Symptom and syndrome efficacy evaluation scales are indispensable tools for clinical efficacy assessment in traditional Chinese medicine （TCM）， and hold significant value at all stages of new drug research development for spleen and stomach diseases. These scales can provide scientific basis for clinical positioning， efficacy evaluation， and expansion of indications of new drugs. By analyzing the current hotspots and difficulties in research， this study aims to explore the important significance of these scales in the development of new drugs for spleen and stomach diseases， summarize the domestic research progress， and conduct comparative analyses with international studies. Future development trends are also discussed in order to promote the application of symptom and syndrome efficacy evaluation scales in the development of new drugs for spleen and stomach diseases and to advance the moder-nization process of TCM.

Objective To observe the efficacy and safety of Buyi Pishen Prescription combined with alisartan ester tablets in patients with primary chronic kidney disease stage 3(CKD3)with spleen-kidney qi deficiency syndrome.Methods Totally 80 patients were divided into treatment group and control group using a random number table method,with 40 cases in each group.Both groups received basic treatment and alisartan ester tablets(1 tablet/day,once daily,orally).The treatment group additionally received the Buyi Pishen Prescription(1 dosage/day,twice daily,orally).Both groups were treated for 24 weeks.TCM syndrome efficacy and clinical efficacy were evaluated.At 8,16 and 24 weeks,24-hour urinary protein(24 hUpro),serum creatinine(SCr),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)and TCM syndrome scores were measured.Serum oxidative stress markers(SOD,GSH-Px,MDA)were assessed before and after treatment.Blood potassium and liver function were monitored throughout.Results The total effective rate for TCM syndrome efficacy was 82.50%(33/40)in the treatment group and 60.00%(24/40)in the control group(P<0.05),and the treatment group was better than the control group.The total clinical efficacy rate was 77.50%(31/40)in the treatment group and 50.00%(20/40)in the control group,and the treatment group was better than the control group(P<0.05).Compared with before treatment,the treatment group showed a significant decrease in 24 hUpro and SCr at weeks 8,16 and 24,a significant decrease in BUN at weeks 16 and 24,and a significant increase in eGFR at weeks 8,16 and 24(P<0.01);the control group showed a decrease in 24 hUpro at weeks 8,16 and 24 of treatment(P<0.05),a decrease in SCr at weeks 16 and 24 of treatment(P<0.05),and an increase in eGFR at weeks 16 and 24 of treatment(P<0.05).In addition,the treatment group had lower 24 hUpro and SCr at weeks 16 and 24 of treatment than the control group(P<0.05,P<0.01),and higher eGFR than the control group(P<0.05,P<0.01).Compared with before treatment,the total scores of both the treatment group and control group significantly decreased at 16 and 24 weeks of treatment(P<0.01).The total scores of the treatment group were significantly lower than those of the control group at 8,16 and 24 weeks of treatment(P<0.01).Compared with before treatment,both groups showed a significant increase in serum SOD levels(P<0.05,P<0.01)and a significant decrease in MDA levels after treatment(P<0.05,P<0.01).The improvement in the treatment group was more significant than that in the control group(P<0.05).Both groups showed no abnormalities in blood potassium and liver function.Conclusion Buyi Pishen Prescription combined with alisartan ester tablets can reduce the levels of 24 hUpro,BUN and SCr,improve eGFR,alleviate TCM symptoms,and delay CKD progression in CKD3 patients with spleen-kidney qi deficiency syndrome,which can effectively reduce the serum MDA level and increase the antioxidant enzyme SOD level in patients,and its mechanism may be related to improving oxidative stress levels.

