This article adopts Professor CHEN Chaozu′s " sanjiao composed by membrane-striae" theory as its foundation to explore the relationship between irritable bowel syndrome and functional/structural abnormalities of the membrane-striae. Sanjiao encompasses both the tangible membrane and the intangible striae. These striae permeate the entire body，and their pathological changes comprehensively reflect qi，body fluids，and fasciae. Based on the physiological function of the membrane-striae in regulating qi and fluids，the pathogenesis of irritable bowel syndrome is characterized by a disharmony of membrane-striae and an imbalance of the qi-fluid interactions. In the early stage，external pathogens，emotional factors，or dietary stimuli often cause membrane-striae constriction and disordered qi-fluid circulation. In the middle stage，stagnant fluids gradually transform into phlegm retention，leading to membrane-striae obstruction. In the late stage，deficiency of vital qi becomes predominant，manifesting as laxity of membrane-striae with impaired control or weakened conduction. The treatment of irritable bowel syndrome should adopt " unblocking" as the guiding principle. In the early stage，therapy should focus on eliminating pathogenic factors and soothing membrane-striae to promptly restore qi-fluid circulation，thereby attaining unblocking through spasm relief. In the middle stage，treatment should focus on resolving tangible obstructions in membrane-striae，achieving unblocking via dredging. In the late stage，the emphasis should shift to reinforcing healthy qi，particularly by strengthening spleen-kidney yang qi，and achieving unblocking through supplementation. Concurrently，throughout the entire treatment process，the regulation of mental state and easing of emotional tension should be integrated to alleviate patient′s anxiety，achieving the goal of holistic treatment of both body and mind.

Gorham-Stout disease(GSD) is a rare osteolytic disorder characterized by spontaneous and progressive osteolysis, along with abnormal angiogenesis and lymphangiogenesis, with no new bone formation. We present a case of a 15-year-old female admitted due to " recurrent right leg pain for 5 years, 11 months after undergoing right femoral fracture surgery". Through comprehensive integration of the patient's clinical phenotype, laboratory tests, imaging findings, pathological examinations, and molecular biological test results, GSD was considered highly likely. A multidisciplinary treatment approach was conducted, including a combination of zoledronic acid and sirolimus to inhibit osteolysis, along with rehabilitation training and orthopedic intervention, providing a personalized and comprehensive treatment strategy.

Traditional treatment for type 1 diabetes mellitus （T1DM） primarily involves insulin replacement， yet some patients encounter issues such as significant blood glucose fluctuations， high risk of hypoglycemia， and weight gain. In recent years， the adjuvant therapeutic role of non-insulin hypoglycemic drugs in T1DM has gradually gained attention. This article reviews the mechanisms of action and clinical research progress of five types of non-insulin hypoglycemic drugs in the treatment of T1DM： amylin analogues （pramlintide）， biguanides （metformin）， sodium-glucose co-transporter 2 inhibitor， dipeptidyl peptidase-4 inhibitor， and glucagon-like peptide-1 receptor agonist. It is found that these drugs can enhance clinical benefits for T1DM patients by improving insulin sensitivity， delaying gastric emptying， promoting urinary glucose excretion， and regulating incretin levels， thereby reducing glycated hemoglobin levels， decreasing insulin dosage， and managing body weight. Simultaneously， these drugs also present limitations such as low patient compliance due to complex dosing regimens， increased risk of diabetic ketoacidosis， and heterogeneity in glycemic control. Future research could focus on developing individualized treatment strategies， combining pharmacogenomics with novel biomarkers to precisely identify subpopulations of patients who may benefit， and delving into the potential value of these drugs in delaying diabetic vascular complications and improving patients’ quality of life.

