κB in colon tissues.RESULTS:Compared with model group,the mice treated with ZLW exhibited an increase in body weight and colon length(P＜0.05),along with a decrease in DAI and colon histo-pathological scores(P＜0.05).Serum levels of IL-1β,IL-6,and TNF-α were significantly lower(P＜0.05),while IL-10 levels increased(P＜0.05).The mRNA expression levels of these inflammatory factors in colonic tissues reflected similar trends.Additionally,levels of TLR4,MyD88,and nuclear NF-κB proteins were reduced(P＜0.05),whereas cytosolic NF-κB protein expression was elevated(P＜0.05)in the colon tissues of treated mice.CONCLUSION:ZLW exerts at-tenuating effects on DSS-induced intestinal injury in UC mice,though modulation of the TLR4/MyD88/NF-κB signaling pathway.

Objective:To explore the association between the metabolic score for insulin resistance (METS-IR) and metabolic dysfunction-associated fatty liver disease (MAFLD), and to compare the diagnostic ability of METS-IR with the fatty liver index (FLI) and hepatic steatosis index (HSI) for MAFLD.Methods:This cross-sectional study enrolled 551 individuals participating in community health screenings in Suzhou between September and November 2022. Data collected included basic demographics, clinical indicators, and iLivTouch? (FibroTouch FT5000, Wuxi Hisky Medical Technologies, China) transient elastography results. Participants were categorized into non-MAFLD ( n=218) and MAFLD ( n=333) groups based on an ultrasound attenuation parameter (UAP) cutoff of 244 dB/m measured by iLivTouch. Logistic regression and restricted cubic spline (RCS) analyses were employed to assess the relationship between METS-IR and MAFLD. The diagnostic value of METS-IR was evaluated using receiver operating characteristic (ROC) curves. DeLong′s test was used to compare the diagnostic performance of the different indices. Results:Among the 551 participants, the prevalence of MAFLD diagnosed by transient elastography was 60.4% (333/552). Compared to the non-MAFLD group, the MAFLD group had significantly higher levels of BMI, SBP, DBP, HbA1c, FPG, 2hPG, TC, TG, LDL-C, ALT, AST, GGT, SUA, liver stiffness measurement (LSM), METS-IR, FLI, and HSI, while HDL-C levels were lower (all P<0.05). The MAFLD group also had a higher prevalence of males, overweight/obesity, smoking, hypertension, pre-diabetes, dyslipidemia, hyperuricemia, metabolic syndrome, and antihypertensive medication use (all P<0.05). Multivariate logistic regression analysis, after adjusting for gender, age, smoking, alcohol consumption, hypertension, diabetes, dyslipidemia, hyperuricemia, ALT, AST, and GGT, demonstrated that METS-IR, FLI, and HSI remained significantly associated with an increased risk of MAFLD ( OR=1.148, 1.042, 1.270, respectively; all P<0.001). The areas under the ROC curve for METS-IR, FLI, and HSI in diagnosing MAFLD were 0.733 (95% CI: 0.691-0.774), 0.727 (95% CI: 0.685-0.770), and 0.677 (95% CI: 0.632-0.722), respectively. The sensitivities were 57.40%, 62.20%, and 48.30%; specificities were 78.00%, 72.90%, and 78.40%; and optimal cutoff values were 38.526, 35.225, and 35.386, respectively. DeLong′s test indicated no significant difference in diagnostic performance between METS-IR and FLI ( P=0.722). However, both METS-IR and FLI demonstrated significantly better diagnostic performance than HSI ( P=0.008 and P=0.018, respectively). Conclusion:METS-IR is significantly associated with MAFLD and effectively identifies MAFLD in community settings. Its diagnostic performance is comparable to FLI and superior to HSI.

