ObjectiveTo observe the clinical efficacy of Sanren Runchang formula in treating constipation-predominant irritable bowel syndrome （IBS-C） by regulating the brain-gut axis and the effects of the formula on serum levels of 5-hydroxytryptamine （5-HT）， vasoactive intestinal peptide （VIP）， and substance P （SP）. MethodsA randomized controlled design was adopted， and 72 IBS-C patients meeting Rome Ⅳ criteria were randomized into observation and control groups （36 cases）.The observation group received Sanren Runchang formula granules twice daily， and the control group received lactulose oral solution daily for 4 weeks. IBS Symptom Severity Scale （IBS-SSS）， IBS Quality of Life Scale （IBS-QOL）， and Bristol Stool Form Scale （BSFS） were used to assess clinical symptoms， and bowel movement frequency was recorded. The Self-Rating Anxiety Scale （SAS） and Self-Rating Depression Scale （SDS） were employed to evaluate psychological status. ELISA was employed to measure the serum levels of 5-HT， VIP， and SP. ResultsThe total response rate in the observation group was 91.67% （33/36）， which was higher than that （77.78%， 28/36） in the control group （χ²=4.50， P<0.05）. After treatment， both groups showed increased defecation frequency and BSFS scores， decreased IBS-SSS total score， abdominal pain and bloating scores， IBS-QOL health anxiety， anxiety， food avoidance， and behavioral disorders scores， SAS and SDS scores， serum 5-HT and VIP levels， and increased SP levels （P<0.05， P<0.01）. Moreover， the observation group showed more significant changes in the indicators above than the control group （P<0.05， P<0.01）. The SP level showed no significant difference between the two groups. During the 4-week follow-up， the recurrence rate was 5.88% in the observation group and 31.25% in the control group. No adverse events occurred in observation group， and 2 cases of mild diarrhea occurred in the control group. ConclusionSanren Runchang formula demonstrated definitive efficacy in alleviating gastrointestinal symptoms and improving the psychological status and quality of life in IBS-C patients， with a low recurrence rate. The formula can regulate serum levels of neurotransmitters such as 5-HT and VIP， suggesting its potential regulatory effect on the brain-gut axis through modulating neurotransmitters and neuropeptides. However， its complete mechanism of action requires further investigation through detection of additional brain-gut axis-related biomarkers.

OBJECTIVE To investigate the mechanism of Huangqin decoction in improving ulcerative colitis （UC） through the gut microbiota-tryptophan metabolism-aryl hydrocarbon receptor （AhR） axis. METHODS Mice were randomly divided into normal group （normal saline）， model group （normal saline）， microbiota depletion-model group （normal saline）， microbiota depletion-Huangqin decoction group （9.1 g/kg， by crude drug， similarly hereinafter）， Huangqin decoction group and mesalazine group （positive control group， 0.4 g/kg）， with 6 mice in each group. Microbiota depletion was achieved by providing free access to a mixed antibiotics for 10 days. The UC model was induced by administering 2.5% dextran sulfate sodium solution for 7 days. After successful modeling， each treatment group received corresponding drugs or normal saline intragastrically once daily for 10 days. After the final administration， body weight change ratio， disease activity index （DAI） score， and colon length were evaluated； colon pathological changes were observed； serum levels of interleukin-6 （IL-6）， IL-10， IL-22， and tumor necrosis factor-α （TNF-α） were measured； the expressions of Occludin， zonula occluden-1 （ZO-1）， and AhR in colon tissue were detected； fecal samples were subjected to high-throughput sequencing to analyze targeted tryptophan metabolomics. RESULTS Compared with the model group， Huangqin decoction group showed reduced infiltration of inflammatory cells in the colon tissue and restoration of the intestinal mucosal structure. Body weight change ratio， colon length， serum content of IL-10， the expressions of Occludin， ZO-1 and AhR in colon tissue and the contents of tryptophan metabolites indole-3-propionic acid （IPA）， N -acetylserotonin （NAS） and indole-3-acetic acid （IAA） were all significantly increased （ P ＜0.05）； DAI score， serum levels of IL-6， TNF-α， and IL-22 and the content of tryptophan metabolite indole-3-ethanol were significantly decreased （ P ＜0.05）； gut microbiota structure was improved， with increased relative abundances of beneficial bacteria such as Lactobacillus ， and decreased relative abundances of pathogenic bacteria such as Escherichia-Shigella . However， after antibiotic-induced microbiota depletion， although Huangqin decoction significantly increased the content of NAS in the feces of mice， the expression of AhR protein in colon tissue did not increase concurrently. CONCLUSIONS Huangqin decoction can repair the intestinal mucosal barrier in UC mice by regulating the gut microbiota and promoting the production of IPA and IAA， thereby activating AhR. This suggests that an intact gut microbiota is an important prerequisite for Huangqin decoction to exert its AhR-regulating effects.

