ObjectiveTo investigate the effect and mechanism of Yijingtang （YJT） in treating diminished ovarian reserve （DOR） in rats by regulating the Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor-κB （NF-κB） signaling pathway. MethodsFifty female SD rats with normal estrous cycles were randomly allocated into blank， model， low- and high-dose （12.579 and 25.158 g·kg^-1， respectively） YJT， and dehydroepiandrosterone （7.487 5 mg·kg^-1） groups， with 10 rats in each group. The rats in other groups except the blank group were administrated with the tripterygium glycosides tablet suspension （5 mg·kg^-1） by gavage for 14 days for the modeling of DOR. The rats in the drug treatment groups were administrated with corresponding drugs by gavage from day 15 for 30 consecutive days， and those in the blank and model groups received equal volumes of distilled water. The vaginal exfoliated cell smears were observed to assess the changes in the estrous cycle. The wet weight of bilateral ovaries was weighed for calculation of the ovarian index. Hematoxylin-eosin staining was performed to observe the histopathological changes in the ovaries and the proportions of follicles at various levels were calculated. The serum levels of sex hormones ［follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， estradiol （E₂）， and anti-Müllerian hormone （AMH）］ and inflammatory factors ［tumor necrosis factor-alpha （TNF-α）， interleukin-1beta （IL-1β）， and interleukin-10 （IL-10）］ were determined by enzyme-linked immunosorbent assay. Real-time quantitative polymerase chain reaction（Real-time PCR） was conducted to determine the mRNA levels of TLR4， MyD88， NF-κB profilin α （IκBα）， NF-κB and inflammatory factors in the ovarian tissue. Western blot was employed to measure the protein levels of factors related to the TLR4/MyD88/NF-κB signaling pathway in the ovarian tissue. Immunofluorescence （IF） was used to detect the nuclear translocation of NF-κB p65 in the ovarian tissue. ResultsCompared with the blank group， the model group showed disturbed estrous cycles， increased inflammatory infiltration in the ovarian tissue， decreases in ovarian index and proportion of presinusoidal follicles， and an increase in the proportion of atretic follicles （P<0.05， P<0.01）. In addition， the model group showed elevated serum levels of FSH， LH， TNF-α， and IL-1β， up-regulated mRNA levels of TLR4， MyD88， IκBα， NF-κB， TNF-α， and IL-1β and protein levels of TLR4， MyD88， p-IκBα， and p-NF-κB p65 （P<0.01）， lowered serum levels of AMH， E₂， and IL-10， down-regulated mRNA level of IL-10 （P<0.01）， and massive nuclear translocation of NF-κB p65 in the ovarian tissue. Compared with the model group， dehydroepiandrosterone and low and high doses of YJT restored the disturbed estrous cycle， reduced inflammatory infiltration in the ovarian tissue， increased the ovarian index （P<0.01）， and changed the follicular composition ratio （P<0.01）. Furthermore， the drugs lowered the serum levels of FSH， LH， TNF-α， and IL-1β， down-regulated the mRNA levels of TLR4， MyD88， IκBα， NF-κB， TNF-α， and IL-1β and the protein levels of TLR4， MyD88， p-IκBα， and p-NF-κB p65 （P<0.05， P<0.01）， raised the serum levels of AMH， E₂， and IL-10， up-regulated the mRNA level of IL-10 （P<0.05， P<0.01）， and reduced the nuclear translocation of NF-κB p65 in the ovarian tissue. ConclusionYJT may inhibit the release and expression of inflammatory factors by regulating the TLR4/MyD88/NF-κB signaling pathway to attenuate the inflammatory responses in the ovarian tissue， thereby improving the ovarian function in DOR rats.

ObjectiveTo investigate the effect and mechanism of Yijingtang （YJT） in treating diminished ovarian reserve （DOR） in rats by regulating the Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor-κB （NF-κB） signaling pathway. MethodsFifty female SD rats with normal estrous cycles were randomly allocated into blank， model， low- and high-dose （12.579 and 25.158 g·kg^-1， respectively） YJT， and dehydroepiandrosterone （7.487 5 mg·kg^-1） groups， with 10 rats in each group. The rats in other groups except the blank group were administrated with the tripterygium glycosides tablet suspension （5 mg·kg^-1） by gavage for 14 days for the modeling of DOR. The rats in the drug treatment groups were administrated with corresponding drugs by gavage from day 15 for 30 consecutive days， and those in the blank and model groups received equal volumes of distilled water. The vaginal exfoliated cell smears were observed to assess the changes in the estrous cycle. The wet weight of bilateral ovaries was weighed for calculation of the ovarian index. Hematoxylin-eosin staining was performed to observe the histopathological changes in the ovaries and the proportions of follicles at various levels were calculated. The serum levels of sex hormones ［follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， estradiol （E₂）， and anti-Müllerian hormone （AMH）］ and inflammatory factors ［tumor necrosis factor-alpha （TNF-α）， interleukin-1beta （IL-1β）， and interleukin-10 （IL-10）］ were determined by enzyme-linked immunosorbent assay. Real-time quantitative polymerase chain reaction（Real-time PCR） was