ObjectiveTo identify potential influencing factors of urate crystal deposition at ankle/foot in patients with hyperuricemia （HUA）， and to analyze the predictive value of inflammatory indicators for urate crystal deposition in patients with different traditional Chinese medicine （TCM） syndromes， so as to provide potential reference for clinical risk assessment and individualized TCM intervention. MethodsA retrospective study was carried out with the enrollment of 231 HUA patients from The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine between January 2021 and December 2024. The enrolled patients were further divided into a crystal deposition-positive group （143 cases） and a crystal deposition-negative group （88 cases） according to the results of dual-energy computed tomography （CT）. Sociodemographic data， living habits， serum uric acid levels， and inflammatory indicators of the enrolled patients were collcted， and TCM syndrome differentiation was performed. Furthermore， univariate analysis was used to compare inter-group differences in clinical characteristics. MMultivariate Logistic regression was applied to identify the influencing factors of urate crystal deposition. In addition， the receiver operating characteristic （ROC） curves were plotted to evaluate the predictive efficacy of inflammatory indicators for crystal deposition across different TCM syndromes. ResultsThere were statistically significant inter-group differences in the proportion of males， age， body mass index， proportion of mental labor， rate of low water intake， and rate of high-sugar beverage consumption （P<0.05），whereas no significant difference in low exercise intensity was found between the two groups. Furthermore， compared with the negative group， the positive group had higher serum uric acid level， neutrophil-to-lymphocyte ratio （NLR）， and platelet-to-lymphocyte ratio （PLR）， but lower systemic immune-inflammation index （SIRI） （P<0.05）. Regarding the distribution of TCM syndromes， the positive group was dominated by the dampness-heat accumulation syndrome （55/143，38.46%）， while the negative group was mainly characterized by the phlegm-turbidity obstruction syndrome （44/88，50.00%）. Multivariate Logistic regression analysis revealed that high-sugar beverage consumption， elevated NLR， and elevated PLR were risk factors for urate crystal deposition ［odd ratio （OR） = 8.002， 5.377， 1.034， respectively； 95% CI 1.572-40.732， 2.179-13.270， 1.013-1.054，all P<0.05］， while SIRI was a protective factor （OR = 0.869， 95% CI 0.778-0.971， P<0.05）. In the positive group， patients with the dampness-heat accumulation syndrome exhibited the highest NLR， while the lowest PLR and SIRI， showing statistically significant differences with those of other syndromes （all P<0.05）. In addition， ROC curve analysis indicated that for the dampness-heat accumulation syndrome， the combined "NLR + PLR" model had an area under the curve （AUC） of 0.901 （95% CI 0.850-0.951， P<0.01）， with a sensitivity of 89.1% and a specificity of 79.5%； for the blood stasis-heat obstruction syndrome， the combined "NLR + PLR" model had an AUC of 0.880 （95% CI 0.825-0.934， P<0.01）， with a sensitivity of 100.0% and a specificity of 67.3%； for the liver-kidney Yin-deficiency syndrome， the single PLR model had an AUC of 0.842 （95% CI 0.731-0.952， P<0.01）， with a sensitivity of 83.3% and a specificity of 84.0%. ConclusionUrate crystal deposition in HUA patients exhibits intimate associations with high-sugar beverage consumption as well as elevated NLR and PLR levels. Meanwhile， TCM syndrome differentiation has potential correlation with inflammatory characteristics. The inflammatory indicator-based prediction model constructed based on TCM syndromes exhibits good predictive value.

Sepsis is a systemic inflammatory response syndrome caused by the invasion of pathogenic microorganisms such as bacteria. In addition to the manifestations of systemic inflammatory response syndrome and primary infection lesions， critical cases often have manifestations of organ hypoperfusion. The morbidity and mortality of sepsis have remained high in recent years， which seriously affect the quality of life of the patients. The pathogenesis of sepsis is complicated， in which uncontrollable inflammation is a key mechanism. The phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） signaling pathway plays a key role in mediating inflammation in sepsis. The available therapies of sepsis mainly include resuscitation， anti-infection， vasoactive drugs， intensive insulin therapy， and organ support， which show limited effects of reducing the mortality. Therefore， finding new therapeutic drugs is a key problem to be solved in the clinical treatment of sepsis. In recent years， studies have shown that traditional Chinese medicine （TCM） can regulate the PI3K/Akt pathway via multiple pathways， multiple effects， and multiple targets to inhibit inflammation and curb the occurrence and development of sepsis， which has gradually become a hot spot in the prevention and treatment of sepsis. Moreover， studies have suggested that TCM has unique advantages in the treatment of sepsis. TCM can regulate the PI3K/Akt signaling pathway to inhibit inflammation， reduce oxidative stress， and control apoptosis in the prevention and treatment of sepsis. Despite the research progress， a systematic review remains to be performed regarding the TCM treatment of sepsis by regulating the PI3K/Akt signaling pathway. After reviewing relevant papers published in recent years， this study systematically summarizes the relationship between PI3K/Akt pathway and sepsis and the role of TCM in the treatment of sepsis， aiming to provide new ideas for the potential treatment of sepsis and the development of new drugs.

