ObjectiveTo observe the clinical efficacy of Anzi Tiaochong decoction combined with aspirin and the effects of this therapy on the peripheral blood phospholipid antibody titers， coagulation function， and CD19⁺CD24^hiCD27⁺regulatory B （Breg） cells in patients with obstetric antiphospholipid syndrome （OAPS） （pattern of kidney deficiency and blood stasis）. MethodsPatients who meet the inclusion criteria were randomly allocated into an observation group （50 patients， with 4 patients dropped out and 46 patients completed） and a control group （50 patients， with 2 patients dropped out， 1 patient excluded， and 47 patients completed） through a random number table method. The control group was treated with aspirin enteric-coated tablets， 75 mg/time， once a day， and the observation group with Anzi Tiaochong decoction， 1 bag/day on the basis of the therapy in the control group. The treatment course for both groups was 8 weeks， and the patients were followed up for 4 weeks. The traditional Chinese medicine （TCM） symptom scores， titers of peripheral blood phospholipid antibodies ［anti-cardiolipin antibody IgM （ACA IgM）， anti-cardiolipin antibody IgG （ACA IgG）， anti-β₂-glycoprotein 1 antibody IgM （β₂GP1-IgM）， and anti-β₂-glycoprotein 1 antibody IgG （β₂GP1-IgG）］， D-dimer （D-D）， thromboelastography parameters ［clotting factor activity （R）， platelet function maximum amplitude （MA）， coagulation composite index （CI）， and clot strength （G）］， CD19⁺CD24^hiCD27⁺ Breg expression rate， and adverse drug reactions were recorded for the two groups before and after treatment. ResultsAfter treatment， both groups showed decreased ACA IgM， ACA IgG， β₂GP1-IgM， β₂GP1-IgG， D-D， MA， and G （P<0.05） and increased R （P<0.05）. There was no statistically significant difference in CI. Compared with the control group， the observation group showed more significant decreases in TCM symptom scores and phospholipid antibody titers （P<0.05）. After treatment， the expression rate of Breg in the observation group was higher than that before treatment （P<0.05）.There was no significant difference in Breg expression rate before and after treatment in the control group. Neither group experienced significant adverse reactions. ConclusionAnzi Tiaochong decoction combined with aspirin can alleviate the symptoms， reduce the phospholipid antibody titers， and restore the coagulation status of patients with obstetric antiphospholipid syndrome （pattern kidney deficiency and blood stasis）. It may exert the therapeutic effects by regulating Breg to maintain the patient's immune balance.

ObjectiveTo observe the clinical efficacy and safety of Shenshuai Guanchang prescription in improving the intestinal barrier function，reducing non-indole uremic toxins，ameliorating micro-inflammatory state，and delaying renal function progression in non-dialysis patients with chronic kidney disease （CKD） stage 4-5. MethodsA total of 80 patients with CKD stage 4-5 who did not receive dialysis replacement therapy and were diagnosed with the syndrome of spleen and kidney deficiency，blood stasis and dampness turbidity were randomly assigned into a control group and a treatment group，with 40 patients in each group. The control group received conventional basic treatment and Western medicine symptomatic treatment，while the treatment group received combined intervention with Shenshuai Guanchang prescription through retention enema in addition to the treatment of the control group. Both groups had a treatment course of 4 weeks. The two groups were compared regarding the changes in urine toxin indicators ［p-cresyl sulfate （PCS） and trimethylamine oxide （TMAO）］，intestinal barrier indicators ［D-lactic acid （D-LA），lipopolysaccharide （LPS），and intestinal fatty acid-binding protein （I-FABP）］，renal function indicators ［serum creatinine （SCr），blood urea nitrogen （BUN），and estimated glomerular filtration rate （eGFR）］，and micro-inflammatory state indicators ［interleukin-6 （IL-6），tumor necrosis factor-α （TNF-α），and neutrophil-to-lymphocyte ratio （NLR）］ before and after treatment. The therapeutic effects were evaluated from three aspects：The efficacy regarding traditional Chinese medicine （TCM） symptom scores，the efficacy regarding laboratory indicators，and comprehensive efficacy. The safety of the clinical research drugs used by both groups of patients was also observed. ResultsA total of 37 cases in the treatment group and 38 cases in the control group completed the observation. After treatment，the treatment group showed declined levels of PCS，TMAO，D-LA，SCr，TNF-α，and NLR，spleen and kidney deficiency symptom score，blood stasis and dampness symptom score，and total symptom score （P<0.05），and increased eGFR （P<0.05）. Moreover，the treatment group had lower levels of PCS，TMAO，D-LA，I-FABP，IL-6，and TNF-α，spleen and kidney deficiency symptom score，blood stasis and dampness symptom score，and total symptom score （P<0.05），higher response rate regarding TCM symptoms （χ²=6.68，P<0.05），and higher comprehensive efficacy （χ²=4.08，P<0.05） than the control group. No significant abnormalities were observed in the safety indicators of the two groups of patients. During the treatment period，adverse reactions were reduced after symptomatic treatment，and no serious adverse reactions occurred. ConclusionShenshuai Guanchang prescription can alleviate the clinical symptoms，improve the intestinal barrier function，reduce non-indole-type uremic toxins，alleviate the micro-inflammatory state，and has good clinical application safety of non-dialysis patients with CKD stage 4-5.