Flap transplantation is a critical surgical strategy for the reconstruction of tissue defects caused by trauma, tumor resection, and congenital malformations, and its survival rate directly determines surgical efficacy and patient prognosis. Following transplantation, flaps inevitably undergo ischemia-reperfusion (I/R) injury, during which oxidative stress, inflammatory responses, and metabolic disturbances are intricately intertwined, ultimately leading to cellular injury and tissue necrosis. Recent studies have demonstrated that multiple forms of programmed cell death—including apoptosis, pyroptosis, ferroptosis, necroptosis, and PANoptosis—play central roles in flap I/R injury. The extensive crosstalk and molecular interactions among these pathways form a highly complex cell death network. Specifically, apoptosis is mediated by the imbalance of Bcl-2 family proteins and the activation of cysteine-dependent aspartate-specific protease (caspase) cascades; pyroptosis is driven by the NLRP3-caspase-1-GSDMD axis, resulting in membrane pore formation and the release of pro-inflammatory cytokines; ferroptosis is characterized by iron-dependent lipid peroxidation and dysfunction of glutathione peroxidase 4 (GPX4); necroptosis is triggered by the receptor-interacting serine/threonine-protein kinase 1 (RIPK1)-RIPK3-MLKL signaling complex, leading to membrane rupture; and PANoptosis represents an integrated form of inflammatory cell death that coordinates multiple death pathways. Importantly, these forms of programmed cell death are not independent but are interconnected through extensive signaling crosstalk. Key regulatory molecules, including caspase-8, reactive oxygen species (ROS), nuclear factor-κB (NF-κB), and nuclear factor erythroid 2-related factor 2 (Nrf2), collectively modulate the dynamic balance among these pathways. Therefore, the multidimensional interplay and spatiotemporal dynamics of programmed cell death constitute a fundamental pathological basis of flap I/R injury. This review systematically summarizes the latest advances in the mechanisms and interactions of various programmed cell death pathways in flap I/R injury, aiming to elucidate the underlying regulatory network. These insights may provide novel theoretical foundations for optimizing flap protection strategies, improving flap survival, and promoting tissue repair.

OBJECTIVE To summarize the key points for design of case-control study,analyze the data and summa-rize the specifications so as to raise the quality of related clinical research on hospital-acquired infections.METHODS The types for design of the case-control study were systematically summarized based on the character-istics of hospital-acquired infection data with strong timeliness and various confounding factors.The design,data clearance and statistical analysis method were studied by analysis of typical cases,the common types for design of the case-control study and the key points of design were listed,and the specifications for report of the result of case-control study based on the clinical problems about hospital-acquired infections were summed up.RESULTS By starting from the key points for the design of the case-control study,the design framework of the study that con-tained three core elements was established based on the characteristics of related research on hospital-acquired in-fections,the three core elements were as follows:clarifying the temporal logic of exposure,developing strategies for the control of confounding factors,selecting appropriate statistical models.Meanwhile,the reporting specifica-tions were formulated to achieve the methodological transparency.CONCLUSION Clarifying the key points for de-sign of the case-control study and the specifications for report of results can improve the quality of clinical research on case-control design for hospital-acquired infection cases and boost the scientificity and feasibility.

Objective:To analyze the correlation between neutrophil-to-lymphocyte (NLR) and urinary albumin-to-creatinine ratio (UACR) in patients with diabetic nephropathies (DN).Methods:A total of 200 patients with DN admitted to the Endocrinology Department of the Sunshine Xinkang Hospital of Huainan from January 2020 to June 2022 were included, and 167 patients with simple type 2 diabetes mellitus (T2DM) admitted during the same period were randomly included. Clinical baseline data of all patients were collected, and indexes such as NLR and UACR were detected in the two groups. Pearson correlation analysis was used to evaluate the correlation between the above indicators and clinical indicators of diabetic nephropathy, and multi-factor logistic regression analysis was used to evaluate the influencing factors of the occurrence of DN. Receiver operating characteristic (ROC) curve was used to analyze the clinical value of DN recognition.Results:The diabetes course, glycated hemoglobin A 1c (HbA 1c), creatinine (Cr), blood urea nitrogen (BUN), NLR, interleukin (IL)-6, high-sensitivity C-reactive protein (hs-CRP) and UACR levels in DN group were significantly higher than those in the T2DM group, but the estimated glomerular filtration rate (eGFR) in the DN group was significantly lower than that in the T2DM group (all P<0.05). Pearson correlation analysis showed that UACR was positively correlated with NLR ( r=0.595, P<0.001), HbA 1c ( r=0.642, P<0.01), Cr ( r=0.469, P=0.014) and IL-6 ( r=0.395, P=0.037). It was negatively correlated with eGFR ( r=-0.483, P<0.01). Multivariate logistic regression analysis showed that the duration of diabetes mellitus, HbA 1c, UACR and NLR were independent risk factors for the development of DN in T2DM patients ( OR=2.87, 1.14, 1.44, 2.01, all P<0.05). ROC curve showed that UACR had the highest clinical value in the diagnosis of DN, and its area under the curve (AUC) (95% CI) was 0.90 (0.86-0.94), which was significantly higher than NLR and HbA 1c (all P< 0.05). The value of NLR in the diagnosis of DN was higher than that of HbA 1c, with AUC of 0.83 (0.78-0.88) and 0.76 (0.70-0.82), respectively ( P<0.05). Conclusions:The NLR and UACR in peripheral blood of patients with DN are significantly increased, and these indicators are correlated with renal function in patients with DN, and are potential markers for the diagnosis of DN.

