AIM: To investigate the correlation of serum leukocyte-derived chemotaxin 2(LECT2)and complement C1q/tumor necrosis factor-related protein 5(CTRP5)with diabetic retinopathy(DR).METHODS:A single-center cross-sectional analysis was conducted on 138 patients with type 2 diabetes mellitus(T2DM)admitted to our hospital from April 2023 to April 2025. According to the diagnostic results, they were divided into a non-DR group(60 cases)and a DR group(78 cases). The DR group was further divided into a proliferative DR(PDR)group(29 cases)and a non-proliferative DR(NPDR)group(49 cases). Pearson correlation analysis was used to assess the correlation of LECT2 and CTRP5 with glucose-lipid metabolism indicators. Logistic regression analysis was conducted to identify the influencing factors for the occurrence of DR in T2DM patients. ROC curve analysis was performed to evaluate the diagnostic value of serum LECT2 and CTRP5 for DR in T2DM patients.RESULTS: A comparison of general patient data between the two groups showed no significant differences. The DR group had higher serum levels of LECT2, CTRP5, total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), and homeostatic model assessment of insulin resistance(HOMA-IR)than the non-DR group, while high-density lipoprotein cholesterol(HDL-C)was lower(all P<0.05). The serum levels of LECT2 and CTRP5 in the PDR group were higher than those in the NPDR group(all P<0.05). Serum LECT2 and CTRP5 positively correlated with TC, TG, LDL-C, and HOMA-IR, and negatively correlated with HDL-C(all P<0.001). Logistic results showed that duration of diabetes, TC, TG, LDL-C, HOMA-IR, LECT2, and CTRP5 were risk factors for DR occurrence in T2DM patients(all P<0.05). The ROC curve showed that the AUCs for serum LECT2, CTRP5 alone, and combined in diagnosing DR in T2DM patients were 0.830, 0.839, and 0.915, respectively. The AUC for the combined diagnosis was higher than that of LECT2 or CTRP5 alone according to the DeLong test(Z=2.818, 2.824, P=0.015, 0.012).CONCLUSION:Serum LECT2 and CTRP5 levels are closely related to the development of DR in T2DM patients, and joint detection has certain clinical value in diagnosing DR in T2DM patients.

AIM:To investigate the predictive value of aqueous humor stromal cell-derived factor-1(SDF-1)and epithelial neutrophil-activating peptide-78(ENA78)for visual impairment following vitrectomy in patients with diabetic retinopathy(DR).METHODS: Patients with DR who underwent vitrectomy in the ophthalmology department of our hospital from March 2022 to March 2024 were enrolled as study group. According to the results of uncorrected visual acuity examination during the 1-year follow-up after surgery, they were further divided into visual impairment group and good visual acuity group. In addition, patients with cataracts who were treated in our hospital during the same period were recruited as control group. The levels of SDF-1 and ENA78 in aqueous humor were detected by enzyme-linked immunosorbent assay(ELISA). Pearson correlation analysis was used to evaluate the correlation of indicators. Multivariate Logistic regression analysis was performed to identify the influencing factors of postoperative visual impairment in DR patients. Relative risk analysis was conducted to assess the impact of different aqueous humor SDF-1 and ENA78 levels on postoperative visual impairment in DR patients. Receiver operating characteristic(ROC)curve analysis was applied to determine the predictive value of aqueous humor SDF-1 and ENA78 levels for postoperative visual impairment in DR patients.RESULTS: Totally 156 cases(156 eyes)were enrolled in the study group, including 87 males and 69 females, with a mean age of 60.65±8.91 years old; and 91 cases(91 eyes)were enrolled in the control group, including 53 males and 38 females, with a mean age of 58.72±8.43 years old. The levels of SDF-1 and ENA78 in aqueous humor of the study group were significantly higher than those of the control group(P<0.001). According to the results of uncorrected visual acuity during the 1-year follow-up after surgery, the study group was further divided into the visual impairment group(n=49)and the good visual acuity group(n=107), including 28 males and 21 females in the visual impairment group, with a mean age of 63.73±7.41 years, and 59 males and 48 females in the good visual acuity group, with a mean age of 59.24±8.47 years. The age and glycated hemoglobin(HbA1c)levels of the visual impairment group were higher than those of the good visual acuity group(all P<0.05). Compared with the good visual acuity group, the levels of SDF-1 and ENA78 in aqueous humor of the visual impairment group were significantly elevated(all P<0.05). A positive correlation was found in the study group between the levels of SDF-1, ENA78 in aqueous humor and HbA1c(r=0.314, 0.362, all P<0.05). Elevated levels of aqueous humor SDF-1(OR=2.936, 95% CI: 1.628-5.296)and ENA78(OR=3.092, 95% CI: 1.738-5.502)were identified as risk factors for postoperative visual impairment in DR patients(all P<0.05). High levels of SDF-1 and ENA78 increased the risk of postoperative visual impairment by 1.958-fold and 2.030-fold compared with the low-level groups, respectively; the area under the curve(AUC)of combined detection of aqueous humor SDF-1 and ENA78 for predicting postoperative visual impairment in DR patients was 0.936, which was superior to the predictive value of SDF-1 or ENA78 alone(Zcombination-SDF-1=2.850, Zcombination-ENA78=2.445, all P<0.05).CONCLUSION: Elevated levels of aqueous humor SDF-1 and ENA78 are risk factors for postoperative visual impairment in DR patients, and the combined detection of SDF-1 and ENA78 has high clinical application value for predicting postoperative visual impairment in DR patients.

