Triptolide （TP）， the core active component of the traditional Chinese medicine Tripterygium wilfordii ， exhibits remarkable pharmacological activities including anti-inflammatory， immunosuppressive and anti-tumor effects， and holds broad application prospects in the treatment of major diseases such as autoimmune diseases and malignant tumors. However， TP has a narrow therapeutic window and causes multi-organ toxicities including liver， kidney and reproductive toxicities， which severely restrict its safe clinical application and new drug development. Therefore， toxicity reduction and efficacy enhancement has become a core scientific problem urgently to be solved in this field. This paper systematically reviews the four core strategies for TP toxicity reduction and efficacy enhancement， including structural modification， dosage form improvement， herbal compatibility， and external therapies of traditional Chinese medicine. Among them， structural modification optimizes the toxic and efficacy characteristics of TP from the molecular structure level， with typica l derivatives including （5 R ）-5-hydroxy triptolide， ZT01， PG490-88， etc. Dosage form modification achieves toxicity reduction and efficacy enhancement via targeted and sustained-controlled drug release of diverse delivery systems. It includes triptolide preparations such as nanoparticles， liposomes， microemulsion gels and liquid crystals， possessing favorable clinical transformation potential. The herbal compatibility and external therapies of traditional Chinese medicine conform to the holistic view of traditional Chinese medicine and have a profound clinical application foundation， but their mechanisms of action are insufficiently elucidated， and they lack unified standardized specifications and high-quality evidence-based proof. In the future， we should rely on multi-omics technology to elucidate the toxic and efficacy mechanisms， integrate technologies to optimize preparations， improve the evaluation system and promote clinical transformation.

The core pathogenesis of childhood IgA vasculitis nephritis （IgAVN） lies in the intermingled conditions of heat， stasis and deficiency. Deficiency is the fundamental cause， while heat acts as the predominant manifestation at the initial stage， and stasis serves as the key factor leading to protracted illness. Based on this understanding， the overall therapeutic principle of clearing heat and cooling blood， dissolving stasis and unblocking collaterals， reinforcing healthy qi and consolidating the root is established. A self-formulated Qingre Zhixue Formula （清热止血方） is used as the basic prescription. According to the characteristics of different disease stages， childhood IgAVN is further classified into three main syndrome types， including blood heat with stasis obstruction， deficiency of both qi and yin， and deficiency of both spleen and kidney， with corresponding syndrome-based treatments. Throughout the treatment process， emphasis is placed on dissolving stasis and unblocking collaterals， while protecting the spleen and stomach of children and maintaining healthy qi. This paper provides new perspectives for diagnosis and treatment of childhood IgAVN with traditional Chinese medicine.

The core pathogenesis of childhood IgA vasculitis nephritis （IgAVN） lies in the intermingled conditions of heat， stasis and deficiency. Deficiency is the fundamental cause， while heat acts as the predominant manifestation at the initial stage， and stasis serves as the key factor leading to protracted illness. Based on this understanding， the overall therapeutic principle of clearing heat and cooling blood， dissolving stasis and unblocking collaterals， reinforcing healthy qi and consolidating the root is established. A self-formulated Qingre Zhixue Formula （清热止血方） is used as the basic prescription. According to the characteristics of different disease stages， childhood IgAVN is further classified into three main syndrome types， including blood heat with stasis obstruction， deficiency of both qi and yin， and deficiency of both spleen and kidney， with corresponding syndrome-based treatments. Throughout the treatment process， emphasis is placed on dissolving stasis and unblocking collaterals， while protecting the spleen and stomach of children and maintaining healthy qi. This paper provides new perspectives for diagnosis and treatment of childhood IgAVN with traditional Chinese medicine.

BACKGROUND:Exercise as a form of active rehabilitation can improve the dysfunction caused by peripheral nerve injury,and different exercise modalities target different lesion sites and recovery mechanisms. OBJECTIVE:To comprehensively analyze the application and mechanisms of different exercise modalities in functional recovery from peripheral nerve injury. METHODS:A computerized search was conducted in PubMed and CNKI databases for relevant literature published before January 2024.The search terms used were"peripheral nerve injury,spinal cord,exercise,cerebral cortex,muscle atrophy,mirror therapy,blood flow restriction training"in both English and Chinese.Finally,77 articles were included for review. RESULTS AND CONCLUSION:Peripheral nerve injury can cause systemic pathological changes such as skeletal muscle atrophy,corresponding spinal cord segmental lesions,and sensorimotor cortex remodeling.Aerobic exercise can improve dysfunction by enhancing the immune response,promoting glial cell polarization,and promoting the release of nerve growth factor.Blood flow restriction exercise can regulate the secretion of muscle growth factor,promote muscle growth and enhance muscle strength.Mirror movement has a good effect in activating the cerebral cortex and reducing cortical remodeling.Different exercise modalities have potential benefits in functional recovery after peripheral nerve injury;however,there are still some problems and challenges,such as the choice of exercise modalities,the control of exercise intensity and frequency,and the detailed analysis of mechanisms.