Ulcerative colitis(UC)is an inflammatory disease characterized by a continuous diffuse lesion in the colorectal mucosa.Macrophages,as key players in the inflammatory microenvironment,are significantly correlated with the development of UC.Based on the TCM pathogenesis of UC,this article reviewed the current research status of targeted regulation of macrophages in the treatment of UC using TCM,summarized the biological processes related to macrophages and their role in the progression of UC,and concluded the molecular mechanism of TCM treatment of UC targeting macrophages.It found that the active components of Chinese materia medica,TCM compounds,and TCM non-pharmacological therapies mainly regulate macrophage activity by regulating macrophage polarization,autophagy,pyroptosis,metabolic reprogramming,oxidative stress,and other processes,thereby delaying the progression of UC.This article aimed to provide references for in-depth exploration of the pathogenesis of UC and the TCM prevention and treatment of UC.

Children with developmental coordination disorder (DCD) commonly experience difficulties with handwriting.However, there is currently no standardized tool for assessing dysgraphia in this population.Therefore, this paper provides a review of the commonly used handwriting assessment tools both domestically and internationally, as well as their application in individuals with DCD.The aim is to offer a reference to clinical professionals involved in the diagnosis and treatment of DCD in selecting appropriate tools for assessing handwriting difficulties in children.

Objective:To gain an in-depth understanding of the career development of male nurses in China, analyze trends, challenges, and opportunities, and provide a basis for policy-making, talent cultivation, and professional development in the nursing field.Methods:A descriptive qualitative research method was adopted. From March 29th to July 30th, 2023, the heads of the male nurses working groups of nursing associations in 26 regions of China were selected by purposive sampling method for semi-structured interviews. Content analysis was used to analyze the data.Results:The current situation of the career development of male nurses in China could be summarized into the following three themes. (1) Current situation: the organizational structure of provincial-level male nurses work was basically complete, but there were obvious differences at the grassroots level; the work was carried out in various forms, and diverse models developed in coordination; (2) Trends: there were obvious stratifications in professional ideology and professional abilities of male nurses among different regions and different-level medical institutions; the gender dividend was gradually decreasing, and male nurses should give play to their advantages in logical thinking ability; (3) Prospects: early intervention was needed to enhance professional identity and organizational support; male nurses should be trained in various aspects through multiple forms such as counterpart assistance, expert databases or online academic forums; interdisciplinary development might be the key to stimulating internal driving force.Conclusions:Significant progress has been made in the career development of male nurses in China, but there are still challenges and issues to address. Further improvements in related policies, enhancement of social recognition and professional status, and increased investment and support in research and education are needed to promote the sustained development of male nursing careers.

AIM:This study aims to investigate the mechanism by which Zhilianwan(ZLW)decoction affects dextran sodium sulfate(DSS)-induced ulcerative colitis(UC)in mice,focusing on the Toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD88)/nuclear factor-κB(NF-κB)signaling pathway.METHODS:Fifty male C57BL/6J mice were allowed ad libitum access to food for 1 week before the experiment.They were randomly divided into 5 groups:control group,model group,mesalazine(ME)group,high-dose ZLW(ZLW-H)group,and low-dose ZLW(ZLW-L)group,with ten mice in each group.All mice,except those in control group that received distilled water,were given a 3%DSS solution for seven consecutive days,starting the intervention on the first day of modeling.Each group re-ceived their respective treatments via gavage at volume of 20 μL/g for ten consecutive days.The mice in control and model groups received an equivalent volume of distilled water,while those in ME,ZLW-H,and ZLW-L groups were adminis-tered 0.2 g·kg-1·d-1 of ME,10.92 g·kg-1·d-1 of ZLW,and 2.73 g·kg-1·d-1 of ZLW,respectively.Body weight and dis-ease activity index(DAI)scores were recorded daily.At the end of the intervention,colon length was measured,and he-matoxylin-eosin staining was performed to assess pathological changes in colon tissues.ELISA and qPCR were employed to measure serum levels of interleukin-1β(IL-1β),IL-6,tumor necrosis factor-α(TNF-α)and IL-10,as well as the mRNA expression levels in colon tissues.Western blot analysis was conducted to evaluate the protein levels of TLR4,MyD88,cytosolic NF-κB and nuclear NF-κB in colon tissues.RESULTS:Compared with model group,the mice treated with ZLW exhibited an increase in body weight and colon length(P＜0.05),along with a decrease in DAI and colon histo-pathological scores(P＜0.05).Serum levels of IL-1β,IL-6,and TNF-α were significantly lower(P＜0.05),while IL-10 levels increased(P＜0.05).The mRNA expression levels of these inflammatory factors in colonic tissues reflected similar trends.Additionally,levels of TLR4,MyD88,and nuclear NF-κB proteins were reduced(P＜0.05),whereas cytosolic NF-κB protein expression was elevated(P＜0.05)in the colon tissues of treated mice.CONCLUSION:ZLW exerts at-tenuating effects on DSS-induced intestinal injury in UC mice,though modulation of the TLR4/MyD88/NF-κB signaling pathway.