Xiaoyao Powder has pharmacological action such as neuroprotection, anti-tumor, anti-depression, liver protection, regulation of intestinal flora, anti-fatigue and so on. Based on the five aspects of quality transfer and traceability, component measurability, component effectiveness, component specificity and compound compatibility environment, the quality marker (Q-marker) of Xiaoyao Powder was predicted and analyzed. It was considered that paeoniflorin, atractylenolide Ⅰ, atractylenolid Ⅱ, atractylenolide Ⅲ, liquiritin,glycyrrhizic acid, Saikosaponin A, Saikosaponin D, ferulic acid, Z-ligustilide, pachymic acid, Menthol,6-gingerol 8-gingerol and 10-gingerol have strong measurability and can be used as Q-marker of Xiaoyao Powder.

Objective To explore the mechanism of action of jolkinolide B in the treatment of gastric cancer by network pharmacology combined with molecular docking technique.Methods The SwissTargetPrediction database was used to obtain the targets of the active compounds.Search Genecards,OMIM,Drugbank,TTD,and PharmGKB databases to obtain targets for gastric cancer.The intersection between the targets of jolkinolide B and those of gastric cancer was identified pinpoint potential targets for jolkinolide B in treating gastric cancer.The String database was utilized construct a protein-protein interaction(PPI)network.Bioconductor bioinformatics packages with R software was employed conduct Gene Ontology(GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis on the shared targets.This process revealed significant regulatory pathways crucial for jolkinolide B's efficacy in treating gastric cancer.Cytoscape 3.7.1 software was utilized create the core network of"Potential Targets of Triptolide B in Gastric Cancer Treatment",and SYBYL-X2.1.1 software was employed conduct molecular docking validation of the selected main active ingredients and critical targets.Results Jolkinolide B may target multiple proteins,including MAPK1,glycogen synthase kinae-3β(GSK-3β),and JUN,impacting the proliferation,invasion,and metastasis of gastric cancer,ultimately inhibiting its growth.Conclusion We predicted the possible molecular mechanism of jolkinolide B in the treatment of gastric cancer to provide guide information for the subsequent experimental research and clinical application.

Objective To explore the spatiotemporal expression patterns of Patched 1(Ptch1)and insulin enhancer binding protein-1(Isl 1)in mouse embryonic foregut and their relationship with the early development of trachea-main bronchus.Methods The foregut of 60 mouse embryos at E9.5-12.5 was separated for the detection of Isl1 and sonic hedgehog(Shh)protein by Western blotting.Serial paraffin sections of 6 mouse embryos at E9.5-14.5 were taken for immunohistochemical staining and immunofluorescence double staining with Isl1,Ptch1,forkhead box protein A2(Foxa2),type Ⅱ collagen α1 chain(Col2a1)and α-smooth muscle actin(α-SMA),as well as HE staining and Masson staining.Results The expression trend of Isl1 and Shh in foregut endoderm at E9.5-12.5 was similar,and the peak of Shh expression was later than Isl1.The foregut developed into the trachea at E9.5-12.5,Ptch1 was expressed in the thickening and protrusion of the respiratory endoderm,the laryngal-tracheal groove and the solid cell cord,accompanied by the increase and aggregation of Isl1-positive mesenchymal cells,forming a characteristic pyramidal structure centered on the respiratory endoderm and the solid cell cord;The main bronchus appeared at E12.5-13.5,Ptch1 was only expressed in its lateral wall,accompanied by the accumulation of Isl1-positive mesenchymal cells;The trachea-main bronchial epithelium lost Ptch1 expression and the surrounding Isl 1-positive mesenchymal cells also decreased rapidly at E13.5-14.5.Co12a1-positive chondrocytes first appeared in the Isl1-positive mesenchymal area adjacent to the Ptch1-positive epithelium at E12.5;Col2a1-positive cartilage was nested within the Isl1-positive mesenchymic area in a"C"shape and expanded in a proximal-distal pattern at E12.5-13.5;Col2a1-positive cartilage extended to the dorsal trachea beyond the Isl1-positive mesenchyma and encircles α-SMA positive smooth muscle in a circular manner at E14.5.Conclusion The expression of Ptch1 in the foregut endoderm is involved in the development and morphogenesis of the trachea-main bronchus epithelium,and is closely related to the proliferation and aggregation of Isl1-positive mesenchyme in the trachea-main bronchial wall,Subsequently,they jointly determine the time,location and extent of airway cartilage.