Hepatocellular carcinoma (HCC) develops within a profoundly immunosuppressive tumor immune microenvironment (TIME), which limits the efficacy of immunotherapy. Polarization of tumor-associated macrophages (TAMs) toward a pro-tumorigenic M2 phenotype is a major driver of immune escape. Ferroptosis, an iron-dependent regulated cell death program, intersects with hepatic iron metabolism and immune regulation and thus offers promising points of therapeutic intervention. This review systematically elucidates the mechanistic role of TAM ferroptosis in HCC immune evasion and highlights a “bidirectional regulation” intervention strategy grounded in the Traditional Chinese medicine (TCM) principle of “fortifying healthy qi and eliminating pathogens” (Fuzheng Quxie). This strategy employs “eliminating pathogens” (Quxie) approaches to exploit the metabolic vulnerability of M2-like TAMs and precisely induce their ferroptosis. Moreover, it utilizes “fortifying healthy qi” (Fuzheng) approaches to protect M1-like TAMs and CD8⁺ T cells from oxidative damage. This parallel “induction-protection” paradigm demonstrates the unique advantages of TCM in systemically remodeling TIME through multitarget synergistic actions. Accordingly, precision regulation of TAM ferroptosis based on the Fuzheng Quxie theory represents a promising integrative Chinese-Western medicine strategy for overcoming current bottlenecks in HCC immunotherapy, although its clinical translational potential warrants further validation.

Objective To evaluate the safety and efficacy of a self-developed micro-normothermic machine perfusion (NMP) system (micro-perfusion device) for preserving isolated porcine limbs. Methods Five healthy Landrace pigs were selected, and their left and right forelimbs were randomly divided into the NMP group and static cold storage (SCS) group. The NMP group was perfused with the self-developed micro-perfusion device and polymerized hemoglobin perfusate for 32 hours at normothermia, while the SCS group was preserved at 4 ℃. Hemodynamic parameters such as perfusion pressure and flow were monitored. The pH value, partial pressure of oxygen (PO₂), lactic acid (Lac), creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate were measured. Hematoxylin-eosin staining was used to assess the muscle tissue structure, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was employed to evaluate muscle cell apoptosis, and immunohistochemistry staining was applied to detect the expressions of tumor necrosis factor (TNF)-α and interleukin (IL)-6. A mixed-effects model was used to analyze the effects of time and treatment methods on tissue structure, cell apoptosis and inflammatory factors. Results The device could stably maintain a perfusion pressure of (69±15) mmHg and a flow rate of (117±42) mL/min. The pH value and electrolytes of the perfusate were generally stable, with PO₂ maintained at a high level. Lac was maintained at 5.38(3.81, 6.45) mmol/L, while CK and LDH increased over time. After 32 hours of perfusion in the NMP group, both the myocyte spacing and apoptosis rate were better than those in the SCS group. Mixed-effects model analysis showed that there were statistically significant differences in the effects of NMP treatment and SCS treatment on myocyte spacing and apoptosis rate per unit time (both P < 0.05). There were no statistically significant differences in TNF-α and IL-6 between the two groups, and mixed-effects model analysis showed no statistically significant differences in the effects of NMP treatment and SCS treatment on TNF-α and IL-6 per unit time (both P > 0.05). Conclusions The micro-perfusion device used in this study may achieve 32-hour normothermic preservation in a porcine limb amputation model, maintain basic metabolism and ionic homeostasis, reduce muscle structural damage and cell apoptosis without inducing additional inflammatory responses. This technology is expected to significantly extend the time window for replantation of amputated limbs in disaster rescue and long-distance transportation, providing an important technical basis for clinical translation and subsequent replantation research.