Objective:To investigate the distribution of iodine and other chemical elements in soil, grain and vegetables in different water iodine areas of Xi'an City, and to provide theoretical basis for prevention and treatment of iodine related diseases and water improvement measures.Methods:From September to November 2021, a stratified cluster sampling method was used to select three survey villages in Xi'an, namely Yehu Village, Xingbei Village, and Quanzhong Village, where the iodine level of residents' drinking water < 10, 10 - 100, and > 100 μg/L. Drinking water samples were collected from seven survey sites based on the source of domestic drinking water to determine the iodine level of the water. At the same time, soil samples of cultivated land, residents' grains (wheat, corn), and vegetables were collected from survey villages to determine the content of 14 elements including calcium, iron, magnesium, chromium, nickel, copper, zinc, cadmium, lead, arsenic, mercury, selenium, iodine, and fluoride.Results:The iodine level in the water of 7 survey sites in three survey villages was 5.80, 6.40, 25.51, 42.20, 53.90, 111.65, and 177.63 μg/L, respectively. A total of 70 samples of soil, 65 samples of wheat, 76 samples of corn, and 141 samples of vegetables were collected. Among them, the levels of various elements in vegetables and grains were lower than those in the soil. Only calcium and fluoride were higher in vegetables than in grains, while iron, chromium, copper, zinc, selenium, and iodine were lower in vegetables than in grains. According to the range of water iodine level, there were statistically significant differences in the content of calcium, iron, chromium, nickel, copper, zinc, mercury, iodine, and fluoride in soils from different water iodine regions ( Fcalcium, iron, chromium, nickel = 42.04, 13.55, 12.22, 11.20, Hcopper, zinc, mercury, iodine, fluoride = 14.27, 9.19, 14.72, 25.14, 16.50, P < 0.05). The comparison of magnesium, zinc, cadmium, arsenic, and selenium content in wheat showed statistically significant differences ( Fadmium, selenium = 6.34, 3.31, Hmagnesium, zinc, arsenic = 6.12, 11.55, 6.23, P < 0.05). The comparison of calcium, iron, magnesium, chromium, nickel, copper, zinc, cadmium, lead, arsenic, mercury, iodine, and fluoride content in corn showed statistically significant differences ( Fmagnesium, chromium, nickel, copper, zinc, iodine = 18.89, 13.76, 17.86, 24.17, 28.46, 15.96, Hcalcium, iron, cadmium, lead, arsenic, mercury, fluoride = 11.57, 40.53, 26.50, 33.05, 33.73, 36.01, 29.21, P < 0.05). The comparison of calcium, iron, magnesium, chromium, zinc, cadmium, lead, arsenic, mercury, and selenium content in vegetables showed statistically significant differences ( H = 23.93, 8.12, 10.03, 7.01, 16.09, 18.36, 23.07, 6.51, 27.67, 7.86, P < 0.05). Conclusions:There are significant differences in the distribution of 14 elements in soil, grain, and vegetables in different water iodine regions. In addition to drinking water, precise guidance should also be provided based on the iodine content in soil, grain, and vegetables in different water iodine areas.

