Radiotherapy is a crucial treatment modality for head and neck tumors. However, while effectively killing tumor cells, it significantly disrupts the homeostasis of the oral microecology, which is closely associated with various complications such as radiation-induced oral mucositis. Literature review indicates that as radiotherapy doses accumulate and treatment durations extend, the richness and diversity of the oral microbiota show a declining trend, with the genus Streptococcus decreasing most markedly. In contrast, radiotherapy selectively promotes the proliferation of bacterial phyla such as Proteobacteria and Bacteroidetes, which are rich in opportunistic pathogens. Mechanistically, radiotherapy activates the nuclear factor-kappa B pathway, triggering chronic inflammation and oxidative stress, damaging the epithelial barrier, suppressing local immunity, and causing damage to organs such as the salivary glands. It can also induce systemic diseases via the oral-gut axis, forming a multi-level, interconnected pathogenic network. In terms of interventions, treatment strategies including probiotics and prebiotics have shown promising efficacy against side effects such as radiation-induced oral mucositis. Saliva-based oral microbiota transplantation is an emerging strategy that is expected to become widely utilized for restoring oral microecological balance. Existing interventions provide preliminary pathways for clinical practice, but this field still faces several key scientific questions. The association between oral microecology and systemic diseases remains largely correlative, lacking causal evidence. Furthermore, critical parameters for oral microbiota transplantation, such as donor screening criteria, transplantation protocols, and long-term safety, are not yet well-defined. Therefore, future research should focus on conducting large-scale clinical trials to establish standardized protocols and safety evaluation systems for oral microecological interventions, and explore combined treatment therapies such as probiotics, prebiotics, and microbiota transplantation to advance the development of personalized precision modulation. These will enable more effective management of radiotherapy-induced oral microecological dysbiosis and improve treatment outcomes and quality of life for patients with head and neck tumors.

[Objective] To explore the strategy of blood management in patients with massive transfusion in the frigid plateau region. [Methods] The treatment process of a patient with liver rupture in the frigid plateau region was analyzed, and the blood management strategy of the frigid plateau region was discussed in combination with the difficulties of blood transfusion and literature review. [Results] The preoperative complete blood count (CBC) test results of the patient were as follows: RBC 3.14×10¹²/L, Hb 10⁶ g/L, HCT 30.40%, PLT 115.00×10⁹/L; coagulation function: PT 18.9 s, FiB 1.31 g/L, DD > 6 μg/mL, FDP 25.86 μg/mL; ultrasound examination and imaging manifestations suggested liver contusion and laceration / intraparenchymal hematoma, splenic contusion and laceration, and massive blood accumulation in the abdominal cavity; it was estimated that the patient's blood loss was ≥ 2 000 mL, and massive blood transfusion was required during the operation; red blood cell components were timely transfused during the operation, and the blood component transfusion was guided according to the patient's CBC and coagulation function test results, providing strong support and guarantee for the successful treatment of the patient. The patient recovered well after the operation, and the CBC test results were as follows: RBC 4.32×10¹²/L, Hb 144 g/L, HCT 39.50%, PLT 329.00×10⁹/L; coagulation function: APTT 29.3 s, PT 12.1 s, FiB 2.728 g/L, DD>6 μg/mL, FDP 25.86 μg/mL. The patient was discharged after 20 days, and regular follow-up reexamination showed no abnormal results. [Conclusion] Individualized blood management strategy should comprehensively consider the patient’s clinical symptoms, the degree of hemoglobin decline, dynamic coagulation test results and existing treatment conditions. Efficient and reasonable patient blood management strategies can effectively improve the clinical outcomes of massive transfusion patients in the frigid plateau region.