This article reports a case of a male patient with anti-N-methyl-D-aspartate receptor （NMDAR） encephalitis comorbid with early-onset Alzheimer's disease （AD）. The patient presented with depression， hallucinations and delusions syndrome， and cognitive impairment， and was admitted to a psychiatric hospital. Through multidisciplinary consultation， the diagnosis was confirmed based on positive biological and pathological biomarkers. The patient's symptoms improved after receiving a therapeutic regimen comprising high-dose glucocorticoid therapy and psychiatric-related treatments. Based on relevant current research findings domestically and internationally， this article reviews the pathogenesis and clinical manifestations of early-onset AD and anti-NMDAR encephalitis， in order to enhance the discrimination ability of psychiatric specialists for such patients and improve the diagnosis and treatment level. ［Funded by Medical Research Project of Chengdu City （number， 2024403）］

Objective To analyze the genomic characteristics of Legionella pneumophila (L. pneumophila) isolated from industrial circulating cooling water in workplace. Methods A total of 20 L. pneumophila strains isolated from industrial circulating cooling water collected from eight chemical enterprises were selected as the research subjects. Whole-genome sequencing was performed on the strains, followed by multilocus sequence typing (MLST), whole-genome single nucleotide polymorphism analysis, virulence factor profiling, and antibiotic resistance gene detection. Results The dominant MLST typing among the 20 L. pneumophila strains was ST2. Serogroup 1 (Lp1) strains exhibited high genetic diversity. Strains from different enterprises showed substantial genomic diversity, suggesting possible inter-enterprise dissemination. Each isolate harbored 175-295 virulence genes; among them, virulence genes were identified, and 139 genes were detected in all the 20 strains. These genes primarily included those related to the Dot/Icm type Ⅳ bacterial secretion system, flagellar synthesis and motility, and type Ⅳ pili. The number of virulence genes carried by L. pneumophila strains of different ST types differed (P<0.01), with unidentified sequence types harboring more virulence genes than other STs (P<0.01). A total of four resistance genes were predicted, including aminoglycoside phosphotransferase-encoding gene APH(9)-Ia, carbapenemase-encoding gene OXA-29, and efflux pump genes-encoding genes LpeA and LpeB, with detection rates of 100.00%, 100.00%, 10.00%, and 10.00%, respectively. These genes may confer resistance to cephalosporins, penicillins, and aminoglycosides, and all strains were multidrug resistance. Conclusion L. pneumophila isolated from industrial recirculating cooling water exhibits high genetic diversity, strong pathogenicity, and significant multidrug resistance potential.

