ObjectiveTo systematically evaluate the methodological quality and measurement properties of traditional Chinese medicine （TCM） syndrome efficacy evaluation scales， and to provide evidence-based references for selecting high-quality assessment tools in TCM clinical practice. MethodsChina National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP Database， Chinese Biomedical Literature Database （CBM）， PubMed， the Cochrane Library， Embase， and Web of Science were searched from inception to April 2， 2025， for studies evaluating the measurement properties of TCM syndrome efficacy evaluation scales. Data were extracted， and the methodological quality and measurement properties of the included scales were assessed according to the consensus-based standards for the selection of health measurement instruments （COSMIN）. Recommendation levels were formulated based on the grading of evidence. ResultsA total of 46 studies were included， involving 22 generic syndrome efficacy evaluation scales and 24 disease-specific syndrome efficacy evaluation scales. None of the scales reported cross-cultural validity or measurement error. According to the recommendation grades， 2 scales met Grade A recommendations and are suggested for clinical use； 38 scales were classified as Grade B， indicating potential applicability but requiring further validation； and 6 scales were classified as Grade C， suggesting the need for further refinement. ConclusionExisting TCM syndrome efficacy evaluation scales exhibit substantial variability in methodological quality， incomplete reporting of measurement properties， and insufficient attention to scale revision. Future efforts should emphasize standardized design in the development of TCM syndrome scales， strengthen validation procedures for key measurement properties， and prioritize dynamic revision of scales， thereby providing high-quality tools to support the precise evaluation of syndrome efficacy.

Objective:To investigate the association between adiponectin-related copy number variation (CNV) region (CNVR) and gestational diabetes mellitus (GDM).Methods:Pregnant women who had prenatal screening in Anqing Municipal Hospital, Anhui Province, from February 2018 to December 2020 were surveyed for baseline information collection, and blood samples were collected. The outcome information was obtained by post pregnancy follow-up. Latex-enhanced immunoturbidimetry and ASA-CHIA chip were used to detect serum adiponectin levels and CNV of pregnant women, respectively. After genotyping, CNV data were processed with software PennCNV 1.0.5 following standard quality control procedure. CNVR were identified and integrated by using software R 4.3.3. Then the associations between CNVR and adiponectin was evaluated, and gene annotation and over-representation analysis were conducted. The log-binomial regression model was used to adjust relevant covariates and analyze the association between adiponectin-related CNVR and GDM.Results:The detection rate of GDM was 9.54% (176/1 845) in the pregnant women. The genotyping information of 1 840 people (99.73%) passed quality evaluation. A total of 33 878 CNVs were identified, and 1 449 CNVRs were obtained after integration. After the false discovery rate method correction, CNVR_132 (CHR2: 47611743-47635062), CNVR_254 (CHR3: 10182703-10183872), CNVR_691 (CHR7: 150637053-150834539) and CNVR_1101 (CHR14: 104248431-104830620) were correlated with adiponectin levels (all P<0.05). Over- representation analysis showed that the molecular function of ribonucleotide binding [Gene Ontology (GO): 0032553] was significantly enriched based on the GO database. The log-binomial regression model, adjusting age, pre-pregnancy BMI, history of miscarriage, smoking history, and family history of diabetes, indicated that CNVR_132 (CHR2: 47611743-47635062) and CNVR_1101 (CHR14: 104248431-104830620) were not statistically associated with the risk for GDM (both P>0.05). However, CNVR_254 (CHR3: 10182703-10183872, a RR=1.83, 95% CI: 1.15-2.91) and CNVR_691 (CHR7: 150637053-150834539, a RR=1.73, 95% CI: 1.23-2.43) might be associated with an increased risk for GDM (all P<0.05). Conclusion:Adiponectin-related CNVR_254 (CHR3: 10182703-10183872) and CNVR_691 (CHR7: 150637053-150834539) might be risk factors for the incidence of GDM.

