ObjectiveTo evaluate the clinical efficacy of Maxing Loushi decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with phlegm turbidity obstructing lung syndrome， and to investigate its effects on inflammatory factors， immune function， and the programmed death-1（PD-1）/programmed death-ligand 1 （PD-L1） signaling pathway. MethodsA randomized controlled study was conducted， enrolling 90 hospitalized patients with AECOPD and phlegm turbidity obstructing lung syndrome in the Respiratory and Emergency Departments of Dongzhimen Hospital， Beijing University of Chinese Medicine， from April 2024 to December 2024. Patients were randomly assigned to a control group and an observation group using a random number table， with 45 patients in each group. The control group received conventional Western medical treatment， while the observation group received additional Maxing Loushi decoction for 14 days. Clinical efficacy， COPD Assessment Test （CAT） score， modified Medical Research Council Dyspnea Scale （mMRC）， 6-minute walk test （6MWT）， serum inflammatory factors， T lymphocyte subsets， and serum PD-1/PD-L1 levels were compared between the two groups before and after treatment. ResultsThe total clinical effective rate was 78.57% （33/42） in the control group and 95.35% （41/43） in the observation group， with the observation group showing significantly higher efficacy than that of the control group. The difference was statistically significant （χ² = 5.136， P<0.05）. After treatment， both groups showed significant reductions in CAT and mMRC scores （P<0.05， P<0.01） and significant increases in 6MWT compared to baseline （P<0.01）. The observation group demonstrated significantly greater improvements than the control group in this regard. Levels of inflammatory markers including C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， monocyte chemoattractant protein-1（MCP-1）， and macrophage inflammatory protein-1α （MIP-1α） were significantly reduced in both groups （P<0.05， P<0.01）， with greater reductions in the observation group （P<0.05， P<0.01）. CD8⁺ levels were significantly reduced （P<0.01）， while CD3⁺， CD4⁺， and CD4⁺/CD8⁺ levels were significantly increased in both groups after treatment （P<0.05， P<0.01）， with more significant improvements observed in the observation group （P<0.05， P<0.01）. Serum PD-1 levels were reduced （P<0.05， P<0.01）， and PD-L1 levels were increased significantly in both groups after treatment （P<0.05， P<0.01）， with more pronounced changes in the observation group （P<0.05）. ConclusionMaxing Loushi decoction demonstrates definite therapeutic efficacy as an adjunctive treatment for patients with AECOPD and phlegm turbidity obstructing lung syndrome. It contributes to reducing serum inflammatory factors， improving immune function， and regulating the PD-1/PD-L1 signaling pathway.

ObjectiveTo evaluate the clinical efficacy of Maxing Loushi decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with phlegm turbidity obstructing lung syndrome， and to investigate its effects on inflammatory factors， immune function， and the programmed death-1（PD-1）/programmed death-ligand 1 （PD-L1） signaling pathway. MethodsA randomized controlled study was conducted， enrolling 90 hospitalized patients with AECOPD and phlegm turbidity obstructing lung syndrome in the Respiratory and Emergency Departments of Dongzhimen Hospital， Beijing University of Chinese Medicine， from April 2024 to December 2024. Patients were randomly assigned to a control group and an observation group using a random number table， with 45 patients in each group. The control group received conventional Western medical treatment， while the observation group received additional Maxing Loushi decoction for 14 days. Clinical efficacy， COPD Assessment Test （CAT） score， modified Medical Research Council Dyspnea Scale （mMRC）， 6-minute walk test （6MWT）， serum inflammatory factors， T lymphocyte subsets， and serum PD-1/PD-L1 levels were compared between the two groups before and after treatment. ResultsThe total clinical effective rate was 78.57% （33/42） in the control group and 95.35% （41/43） in the observation group， with the observation group showing significantly higher efficacy than that of the control group. The difference was statistically significant （χ² = 5.136， P<0.05）. After treatment， both groups showed significant reductions in CAT and mMRC scores （P<0.05， P<0.01） and significant increases in 6MWT compared to baseline （P<0.01）. The observation group demonstrated significantly greater improvements than the control group in this regard. Levels of inflammatory markers including C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， monocyte chemoattractant protein-1（MCP-1）， and macrophage inflammatory protein-1α （MIP-1α） were significantly reduced in both groups （P<0.05， P<0.01）， with greater reductions in the observation group （P<0.05， P<0.01）. CD8⁺ levels were significantly reduced （P<0.01）， while CD3⁺， CD4⁺， and CD4⁺/CD8⁺ levels were significantly increased in both groups after treatment （P<0.05， P<0.01）， with more significant improvements observed in the observation group （P<0.05， P<0.01）. Serum PD-1 levels were reduced （P<0.05， P<0.01）， and PD-L1 levels were increased significantly in both groups after treatment （P<0.05， P<0.01）， with more pronounced changes in the observation group （P<0.05）. ConclusionMaxing Loushi decoction demonstrates definite therapeutic efficacy as an adjunctive treatment for patients with AECOPD and phlegm turbidity obstructing lung syndrome. It contributes to reducing serum inflammatory factors， improving immune function， and regulating the PD-1/PD-L1 signaling pathway.