ObjectiveTo preliminarily explore the active components and target pathways of Angelicae Sinensis Radix-Polygonati Rhizoma （ASR-PR） herb pair in the treatment of simple obesity through network pharmacology and molecular docking， and to verify and investigate its mechanism of action via animal experiments. MethodsThe chemical constituents and targets of ASR and PR were predicted using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）. Targets related to simple obesity were identified by retrieving the GeneCards， Online Mendelian Inheritance in Man （OMIM）， Pharmacogenomics Knowledgebase （PharmGKB）， and DisGeNET databases. The intersection of drug and disease targets was used to construct an active component-target network using Cytoscape software. This network was imported into the STRING database to construct a protein-protein interaction （PPI） network， and topological analysis was conducted to identify core genes. Gene Ontology （GO） analysis and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis and mapping were performed using the DAVID database and the Microbioinformatics platform. AutoDock 1.5.7 software was used to perform molecular docking between the top five active components and core targets. An animal model of simple obesity was established by feeding C57BL/6J mice a high-fat diet. The mice were administered ASR （2.06 g·kg^-1）， PR （2.06 g·kg^-1）， or ASR-PR （4.11 g·kg^-1） for 10 weeks， while the model group received an equal volume of purified water by gavage. After the administration period， the mice were sacrificed to measure body fat weight and serum levels of total cholesterol （TC）， triglycerides （TG）， high-density lipoprotein （HDL）， and low-density lipoprotein （LDL）. Hematoxylin-eosin （HE） staining was used to observe histopathological sections of liver and adipose tissue. Serum levels of leptin， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） were determined by enzyme-linked immunosorbent assay （ELISA）， and the mRNA expression levels of epidermal growth factor receptor （EGFR） and signal transducer and activator of transcription 3 （STAT3） in liver tissue were detected by real-time quantitative polymerase chain reaction （Real-time PCR）. ResultsNetwork pharmacology and molecular docking results indicated that the treatment of simple obesity by ASR-PR may involve the regulation of protein expression of core targets EGFR and STAT3 by its main components MOL009760 （Siberian glycoside A_qt）， MOL003889 （methyl protodioscin_qt）， MOL009766 （resveratrol）， MOL006331 （4′，5-dihydroxyflavone）， and MOL004941 （baicalin）， thereby modulating the PI3K/Akt and JAK/STAT signaling pathways. The animal experiment results showed that compared with the normal group， the model group had significantly increased body weight， body fat weight， and serum levels of TG， TC， TNF-α， IL-6， and leptin （P<0.01）. EGFR mRNA expression was significantly elevated （P<0.05）， while STAT3 mRNA expression was significantly decreased （P<0.01）. Histological analysis revealed disordered hepatic architecture in the model group， with pronounced lipid vacuoles， cytoplasmic loosening， lipid accumulation， and steatosis. Adipocytes in white adipose tissue （WAT） and brown adipose tissue （BAT） of the model group exhibited markedly increased diameters， reduced cell counts per unit area， and irregular morphology. Compared with the model group， the ASR-PR group significantly reduced body weight， body fat weight， serum TC， IL-6， TNF-α， leptin levels， and EGFR mRNA expression （P<0.01）. TG levels were also significantly decreased （P<0.05）， while STAT3 mRNA expression was significantly increased （P<0.01）. Histopathological improvements included reduced size and number of hepatic lipid vacuoles and restoration of liver cell morphology toward that of the normal group. The diameter of adipocytes significantly decreased， and the number of adipocytes per unit area increased. ConclusionASR-PR may regulate the expression of key target proteins such as EGFR and STAT3 via its core active components， modulate the PI3K/Akt and JAK/STAT signaling pathways， repair damaged liver and adipose tissues， and thereby alleviate the progression of obesity in mice.

