The purpose of this paper is to explore the decoction and dosing methods of rhubarb root and rhizome in classical prescriptions and to provide a reference basis for the clinical use of rhubarb root and rhizome. By collating the relevant classical prescriptions of rhubarb root and rhizome in Shanghan Lun and Jingui Yaolüe, the relationship between its decoction and dosing methods and the syndrome was analyzed. The decoction of rhubarb root and rhizome in classical prescriptions can be divided into three categories: simultaneous decoction, decoction later, and other methods (impregnation in Mafei decoction, decoction with water from the well spring first taken in the morning, and pills). If it enters the blood level or wants to slow down, rhubarb root and rhizome should be decocted at the same time with other drugs. If it enters the qi level and wants to speed up, rhubarb root and rhizome should be decocted later. If it wants to upwardly move, rhubarb root and rhizome should be immersed in Mafei decoction. If it wants to suppress liver yang, rhubarb root and rhizome should be decocted with water from the well spring first taken in the morning. If the disease is prolonged, rhubarb root and rhizome should be taken in pill form. The dosing methods of rhubarb root and rhizome can be divided into five categories: draught, twice, three times, before meals, and unspecified. For acute and serious illnesses with excess of pathogenic qi and adequate vital qi, we choose draught. For gastrointestinal diseases, we choose to take the medicine twice. For achieving a moderate and long-lasting effect, we choose to take the medicine three times. If the disease is located in the lower part of the heart and abdomen, we choose to take it before meals. The use of rhubarb root and rhizome in clinical practice requires the selection of the appropriate decoction and dosing methods according to the location of the disease, the severity of the disease, the patient′s constitution, and the condition after taking the medicine.

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.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Most of the life forms on Earth have gradually evolved an endogenous biological clock under the long-term influence of periodic daily light-dark cycles. This biological clock system plays a crucial role in the orderly progression of life activities. In mammals, central circadian clock is located in the suprachiasmatic nucleus of the hypothalamus and the function of the biological clock relies on a transcription-translation negative feedback loop. As a negative regulator in this loop, the function of CHRONO is less known. To deeply explore the role of the Chrono gene in rhythm entrainment and physiology, we constructed a Chrono gene knockout mouse strain using the CRISPR/Cas9 technology and analyzed its entrainment ability under different T cycles. Running wheel tests and glucose tolerance tests were also performed. The results showed that the period of the endogenous biological clock of Chrono knockout mice was prolonged, and the entrainment rate under the T21 cycle was decreased. In addition, metabolic abnormalities, including weight gain and impaired glucose tolerance, were observed in the non-entrained mice. Overall, this study reveals a crucial role of the Chrono gene in maintaining circadian rhythms and metabolic balance, providing a new perspective for understanding the relationship between the biological clock and metabolism. Further research is needed to fully understand the underlying molecular mechanisms.
Animals ; Mice, Knockout ; Mice ; Circadian Rhythm/genetics* ; Metabolic Diseases/physiopathology* ; Photoperiod ; Male ; Period Circadian Proteins/physiology* ; Light ; Circadian Clocks/physiology*

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, contact tracers were under immense pressure to deliver effective and timely contact tracing, raising concerns of higher susceptibility to burnout. Our study aimed to determine burnout prevalence among hospital-based contact tracers and associated risk factors, so that interventions to reduce burnout risk could be formulated. METHODS: One hundred and ninety-six active contact tracers across three hospitals within a healthcare cluster were invited to complete an anonymous online survey. To identify burntout, data such as demographics, work-related variables and contact tracing-related variables were collected using the Copenhagen Burnout Inventory. Associated factors were identified using multivariate statistics. Open-ended questions were included to understand the challenges and potential improvements through qualitative analysis. RESULTS: A total of 126 participants completed the survey, giving a completion rate of 64%, and almost half of these participants (42.9%) reported burnout. Protective factors included being on work-from-home arrangements (adjusted odds ratio [OR] 0.22, 95% confidence interval [CI] 0.08-0.56), perception of being well supported by their institution (adjusted OR 0.25, 95% CI 0.08-0.80) and being married (adjusted OR 0.28, 95% CI 0.12-0.64). Risk factors included having an administrative role pre-COVID-19 (adjusted OR 3.62, 95% CI 1.33-9.83). Work-related burnout was related to being activated for more than 1 day in the preceding week (unadjusted OR 3.25, 95% CI 1.33-7.94) and multiple activations in a day (unadjusted OR 3.54, 95% CI 1.44-4.41). Biggest challenges identified by participants were language barrier (62.7%), followed by workflow-related issues (42.1%). CONCLUSION Our study demonstrated burnout and other challenges faced by a team of mostly hospital-based administrative staff redeployed on a part-time basis to ensure timely contact tracing. To mitigate burnout, we recommend choosing staff on work-from-home arrangements and ensuring adequate manpower and rostering arrangements.
Humans ; COVID-19/epidemiology* ; Burnout, Professional/epidemiology* ; Singapore/epidemiology* ; Female ; Male ; Cross-Sectional Studies ; Adult ; Middle Aged ; Risk Factors ; Surveys and Questionnaires ; Contact Tracing/methods* ; SARS-CoV-2 ; Prevalence ; Pandemics

A growing body of research points out that gut microbiota plays a key role in tumor immunotherapy. By optimizing the composition of intestinal microbiota, it is possible to effectively improve immunotherapy resistance and enhance its therapeutic effect. This article comprehensively analyzes the mechanism of intestinal microbiota influencing tumor immunotherapy resistance, expounds the current strategies for targeted regulation of intestinal microbiota, such as traditional Chinese medicine and plant components, fecal microbiota transplantation, probiotics, prebiotics and dietary therapy, and explores the potential mechanisms of these strategies to improve patients' resistance to tumor immunotherapy. At the same time, the article also briefly discusses the prospects and challenges of targeting intestinal microbiota to improve tumor immunotherapy resistance, which provides a reference for related research to help the strategy research of reversing tumor immunotherapy resistance.