conducted to determine the mRNA levels of TLR4， MyD88， NF-κB profilin α （IκBα）， NF-κB and inflammatory factors in the ovarian tissue. Western blot was employed to measure the protein levels of factors related to the TLR4/MyD88/NF-κB signaling pathway in the ovarian tissue. Immunofluorescence （IF） was used to detect the nuclear translocation of NF-κB p65 in the ovarian tissue. ResultsCompared with the blank group， the model group showed disturbed estrous cycles， increased inflammatory infiltration in the ovarian tissue， decreases in ovarian index and proportion of presinusoidal follicles， and an increase in the proportion of atretic follicles （P<0.05， P<0.01）. In addition， the model group showed elevated serum levels of FSH， LH， TNF-α， and IL-1β， up-regulated mRNA levels of TLR4， MyD88， IκBα， NF-κB， TNF-α， and IL-1β and protein levels of TLR4， MyD88， p-IκBα， and p-NF-κB p65 （P<0.01）， lowered serum levels of AMH， E₂， and IL-10， down-regulated mRNA level of IL-10 （P<0.01）， and massive nuclear translocation of NF-κB p65 in the ovarian tissue. Compared with the model group， dehydroepiandrosterone and low and high doses of YJT restored the disturbed estrous cycle， reduced inflammatory infiltration in the ovarian tissue， increased the ovarian index （P<0.01）， and changed the follicular composition ratio （P<0.01）. Furthermore， the drugs lowered the serum levels of FSH， LH， TNF-α， and IL-1β， down-regulated the mRNA levels of TLR4， MyD88， IκBα， NF-κB， TNF-α， and IL-1β and the protein levels of TLR4， MyD88， p-IκBα， and p-NF-κB p65 （P<0.05， P<0.01）， raised the serum levels of AMH， E₂， and IL-10， up-regulated the mRNA level of IL-10 （P<0.05， P<0.01）， and reduced the nuclear translocation of NF-κB p65 in the ovarian tissue. ConclusionYJT may inhibit the release and expression of inflammatory factors by regulating the TLR4/MyD88/NF-κB signaling pathway to attenuate the inflammatory responses in the ovarian tissue， thereby improving the ovarian function in DOR rats.

Objective:To investigate the correlation between the imaging markers of cerebral small vessel disease (CSVD) and early hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (sICH).Methods:Patients with sICH admitted to the Department of Neurology, the Affiliated Hospital of Qingdao University between January 1, 2015 and December 31, 2019 were enrolled retrospectively. All patients received noncontrast CT (NCCT) within 6 h after onset. Within 24 h after the initial NCCT examination, they were reexamed to determine whether HE occurred, and brain MRI examination was completed within 48 h after onset. HE was defined as the increase of hematoma volume on NCCT reexamination by >33% or >6 ml compared with the baseline. NCCT was used to evaluate the abnormal morphology and density signs, including blend sign, swirl sign, black hole sign, island sign, and satellite sign. MRI was used to evaluate CSVD imaging markers, including lacunar infarcts (LIs), enlarged perivascular space (EPVS), white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and cortical superficial siderosis (CSS). Multivariate logistic regression analysis was used to determine independent risk factors for HE. The receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of imaging markers for HE in patients with sICH. Results:A total of 216 patients with sICH were included. Their age was 57±15 years, 113 (61.6%) were male, 88 (40.7%) had HE, 123 (56.9%) had NCCT signs, 122 (56.5%) had CMBs, 143 (66.2%) had WMHs, 44 (20.4%) had CSS, 25 (11.6%) had LIs, and 31 (14.4%) had EPVS. The baseline hematoma volume, blood calcium, the modified Rankin Scale score and the National Institutes of Health Stroke Scale score at admission, and detection rates of NCCT signs, CMBs, WMHs and CSS in the HE group were significantly higher than those in the non-HE group (all P<0.05). Multivariate logistic regression analysis showed that the blood calcium (odds ratio [ OR] 0.040, 95% confidence interval [ CI] 0.004-0.238; P=0.001), any NCCT signs ( OR 3.275, 95% CI 1.492-7.188; P=0.003), CMBs grade 4 ( OR 3.591, 95% CI 1.146-11.250; P=0.028), CSS ( OR 3.008, 95% CI 1.214-7.452; P=0.017), NCCT signs+ CMBs grade 3 ( OR 3.390, 95% CI 1.035-11.102; P=0.044), NCCT signs+ CMBs grade 4 ( OR 5.473, 95% CI 1.352-22.161; P=0.017), and NCCT signs+ CSS ( OR 3.544, 95% CI 1.215-10.336; P=0.021) were the independent risk factors for HE in patients with sICH. ROC curve analysis showed that the sensitivity of NCCT signs, CMBs and CSS for predicting HE were 81.8%, 64.8% and 34.1%, respectively, and the specificity were 60.2%, 60.9% and 89.1%, respectively. The predictive sensitivity of NCCT signs+ CMBs and NCCT signs+ CSS (59.1% and 30.7%, respectively) was lower than that of single imaging marker, while the specificity (78.1% and 93.7%, respectively) was higher than that of single imaging marker. Conclusions:The imaging markers of CSVD are closely associated with the risk of HE in patients with sICH. Severe CMBs and CSS are the independent risk factors for HE in patients with sICH. The specificity of NCCT signs combined with CSVD imaging markers for predicting HE is increased but the sensitivity decreased.