ObjectiveAutism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties with communication and social interaction, restricted and repetitive behaviors. Previous studies have indicated that individuals with ASD exhibit early and lifelong attention deficits, which are closely related to the core symptoms of ASD. Basic visual attention processes may provide a critical foundation for their social communication and interaction abilities. Therefore, this study explores the behavior of children with ASD in capturing attention to changes in topological properties. MethodsOur study recruited twenty-seven ASD children diagnosed by professional clinicians according to DSM-5 and twenty-eight typically developing (TD) age-matched controls. In an attention capture task, we recorded the saccadic behaviors of children with ASD and TD in response to topological change (TC) and non-topological change (nTC) stimuli. Saccadic reaction time (SRT), visual search time (VS), and first fixation dwell time (FFDT) were used as indicators of attentional bias. Pearson correlation tests between the clinical assessment scales and attentional bias were conducted. ResultsThis study found that TD children had significantly faster SRT (P<0.05) and VS (P<0.05) for the TC stimuli compared to the nTC stimuli, while the children with ASD did not exhibit significant differences in either measure (P>0.05). Additionally, ASD children demonstrated significantly less attention towards the TC targets (measured by FFDT), in comparison to TD children (P<0.05). Furthermore, ASD children exhibited a significant negative linear correlation between their attentional bias (measured by VS) and their scores on the compulsive subscale (P<0.05). ConclusionThe results suggest that children with ASD have difficulty shifting their attention to objects with topological changes during change detection. This atypical attention may affect the child’s cognitive and behavioral development, thereby impacting their social communication and interaction. In sum, our findings indicate that difficulties in attentional capture by TC may be a key feature of ASD.

Objective:To investigate the association between estimated cumulative low-density lipoprotein cholesterol (LDL-C) exposure and the severity of coronary artery disease and long-term adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS).Methods:The subjects were from the PROMISE study. This study was a prospective cohort study led by Fuwai Hospital, Chinese Academy of Medical Sciences, with participation from eight regional tertiary hospitals as sub-centers, and enrolled 18 701 patients with confirmed coronary heart disease between January 2015 and May 2019. Among them, 8 429 patients with ACS were included in this study. The estimated cumulative LDL-C exposure was calculated by multiplying LDL-C by age. Participants were then divided into four groups based on quartiles. Baseline data and coronary angiography data were collected, and participants were followed for 2 years. The primary endpoint was MACCE, which was composed of all-cause death, cardiac death, myocardial infarction, revascularization, and stroke. Spearman correlation analysis was used to estimate the correlation between cumulative LDL-C exposure and the severity of coronary artery disease. The differences in MACCE among the four groups were compared, and multivariate Cox regression was used to divide the estimated cumulative exposure LDL-C into two groups, three groups, and four groups to analyze its relationship with MACCE.Results:The 8 429 ACS patients included in the study had an age of (60.9±11.4) years, with 1 951(23.1%) females. Spearman correlation analysis revealed that estimated cumulative LDL-C exposure was positively associated with the preoperative SYNTAX score, three-vessel lesions disease, left main disease, and the number of target lesions (correlation coefficients r=0.14, 0.10, 0.04 and 0.03, respectively, with all P<0.05). The 2-year follow-up results indicated that the incidence rates of MACCE, all-cause death, cardiac death, myocardial infarction, and stroke in ACS patients grouped by different levels of estimated cumulative LDL-C exposure were statistically significant (all P<0.05). The results of the Cox multivariate regression analysis showed that when the estimated cumulative LDL-C exposure was treated as a continuous variable and analyzed in two, three, and four groups, with the lowest group as the reference, the risk of MACCE occurrence in the high-value group increased by 21% (95% CI 1.08-1.37, P=0.002), 24% (95% CI 1.07-1.43, P=0.004), and 21% (95% CI 1.02-1.43, P=0.025) respectively. Conclusions:A positive correlation was found between estimated cumulative LDL-C exposure and severity of coronary artery disease. High estimated cumulative LDL-C exposure level is a risk factor for MACCE in ACS patients within 2 years.