Objective To observe the efficacy and safety of Buyi Pishen Prescription combined with alisartan ester tablets in patients with primary chronic kidney disease stage 3(CKD3)with spleen-kidney qi deficiency syndrome.Methods Totally 80 patients were divided into treatment group and control group using a random number table method,with 40 cases in each group.Both groups received basic treatment and alisartan ester tablets(1 tablet/day,once daily,orally).The treatment group additionally received the Buyi Pishen Prescription(1 dosage/day,twice daily,orally).Both groups were treated for 24 weeks.TCM syndrome efficacy and clinical efficacy were evaluated.At 8,16 and 24 weeks,24-hour urinary protein(24 hUpro),serum creatinine(SCr),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)and TCM syndrome scores were measured.Serum oxidative stress markers(SOD,GSH-Px,MDA)were assessed before and after treatment.Blood potassium and liver function were monitored throughout.Results The total effective rate for TCM syndrome efficacy was 82.50%(33/40)in the treatment group and 60.00%(24/40)in the control group(P<0.05),and the treatment group was better than the control group.The total clinical efficacy rate was 77.50%(31/40)in the treatment group and 50.00%(20/40)in the control group,and the treatment group was better than the control group(P<0.05).Compared with before treatment,the treatment group showed a significant decrease in 24 hUpro and SCr at weeks 8,16 and 24,a significant decrease in BUN at weeks 16 and 24,and a significant increase in eGFR at weeks 8,16 and 24(P<0.01);the control group showed a decrease in 24 hUpro at weeks 8,16 and 24 of treatment(P<0.05),a decrease in SCr at weeks 16 and 24 of treatment(P<0.05),and an increase in eGFR at weeks 16 and 24 of treatment(P<0.05).In addition,the treatment group had lower 24 hUpro and SCr at weeks 16 and 24 of treatment than the control group(P<0.05,P<0.01),and higher eGFR than the control group(P<0.05,P<0.01).Compared with before treatment,the total scores of both the treatment group and control group significantly decreased at 16 and 24 weeks of treatment(P<0.01).The total scores of the treatment group were significantly lower than those of the control group at 8,16 and 24 weeks of treatment(P<0.01).Compared with before treatment,both groups showed a significant increase in serum SOD levels(P<0.05,P<0.01)and a significant decrease in MDA levels after treatment(P<0.05,P<0.01).The improvement in the treatment group was more significant than that in the control group(P<0.05).Both groups showed no abnormalities in blood potassium and liver function.Conclusion Buyi Pishen Prescription combined with alisartan ester tablets can reduce the levels of 24 hUpro,BUN and SCr,improve eGFR,alleviate TCM symptoms,and delay CKD progression in CKD3 patients with spleen-kidney qi deficiency syndrome,which can effectively reduce the serum MDA level and increase the antioxidant enzyme SOD level in patients,and its mechanism may be related to improving oxidative stress levels.

ObjectiveTo explore the effect of Ganoderma leucocontextum ethanol extract (GLE) on silicosis and its potential molecular mechanism using network pharmacology, molecular docking technology and animal experiments. Methods i) The components of GLE were analyzed using ultra-performance liquid chromatography-Q Exactive-mass spectrometry (UPLC-QE-MS) method. The active components, potential molecular pathways and targets of GLE in the intervention of inflammation process of silicosis was explored using network pharmacology and molecular docking technology. ii) Specific pathogen free male C57BL6/J mice were divided into four groups with 10 mice in each group. The mice in the silicosis model group and GLE intervention group were given a dose of 80 μL silica suspension with a mass concentration of 50 g/L once by non-exposed tracheal instillation, and the mice in the blank control group and GLE control group were given an equal volume of sterile 0.9% sodium chloride solution. From the second day after modeling, GLE control group and GLE intervention group were given GLE at a dose of 200 mg/(kg•d) by gavage, while blank control group and silicosis model group were given the same volume of 0.9% sodium chloride solution by gavage, once per day for 35 days. After that, the histopathological changes of lung tissues of mice were observed, the lung mass coefficient, inflammation score and the ratio of collagen deposition area were calculated, and the levels of tumor necrosis factor (TNF) -α, interleukin (IL) -1β and IL-6 in the lung tissues of mice were detected by enzyme-linked immunosorbent assay. Results i) A total of 76 active components of GLE were detected by UPLC-QE-MS. Among them, 36 ingredients met the screening criteria of the five principles of drug-like components. A total of 67 potential targets of the 36 GLE active ingredients to improve the inflammatory response of silicosis were screened based on the network pharmacology theory. The result of Kyoto Encyclopedia of Genes and Genomes enrichment analysis and Gene Ontology functional analysis showed that IL signaling and cytokine signaling of immune cells played a key role in the process of anti-silicosis of GLE. The results of molecular docking showed that the top 10 targets based on the 67 intersection targets were TNF, IL6, B-cell lymphoma 2, cellular tumor antigen p53, Caspase-3 subunit p12, JUN, epidermal growth factor receptor, IL1B, 67 kDa matrix metalloproteinase-9 and prostaglandin G/H synthase 2. The result of protein-protein interaction analysis showed that glycyrrhetinic acid had the strongest affinity with the key targets TNF-α, IL-1β and IL-6, followed by ganoderma acid DM, alismatol C, ganoderma acid β and red sapogenin. ii) The results of histopathological examination showed that the inflammatory response and collagen deposition were alleviated in the lungs of mice with silicosis. The lung mass coefficient, inflammation score, ratio of collagen deposition area and IL-6 expression in lung were lower in mice of the GLE intervention group (all P<0.05), compared with the silicosis model group. However, there was no significant difference in the levels of TNF-α and IL-1β in lung tissues between the two groups (all P>0.05). Conclusion GLE may reduce silica-induced lung inflammation and fibrosis by inhibiting the IL-6 level in lung tissues of mice. Its mechanism is associated with the synergistic action of multi-components, multi-targets and multi-pathways.

