OBJECTIVE To explore the effects of the Jianpi huatan formula （JPHTF） on polycystic ovary syndrome （PCOS） in rats by regulating the high mobility group box 1 protein （HMGB1）/receptor for advanced glycation end products （RAGE） signaling pathway. METHODS The rats were randomly divided into the normal （Con） group， the PCOS group， the JPHTF-L group （5.54 g/kg）， the JPHTF-H group （11.07 g/kg）， the JPHTF-H+rHMGB1 group （11.07 g/kg of JPHTF+8 μg/kg of rHMGB1）， and metformin group （0.27 g/kg）， with 12 rats in each group. Except for the rats of Con group， which were given 1% sodium carboxymethyl cellulose intragastrically and fed with normal chow， the remaining rats were induced to develop PCOS models by using a high-fat diet combined with letrozole. Af ter successful modeling， rats in each drug group were administered the corresponding drugs by gavage or tail vein injection once a day for 4 consecutive weeks. 24 h after the intervention， body weight and ovarian coefficient were detected. The levels of fasting blood glucose （FBG）， serum levels of fasting insulin （FINS）， follicle stimulating hormone （FSH）， luteinizing hormone （LH）， testosterone （T） and estradiol （E 2 ） were detected. The homeostasis model assessment of insulin resistance （HOMA-IR） was calculated. The levels of tumor necrosis factor-α （TNF-α）， interleukin-18 （IL-18） and IL-1β and the protein expressions of HMGB1， RAGE， phosphorylated nuclear factor-κB （p-NF-κB） and NF-κB in the ovarian tissues of rats were detected. The morphology of ovarian tissue was observed， and the numbers of cystic follicles and corpora lutea were counted. RESULTS Compared with PCOS group， polycystic changes of ovarian tissue in rats showed varying degrees of improvement in the JPHTF-L group， JPHTF-H group， and metformin group； body weight， ovarian coefficient， FBG， the number of cystic follicles， serum levels of FINS， HOMA-IR， T， LH， LH/FSH， the levels of TNF-α， IL-18 and IL-1β and protein expressions of HMGB1 and RAGE in ovarian tissue as well as phosphorylation level of NF-κB protein all significantly decreased； the number of corpora lutea and the serum levels of E 2 and FSH significantly increased （ P ＜0.05）. Compared with JPHTF-H group， above indexes of rats were reversed significantly in JPHTF-H+rHMGB1 group （ P ＜0.05）. CONCLUSIONS JPHTF can reduce the inflammatory response in PCOS rats， mitigate ovarian injury， regulate hormone balance， and improve insulin resistance and follicular development by inhibiting the HMGB1/RAGE signaling pathway.

Objective: To explore the regulatory effects of ginkgo biloba extract on airway inflammatory injury and Toll⁃like receptor 4(TLR4)/nucleotide⁃binding oligomerization domain⁃containing 3(NLRP3) pathway in rats with vided into four groups : the normal control group , Methods: Thirty⁃six male SD rats were selected and randomly divided into four groups : the normal control group , the model group , the prednisone treatment group , and the ginkgo biloba extract treatment group , with 9 rats in each group. Except for the normal control group , the COPD rat mod⁃els in the other groups was constructed by intratracheal instillation of lipopolysaccharide (LPS) combined with ciga⁃rette smoke exposure. After successful modeling , the rats were continuously administered drugs for 12 weeks , fol⁃lowed by sampling. The general conditions and respiratory symptoms of the rats were observed. The pathological changes of lung tissues were observed by hematoxylin⁃eosin (HE) staining technique ; the mRNA and protein ex⁃pression levels of TLR4 , tumor necrosis factor⁃α (TNF⁃α ) , interleukin⁃1β (IL⁃1β) and NLRP3 in rat lung tissueswere detected by real⁃time quantitative polymerase chain reaction (RT⁃qPCR) and Western blot. Results: Com⁃pared with the normal control group , the lung tissues of rats in the model group were significantly damaged , and the protein and mRNA expression of TLR4 , TNF⁃α , IL⁃1β , and NLRP3 increased ( P < 0. 05 ) . Compared with the model group , lung tissue damage was reduced in the prednisone group and the ginkgo biloba extract group , and TLR4 , TNF⁃α , IL⁃1β , NLRP3 protein and mRNA expression decreased (P < 0. 05) . Conclusion Ginkgo biloba airway inflammatory response by inhibiting the TLR4/NLRP3 signaling pathway.