Objective:To investigate the factors influencing left atrial fibrosis in patients with atrial fibrillation(AF)and the association of Periostin protein,serum transforming growth factor-β2(TGF-β2)with left atrial fibrosis.Methods:We enrolled 100 AF patients admitted to Gansu Provincial People's Hospital between March 2021 and March 2023.They were divided into control group(＜10％,n=53)and fibrosis group(≥10％,n=47)according to their left atrial low voltage region.Univariate and multivariate Logistic regression were used to analyze the influ-encing factors of left atrial fibrosis in AF patients and construct a nomogram model.The diagnostic value of related factors and their combined detection for left atrial fibrosis in AF patients were analyzed by receiver operating char-acteristic curve(ROC).Spearman correlation analysis was used to analyze the association of Periostin protein,TGF-β2 with left atrial fibrosis in AF patients.Results:Compared to patients in the control group,those in the fibrosis group had significant higher left atrial diameter(LAD)[(37.08±3.19)mm vs.(33.45±2.45)mm],levels of ser-um uric acid(SUA)[(313.75±49.06)μmol/L vs.(279.88±38.15)μmol/L],Periostin protein[(83.27±3.98)ng/L vs.(75.21±3.04)ng/L],TGF-β2[(4346.84±321.34)ng/L vs.(4186.02±306.91)ng/L],and signifi-cant lower left atrial ejection fraction(LVEF)[(62.28±5.00)％vs.(67.24±3.07)％](P＜0.05 or＜0.01).Multivariate Logistic regression analysis showed that LAD(OR=1.663,95％CI 1.238～3.887,P=0.001),SUA(OR=1.586,95％CI 1.164～2.892,P＜0.001),Periostin protein(OR=1.997,95％CI 1.513～4.585,P=0.001),TGF-β2(OR=2.013,95％CI 1.543～5.864,P＜0.001)were independent risk factors for left atrial fi-brosis in AF patients,while LVEF was an independent protective factor(OR=0.524,95％CI 0.141～0.920,P=0.002).The nomogram model for left atrial fibrosis in AF patients:logit(P)=4.631+0.445 × LVEF+0.546 × LAD+0.575 × SUA+0.530 × Periostin protein+0.347 × TGF-β2.ROC curve showed that the area under the curve(AUC)of combined detection(0.893,95％CI 0.842～0.932)was significantly higher than SUA(AUC=0.637,95％CI 0.566～0.704),LVEF(AUC=0.701,95％CI 0.632～0.763),LAD(AUC=0.649,95％CI 0.579～0.715),Periostin protein(AUC=0.676,95％CI 0.606～0.740),TGF-β2(AUC=0.641,95％CI 0.570～0.707)alone(Z=5.265,6.399,6.379,6.040,6.483,P＜0.001 all).Spearman correlation analysis showed that Perios-tin protein and TGF-β2 were significantly positive correlated with left atrial fibrosis in AF patients(r=0.536,0.578,P＜0.001 all).Conclusion:Periostin protein and TGF-β2 were independent risk factors for left atrial fi-brosis in AF patients and were significantly positive correlated with it,a combination of above-mentioned indexes,cardiac function indexes and uric acid had good diagnostic value for left atrial fibrosis.

Dampness-heat syndrome of the spleen and stomach refers to the evil dampness-heat invading the spleen and stomach,the abnormal rise and fall of the middle jiaoqi machinery,dampness-heat depression and steaming,the physiological dysfunction of the spleen and stomach,with abdominal distention and distention,nausea and lethargy of the limbs,poor loose stool,red tongue and yellow greasy fur,and slippery pulse as the main symptoms of the syndrome,most common in digestive system diseases,among which chronic gastritis is the first.This paper summarized the research results in the past decade and related fields.In the mode of combination of disease and syndrome,based on the principle of corresponding prescription and syndrome,combined with the etiology and pathogenesis evolution of spleen and stomach damp-heat syndrome,the biological connotation of spleen and stomach damp-heat syndrome was explained from various aspects such as inflammation and immune disorders,gastrointestinal motivity disorders,water and humidity loss,endoplasmic reticulum function,and micro-ecological disorders.Enrich the research of the essence of syndrome.