Purpose To investigate the value of oxaliplatin-induced sinusoidal injury based on 3D CT image segmentation technology,and to analyze its variation.Materials and Methods A total of 24 patients with uneven hypoperfusion of liver parenchyma in the portal vein phase of enhanced CT after receiving oxaliplatin regimen chemotherapy from November 2019 to July 2021 in the Second Affiliated Hospital,Jiangxi Medical College,Nanchang University were analyzed,retrospectively.The imaging data of patients with epigastric CT enhancement before chemotherapy,early chemotherapy(1-3 cycles)and late chemotherapy(≥4 cycles)were collected.Two doctors used 3D Slicer software to segment and measure the liver volume and spleen volume at each stage on the CT image,as well as the hepatic hypoperfusion volume(HHV)of the liver in the portal vein phase after chemotherapy,and calculated the HHV ratio(HHVR),liver volume hepatomegaly rate and spleen volume splenomegaly rate,and performed statistical analysis.Results The ICC for HHV,liver volume and spleen volume measured by two doctors were 0.997(P=0.000),0.905(P=0.000)and 0.998(P=0.000),respectively.Reddish-brown could be used to represent normal liver parenchyma,and blue could be used to render the HHV area to achieve HHV visualization.There was a statistically significant increase in HHVR in the late stage of chemotherapy compared with the early stage of chemotherapy[(74.35±30.56)%vs.(57.15±30.53)%;t=3.226,P=0.004].In the early and late stages of chemotherapy,the liver volume and spleen volume increased statistically significantly compared with those before chemotherapy(all P<0.05),and the spleen volume splenomegaly rate value in the late stage of chemotherapy increased statistically compared with the early stage of chemotherapy[25.75(7.40,70.66)%vs.17.86(4.44,63.59)%;Z=2.229,P=0.026].The Pearson correlation coefficient between liver volume hepatomegaly rate and HHVR was 0.377(P=0.008),and the Spearman correlation coefficient between spleen volume splenomegaly rate and HHVR was 0.296(P=0.041).Conclusion The application of 3D CT image segmentation technology to measure the HHV caused by oxaliplatin has good consistency,and can realize the visual display of HHV.With the increase of chemotherapy cycle,the extent of oxaliplatin-induced sinusoidal injury shows an increasing trend,and is positively correlated with hepatomegaly and splenomegaly.

Objective:To evaluate the effects and underlying mechanisms of preoperative intestinal microbiota modulation on the recovery of prolonged postoperative ileus(PPOI)in gastric cancer patients with sarcopenia Methods:Skeletal muscle mass(SMM)was assessed using bioelectrical impedance analysis(BIA),and the skeletal muscle index(SMI)was calculated.A total of 156 gastric cancer patients with sarcopenia who underwent surgery at the Department of Gastrointestinal Surgery,Liyang People's Hospital,from January 2022 to December 2024 were randomly assigned to either the control group or the experimental group.The control group received conventional prehabilitation interventions,including nutritional support,respiratory function training,and physical exercise.The experimental group received probiotic-based intestinal microbiota modulation in addition to conventional prehabilitation interventions.Postoperative recovery indicators,including time to first flatus,incidence of postoperative complications,length of hospital stay,and hospitalization costs,were compared between the two groups.Results:Among the 156 sarcopenic gastric cancer patients,121 were male,and 35 were female.Statistically significant differences were observed between the two groups in terms of time to first flatus,incidence of postoperative complications,and length of hospital stay(P<0.05).Postoperative complications occurred in 38 patients(24.3%),with 10 cases(6.4%)in the experimental group and 28 cases(17.9%)in the control group.The time to first flatus in the experimental group was significantly shorter than in the control group(48.0 hours vs 72.0 hours,P<0.001).Conclusion:Preoperative intestinal microbiota modulation significantly reduces the incidence of PPOI and postoperative complications in gastric cancer patients with low SMI,thereby promoting postoperative gastrointestinal function recovery.