Depression is a common psychiatric disorder characterized by persistent low mood or mental disorders. Current treatments primarily focus on regulating neurotransmitter levels， but their effectiveness is limited. The mechanisms underlying its onset are complex， and there is no unified consensus. Abnormal signaling pathway transmission plays a crucial role in the development of depression， involving multiple pathways， including Toll-like receptor 4/nucleotide-binding oligomerization domain-like receptor protein 3 （TLR4/NLRP3）， nuclear factor-κB （NF-κB）， Janus kinase/signal transducer and activator of transcription （JAK/STAT）， mitogen-activated protein kinase/extracellular signal-regulated kinase （MAPK/ERK）， brain-derived neurotrophic factor/tyrosine kinase receptor B （BDNF/TrkB）， cyclic AMP/protein kinase A/cAMP response element-binding protein （cAMP/PKA/CREB）， and others. Traditional Chinese medicine（TCM） is based on a holistic approach and the principle of treatment based on the differentiation of syndromes， regulating the balance of multiple systems and organ functions from a macroscopic perspective. This approach has shown unique advantages in the treatment of depression. TCM attributes the onset of depression to dysfunction of the organ systems， involving liver Qi stagnation， heart spirit deficiency， kidney essence depletion， and spleen dysfunction. TCM compound treatments focus on soothing the liver， strengthening the spleen， calming the heart， and replenishing essence， with formulas such as Xiaoyaosan， Zishui Qinggan Yin， and Chahu Jia Guizhi Longgu Muli Tang. The active components of Chinese herbs mainly aim to tonify and regulate Qi， such as salidroside， ginsenoside Rb₁， astragaloside， and muscone. External TCM treatments， primarily acupuncture， aim to open the orifices and invigorate the spirit. Acupoints such as Baihui， Shenting， and Yintang are commonly used. Additionally， massage and moxibustion therapy can intervene in depression by regulating signaling pathways. This article reviews the core role of signaling pathways in the development of depression and the mechanism of TCM regulation of signaling pathways to intervene in depression， aiming to discover new therapeutic approaches that can improve the symptoms of depressed patients.

Objective There is limited research on the combined use of multiple drugs in the prevention and treatment of radiation-induced oral mucositis (RTOM). This study aims to investigate the synergistic effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF), Kangfuxin Liquid, and vitamin B₁₂ via mouthwash on RTOM, and provide a novel approach for the prevention and treatment of acute RTOM. Methods A total of 82 patients with head and neck cancer who underwent radical radiotherapy were randomly divided into four groups: a control group (vitamin B₁₂, 20 cases), observation group 1 (rhG-CSF + vitamin B₁₂, 20 cases), observation group 2 (Kangfuxin Liquid + vitamin B₁₂, 21 cases), and observation group 3 (rhG-CSF + Kangfuxin Liquid + vitamin B₁₂, 21 cases). After 4 weeks of therapy, the therapeutic effects of the four groups were compared. Results Compared to the control group, there was no statistically significant difference in the incidence of RTOM. However, the incidence of severe RTOM was significantly reduced in the observation groups, following the order of observation group 1 (20.00%) > observation group 2 (14.28%) > observation group 3 (9.52%). The initiation period of RTOM in observation group 3 was 24 days, exhibiting a considerable delay in comparison to the control group (16 days), observation group 1 (18 days), and observation group 2 (22 days). The levels of pain experienced by the groups receiving combined treatments were significantly reduced compared to the control group. Observation group 3 exhibited the most effective pain reduction. Conclusion The combined administration of rhG-CSF, Kangfuxin Liquid, and vitamin B₁₂ can prevent radiation-induced oral mucosal injury and promote mucosal healing. This regimen represents an effective strategy for the prevention and treatment of acute RTOM.