Objective:To evaluate the efficacy and safety of Saccharomyces boulardii ( S. boulardii) as an adjuvant therapy for ulcerative colitis (UC). Methods:Databases including PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, CNKI, Wanfang Database, and Chongqing VIP Chinese Science and Technology Journal Database were retrieved from their inception to September 1, 2023. Randomized controlled trials (RCTs) about S. boulardii as an adjuvant therapy for UC were included. The intervention method was S. boulardii monotherapy or as an adjunct to other medications ( Saccharomyces group), while the control group received other medications. The risk of bias of the included studies was assessed by the Cochrane risk of bias assessment tool (RoB 2.0). Primary outcome indicators included overall efficacy, clinical remission rate, and endoscopic remission rate. Secondary outcome indicators included Baron score, Sutherland disease activity index, indicators of intestinal mucosal barrier function, levels of inflammatory cytokines, and overall adverse events. RevMan 5.3 software was used for statistical analysis. RR and MD were taken as effect indicators of count data and measurement data, respectively. Results:A total of 26 RCTs were included, all from China. Among them, 22 studies reported the overall efficacy in UC patients. The results indicated that the overall efficacy of Saccharomyces group was higher than that of the control group (93.5%(943/1 009) vs. 76.8%(771/1 004)), and the difference was statistically significant ( RR=1.20, 95% confidence interval (95% CI): 1.16 to 1.25, P<0.001). And 9 studies assessed the efficacy in patients with mild or moderate UC. The results showed that the clinical remission rate and endoscopic remission rate of Saccharomyces group were both higher that those of the control group (68.1%(581/853) vs. 53.1%(455/857); 54.9%(425/774) vs. 35.5%(273/769)), and the differences were statistically significant ( RR=1.21, 95% CI: 1.14 to 1.25, P<0.001; RR=1.49, 95% CI: 1.28 to 1.73, P<0.001). S. boulardii as an adjunctive therapy could significantly lower the Baron score in patients with UC (7 studies) and mild to moderate UC (5 studies) ( MD=-0.51, 95% CI: -0.68 to -0.33; MD=-0.50, 95% CI: -0.75 to -0.26; both P<0.001). Additionally, S. boulardii as an adjunctive therapy could significantly decrease the Sutherland disease activity index in patients with UC (6 studies) and mild to moderate UC (3 studies), and the differences were statistically significant ( MD=-1.50, 95% CI: -2.26 to -0.74; MD=-0.92, 95% CI: -1.16 to -0.69; both P<0.001). Compared with the control group, S. boulardii as an adjunctive therapy significantly improved intestinal mucosal barrier function and decreased inflammatory cytokine levels in patients with UC and patients with mild to moderate UC (all P<0.05), such as D-lactate ( MD=-2.44, 95% CI: -4.43 to -0.45; MD=-1.47, 95% CI: -2.03 to -0.91), Geboes index ( MD=-0.40, 95% CI: -0.46 to -0.35; MD=-0.39, 95% CI: -0.46 to -0.32), C-reactive protein ( MD=-3.70, 95% CI: -5.65 to -1.76; MD=-3.36, 95% CI: -5.07 to -1.64), and tumor necrosis factor-α levels ( MD=-7.64, 95% CI: -11.27 to -4.01; MD=-7.75, 95% CI: -12.25 to -3.25). There was no statistically significant difference in the incidence of adverse events between Saccharomyces group and the control group (13 studies) (7.8%(47/602) vs. 10.9%(65/596)), RR=0.75, 95% CI: 0.52 to 1.09, P=0.130). Conclusions:The additional use of S. boulardii in the treatment of UC. It can improve the clinical remission rate, alleviate intestinal inflammation, promote the recovery is safe of the injury in intestinal mucosal barrier.