Objective:To investigate the multiple mediating effects of anxiety and depression on the relationship between dietary nutri-tion and perimenopausal symptoms in middle-aged and elderly women.Methods:A total of 1129 middle-aged and older women were surveyed using a dietary nutrition status questionnaire,the modified Kupperman Index,the Patient Health Questionnaire-9,and the Generalized Anxiety Disorder 7-item scale.The multiple mediating effect analysis was performed using the PROCESS macro in SPSS.Results:Dietary nutrition,anxiety,and depression were all significantly associated with perimenopausal symptoms(P<0.01).Dietary nutrition had a significant direct impact on perimenopausal symptoms(β=0.06,95%CI=0.002-0.119),and also exerted indirect nega-tive effects through three pathways:anxiety(β=0.059,95%CI=0.031-0.091),accounting for 29.65%of the total effect;depression(β=0.034,95%CI=0.017-0.054),accounting for 17.29%of the total effect;and anxiety-depression(β=0.045,95%CI=0.024-0.073),accounting for 22.76%of the total effect.Conclusion:Dietary nutrition not only directly affects perimenopausal symptoms,but also influences them through the mediating effects of anxiety and depression.

Objective:To investigate the association between fibroblast growth factor 21(FGF21)and chronic kidney disease(CKD)in a prediabetic population by conducting a 4-year prospective cohort study among community-dwelling residents aged≥40 years in Guangzhou,China.Methods:A total of 1505 subjects who met the criteria for prediabetes and had complete baseline data were col-lected from the 2012 REACTION cohort,and they were followed up for 4 years to observe newly-onset CKD and the changes in urinary albumin-to-creatinine ratio(UACR)and estimated glomerular filtration rate(eGFR).Results:Among the 1 505 subjects with predia-betes,142 reached the diagnostic criteria for CKD during follow-up,yielding an overall incidence rate of 9.43%(95%CI=7.895%-10.902%).According to baseline serum FGF21 level,the subjects were divided into Q1-Q4 groups,with the lowest level of FGF21 in the Q1 group,and the Q4 group had a significantly higher eGFR than the other groups(P<0.05).After a mean follow-up time of 4 years,UACR was increased by 0.87 mg/g(P<0.001)and eGFR was reduced by 4.8 mL/(min·1.73 m2)(P<0.001).After stratification by FGF21 quartiles,there were differences in the declines of eGFR across groups,with the lowest degree of reduction in the Q2 group.In the multivariate regression model,the serum level of FGF21 was significantly negatively associated with the onset of CKD.When FGF21 was analyzed as a continuous variable in the multivariate lo-gistic regression analysis,FGF21 was still significantly negatively associated with the risk of CKD,which was consistent with the re-sults of the quartile-based analysis.However,restricted cubic spline curves showed an L-shaped non-linear relationship between FGF21 level and the risk of CKD,i.e.,the incidence rate of CKD de-creased with the increase in FGF21 level,but when FGF21 level reached a certain threshold,the risk of CKD no longer changed with FGF21.The linear regression analysis showed that FGF21 was positively associated with UACR and eGFR.Conclusion:In this pro-spective cohort study,FGF21 level might be potentially associated with the future risk of CKD among adults with prediabetes,while fur-ther studies are needed to clarify related mechanisms and clinical value.

Objective:To investigate the efficacy and safety of endovascular treatment (EVT) in young patients with symptomatic intracranial atherosclerotic stenosis (sICAS).Methods:Young patients with sICAS admitted to the Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University, Medical School from January 2020 to July 2024 were included retrospectively. According to the therapeutic modalities, they were divided into a best medical treatment (BMT) group and an EVT group. The efficacy outcome was any stroke recurrence or death within 30 days and 1 year. The safety outcome was symptomatic intracranial hemorrhage (sICH) within 30 days and restenosis within 1 year.Results:A total of 113 patients were enrolled, including 85 males (75.2%), with a median age of 43 (interquartile range, 37-48) years; 44 patients (38.9%) received EVT, and 69 (61.1%) received BMT. Among the 44 patients who underwent EVT, 8 (18.2%) underwent balloon angioplasty and 36 (81.8%) underwent stenting. There was no significant difference in the incidence of stroke recurrence or death within 30 days (2.9% vs. 2.3%) and sICH incidence (0% vs. 2.3%) between the BMT group and the EVT group. However, the 1-year stroke recurrence or death rate in the EVT group was significantly lower than that in the BMT group (18.8% vs. 4.5%; P=0.029). Cox proportional hazards regression analysis showed that EVT was independently associated with a lower incidence of stroke recurrence or death within 1 year (hazard ratio 0.225, 95% confidence interval 0.051-0.996; P<0.05). The median age of the balloon angioplasty group was significantly lower than that of the stenting group (33.5 years vs. 46 years; P=0.007), while there were no significant differences in other demographic and baseline data. There was no significant difference in all efficacy and safety outcome between the balloon angioplasty group and the stenting group. Conclusions:For young patients with sICAS who have an unsatisfactory response to drug treatment, EVT can reduce the risk of stroke recurrence or death within 1 year without increasing the risk of sICH. The safety and efficacy of balloon angioplasty and stenting are similar.