OBJECTIVE To explore the regulatory effects of Buqi tongqiao formula on intestinal flora and immune balance in immunoglobulin A nephropathy （IgAN） rats based on the theory of “treating different diseases with the same therapy”. METHODS Male SD rats were randomly assigned to the Normal group and the modeling group. IgAN rat models were established in the modeling group by intragastric administration of bovine serum albumin， subcutaneous injection of carbon tetrachloride and castor oil mixture， and tail vein injection of lipopolysaccharide. Successfully modeled rats were then randomly divided into the model group （Model group）， Buqi tongqiao formula low-dose group （BQTQ-L group）， Buqi tongqiao formula high-dose group （BQTQ- H group）， and positive control group （BZP group）， with 15 rats in each group. BZP group received intragastric administration of benazepril hydrochloride （10 mg/kg）， while BQTQ-L and BQTQ-H groups were given Buqi tongqiao formula at doses of 9.81 and 19.62 g/kg （calculated as raw herb weight）， respectively. The Normal group and the Model group received an equal volume of normal saline intragastrically， once a day， for 8 consecutive weeks. The 24-hour urinary total protein （24 h UTP） contents were measured at weeks 8， 10， 12， 14 and 16 of the experiment. After the last administration， serum creatinine （Scr） and blood urea nitrogen （BUN） contents were detected. Renal histopathological changes and glomerular IgA immune complex deposition were examined. Additionally， alterations in gut microbiota composition， the proportions of peripheral T helper cell 17 （Th17） and regulatory T cell （Treg）， as well as the ratio of Th17 and Treg （Th17/Treg）， were analyzed across all groups. RESULTS Compared with the Model group， rats in both BQTQ-L and BQTQ-H groups showed alleviated mesangial cell hyperplasia， reduced matrix expansion， and decreased IgA immune complex deposition in the glomeruli. The 24 h UTP contents （at weeks 14 and 16 in the BQTQ-L group； at weeks 12， 14 and 16 in the BQTQ-H group）， Scr and BUN contents， IgA-positive area fluorescence intensities， relative abundances of Firmicutes， Th17 cell proportions， and Th17/Treg were significantly decreased in both BQTQ-L and BQTQ-H groups （P＜0.05）； while the Chao1， Observed species， Shannon， and Simpson （except for BQTQ-H group） indexes， the relative abundances of Bacteroidota， and the proportions of Treg were significantly increased （P＜0.05）. Differential microbiota included c_Clostridia （BQTQ-L group vs. Model group） and g_Ruminococcus （BQTQ-H group vs. Model group）， etc. CONCLUSIONS Buqi tongqiao formula may alleviate renal injury and exert a renal protective effect in IgAN rats by modulating intestinal flora homeostasis and Th17/Treg immune balance.

OBJECTIVE: To compare the clinical efficacy of electroacupuncture (EA) at neuro-arterial stimulation points with topical western medication in treating post-stroke shoulder-hand syndrome (SHS). METHODS: A total of 72 patients with post-stroke SHS were randomly assigned to an observation group (n=36, 2 cases dropped out) and a control group (n=36, 3 cases dropped out). Both groups received standard neurological treatment, comprehensive rehabilitation, and physical therapy. The observation group received EA at neuro-arterial stimulation points, including the ipsilateral stellate ganglion point, vagus nerve trunk and auricular branch (left side), and stimulation points of the radial and ulnar arteries, radial nerve, ulnar nerve, and median nerve, once daily for 4 weeks. The control group was treated with topical diclofenac diethylamine emulgel, and mucopolysaccharide polysulfate cream was added for patients with pronounced early-stage edema, twice a day for 4 weeks. The VAS pain score and hand edema volume were recorded before treatment, at 2 and 4 weeks during treatment, and 2 weeks after treatment completion (follow-up). Musculoskeletal ultrasound was used to measure the thickness of the dorsal hand and middle finger skin on the affected side before and after 4 weeks of treatment. RESULTS: Compared before treatment, the VAS pain scores and edema volume of the affected hand in both groups were decreased at week 2, week 4, and follow-up (P<0.05). At week 4, both groups showed lower VAS pain scores and edema volume than those at week 2 (P<0.05); during follow-up, both VAS pain scores and edema volume were further reduced compared to those at week 4 (P<0.05). At week 2, week 4, and follow-up, the VAS scores and edema volume of the affected hand in the observation group were lower than those in the control group (P<0.05). Compared before treatment, the dorsal hand skin thickness and middle finger skin thickness on the affected side were decreased in both groups after 4 weeks of treatment (P<0.05). Compared with the control group, the observation group showed thinner dorsal hand and middle finger skin thickness after 4 weeks of treatment (P<0.05). CONCLUSION EA at neuro-arterial stimulation points effectively alleviates pain and edema in patients with post-stroke SHS, and demonstrates superior efficacy compared to topical western medication.
Humans ; Male ; Female ; Middle Aged ; Electroacupuncture ; Aged ; Stroke/complications* ; Acupuncture Points ; Adult ; Reflex Sympathetic Dystrophy/physiopathology* ; Treatment Outcome ; Hand