Direct compression is an ideal method for tablet preparation, but it requires the powder's high functional properties. The functional properties of the powder during compression directly affect the quality of the tablet. 15 parameters such as Py, FES-8KN, FES-12KN, FES-16KN, CR-8KN, CR-12KN, and CR-16KN were used as the characteristic variables in this paper. Unsupervised learning methods like principal component analysis, cluster analysis, and factor analysis were applied to analyze and classify the compression behavior data of 36 traditional Chinese medicine powders. The results showed that both different dimensionality reduction classification methods could effectively differentiate the compression behavior characteristics of 36 traditional Chinese medicine compound powders. The hierarchical cluster analysis results showed a better agreement with the actual compression phenomena of the powders, where group 1 was high elasticity and low compressibility, group 2 was easily compressed and hard to break, group 3 was excellent compressibility and compactibility. This study is expected to provide references and ideas for predicting the behavior of traditional Chinese medicine powders and the screening of tablet formulations.

BackgroundSocial support can help alleviate depressive symptoms in patients with major depressive disorder （MDD） and improve individual levels of empathy. The higher the level of empathy， the lower the probability of depressive symptoms. At present， the relationship between social support， empathy and depressive symptoms in MDD patients is unclear. ObjectiveTo explore the pathway of empathy in the relationship between social support and depressive symptoms in patients with MDD， so as to provide references for clinical treatment of MDD patients. MethodsA total of 126 patients who visited the outpatient clinic of Tianjin Anding hospital from July 2020 to September 2022 and met the diagnostic criteria for Major Depressive Disorder （MDD） according to the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were selected as the study subjects. Hamilton Depression Scale-17 item （HAMD-17）， Interpersonal Reactivity Index （IRI） and Social Support Rating Scale （SSRS） were used for assessment. Pearson correlation analysis was conducted to examine the correlations among the scale scores. Path analysis was performed using Model 4 of the Process 3.4.1. Bootstrap method was used to test the path effects. ResultsAmong MDD patients， HAMD-17 total score was positively correlated with IRI total score and its subscales of fantasy and personal distress （r=0.225， 0.213， 0.220， P<0.05）. HAMD-17 total score was negatively correlated with SSRS total score and its subscales of subjective support and support utilization （r=-0.211， -0.181， -0.208， P<0.05）. The score of support utilization subscale of SSRS was positively correlated with IRI total score and its subscale of perspective taking and empathic concern （r=0.257， 0.261， 0.331， P<0.01）. Empathy served as a pathway between support utilization and depressive symptoms， with an indirect effect of 0.217 （95% CI： 0.060~0.426）， and the effect size was 36.90%. ConclusionEmpathy may serve as a pathway between support utilization and depressive symptoms in patients with MDD.

AIM To study the chemical constituents from dichloromethane fraction of Dalbergia odorifera T.Chen heartwood.METHODS Separation and purification were performed using silica gel,Sephadex LH-20,thin-layer chromatography,and semi-preparative HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.RESULTS Twenty-four compounds were isolated and identified as 7,2′-dihydroxy-4′-methoxy-isoflavanol(1),vanillin(2),2,2′-oxybis-(1,4-di-tert-butylbenzene)(3),7-hydroxy-6-methoxyflavone(4),sativan(5),5-hydroxy-4′,7-dimethoxyisoflavone(6),2-hydroxy-4,4′-dimethoxychalcone(7),7,2′,3′,4′-tetramethoxydihydroisoflavone(8),2,4,2′-trihydroxy-4′-methoxybenzil(9),ethyl-3-hydroxy-3-phenyl-2-propenoate(10),6,7-dimethoxy-2,3-dihydr-ochromen-4-one(11),sophorophenolone(12),apocynin(13),ethyl-2,4-dihydroxybenzoate(14),ethylparaben(15),methyl-2,4-dihydroxybenzoate(16),5,7-dihydroxy-6-methoxyflavanone(17),7-hydroxyflavanone(18),mimosifoliol(19),7-hydroxy-4′-methoxyisoflavane(20),virolane(21),5-hydroxy-7-methoxychromone(22),3-hydroxyl-5-methoxy-stilbene(23),2′,4′-dihydroxydihydrochalcone(24).CONCLUSION Compound 8 is new natural product,2-6,15,17-18 are isolated from this plant for the first time,7,9-14,16,20-24 are first isolated from genus Dalbergia.

This paper reported a case of simultaneous twin pregnancy and successful delivery in each horn of uterus didelphys. The patient had a history of adverse pregnancies and was diagnosed with a uterus didelphys with double cervix through hysteroscopy, although the uterine cavity morphology was normal. This pregnancy was conceived naturally, with the last menstrual period on December 21, 2023. The patient underwent regular prenatal check-ups at Xi'an People's Hospital (Xi'an Fourth Hospital). Early pregnancy ultrasound confirmed simultaneous twin pregnancy in each horn of uterus didelphys. Multiple ultrasounds showed no fetal growth restriction or other abnormalities. At 37 weeks of gestation, the patient experienced chest tightness and shortness of breath due to polyhydramnios, and one fetus was in the cephalic position while the other was in the breech position, posing a high risk for vaginal delivery. Therefore, an elective cesarean section was performed at 37 weeks and one day of gestation, delivering a male infant weighing 3 260 g and a female infant weighing 2 400 g. The 1-,5-, and 10-minute Apgar scores were all 10 points, with favorable maternal and neonatal outcomes.