Objective:To investigate the efficacy and safety of avatrombopag in promoting hematopoietic reconstitution after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Method:A retrospective analysis was conducted on 60 recipients with hematological malignancies who underwent allo-HSCT at the Affiliated Hospital of Xuzhou Medical University from January 2022 to August 2023. Recipients with hepatic or renal insufficiency before conditioning, those who received other thrombopoietic agents after allo-HSCT, those with severe respiratory or circulatory system diseases, and those with a history of thromboembolic events were excluded. Among them, 30 recipients who received avatrombopag within 14 days post-transplantation were assigned to the avatrombopag group, while the remaining 30 recipients who did not receive any thrombopoietic agents served as the control group. Clinical characteristics, hematopoietic stem cell engraftment, bone marrow proliferation, transfusion requirements, transplant-related complications, and laboratory adverse events were compared between the two groups.Result:The median platelet engraftment time in the avatrombopag group was 13 days (range: 9~25 days), and the neutrophil engraftment time was 13 days (range: 11~21 days). In the control group, he platelet engraftment time was 15 days (range: 10~51 days), and neutrophil engraftment time was 14 days (range: 10~30 days). The difference in platelet engraftment time between the two groups was statistically significant ( P=0.039). Bone marrow analysis on day 28 post-transplant showed that the proportion of recipients with active bone marrow hyperplasia was 96.7% in the avatrombopag group and 73.3% in the control group ( P=0.030); the median number of megakaryocytes was 30 vs. 6, respectively ( P<0.001); and the proportion of mature platelet-producing megakaryocytes was 44% vs. 26.3% ( P<0.001). Regarding transfusion requirements, the median platelet transfusion volume within 28 days post-transplantation was 4.5 U (range: 2~16 U) in the avatrombopag group and 6.5 U (range: 3~32 U) in the control group ( P=0.007). The time to achieve platelet transfusion independence was 13 days (range: 8~25 days) in the avatrombopag group and 14 days (range: 10~36 days) in the control group ( P=0.026). The median red blood cell transfusion volume in both groups was 4 U, with no significant difference ( P=0.354). Medication adherence in the avatrombopag group was 100%. There were no statistically significant differences between the two groups in terms of incidence of post-transplant infections (70% vs. 83.3%), bleeding (50% vs. 60%), graft-versus-host disease (GVHD) (30% vs. 40%), or abnormal laboratory tests (86.7% vs. 90%) (all P>0.05). Conclusion:The use of avatrombopag after allo-HSCT in patients with hematologic malignancies can promote bone marrow hematopoiesis and platelet engraftment, reduce platelet transfusion volume, and shorten the duration of platelet transfusion dependence. Avatrombopag is well tolerated, and no serious adverse reactions were observed during treatment.

Targeting T-cell is a strategy to control allogeneic response disorders, such as acute graft-versus-host disease (GVHD) which is an important cause of therapy-failure after allogeneic hematopoietic cell transplants. Free fatty acid receptor-4 (FFAR4) is a regulator of obesity but its role in T-cell and allogeneic reactions is unknown. Here, we found knockout of Ffar4 in donor T-cells in a mouse allograft model increased acute GVHD whereas the natural FFAR4 ligands and the synthetic FFAR4 agonists decreased it. FFAR4 agonist-mediated anti-acute GVHD effects depended on FFAR4-expression in donor T-cells. The FFAR4 agonist CpdA suppressed donor T-cell-mediated alloreaction by activating an aryl hydrocarbon receptor (AhR) pathway. CpdA recruited β-Arrestin2 to FFAR4 which facilitated nuclear translocation of AhR and upregulation of IL-22. The CpdA-mediated anti-acute GVHD effect was absent in mice receiving Ahr-knockout or Il22-knockout T-cells. Recipient-expressing Ffar4 was also important for the anti-acute GVHD effect of CpdA which inhibited activation of antigen presenting cells. Importantly, CpdA decreased acute GVHD in obese mice, an effect also depended on Ffar4-expression in donor T-cells and recipients. Our study shows the immunoregulatory effect of FFAR4 in T-cell, and targeting FFAR4 might be a relative option for controlling allogeneic reactions in obese patients.