Aim Mouse model of myocardial hypertro-phy was established via intraperitoneal injection of iso-proterenol(ISO)in mice.This approach allows for an in-depth investigation into the pharmacological effects and mechanisms of action of emodin,offering novel in-sights and directions for the improvement of myocardial hypertrophy.Methods The mice were randomly di-vided into the following groups:control group(CON),emodin group(EMO),MAPK activator control group(EMO+Ani),model group(ISO),treatment group(ISO+EMO),and activator intervention group(ISO+EMO+Ani).After treatment with emodin and inter-vention with MAPK activator,the heart weight ratio and cardiac size of each group were observed.Hematoxy-lin-eosin(HE)staining was used to observe the patho-logical changes in cardiac tissue,and kits were utilized to measure the levels of GSH,LDH,and MDA in the serum.Western blot was employed to detect the protein expression levels of inflammatory and oxidative factors,as well as p-p38,p-ERK,p38,and ERK in cardiac tis-sue.Results Emodin can significantly inhibit the production of myocardial inflammatory and oxidative factors induced by ISO,thereby effectively alleviating the degree of myocardial hypertrophy and fibrosis.Af-ter the p38/ERK signaling pathway was specifically ac-tivated by farnesol,the improvement effect of emodin on myocardial hypertrophy was weakened.Further comparison revealed that,compared with the myocardi-al hypertrophy pathological model group,the pathologi-cal protein expression levels in the farnesol-treated group showed no significant difference,and were even higher in some indicators.Conclusion Emodin can effectively inhibit the release of inflammatory factors and improve the state of oxidative stress by modulating the p38/ERK signaling pathway,thereby exerting an ameliorative effect on myocardial hypertrophy.

Aim To investigate the effects of tran-scription factor FoxO1 on acute kidney injury(AKI)induced by ischemic reperfusion injury(IRI)and to explore the underlying mechanisms.Methods Male C57BL/6 mice were randomly divided into four groups:Sham,IRI,FoxO1 inducible cell-specific knockout(FoxO1 icKO),and IRI+FoxO1 icKO.Tamoxifen(25 mg·kg-1)was intraperitoneally injec-ted to specifically knock out FoxO1 in mouse macro-phages,and a unilateral renal IRI model was estab-lished.The levels of serum creatinine(Scr),blood u-rea nitrogen(BUN),Fe2+,malondialdehyde(MDA),reactive oxygen species(ROS),and reduced glutathi-one(GSH)in renal tissues were detected.Hematoxy-lin-eosin(HE)staining was used to observe the patho-logical changes in renal tissues.Quantitative polymer-ase chain reaction(qPCR)was used to detect the mR-NA levels of inflammatory factors such as IL-1β and MCP1 in renal tissues.Western blot was used to detect the expression levels of apoptosis and ferroptosis-relat-ed proteins.Results Compared with the control group,the levels of Scr and BUN in the IRI group were significantly upregulated,the infiltration of inflammato-ry factors IL-1β,TNF-α and MCP1 increased,the pro-tein expressions of Bax/Bc12,cleaved-caspase-3/caspase-3,cytochrome C,and FTH1 in renal tissues were significantly enhanced,while the expression of GPX4 decreased.In addition,the levels of Fe2+,MDA and ROS in the renal cortex of the IRI group signifi-cantly increased,and the level of GSH markedly de-creased(P＜0.05).Compared with the IRI group,the levels of Scr and BUN in the FoxO1 icKO group were significantly reduced,the infiltration of inflammatory factors was alleviated,the expression of apoptosis-relat-ed proteins in renal tissue decreased,the expression level of ferroptosis protein GPX4 increased,and the ex-pression of FTH1 decreased.The levels of Fe2+,MDA and ROS in the renal cortex decreased,and the level of GSH significantly increased(P＜0.05).Conclusion Inducing the specific knockout of FoxO1 in macro-phages can alleviate AKI induced by IRI,and its mech-anism may be related to the inhibition of ferroptosis caused by IRI by FoxO1.

OBJECTIVE To summarize the key points for design of case-control study,analyze the data and summa-rize the specifications so as to raise the quality of related clinical research on hospital-acquired infections.METHODS The types for design of the case-control study were systematically summarized based on the character-istics of hospital-acquired infection data with strong timeliness and various confounding factors.The design,data clearance and statistical analysis method were studied by analysis of typical cases,the common types for design of the case-control study and the key points of design were listed,and the specifications for report of the result of case-control study based on the clinical problems about hospital-acquired infections were summed up.RESULTS By starting from the key points for the design of the case-control study,the design framework of the study that con-tained three core elements was established based on the characteristics of related research on hospital-acquired in-fections,the three core elements were as follows:clarifying the temporal logic of exposure,developing strategies for the control of confounding factors,selecting appropriate statistical models.Meanwhile,the reporting specifica-tions were formulated to achieve the methodological transparency.CONCLUSION Clarifying the key points for de-sign of the case-control study and the specifications for report of results can improve the quality of clinical research on case-control design for hospital-acquired infection cases and boost the scientificity and feasibility.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.