Objective To investigate value and risk factors of pelvic floor three-dimensional ultrasound parameters in single spontaneous delivery primipara with bladder neck funnel formation at 6-8weeks after delivery.Methods A total of 108 cases of single spontaneous delivery primipara were selected as research objects according to three-dimensional ultrasound indexes of pelvic floor,they were assigned into two groups:Observation group(40 cases)with bladder neck funnel formation and control group(68 cases)without bladder neck funnel formation.Three-dimensional ultrasound indexes of pelvic floor and clinical symptoms were compared between two groups.Results The incidence of stress urinary incontinence(SUI),anterior vaginal wall prolapse,bladder neck distance(BND),posterior urethrovesical angle(PUA)in Valsalva state,levator hiatus area(LHA)in resting and Valsalva states,levator hiatus length(LHL),and changes in LHL(△ LHL)in observation group were all higher than those in control group(P＜0.05).Logistic regression analysis revealed that SUI and anterior vaginal wall prolapse are independent risk factors for bladder neck funnel formation,adjusted OR were 11.255 and 3.643;Resting state and Valsalva state LHA,LHL,and △ LHL were also independent risk factors for bladder neck funnel formation(P＜0.05).Receiver operating characteristic(ROC)curve analysis revealed that area under the curve(AUC)for diagnosing bladder neck funnel formation in SUI and anterior vaginal wall prolapse were 0.744 and 0.615,respectively;In ultrasound indicators,when the LHL of Valsalva state is＞63.5mm,the AUC is 0.706;The diagnostic sensitivity of the combination factor 1(resting state LHA+Valsalva state LHA)is 95.0％;The diagnostic specificity of the combination factor 2(Valsalva state LHL+△LHL)is 80.9％.Conclusion In patients of single spontaneous delivery primipara with bladder neck funnel formation,occurrence of SUI and vaginal anterior wall prolapse,increased LHA and LHL under two states and △LHL were independent risk factors.The diagnostic sensitivity of the combination factor 1 was higher than single index,the diagnostic specificity of the combination factor 2 was higher.

Objective To analyze the disease burden of multidrug-resistant tuberculosis (MDR-TB) in China and regions with different income levels in the world from 1990 to 2019. Methods Using the Global Burden of Disease Study 2019 (GBD2019) results, the changes of the disease burden of MDR-TB in China and regions with different income levels in the world were described and analyzed using the Joinpoint Regression Program 4.8.0.1 software. Results From 1990 to 2019, the age standardized incidence, mortality and DALY rates in China and other areas with different income levels in the world basically showed a trend of first rising and then decreasing at the turning point of the late 20th century and early 21st century, except for low-income areas where the age standardized incidence rate showed an overall upward trend. In 2019, the incidence rate, mortality and DALY rate of MDR-TB in China were 9 times, 6.67 times and 6.89 times higher than those in high-income areas, respectively. The incidence rate in China was 6 times lower than that in low and middle-income areas, while the mortality and DALY rate in China were 26 times and 32.53 times lower than those in low-income areas, respectively. The age standardized incidence, mortality rate and DALY rate of MDR-TB in men were higher than those in women. Risk factors for the burden of MDR-TB disease included alcohol consumption, smoking, and high fasting blood glucose. Conclusion From 1990 to 2019, there are significant regional and gender differences in the disease burden of multidrug-resistant tuberculosis in China and regions with different income levels in the world. Multidrug-resistant tuberculosis is still a major challenge for tuberculosis control in the world. It is necessary to develop more effective control strategies and health care systems to deal with multidrug-resistant tuberculosis.