Objective:To explore the association between the metabolic score for insulin resistance (METS-IR) and metabolic dysfunction-associated fatty liver disease (MAFLD), and to compare the diagnostic ability of METS-IR with the fatty liver index (FLI) and hepatic steatosis index (HSI) for MAFLD.Methods:This cross-sectional study enrolled 551 individuals participating in community health screenings in Suzhou between September and November 2022. Data collected included basic demographics, clinical indicators, and iLivTouch? (FibroTouch FT5000, Wuxi Hisky Medical Technologies, China) transient elastography results. Participants were categorized into non-MAFLD ( n=218) and MAFLD ( n=333) groups based on an ultrasound attenuation parameter (UAP) cutoff of 244 dB/m measured by iLivTouch. Logistic regression and restricted cubic spline (RCS) analyses were employed to assess the relationship between METS-IR and MAFLD. The diagnostic value of METS-IR was evaluated using receiver operating characteristic (ROC) curves. DeLong′s test was used to compare the diagnostic performance of the different indices. Results:Among the 551 participants, the prevalence of MAFLD diagnosed by transient elastography was 60.4% (333/552). Compared to the non-MAFLD group, the MAFLD group had significantly higher levels of BMI, SBP, DBP, HbA1c, FPG, 2hPG, TC, TG, LDL-C, ALT, AST, GGT, SUA, liver stiffness measurement (LSM), METS-IR, FLI, and HSI, while HDL-C levels were lower (all P<0.05). The MAFLD group also had a higher prevalence of males, overweight/obesity, smoking, hypertension, pre-diabetes, dyslipidemia, hyperuricemia, metabolic syndrome, and antihypertensive medication use (all P<0.05). Multivariate logistic regression analysis, after adjusting for gender, age, smoking, alcohol consumption, hypertension, diabetes, dyslipidemia, hyperuricemia, ALT, AST, and GGT, demonstrated that METS-IR, FLI, and HSI remained significantly associated with an increased risk of MAFLD ( OR=1.148, 1.042, 1.270, respectively; all P<0.001). The areas under the ROC curve for METS-IR, FLI, and HSI in diagnosing MAFLD were 0.733 (95% CI: 0.691-0.774), 0.727 (95% CI: 0.685-0.770), and 0.677 (95% CI: 0.632-0.722), respectively. The sensitivities were 57.40%, 62.20%, and 48.30%; specificities were 78.00%, 72.90%, and 78.40%; and optimal cutoff values were 38.526, 35.225, and 35.386, respectively. DeLong′s test indicated no significant difference in diagnostic performance between METS-IR and FLI ( P=0.722). However, both METS-IR and FLI demonstrated significantly better diagnostic performance than HSI ( P=0.008 and P=0.018, respectively). Conclusion:METS-IR is significantly associated with MAFLD and effectively identifies MAFLD in community settings. Its diagnostic performance is comparable to FLI and superior to HSI.