Objective:To quantitatively detect plasma ceramide (Cer) levels using high-performance liquid chromatography tandem mass spectrometry (LC-MS/MS) and analyze plasma ceramide levels in homozygous familial hypercholesterolemia (HoFH) patients.Methods:A case-control study was conducted. Plasma samples were collected from 70 healthy individuals who underwent physical examinations at the Health Check-Up Center of Suzhou Municipal Hospital between October 2023 and December 2023, as well as from 34 HoFH patients (including 11 patients with concomitant coronary artery disease) who were treated in the Cardiology Department of the same hospital during the same period. Deuterated isotopes were used as internal standards, and a Phenomenex Kinetex C18 column (2.1×100 mm, 2.6 μm) was employed for separation. An LC-MS/MS method was developed using an AB Sciex 6500+triple quadrupole mass spectrometer for the detection of ceramides, followed by method validation. Additionally, the differences in ceramide levels among healthy individuals, HoFH patients, and HoFH patients with concomitant coronary artery disease were compared. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value of various ceramides for HoFH.Results:A method for the quantification of 9 plasma ceramides was established, showing excellent linearity ( r>0.99), precision (1.8%-11.0%), and recovery rates (89.9%-114.7%), meeting the requirements for detection. Compared to the control group, the HoFH group exhibited significantly higher levels of Cer(d18∶1/14∶0), Cer(d18∶1/16∶0), Cer (d18∶1/18∶0), Cer (d18∶1/18∶1), Cer (d18∶1/20∶0), Cer(d18∶1/22∶0), Cer(d18∶1/24∶0), and Cer(d18∶1/24∶1) ( P<0.05). ROC curve analysis revealed that Cer(d18∶1/18∶0) had the highest diagnostic value for HoFH, with an area under the curve (AUC) of 0.83, a cutoff value of 64.6 ng/ml, and sensitivity and specificity of 82.4% and 87.1%, respectively. In HoFH patients complicated with coronary artery disease, the plasma ceramide levels of Cer(d18∶1/18∶0) [(155.7±25.1) ng/ml vs (103.0±11.1) ng/ml, P=0.03] and the ratio of Cer (d18∶1/18∶0) to Cer(d18∶1/24∶0) (0.077±0.012 vs 0.048±0.006, P=0.03) were significantly higher than in HoFH patients without coronary artery disease. Conclusion:A quantitative LC-MS/MS method was developed for detecting ceramides in human plasma, which shows potential diagnostic value for patients with HoFH.

Objective:To evaluate the clinical efficacy of Tianma Xionglin Zhixuan Tablets in treating hypertension patients with liver yang hyperactivity or comorbid phlegm-stasis syndrome and explore its therapeutic mechanisms through plasma metabolomics.Methods:Thirty-six hypertension patients(4 dropouts)diagnosed with liver yang hyperactivity or phlegm-stasis syndrome were enrolled as the treatment group from June 2022 to September 2023 at the First Affiliated Hospital of Hunan University of Chinese Medicine,while 30 healthy volunteers with balanced constitutions were recruited as the blank group.Plasma samples were collected from patients pre-and post-treatment and from healthy volunteers.Clinical outcomes,including syndrome scores,office blood pressure(BP),and 24-hour ambulatory BP,were recorded.Plasma metabolomic profiling was performed using liquid chromatography-mass spectrometry(LC-MS).Results:Compared with baseline,Tianma Xionglin Zhixuan Tablets significantly reduced traditional Chinese medicine syndrome scores(P＜0.01),office systolic/diastolic BP(P＜0.01),and 24-hour ambulatory BP parameters(24-hour mean BP,daytime/nighttime mean BP;all P＜0.01).Metabolomic analysis identified 45 differential metabolites between the blank group and pretreatment patients,and 64 metabolites altered post-treatment(VIP＞1,P＜0.05).Enrichment analysis of 16 overlapping endogenous metabolites revealed that Tianma Xionglin Zhixuan Tablets primarily modulated arachidonic acid metabolism and sphingolipid metabolism pathways.Conclusion:Tianma Xionglin Zhixuan Tablets demonstrates significant clinical efficacy in hypertension patients with liver yang hyperactivity or phlegm-stasis syndrome,potentially mediated through regulation of arachidonic acid and sphingolipid metabolism.