This study explored the application of traditional and complementary medicine (T&CM) in the WHO eastern Mediterranean region, revealing the progressive emphasis on T&CM and its uneven development in the region. The study identified herbal and indigenous traditional medicine as the most prevalent T&CM therapies in the area, but there are relatively few relevant policies and scientific studies, and national health insurance coverage for T&CM has been weak. In addition, China provides assistance in TCM services to some countries through medical teams and TCM centers, while India provides assistance to specific countries through academic exchanges and educational cooperation, promoting the construction and development of local T&CM. It is recommended to provide management experience to countries in the region to strengthen supervision, actively carry out scientific research cooperation and people-to-people exchanges, promote their expansion of health insurance coverage to promote the high-quality development of T&CM in the region.

Objective:To investigate the mechanism of Polygonati Rhizoma-Angelicae Sinensis Radix in the treatment of prediabetes based on network pharmacology and animal experiments.Methods:The active components of Polygonati Rhizoma and Angelicae Sinensis Radix were retrieved from the TCMSP database. The potential targets of the active components were predicted using the Swiss Target Prediction database. The "drug-active component-target" network was constructed by Cytoscape 3.10 software. The disease targets were obtained from OMIM, Genecards, TTD and the U.S. National Library of Medicine. The common targets of drugs and diseases were screened by Venny 2.1.0 platform and imported into STRING database to construct the PPI network. The DAVID database was employed to perform Gene Ontology (GO) functional and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses on the common targets of drugs and diseases. The prediabetes model was established by feeding C57BL/6J mice with high-fat diet. 24 high-fat fed mice were divided into four groups using a random number table: the model group, Polygonati Rhizoma group, Angelicae Sinensis Radix group and Polygonati Rhizoma-Angelicae Sinensis Radix group (herb pair group), with 6 mice in each group. Another 6 normal mice were set as the normal group. Polygonati Rhizoma group was intragastrically administered with Polygonati Rhizoma granule solution at 2.055 g/kg, the Angelicae Sinensis Radix group was intragastrically administered with Angelicae Sinensis Radix granule solution at 2.055 g/kg, and the herb pair group was intragastrically administered with Polygonati Rhizoma-Angelicae Sinensis Radix herb pair at 4.11 g/kg, once daily. The model group and the normal group were intragastrically administered with an equal volume of deionized water for 10 weeks. Fasting blood glucose (FBG) and oral glucose tolerance tests (OGTT) were regularly performed. After 10 weeks of intragastric administration, the levels of serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and fasting insulin (FINS) were measured; glycogen deposition in liver tissues was observed using periodic acid-Schiff (PAS); the mRNA expression levels of FGF1, FGF2, PGF, KDR, IGF1R, INSR, PI3Kca, PI3Kcb, PI3Kcg, Akt1, Akt2 and GSK-3β in liver tissues were detected by Real-time PCR; the protein expression levels of PI3K, phosphorylated (p)-Akt, Akt, p-GSK-3β and GSK-3β in liver tissues of mice were detected by Western blot.Results:205 core targets of Polygonati Rhizoma-Angelicae Sinensis Radix in the treatment of prediabetes were identified; KEGG enrichment analysis revealed that the herb pair may exert hypoglycemic effects by activating the PI3K-Akt signaling pathway. Compared with the model group, the FBG level and AUC values in the herb pair group decreased ( P<0.05), the levels of LDL-C and HDL-C decreased ( P<0.01), the FINS and HOMA-IR levels decreased ( P<0.05), the mRNA expression levels of FGF1, FGF2, PGF, KDR, IGF1R, INSR, PI3Kca, PI3Kcb, PI3Kcg, Akt1, Akt2 and GSK-3β in liver tissues were elevated significantly ( P<0.01), and the protein expression levels of PI3K/β-actin, p-Akt/Akt and p-GSK-3β/GSK-3β in liver tissues of the herb pair group significantly increased ( P<0.01). Conclusion:Polygonati Rhizoma-Angelicae Sinensis Radix may activate PI3K/Akt/GSK-3β signaling pathway by up-regulating FGF1, FGF2, PGF, etc., and affect insulin resistance, glycogen synthesis and other processes, so as to treat prediabetes.