The alternative pathway (AP) of the complement system is a key contributor to the pathogenesis of several diseases including paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome (aHUS), C3 glomerular disease (C3G) and age-related macular degeneration (AMD). Complement factor B (CFB) is a trypsin-like serine protein that circulates in the human bloodstream in a latent form. As a key node of the alternative pathway, it is an important target for the treatment of diseases mediated by the complement system. With the successful launch of iptacopan, the CFB small molecule inhibitors has become a current research hotspot, a number of domestic and foreign pharmaceutical companies are actively developing CFB small molecule inhibitors. In this paper, the research progress of CFB small molecule inhibitors in recent years is systematically summarized, the representative compounds and their activities are introduced according to structural types and design ideas, so as to provide reference and ideas for the subsequent research on CFB small molecule inhibitors.

AIM:To compare the effects and effi-cacy of methoxyamine and norepinephrine on sub-lingual microcirculation in patients with high-alti-tude septic shock.METHODS:A total of forty-six patients with septic shock from the Xining area of Qinghai Province were randomized into two groups:the M-hydroxylamine group(Group M,n=22)and the norepinephrine group(Group N,n=24).Baseline data as well as the incidence of acute kid-ney injury(AKI),distal limb necrosis/ischemia,and 28-day survival rates were documented.Sublingual microcirculation parameters were monitored and recorded at four time points:before treatment(T0),24 hours post-treatment(T1),48 hours post-treatment(T2),and 72 hours post-treatment(T3)using side-flow dark-field(SDF)imaging.The pa-rameters included total vascular density(TVD),per-fused vascular density(PVD),perfused vessel ratio(PPV),microvascular flow index(MFI),and hetero-geneity index(HI).Additionally,changes in heart rate(HR),mean arterial pressure(MAP),blood urea nitrogen(BUN),serum creatinine(Cr),and lac-tate(Lac)levels were also recorded.RESULTS:There were no significant differences between the two groups in terms of baseline data,incidence of AKI,distal limb necrosis/ischemia,and 28-day sur-vival rate.Additionally,there were no significant differences in HR,MAP,and Lac indices between the two groups at any time point.However,within-group comparisons showed that HR,MAP,and Lac indices improved over the course of treatment,with statistically significant differences.The BUN level at the T3 time point was significantly lower in the mehydroxyamine group compared to the nor-epinephrine group(P<0.05).Similarly,Cr levels were significantly lower at both T2 and T3 time points(P<0.05).There were no significant differenc-es in sublingual microcirculation indices between the two groups at any time point.However,TVD,PVD,PPV,MIF,and HI in both groups improved over the course of treatment,with statistically sig-nificant differences.CONCLUSION:Both methoxy-amine and norepinephrine can enhance both the macrocirculation and sublingual microcirculation in patients with septic shock at high altitudes.Addi-tionally,methoxyamine leads to a faster recovery of creatinine levels within 72 hours.

The medical ultrasonic nebulizer was introduced in terms of composition,working principle and testing principle and method of the maximum nebulization rate.The testing characteristics of the volumetric and gravimetric methods were compared.A series of experiments were conducted using the whole-unit gravimetric approach.The initial liquid charge was indicated to be the primary factor affecting the maximum nebulization rate,and the influence increased significantly when the nebulizer's nominal volume got expanded.References were provided for medical testing staffs in selecting testing methods.