Functional dyspepsia (FD), characterized by persistent or recurrent dyspeptic symptoms without identifiable organic, systemic or metabolic causes, is an increasingly recognized global health issue. The objective of this guideline is to equip clinicians and nursing professionals with evidence-based strategies for the management and treatment of adult patients with FD using traditional Chinese medicine (TCM). The Guideline Development Group consulted existing TCM consensus documents on FD and convened a panel of 35 clinicians to generate initial clinical queries. To address these queries, a systematic literature search was conducted across PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, China Biology Medicine (SinoMed) Database, Wanfang Database, Traditional Medicine Research Data Expanded (TMRDE), and the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS). The evidence from the literature was critically appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The strength of the recommendations was ascertained through a consensus-building process involving TCM and allopathic medicine experts, methodologists, pharmacologists, nursing specialists, and health economists, leveraging their collective expertise and empirical knowledge. The guideline comprises a total of 43 evidence-informed recommendations that span a range of clinical aspects, including the pathogenesis according to TCM, diagnostic approaches, therapeutic interventions, efficacy assessments, and prognostic considerations. Please cite this article as: Zhang SS, Zhao LQ, Hou XH, Bian ZX, Zheng JH, Tian HH, Yang GH, Hong WS, He YY, Liu L, Shen H, Li YP, Xie S, Shu J, Zeng BF, Li JX, Liu Z, Xiao ZH, Xiao JD, Zheng PY, Huang SG, Chen SL, Fei GJ. International clinical practice guideline on the use of traditional Chinese medicine for functional dyspepsia (2025). J Integr Med. 2025; 23(5):502-518.
Dyspepsia/drug therapy* ; Humans ; Medicine, Chinese Traditional/methods* ; Practice Guidelines as Topic ; Drugs, Chinese Herbal/therapeutic use*

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To analyze the coordination between the growth of per capita health expenditure and per capita gross domestic product (GDP) in China from 2012 to 2021, and to explore the changes and regional disparities in the health consumption elasticity coefficient.Methods:Descriptive analysis was used to compare the average annual growth rates of per capita health expenditure and per capita GDP between 2012-2019, Pearson correlation analysis was conducted to test the relationship between the two variables. The health consumption elasticity coefficient was calculated as the ratio of the growth rates of health expenditure to GDP, and its temporal changes and regional distribution characteristics were analyzed.Results:After adjusting for price factors, the average annual growth rate of per capita health expenditure in China from 2012 to 2021 was 9.11%, higher than that of per capita GDP (6.11%), with no correlation between the two variables ( r=0.30, P>0.05). The national average health consumption elasticity coefficient was 1.49, lower than that in 2012-2019 (1.60), indicating an improvement in coordination. Compared with developed countries, China′s elasticity coefficient was at a moderate level. Conclusions:Overall, the growth of health expenditure in China remains faster than that of economic growth, with certain regional differences, but the degree of coordination has improved compared with the previous period.

BACKGROUND: P16 inactivation is frequently accompanied by telomerase reverse transcriptase ( TERT ) amplification in human cancer genomes. P16 inactivation by DNA methylation often occurs automatically during immortalization of normal cells by TERT . However, direct evidence remains to be obtained to support the causal effect of epigenetic changes, such as P16 methylation, on cancer development. This study aimed to provide experimental evidence that P16 methylation directly drives cancer development. METHODS: A zinc finger protein-based P16 -specific DNA methyltransferase (P16-Dnmt) vector containing a "Tet-On" switch was used to induce extensive methylation of P16 CpG islands in normal human fibroblast CCD-18Co cells. Battery assays were used to evaluate cell immortalization and transformation throughout their lifespan. Cell subcloning and DNA barcoding were used to track the diversity of cell evolution. RESULTS: Leaking P16-Dnmt expression (without doxycycline-induction) could specifically inactivate P16 expression by DNA methylation. P16 methylation only promoted proliferation and prolonged lifespan but did not induce immortalization of CCD-18Co cells. Notably, cell immortalization, loss of contact inhibition, and anchorage-independent growth were always prevalent in P16-Dnmt&TERT cells, indicating cell transformation. In contrast, almost all TERT cells died in the replicative crisis. Only a few TERT cells recovered from the crisis, in which spontaneous P16 inactivation by DNA methylation occurred. Furthermore, the subclone formation capacity of P16-Dnmt&TERT cells was two-fold that of TERT cells. DNA barcoding analysis showed that the diversity of the P16-Dnmt&TERT cell population was much greater than that of the TERT cell population. CONCLUSION P16 methylation drives TERT -mediated immortalization and transformation of normal human cells that may contribute to cancer development.
Humans ; Telomerase/genetics* ; DNA Methylation/physiology* ; Fibroblasts/cytology* ; Cyclin-Dependent Kinase Inhibitor p16/metabolism* ; Cell Line ; Cell Transformation, Neoplastic/genetics*