Traditional and complementary medicine (T&CM) in WHO Southeast Asian Region has a long history, rich variety, large scale, strong government support and relatively complete institutional construction. Among them, TCM is highly popular in Thailand and Indonesia and the legislation is relatively complete; there is a relative lack of legislation and policy in India, Nepal and Myanmar; development in Sri Lanka, East Timor, Bhutan, Bangladesh, Maldives and Democratic People's Republic of Korea is still in its infancy. India, Japan, Republic of Korea and China have provided T&CM assistance to the WHO Southeast Asia Region through signing memorandums, financial support, teaching and research cooperation, preparation export, personnel training, medical service base construction, and special assistance in TCM, so as to promote the improvement of T&CM services and standardization in the region. At present, some countries lack T&CM development funds, scientific research data and effective information exchange. In the future, it is necessary to strengthen legislative supervision and cooperation in education and scientific research based on the national conditions and cultural backgrounds of various countries, and promote the better integration of T&CM into the global health system. The dissemination and development of TCM in the WHO Southeast Asia Region can learn from the experience of T&CM in India, Japan and the Republic of Korea in terms of organizational guarantee, standard establishment, cultural publicity and brand effect, pay attention to the exchange and integration with local culture, give full play to the advantages of TCM, and enhance the public's sense of trust, so as to enhance the overseas influence of TCM.

Objective: To examine the impacts of chemotherapy/radiotherapy, targeted therapy, and combined treatment on the quality of life in patients with intermediate and advanced lung cancer. Methods: The patients with intermediate and advanced lung cancer undergoing chemotherapy/radiotherapy, targeted therapy, and combined treatment for the first time were recruited from a tertiary hospital in Weifang City, Shandong Province, using a quota sampling method in September 2023. Basic information was collected using a general information questionnaire, and the quality of life was assessed using the Chinese version of Functional Assessment of Cancer Therapy-General. The investigation started on the 7th day of treatment, and the follow-ups were conducted at 3 and 6 months. The quality of life in patients with different treatment regimens and at different treatment time were compared using repeated measure analysis of variance. Results: There were 26 chemotherapy/radiotherapy patients, 32 targeted therapy patients, and 95 combination therapy patients. There were no significant differences in age, gender, place of residence, education level, self-rated economic status, medical insurance, pathological type and disease stage among the three treatment regimens (all P>0.05). The repeated measure analysis of variance showed an interaction effect between time and group among patients receiving the three treatment regimens (P<0.05). The quality of life scores of patients receiving combination therapy decreased with extended treatment time (all P<0.05). The quality of life scores of patients receiving targeted therapy at 3 and 6 months were lower than those treated for 7 days (both P<0.05). No significant differences were observed in quality of life scores among chemotherapy/radiotherapy patients with different treatment durations (all P>0.05). At 3 and 6 months, patients receiving combination therapy had lower quality of life scores compared to those receiving chemotherapy/radiotherapy or targeted therapy (all P<0.05). Conclusion The decline in quality of life for patients with intermediate and advanced lung cancer undergoing chemotherapy/radiotherapy and targeted therapy is less than that for patients receiving combined therapy.