Objective:To investigate the association between adiponectin-related copy number variation (CNV) region (CNVR) and gestational diabetes mellitus (GDM).Methods:Pregnant women who had prenatal screening in Anqing Municipal Hospital, Anhui Province, from February 2018 to December 2020 were surveyed for baseline information collection, and blood samples were collected. The outcome information was obtained by post pregnancy follow-up. Latex-enhanced immunoturbidimetry and ASA-CHIA chip were used to detect serum adiponectin levels and CNV of pregnant women, respectively. After genotyping, CNV data were processed with software PennCNV 1.0.5 following standard quality control procedure. CNVR were identified and integrated by using software R 4.3.3. Then the associations between CNVR and adiponectin was evaluated, and gene annotation and over-representation analysis were conducted. The log-binomial regression model was used to adjust relevant covariates and analyze the association between adiponectin-related CNVR and GDM.Results:The detection rate of GDM was 9.54% (176/1 845) in the pregnant women. The genotyping information of 1 840 people (99.73%) passed quality evaluation. A total of 33 878 CNVs were identified, and 1 449 CNVRs were obtained after integration. After the false discovery rate method correction, CNVR_132 (CHR2: 47611743-47635062), CNVR_254 (CHR3: 10182703-10183872), CNVR_691 (CHR7: 150637053-150834539) and CNVR_1101 (CHR14: 104248431-104830620) were correlated with adiponectin levels (all P<0.05). Over- representation analysis showed that the molecular function of ribonucleotide binding [Gene Ontology (GO): 0032553] was significantly enriched based on the GO database. The log-binomial regression model, adjusting age, pre-pregnancy BMI, history of miscarriage, smoking history, and family history of diabetes, indicated that CNVR_132 (CHR2: 47611743-47635062) and CNVR_1101 (CHR14: 104248431-104830620) were not statistically associated with the risk for GDM (both P>0.05). However, CNVR_254 (CHR3: 10182703-10183872, a RR=1.83, 95% CI: 1.15-2.91) and CNVR_691 (CHR7: 150637053-150834539, a RR=1.73, 95% CI: 1.23-2.43) might be associated with an increased risk for GDM (all P<0.05). Conclusion:Adiponectin-related CNVR_254 (CHR3: 10182703-10183872) and CNVR_691 (CHR7: 150637053-150834539) might be risk factors for the incidence of GDM.

Objective:To investigate the efficacy and safety of avatrombopag in promoting hematopoietic reconstitution after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Method:A retrospective analysis was conducted on 60 recipients with hematological malignancies who underwent allo-HSCT at the Affiliated Hospital of Xuzhou Medical University from January 2022 to August 2023. Recipients with hepatic or renal insufficiency before conditioning, those who received other thrombopoietic agents after allo-HSCT, those with severe respiratory or circulatory system diseases, and those with a history of thromboembolic events were excluded. Among them, 30 recipients who received avatrombopag within 14 days post-transplantation were assigned to the avatrombopag group, while the remaining 30 recipients who did not receive any thrombopoietic agents served as the control group. Clinical characteristics, hematopoietic stem cell engraftment, bone marrow proliferation, transfusion requirements, transplant-related complications, and laboratory adverse events were compared between the two groups.Result:The median platelet engraftment time in the avatrombopag group was 13 days (range: 9~25 days), and the neutrophil engraftment time was 13 days (range: 11~21 days). In the control group, he platelet engraftment time was 15 days (range: 10~51 days), and neutrophil engraftment time was 14 days (range: 10~30 days). The difference in platelet engraftment time between the two groups was statistically significant ( P=0.039). Bone marrow analysis on day 28 post-transplant showed that the proportion of recipients with active bone marrow hyperplasia was 96.7% in the avatrombopag group and 73.3% in the control group ( P=0.030); the median number of megakaryocytes was 30 vs. 6, respectively ( P<0.001); and the proportion of mature platelet-producing megakaryocytes was 44% vs. 26.3% ( P<0.001). Regarding transfusion requirements, the median platelet transfusion volume within 28 days post-transplantation was 4.5 U (range: 2~16 U) in the avatrombopag group and 6.5 U (range: 3~32 U) in the control group ( P=0.007). The time to achieve platelet transfusion independence was 13 days (range: 8~25 days) in the avatrombopag group and 14 days (range: 10~36 days) in the control group ( P=0.026). The median red blood cell transfusion volume in both groups was 4 U, with no significant difference ( P=0.354). Medication adherence in the avatrombopag group was 100%. There were no statistically significant differences between the two groups in terms of incidence of post-transplant infections (70% vs. 83.3%), bleeding (50% vs. 60%), graft-versus-host disease (GVHD) (30% vs. 40%), or abnormal laboratory tests (86.7% vs. 90%) (all P>0.05). Conclusion:The use of avatrombopag after allo-HSCT in patients with hematologic malignancies can promote bone marrow hematopoiesis and platelet engraftment, reduce platelet transfusion volume, and shorten the duration of platelet transfusion dependence. Avatrombopag is well tolerated, and no serious adverse reactions were observed during treatment.