Objective:To evaluate the efficacy and safety of mitoxantrone hydrochloride liposome injection in the treatment of peripheral T-cell lymphoma (PTCL) in a real-world setting.Methods:This was a real-world ambispective cohort study (MOMENT study) (Chinese clinical trial registry number: ChiCTR2200062067). Clinical data were collected from 198 patients who received mitoxantrone hydrochloride liposome injection as monotherapy or combination therapy at 37 hospitals from January 2022 to January 2023, including 166 patients in the retrospective cohort and 32 patients in the prospective cohort; 10 patients in the treatment-na?ve group and 188 patients in the relapsed/refractory group. Clinical characteristics, efficacy and adverse events were summarized, and the overall survival (OS) and progression-free survival (PFS) were analyzed.Results:All 198 patients were treated with mitoxantrone hydrochloride liposome injection for a median of 3 cycles (range 1-7 cycles); 28 cases were treated with mitoxantrone hydrochloride liposome injection as monotherapy, and 170 cases were treated with the combination regimen. Among 188 relapsed/refractory patients, 45 cases (23.9%) were in complete remission (CR), 82 cases (43.6%) were in partial remission (PR), and 28 cases (14.9%) were in disease stabilization (SD), and 33 cases (17.6%) were in disease progression (PD), with an objective remission rate (ORR) of 67.6% (127/188). Among 10 treatment-na?ve patients, 4 cases (40.0%) were in CR, 5 cases (50.0%) were in PR, and 1 case (10.0%) was in PD, with an ORR of 90.0% (9/10). The median follow-up time was 2.9 months (95% CI 2.4-3.7 months), and the median PFS and OS of patients in relapsed/refractory and treatment-na?ve groups were not reached. In relapsed/refractory patients, the difference in ORR between patients with different number of treatment lines of mitoxantrone hydrochloride liposome injection [ORR of the second-line, the third-line and ≥the forth-line treatment was 74.4% (67/90), 73.9% (34/46) and 50.0% (26/52)] was statistically significant ( P = 0.008). Of the 198 PTCL patients, 182 cases (91.9%) experienced at least 1 time of treatment-related adverse events, and the incidence rate of ≥grade 3 adverse events was 66.7% (132/198), which was mainly characterized by hematologic adverse events. The ≥ grade 3 hematologic adverse events mainly included decreased lymphocyte count, decreased neutrophil count, decreased white blood cell count, and anemia; non-hematologic adverse events were mostly grade 1-2, mainly including pigmentation disorders and upper respiratory tract infection. Conclusions:The use of mitoxantrone hydrochloride liposome injection-containing regimen in the treatment of PTCL has definite efficacy and is well tolerated, and it is a new therapeutic option for PTCL patients.

Objective:To establish a prediction model of acute gastrointestinal injury (AGI) above grade II in elderly patients with severe pneumonia, and to evaluate and validate the model internally.Methods:A retrospective analysis was performed on 268 patients aged >65 years with severe pneumonia admitted to the Second People′s Hospital of Hefei from June 2019 to May 2022 (207 cases in the training set and 61 cases in the verification set). Sixteen indicators, including age, sex, underlying disease, pneumonia Severity index (PSI) score, dosage of sedative and analgesic drugs, and mechanical ventilation time of all patients were collected. After logistic regression analysis in the training set, a model was established to predict AGI above grade Ⅱ in elderly patients with severe pneumonia. Receiver operating characteristic (ROC) curve was drawed and correction curve was used to evaluate the reliability of the model. The model was internally validated by validation set data.Results:Among 207 patients with severe pneumonia in the training set, 50 patients developed AGI above grade Ⅱ during treatment. The prediction model was established by logistic regression analysis as follows: When L=Sequential Organ Failure Assessment (SOFA)×0.181+ PSI score×0.066+ propofol dosage×0.607+ reifentanil dosage×1.187, L>19.288, it can be considered that patients with severe pneumonia have a 93.24% chance of developing grade Ⅱ or above AGI. The ROC curve showed that the model was well differentiated, AUC=0.960. H-L test indicated (χ 2=7.39, P=0.496>0.05) the model fit was good. The sensitivity and specificity of the model were 82.00% and 96.82% respectively. AUC=94.58% (sensitivity 81.25%, specificity 93.33%), H-L test indicated ( χ 2=4.51, P=0.808>0.05) the prediction accuracy was 90.16%. Conclusions:The prediction model for AGI after severe pneumonia in elderly patients can be used clinically to help predict the occurrence of AGI in elderly patients with multiple injuries.