Objective:To analyze the abdominal CT types, surgical methods, obstruction recurrence rate and postoperative chemotherapy rate in patients with recurrent ovarian cancer and malignant bowel obstruction (MBO).Methods:The clinical data of 43 patients with recurrent ovarian cancer and MBO from September 30, 2021 to December 31, 2024 in the Fourth Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Intestinal surgical plans were determined based on abdominal CT classification and intraoperative conditions. The imaging data, surgical conditions, occurrence of severe complications within 30 d after surgery and mortality within 30 d after surgery were recorded. The patients were followed up once a month until February 28, 2025, and the obstruction recurrence rate and chemotherapy rate were recorded.Results:Among the 43 patients, the abdominal CT types were as follows: 9 cases (20.9%) of isolated recurrence type, 25 cases (58.2%) of non-infiltrating proximal small intestine type, 8 cases (18.6%) of infiltrating proximal small intestine type, and 1 case (2.3%) of other types. Two patients underwent exploratory laparotomy; 41 patients completed the intended surgical treatment, including 5 cases of intestinal intubation ostomy, 2 cases of pull-through ostomy, 2 cases of bypass surgery, 26 cases of resection + ostomy, and 6 cases of resection + anastomosis. After surgery, 19 cases (43.2%) resumed partial enteral nutrition, and 16 cases (37.2%) achieved complete enteral nutrition. The incidence of severe postoperative complications within 30 d after surgery was 9.3% (4/43). Obstructive symptoms such as abdominal distension were relieved in 41 cases (95.3%). The mortality within 30 d after surgery was 7.0% (3/43), the obstruction recurrence rate was 7.0% (3/43), and the chemotherapy rate was 76.7% (33/43). By the end of follow-up, 7 patients were still alive.Conclusions:Recurrent ovarian cancer complicated by MBO is a high-risk disease. Identifying patients who may benefit can improve the relief rate of obstructive symptoms such as abdominal distension, reduce the obstruction recurrence rate, and increase the chemotherapy rate.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

The success of"New Medical Sciences"in higher education requires effective tools in evalua-ting students'performance in courses.Previously,we reported a teamwork(T),critique(C)and ap-preciation(A)(TCA)ideological and political model,a teaching model widely applied in Basic Medical courses.TCA is an abbreviation derived from Tricarboxylic Acid Cycle in Biochemistry as an analogy for nurturing the abilities of thinking and teamwork(T),critique(C)and appreciation(A),which hope-fully could provide students with moral norms for cognition,science and life.This paper further explores the tools to assess the educational outcomes of the TCA model,by which teachers can collect feedback and reflect on teaching quality and effectiveness.Addressing the challenges of individual differences in large classes,fragmented learning feedback,and the difficulty of measuring meta-cognition in educational evaluation,this study employs strategies of value-added assessment,matrix assessment and norm-transfer-able assessment to evaluate the TCA abilities from the aspects of thinking quality,thinking creativity,co-operation ability,iterative thinking,dialectical thinking and job responsibility.By modifying/using 18 e-valuation tools in Education and Psychology,we have established a rubric system composed of 30 primary indicators(with 11 newly designed,10 partly modified and 9 directly adopted),along with 49 secondary indicators and 98 tertiary indicators to enhance the feasibility of the evaluation process.This rubric sys-tem was applied to Biochemistry teaching among the five-year-program undergraduates at Air Force Medi-cal University.Specifically,thinking and teamwork are evaluated by creative works from"the magic bio-chemical-circle",while critiques are assessed in large classes under the guidance of basic and clinical teachers,coupled with appreciation measured by job responsibility in a task-driven virtual reality(VR)project.The results indicate that Biochemistry teaching not only accumulates knowledge in students,but also achieves the goals in nurturing values and cognition.The inclusion of creative performance evalua-tion,cooperative learning and clinical case studies,can enhance students'interpersonal skills,coopera-tion,quality of thinking,creative thinking,iterative thinking and dialectical thinking to varying degrees.TCA-based Biochemistry teaching has a long-lasting impact on character education,and is capable of in-ducing positive long-term changes in students'cognition and lifestyle.Taken together,with the help of this rubric system,teachers can promptly acknowledge the effectiveness of their teaching,thereby facilita-ting their teaching strategies.

Objective:To investigate the effect of traditional Chinese medicine chronic disease management model based on empowerment theory in patients with chronic heart failure(CHF).Methods:A total of 115 CHF patients admitted in Guangdong Provincial Hospital of Chinese Medicine between January 2020 and December 2021 were se-lected.Patients received traditional Chinese medicine chronic disease management model based on empowerment theory according to voluntary principle,and were followed up for 12 months.Exercise capacity,scores of Tradition-al Chinese Medicine Symptom Grading and Quantification Scale,Hospital Anxiety and Depression Scale(HADS)and Minnesota Living with Heart Failure Questionnaire(MLHFQ)were compared between before and after inter-vention.Results:Compared to before intervention,scores of Traditional Chinese Medicine Symptom Grading and Quantification Scale[(6.40±6.11)points vs.(8.88±6.72)points],HADS[(5.95±4.68)points vs.(7.69±5.95)points],MLHFQ[(13.10±10.54)points vs.(25.53±11.16)points]and 3m round-trip movement time[(7.54±1.70)s vs.(8.86±3.65)s]were significantly lower,and right hand grip strength[(27.23±10.49)kg vs.(26.10±9.94)kg]and 6-minute walking distance[(464.79±80.78)m vs.(415.55±79.33)m]were sig-nificantly higher after 12-month intervention(P＜0.05 or＜0.01).Conclusion:The traditional Chinese medicine chronic disease management model based on empowerment theory may improve clinical symptoms of traditional Chi-nese medicine,mental state,exercise capacity and quality of life in patients with chronic heart failure.