Objective To identify the taste critical quality attribute and design and optimize the flavor-correcting formulation of the traditional Chinese medicine oral preparation Qingre Jiedu Oral Liquid,in order to improve its taste and enhance patient medication adherence.Methods The taste assignment method was employed to identify the taste critical quality attribute of Qingre Jiedu Oral Liquid.Based on human sensory evaluation and the standardized Euclidean distance in electronic tongue analysis,suitable types of corrigent were determined.Subsequently,under constraints such as maximum allowable dosage,solubility,and sweetness,the optimal taste formulation for the sugar-free intermediate of Qingre Jiedu Oral Liquid was determined using Box-Behnken experimental design combined with electronic tongue and human sensory evaluation results.The study was reviewed and approved by the Ethics Committee of Beijing University of Chinese Medicine(Ethics Approval Number 2020BZYLL0609).Results The quantitative score for bitter taste of Qingre Jiedu Oral Liquid accounted for 30.36%,confirming bitterness as the taste critical quality attribute requiring attention.The optimal taste formulation for the sugar-free intermediate of Qingre Jiedu Oral Liquid was determined to be 120 mg·mL?1 erythritol,12 mg·mL?1 acesulfame potassium,and 2.4 mg·mL?1 stevioside.This formulation achieved an 11.75-point improvement in sensory evaluation scores compared to the original commercially available oral liquid.Conclusion This study successfully improved the taste of Qingre Jiedu Oral Liquid and established a comprehensive strategy for flavor-correcting formulation optimization,including a method for identifying taste critical quality attribute.This strategy provides a referential paradigm for palatability enhancement of similar traditional Chinese medicine oral preparations,laying a crucial technical foundation for elevating the clinical value of Chinese herbal medicines and promoting the high-quality development of traditional Chinese medicine(TCM).

Aim To study the therapeutic effect of al-licin on senna-induced diarrhea in mice and to explore the underlying mechanism.Methods Forty-eight C57BL/6J mice were randomly divided into six groups:control,model,loperamide positive control group(2 mg·kg-1),allicin low-dose group(6 mg·kg-1),allicin medium-dose group(12 mg·kg-1)and allicin high-dose group(18 mg·kg-1).Except for the con-trol group,the diarrhea model was induced in the other groups by intragastric administration of senna leaf ex-tract.After drug administration,several diarrhea indi-ces were measured:the rate of loose stools,diarrhea index,accumulated frequency of loose stools at differ-ent time points within 5 hours,and small intestine pro-pelling rate.Serum levels of TNF-α and IL-6 were de-tected by ELISA.Serum NO content was determined u-sing the Griess method.The activities of SOD and CAT,as well as MDA content in the ileum and colon,were measured.The pathological changes and the ex-pression of mRNA related to intestinal barrier proteins in the ileum and colon were evaluated using HE stai-ning and RT-qPCR.Results Allicin improved diar-rhea symptoms in mice induced by senna leaf.It re-duced the rate of loose stools,diarrhea index,cumula-tive number of loose stools in five hours,and the intes-tinal propulsion rate.Allicin also protected the intesti-nal mucosa,decreased serum TNF-α and IL-6 levels,and lowered MDA content in the intestines.It in-creased serum NO levels and enhanced SOD and CAT activities in the intestines.Additionally,allicin upreg-ulated the mRNA expression of AQP1,AQP4,and ZO-1 in intestinal tissues.Conclusions Allicin has a significant therapeutic effect on senna-induced diarrhea in mice.The underlying molecular mechanisms may involve anti-inflammatory and antioxidant effects,in-creased NO content,and upregulation of mRNA ex-pression of aquaporins and tight-junction proteins.