Objective To establish a nomogram model for efficiently predicting overall survival(OS)and cancer-specific survival(CSS)in patients with CRCHBM.Method 2239 patients from 2010 to 2019 were retrospectively analyzed from the Surveillance,Epidemiology,and End Results Program(SEER)databases and Wuhan Union Hospital Cancer Center.SEER is randomly assigned to the training and internal validation cohorts,and the Wuhan database serves as the external validation.Cox regression analyses were used to determine the independent clinicopathological prognosis factors affecting OS and CSS,and a nomogram was constructed to predict OS and CSS.The clinical utility of columnar plots was assessed using calibration curves,area under the curve(AUC),and decision curve analysis(DCA).Result OS column line graphs were constructed based on nine independent predictors:age,tumor location,degree of differentiation,tumor size,TNM stage,chemotherapy,primary focus surgery,number of lymph nodes sampled,and serum carcinoembryonic antigen(CEA)level.The C-index of the nomogram to predict the 1-,3-,and 5-year OS were 0.764,0.790,and 0.805 in the training group,0.754,0.760,and 0.801 in the internal validation group,and 0.822,0.874,and 0.906 in the external validation group.CSS column line graphs were constructed based on 3 independent predictors of TNM staging,radiotherapy and chemotherapy.The 1-,3-,and 5-year CSS AUROC values of the training group were 0.791,0.757,and 0.782,respectively.0.682,0.709,0.625 in the internal validation group and 0.759,0.702,0.755 in the external validation group,respectively.The results of receiver operating characteristic curve(ROC),ROC and DCA showed that the use of our model was more effective in predicting OS and CSS than other single clinicopathological features.Conclusion In summary,the nomogram based on significant clinicopathological features can be conveniently used to predict OS and CSS individually in patients with CRCHBM.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Objective To isolate endophytic fungi from Angelica sinensis and evaluate the bioactivity of their secondary metabolites.Methods Angelica sinensis and rhizosphere soil were utilized as materials.The tissue homogenization method was employed with six diverse culture media to isolate endophytic fungi.The antibacterial activity of secondary metabolites was gauged using a 96-well plate assay,while UV spectrophotometry was used to evaluate the inhibitory activity of four enzymes.Results A total of 153 fungal strains were isolated and purified from Angelica sinensis roots,stems,leaves,and soil.The samples exhibited specific inhibitory activities against adenosine deaminase(ADA),β-lactamase,xanthine oxidase(XO),and tyrosinase(TYR),with rates of 45.83%,52.78%,51.39%and 55.56%,respectively.Furthermore,1.39%of the samples displayed wide-ranging inhibitory effects against four indicator bacteria.Strain 6B also showcased the lowest inhibitory concentration values of 62.5 and 7.81 μg/mL against Escherichia coli ATCC25922 and ATCC35218,respectively,signifying its potential research significance.Conclusion Angelica sinensis has abundant endophytic fungal resources and is a good source for discovering active compounds,demonstrating certain research value.