Objective To explore the neuroprotective effect and related mechanism of electroacu-puncture(EA)combined with tanshinone Ⅱ A(Tan ⅡA)for the treatment of rats with cerebral ische-mia-reperfusion(I/R)injury.Methods Model rats with cerebral I/R were established by the modi-fied Longa suture occlusion method and randomly divided into Model group,EA group,Tan Ⅱ A group,and EA+Tan Ⅱ A group,with 16 rats in each group.Rats in the Sham group(n=16)had their carotid arteries exposed and dissected but not occluded.Neurological deficit score and Morris wa-ter maze test were used to assess neurological impairment and cognitive function in rats.2,3,5-triph-enyltetrazolium chloride(TTC)staining was used to evaluate cerebral infarction volume.Hematoxylin-eosin(HE)staining and TUNEL staining were used to assess neuronal damage in the hippocampus.Western blot was used to detect apoptosis-related proteins and proteins related to the Hippo signaling pathway.Results Compared with the Sham group,the Model group showed increased neurological deficit score,percentage of cerebral infarction area,escape latencies during acquisition training,proportion of TUNEL-positive stained cells in brain tissue,Caspase-3 activity,expression of Cleaved Caspase-3 protein and Bax protein,and decreased expression of time spent in the target quadrant during probe training,the number of platform crossings within 60 s,Bcl-2 protein,Yes-associated protein(YAP),and transcriptional co-activator with PDZ-binding motif(TAZ)protein,and all the differences were significant(P＜0.05).Compared with the Model group,the EA group,Tan Ⅱ A group,and EA+Tan Ⅱ A group showed decreased neurological deficit score,percentage of cerebral infarction volume,escape latencies during acquisition training,time spent in the target quadrant during probe training,number of platform crossings within 60 s,proportion of TUNEL-positive stained cells in brain tissue,Caspase-3 activity,expression of Cleaved Caspase-3 protein and Bax protein,with the EA+Tan Ⅱ A group showing lower values than the EA group and Tan Ⅱ A group,and all the differences were significant(P＜0.05).Compared with the Model group,the EA group,Tan Ⅱ A group,and EA+Tan Ⅱ A group showed increased expression of Bcl-2,YAP,and TAZ proteins,with the EA+Tan Ⅱ A group showing higher protein expression levels than the EA group and Tan Ⅱ A group,and all the differences were significant(P＜0.05).Conclusion The combination of EA and Tan Ⅱ A for the treatment of cerebral I/R injury exhibits synergistic effect,and its mechanism may be related to the inhibition of Hippo pathway activity.

Objective To understand the current situation and influencing factors of work-related musculoskeletal disorders (WMSDs) in medical staff in Beijing City. Methods A total of 2 687 medical staff were selected as the research subjects using the multi-stage sampling method. The current situation of WMSDs and occupational stress, anxiety symptoms, depressive symptoms, and insomnia symptoms were investigated using the Musculoskeletal Disorders Questionnaire, the Core Occupational Stress Scale, the Generalized Anxiety Disorder Scale, the Patient Health Questionnaire Depression Scale, and the Self-Sleep Management Questionnaire. The Max-Min Hill-Climbing algorithm was used to construct a Bayesian network model to analyze the influencing factors and internal relationships of WMSDs and to conduct reasoning and prediction of the model. Results The prevalence of WMSDs among the research subjects was 88.9%. Binary logistic regression analysis was used to identify age, educational level, personal monthly income, anxiety symptoms, depressive symptoms, insomnia symptoms, prolonged forward-head desk work, and prolonged static posture work to construct the Bayesian network model. The model consisted of nine nodes and eleven directed edges. Prolonged static posture work, prolonged forward-head desk work, and anxiety symptoms were directly related to WMSDs. Age and educational level were indirectly related to WMSDs through their influence on prolonged forward-head desk work. Depression symptoms were indirectly associated with WMSDs through their influence on anxiety symptoms. The model's prediction accuracy was 90.5%. Conclusion The prevalence of WMSDs among medical staff in Beijing City is relatively high. Prolonged static posture work, prolonged forward-head desk work, and anxiety symptoms may directly increase the risk of developing WMSDs.