Purpose To investigate the value of oxaliplatin-induced sinusoidal injury based on 3D CT image segmentation technology,and to analyze its variation.Materials and Methods A total of 24 patients with uneven hypoperfusion of liver parenchyma in the portal vein phase of enhanced CT after receiving oxaliplatin regimen chemotherapy from November 2019 to July 2021 in the Second Affiliated Hospital,Jiangxi Medical College,Nanchang University were analyzed,retrospectively.The imaging data of patients with epigastric CT enhancement before chemotherapy,early chemotherapy(1-3 cycles)and late chemotherapy(≥4 cycles)were collected.Two doctors used 3D Slicer software to segment and measure the liver volume and spleen volume at each stage on the CT image,as well as the hepatic hypoperfusion volume(HHV)of the liver in the portal vein phase after chemotherapy,and calculated the HHV ratio(HHVR),liver volume hepatomegaly rate and spleen volume splenomegaly rate,and performed statistical analysis.Results The ICC for HHV,liver volume and spleen volume measured by two doctors were 0.997(P=0.000),0.905(P=0.000)and 0.998(P=0.000),respectively.Reddish-brown could be used to represent normal liver parenchyma,and blue could be used to render the HHV area to achieve HHV visualization.There was a statistically significant increase in HHVR in the late stage of chemotherapy compared with the early stage of chemotherapy[(74.35±30.56)%vs.(57.15±30.53)%;t=3.226,P=0.004].In the early and late stages of chemotherapy,the liver volume and spleen volume increased statistically significantly compared with those before chemotherapy(all P<0.05),and the spleen volume splenomegaly rate value in the late stage of chemotherapy increased statistically compared with the early stage of chemotherapy[25.75(7.40,70.66)%vs.17.86(4.44,63.59)%;Z=2.229,P=0.026].The Pearson correlation coefficient between liver volume hepatomegaly rate and HHVR was 0.377(P=0.008),and the Spearman correlation coefficient between spleen volume splenomegaly rate and HHVR was 0.296(P=0.041).Conclusion The application of 3D CT image segmentation technology to measure the HHV caused by oxaliplatin has good consistency,and can realize the visual display of HHV.With the increase of chemotherapy cycle,the extent of oxaliplatin-induced sinusoidal injury shows an increasing trend,and is positively correlated with hepatomegaly and splenomegaly.

Objective:To investigate the correlation between the density and volume of left atrial-epicardial adipose tissue(LA-EAT)and the occurrence and severity of atrial fibrillation(AF)in elderly patients.Methods:This was a retrospective case-control study.A total of 197 elderly patients with AF and 82 patients with sinus rhythm who were hospitalized in the Department of Cardiology and Geriatric Cardiology of the First Affiliated Hospital of Nanjing Medical University from June 2023 to July 2024.were selected.The AF group was further divided into paroxysmal AF(PAF)subgroup(111 cases)and persistent AF(PeAF)subgroup(86 cases). The density and volume of LA-EAT in all patients were meansured by coronary artery enhanced CT or left atrial enhanced CT.The differences in LA-EAT density, volume and related data among the 3 groups were compared, and their relationship with different severity of senile AF was analyzed.Logistic regression was used to analyze whether LA-EAT density and volume were risk factors for senile AF.The predictive value of LA-EAT density and volume for AF in the elderly was compared throuh restricted cubic spline analysis.Results:The average LA-EAT density in the sinus rhythm group, PAF group and PeAF group was -82.75(-87.15, -79.63), -81.70(-85.55, -75.85)and -80.45(-83.40, -76.10)HU, respectively; the standard deviation of density was 34.70(31.93, 36.28), 36.20(34.30, 37.65)and 35.45(33.63, 37.28)HU, respectively; the LA-EAT volume was 23 483.40(13 964.10, 31 645.53), 25 112.20(18 479.10, 36 917.50)and 37 836.50(25 933.80, 45 537.90)mm 3, respectively.The LA-EAT density and volume in the PAF group and PeAF group were higher than those in the sinus rhythm group(all P<0.05). The LA-EAT volume in the PeAF group was greater than that in the PAF group( P<0.001), but there was no significant difference in LA-EAT density between the two groups( P>0.05). Multivariate logistic regression analysis showed that LA-EAT density and volume, left atrial diameter(LAD)and body mass index(BMI)were the independent risk factors for AF in the elderly( P<0.05). Conclusions:LA-EAT density and volume are significantly correlated with occurrence of senile AF, and show a positive dose-response relationship.LA-EAT volume is significantly related to the severity of AF( P<0.05), while the density is not significantly related to it( P>0.05).