Objective:To investigate the impact of fresh and frozen-thawed embryo transfer on pregnancy outcomes in patients with diminished ovarian reserve (DOR) at an advanced age.Methods:Using a retrospective cohort study design, we enrolled elderly women with DOR who underwent their first in vitro fertilization and embryo transfer (IVF-ET) treatment at Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital between January 2018 and December 2022. Patients were grouped according to the cycle type of their first embryo transfer: a fresh cycle transfer group (group A, n=563) and a frozen-thawed cycle transfer group (group B, n=234). Propensity score matching (PSM, 1∶1) was used to match the baseline characteristics and embryo transfer information of the two groups, resulting in 184 patients in each group. The impact of fresh versus frozen-thawed embryo transfer on reproductive outcomes in elderly DOR patients was analyzed. Results:1) There were no statistically significant differences in general data, ovarian stimulation, and laboratory parameters of embryos between the two groups after PSM (all P>0.05). 2) The clinical pregnancy rate [23.91% (44/184)], the implantation rate [16.55% (48/290)], the ongoing pregnancy rate [16.85% (31/184)], and the live birth rate [16.30% (30/184)] in group A were significantly higher than those in group B [14.67% (27/184), P=0.025; 10.27% (30/292), P=0.026; 9.78% (18/184), P=0.046; 9.24% (17/184), P=0.042], with statistically significant differences. There were no statistically significant differences in miscarriage rate, multiple pregnancy rate, preterm birth rate, gestational age at delivery, and neonatal birth weight between the two groups (all P>0.05). 3) After controlling for confounding factors, frozen-thawed embryo transfer, female age, and the number of transferred quality embryos were independent factors influencing clinical pregnancy ( OR=0.486, 95% CI: 0.275-0.858, P=0.013; OR=0.761, 95% CI: 0.686-0.844, P<0.001; transferring one high-quality embryo OR=5.213, 95% CI: 1.501-18.105, P=0.009; transferring two high-quality embryos OR=8.144, 95% CI: 2.072-32.009, P=0.003) and live birth ( OR=0.468, 95% CI: 0.240-0.916, P=0.027; OR=0.733, 95% CI: 0.645-0.834, P<0.001; transferring one high-quality embryo OR=5.457, 95% CI: 1.218-24.448, P=0.027; transferring two high-quality embryos OR=5.900, 95% CI: 1.132-30.754, P=0.035). 4) After controlling for confounding factors, in transfer cycles of patients older than 40 years, the clinical pregnancy rate in group A [14.46% (12/83)] was significantly higher than that in group B [4.88% (4/82)], with a statistically significant difference ( OR=0.285, 95% CI: 0.086-0.946, P=0.040). In single cleavage-stage embryo transfer cycles, the clinical pregnancy rate [21.79% (17/78)] and the live birth rate [16.67% (13/78)] in group A were significantly higher than those in group B [9.21% (7/76), OR=0.311, 95% CI: 0.113-0.857, P=0.024; 6.58% (5/76), OR=0.468, 95% CI: 0.24-0.916, P=0.027], with both statistically significant differences. In cycles with transfer of only one high-quality embryo, the clinical pregnancy rate [27.66% (26/94)] and the live birth rate [20.21% (19/94)] in group A were significantly higher than those in group B [13.54% (13/96), OR=0.347, 95% CI: 0.157-0.765, P=0.009; 10.42% (10/96), OR=0.407, 95% CI: 0.171-0.968, P=0.042], with both statistically significant differences. Conclusion:Fresh cycle embryo transfer can achieve better reproductive outcomes in elderly women with DOR, especially in patients older than 40 years, in single cleavage-stage embryo transfer cycles, or when only one high-quality embryo is available. Fresh cycle embryo transfer should be prioritized in these situations.

Objective:To investigate the short-term efficacy of bevacizumab combined with chemotherapy in patients with advanced cervical cancer, as well as its effects on tumor markers and immune function.Methods:A retrospective analysis was conducted on 60 patients with advanced cervical cancer who received treatment at Yiwu Central Hospital from January 2020 to March 2024. The patients were divided into an observation group and a control group ( n = 30 per group) based on whether they received bevacizumab. Patients in the observation group received bevacizumab in combination with chemotherapy, while those in the control group received chemotherapy alone. The two groups were evaluated over two consecutive treatment cycles, with each cycle lasting 21 days. Short-term efficacy was compared between the two groups. The Karnofsky score, tumor markers, and immune function were assessed before and after treatment in both groups. Additionally, the incidence of adverse reactions was compared between the two groups. Results:The objective response rate in the observation group was significantly higher than that in the control group [73.33% (22/30) vs. 46.67% (14/30), χ2 = 4.44, P<0.05]. After treatment, the Karnofsky score in the observation group was significantly higher than that in the control group [(83.39 ± 4.43) vs. (75.48 ± 4.06), t = 7.21, P<0.001]. The serum levels of carbohydrate antigen 125, carcinoembryonic antigen, and carbohydrate antigen 19-9 in the observation group were all significantly lower than those in the control group ( t = -11.27, -8.91, -13.33, all P<0.001). CD 3+, CD 4+, and CD 4+/CD 8+ were significantly higher in the observation group compared with the control group ( t = 10.20, 10.74, 10.17, all P<0.001). The incidence of adverse reactions did not differ significantly between the two groups (all P>0.05). Conclusions:In patients with advanced cervical cancer, bevacizumab combined with chemotherapy demonstrates better efficacy than chemotherapy alone. The combined therapy is more effective in lowering serum levels of carbohydrate antigen 125, carcinoembryonic antigen, and carbohydrate antigen 19-9, as well as enhancing immune function, without increasing adverse reactions compared with chemotherapy alone.

Objective To investigate the application value of the subject-achieving quality control circle theory in enhan-cing medication adherence among newly diagnosed tuberculosis patients through via popular science intervention.Methods From September 2023 to April 2024,100 patients with newly diagnosed tuberculosis treated at the outpatient department were ran-domly divided into control and intervention groups,each comprising 50 cases.The control group received only routine medication education;whereas the intervention group,in addition to this,implemented popular science intervention measures based on the quality control circle theory.The medication adherence,full course completion rate,non-disease interruption rate,and self-re-ported adverse reaction rate were compared.Results After treatment,the intervention group showed higher medication adher-ence(6.76±1.02 vs.6.15±1.36),better adherence rates(78％vs.62％),and higher cure rates(76％vs.42％)than the control group,all with statistical significance.The non-disease interruption rate was also significantly lower in the intervention group(2％vs.14％).Adverse reaction reports were 6％in control and 18％in intervention group.Conclusion The subject-achieving quality control circle effectively improves medication adherence in newly diagnosed tuberculosis patients.