Objective To investigate the perioperative management of antithrombotic drugs in patients undergoing non-cardiac surgery.Methods Patients on long-term antithrombotic drugs who underwent non-cardiac surgery in our hospital were included.Through interviews with patients and physicians,perioperative antithrombotic medication regimens were reviewed and compared with the"Multidisciplinary Expert Consensus on Perioperative Management of Antithrombotic Therapy"to evaluate compliance with consensus and analyze influencing factors.Results A total of 372 patients were included in the analysis.Among them,355 patients were on long-term antiplatelet therapy alone,and 17 were on long-term oral anticoagulantion.364(97.8％)discontinued antithrombotic medications prior to surgery.109 patients(29.3％)received low molecular weight heparin(LMWH)bridging therapy.Among the 355 patients on antiplatelet therapy,108(30.4％)had discontinuation durations consistent with the consensus recommendations,while 186(52.4％)discontinued medications for longer periods.Postoperatively,the average hospital stay for antiplatelet therapy patients was 6.64 days,with only 37(10.4％)resuming therapy during hospitalization.The average hospital stay for patients on anticoagulants was 9.94 days,with only 2(11.8％)resuming therapy during hospitalization.Regarding perioperative risk assessment,only 40(10.8％)of patients underwent additional internal medical evaluation for thromboembolic risk after medication discontinuation,with the remainder assessed soly by surgeons.Coronary heart disease was an independent risk factor associated with internal medical evaluation(OR 2.851,95％CI 1.160-7.011,P=0.022).For bleeding risk assessment,surgeons evaluations aligned with the consensus in 68.0％of cases,but surgeons tended to underestimate risk compared to the consensus.Conclusions In this single-center study,perioperative antithrombotic management showed low compliance with expert consensus,characterized by prolonged preoperative medication discontinuation,high rates of LMWH bridging,and low postoperative in-hospital resumption of therapy.A robust multidisciplinary collaboration system should be established to enhance comprehensive patient assessment.

Objective To explore the neuroelectrophysiological mechanism of the decline of overall cognitive function and prospective memory,the syndrome manifestation of liver failing to govern conveyance and dispersion of the middle-aged and elderly people in the community with long-term emotional disturbance were evaluated.Methods Eysenck personality questionnaire(EPQ)and general condition questionnaire were used to screen the middle-aged and elderly people from 46 to 65 years old in the community who met the high and low neuroticism criteria,which were included in the long-term emotional disturbance group and the control group.According to the principle of matching sex,age(±2 years)and years of education(±2 years),60 subjects in each group were included.The scores of livers meridian syndrome,anxiety factor,depression factor and the total scores of three factors in the two groups were detected with the emotion rating scale for Ganzangxiang of traditional Chinese medicine.The overall cognitive function,the overall level of prospective memory and the dual-task paradigm of event-related memory were evaluated and event-related potential components were detected.Results Compared to the control group,the total scores of emotion rating scale for Ganzangxiang of traditional Chinese medicine and the scores of liver meridian syndrome factor,anxiety factor and depression factor all increased in the long-term emotional disturbance group significantly(P<0.05).The total scores of MoCA scale(after correction)and the level scores of visual space and executive function,attention and delayed recall decreased significantly(P<0.05),and the total scores of prospective memory questionnaire decreased significantly(P<0.05).The correct rates of ongoing tasks and prospective memory tasks in the event-based prospective memory dual task paradigm were decreased,and the reaction time was prolonged in the long-term emotional disorder group significantly(P<0.05).The amplitude of P200 of ongoing task and prospective memory task were increased in the long-term emotional disorder group(0.05

Objective:To assess the core competencies of internal medicine residents undergoing standardized residency training and to explore the effectiveness of core competency evaluation on mobile devices.Methods:The mobile formative evaluation module was developed based on the "Xueyiku" teaching management platform. From January to December 2023, clinical teachers were asked to evaluate 150 internal medicine residents based on the "Resident Core Competency Milestone Evaluation System in China Consortium of Elite Teaching Hospitals", and the results were analyzed using non-parametric tests.Results:Among the six core competencies of internal medicine residents, professionalism received the highest score, whereas teaching skill received a lower score (97.50 vs. 90.00; H=167.31, P<0.001). Second-year residents had significantly higher scores than first-year residents (93.00 vs. 90.00; P<0.001), but similar scores to third-year residents (93.00 vs. 93.00; P>0.05). In addition, there was no significant difference in score among residents with different medical education backgrounds ( P>0.05). Conclusions:More emphasis should be placed on improving the teaching skills of internal medicine residents, along with the implementation of tiered progressive training. The mobile core competency evaluation is an effective means for assessing the comprehensive skills of residents in a timely manner.