While generative artificial intelligence(AI), exemplified by ChatGPT, demonstrated impressive capabilities in understanding the semantics and context of natural language, and generating coherent and meaningful responses, its performance in the medical field, which required high-level expertise and complex reasoning, remained uncertain. This article aimed to explore the potential applications and challenges of generative AI technology, with ChatGPT as a representative example, in enhancing the capabilities of primary healthcare services. Generative AI, represented by ChatGPT, had potential applications in enhancing primary healthcare services, including clinical assistance in diagnosis, electronic medical record documentation, remote management of chronic patients, and patient education. However, limitations such as the inability to guarantee accuracy, lack of doctor-patient interaction, language barriers, and concerns related to data security, patient privacy, and ethical considerations constrained its practical implementation. Therefore, the application of ChatGPT in improving the capabilities of primary healthcare services required extensive discussion and analysis throughout society. A comprehensive evaluation of potential risks and the establishment of corresponding policies and regulations were necessary to ensure the prudent and responsible introduction and application of ChatGPT, ultimately achieving the goal of empowering primary healthcare services.

Objective:To evaluate the effect of melatonin preconditioning on hepatic ischemia-reperfusion (I/R) injury in rats with non-alcoholic fatty liver disease (NAFLD).Methods:Forty-eight SPF male Sprague-Dawley rats, aged 10-12 weeks, weighing 200-230 g, were divided into 4 groups ( n=12 each) using a random number table method: control group (Con group), NAFLD group, NAFLD + hepatic I/R group (NAFLD+ HIR group), and NAFLD + hepatic I/R + melatonin treatment group (NAFLD+ HIR+ MT group). The NAFLD model was developed by a high-fat and high-glucose diet (10% glucose, 10% fat) for 8 consecutive weeks in NAFLD, NAFLD+ HIR and NAFLD+ HIR+ M groups, and rats were fed with common chow and freely drank water in the other groups.Melatonin 10 mg/kg was given intragastrically daily for 2 consecutive weeks before developing the model in group NAFLD+ HIR+ MT.The model of liver I/R injury was developed by clipping the hepatic artery and portal vein for 20 min, opening for 5 min, and re-clamping for 20 min followed by restoration of perfusion.Blood samples from inferior vena cava were collected and liver tissues were obtained at 6 h of reperfusion to detect serum levels of insulin, blood glucose, free fatty acid (FFA), triglyceride (TG), alanine aminotransferase (ALT), aspartate amino transferase (AST) and ferritin, and insulin resistance index was calculated.The levels of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), reactive oxygen species (ROS) and Fe 2+ in liver tissues were detected by enzyme-linked immunosorbent assay, the pathological changes of liver tissues were examined with a light microscope after hematoxylin-eosin staining.The expression of nuclear factor E2-related factor 2 (Nrf2), lysophosphatidylcholine acyltransferase 3 (LPCAT3), long-chain fatty acyl-CoA synthase 4 (ACSL4) and glutathione peptide peroxidase 4 (GPX4) was detected by Western blot. Results:Compared with Con group, the levels of serum FFA, TG, ALT, AST and ferritin and insulin resistance index were significantly increased, the levels of ROS and Fe 2+ in liver tissues were increased, the levels of GSH-Px and SOD were decreased, the expression of ACSL4 and LPCAT3 was up-regulated, and the expression of Nrf2 and GPX4 was down-regulated in NAFLD group ( P<0.05). Compared with NAFLD group, the serum levels of FFA, TG, ALT, AST and ferritin and insulin resistance index were significantly increased, the levels of ROS and Fe 2+ were decreased, the levels of GSH-Px and SOD were increased, the expression of ACSL4 and LPCAT3 was up-regulated, and the expression of Nrf2 and GPX4 was down-regulated in NAFLD+ HIR group ( P<0.05). Compared with NAFLD+ HIR group, the serum levels of FFA, TG, ALT, AST and ferritin and insulin resistance index were significantly increased, the levels of ROS and Fe 2+ were decreased, the levels of GSH-Px and SOD were increased, the expression of ACSL4 and LPCAT3 was down-regulated, and the expression of Nrf2 and GPX4 was up-regulated in NAFLD+ HIR+ MT group ( P<0.05). Conclusions:Melatonin preconditioning can alleviate hepatic I/R injury in rats with NAFLD, and the mechanism may be related to activation of Nrf2 signaling pathway, reduction of lipid peroxidation and inhibition of ferroptosis.