OBJECTIVE To analyze the prototype components absorbed into blood and brain of Lithocarpus litseifolius leaves， so as to provide a reference for clarifying the pharmacological material basis of its prevention and treatment of central nervous system dis eases. METHODS The ethanol extract of L. litseifolius leaves， as well as the gastric lavage fluid and perfusion solution were prepared. Using rats as subjects， plasma samples of intestinal wall metabolism， intestinal flora metabolism and hepatic metabolism were prepared via in situ intestinal perfusion and closed intestinal loop method； while comprehensive metabolic plasma samples， brain tissue samples， and cerebrospinal fluid samples were collected after intragastric administration. UPLC-HRMS technology was utilized to analyze and identify chemical components and prototype components absorbed into blood and brain of L. litseifolius leaves. RESULTS A total of 66 chemical constituents were identified in L. litseifolius leaves， primarily consisting of flavonoids， organic acids， and others. A total of 16， 13， 11， and 5 prototype components were identified in intestinal wall metabolism， intestinal flora metabolism， hepatic metabolism， and comprehensive metabolic plasma samples， respectively. Additionally， 4 prototype components were detected in brain tissue and 9 in cerebrospinal fluid. Phloridzin， trilobatin， phloretin-2- O -malonyl hexoside， and phloretin were identified as common components across all sample types. CONCLUSIONS Prototype components absorbed into blood and brain of L. litseifolius leaves， such as phloridzin， trilobatin， phloretin， and other components may serve as the pharmacological material basis for their therapeutic effects on central nervous system diseases.

This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

Mainly based on the "constitution-syndrome-disease location correlation" approach， this study constructs a traditional Chinese medicine （TCM） framework for understanding hypertension comorbidities. From the perspective of shared constitutional predispositions and similar pathomechanistic characteristics， hypertension comorbidity should not be regarded as a simple aggregation of multiple diseases. Rather， it is generally rooted in biased constitutions such as yin-deficiency， qi-deficiency， yang-deficiency， phlegm-dampness， dampness-heat， and blood-stasis constitutions， accompanied by the long-term interplay of pathogenic mechanisms involving wind， fire， phlegm， stasis， and deficiency， and gradually manifests as comorbidities affecting different systems through the evolution of disease locations related to the liver， heart， spleen， and kidney. On this basis， cardiac-， cerebral-， renal-， and metabolic-related comorbidities are taken as the major categories， and their characteristics related to constitution， syndrome， and disease location are systematically summarized to clarify the correspondence between shared pathomechanisms and predominant disease locations， and to propose corresponding prevention and treatment strategies. This framework further incorporates constitution-based stratification into risk stratification for prospective intervention， and takes syndrome as the central link in developing multi-disease treatment strategies such as boosting qi and activating blood， as well as resolving phlegm and unblocking collaterals. A clinical pathway is thereby proposed， encompassing constitution assessment， syndrome differentiation， comorbidity risk stratification， integrated traditional Chinese and western medicine intervention， and follow-up feedback. This study aims to provide a reference for the theoretical development and collaborative management of hypertension comorbidities in TCM.

Low anterior resection syndrome （LARS） is a common complication of sphincter-preserving rectal cancer surgery， and its manifestations change dynamically at different stages. By analyzing and summarizing the clinical symptoms and pathomechanism evolution of LARS across different stages， this paper proposes a staged prevention and treatment strategy using acupuncture. During perioperative stage， the main principle is activating the transport function of the body， supplemented by regulating the mind， with the use of dredging the bowels as needed. During the stoma reversal stage， treatment focuses primarily on fortifying the spleen， with draining dampness as a supplementary method， to help consolidate the intestines. During the radiotherapy or chemotherapy stage， the main focus is reinfor-cing healthy qi， with reducing toxin as an adjunct， to achieve the effect of activating the transport of the pivot. During the survival management stage， treatment primarily focuses on tonifying the kidneys and secondarily on fortifying the spleen， with regulating the corporeal soul as the therapeutic emphasis. Acupoints are selected and combined in accordance with the treatment principles at each stage， and different stimulation methods such as electroacupuncture and moxibustion are applied. An analysis of the mechanisms underlying acupuncture for LARS is also provided， offering a theoretical basis and practical approach for the prevention and treatment of LARS with acupuncture.

Autosomal dominant polycystic kidney disease （ADPKD） is a systemic hereditary renal disorder and can affect multiple organs， and congenital hepatic fibrosis is one of the manifestations of liver involvement and is an important complication of ADPKD. Symptomatic management is currently the main treatment method for this disease， and disease-specific drugs such as tolvaptan have limited indications and cannot correct the underlying genetic defect. This article reports a case of ADPKD with congenital hepatic fibrosis， and sirolimus was identified as the individualized treatment regimen based on peripheral blood functional genomic analysis and drug sensitivity prediction platform. The patient achieved significant improvements in symptoms and quality of life after treatment， with a stable kidney volume. This case shows that functional genomics has a potential value in guiding individualized treatment of rare genetic disorders， which provides new treatment ideas and practice paths for similar patients.

Objective:To screen differentially expressed circular RNAs(circRNA)associated with lymph node metastasis in cervical cancer and investigate their molecular mechanism and biological function.Methods:Cancer tissue samples were collected from 40 cervical cancer patients(20 with lymph node metastasis and 20 without lymph node metastasis).Three specimens were randomly selected from each group,and the circRNA expression profile was analyzed using high-throughput sequencing technology,and perform KEGG and GO enrichment analy-sis was performed on the differentially expressed circRNA derived mother genes.Real-time fluorescence quantita-tive PCR(qRT-PCR)technology was used to validate four significantly upregulated circRNAs with high differential multiples,and a ceRNA network was constructed for database prediction.The relationship between circRNA with the most significant differential expression and clinical pathological features was analyzed.Transfect circRNA small interfering RNA(siRNA)into cervical cancer cell lines.Cell lines were divided into circRNA knockdown group and negative control(si-NC)group.The proliferation of SiHa cells and HeLa cells in cervical cancer was detected by Cell Counting Kit-8(CCK-8).Results:①A total of 2039 differentially expressed circRNAs were detec-ted.The differentially expressed circRNA derived mother genes are mainly enriched in ubiquitin mediated protein hydrolysis,MAPK signaling pathway,endocytosis,apoptosis and other signaling pathways.②Four significantly up-regulated circRNAs with high differential multiples in the transfer group were selected,which are hsa_circ_0067492,hsa_circ_0004904,hsa_circ_0085465,and hsa_circ_0007718.qRT-PCR showed that hsa_circ_0004904,hsa_circ_0085465,and hsa_circ_0007718 were all highly expressed in cervical cancer tissues with lymph node metas-tasis(P<0.01).Hsa_circ_0004904 could interact with microRNAs(miRNAs)such as hsa-miR-3916.Hsa_circ_0085465 could interact with miRNAs such as hsa-miR-4659b-3p,and hsa_circ_0007718 could interact with miRNAs such as hsa-miR-127-5p.③The high and low expression groups of hsa_circ_0004904 showed statistically signigi-cant differences in lymph node metastasis and lymphovascular invasion status(P<0.05).Compared with the si-NC group,the proliferation ability of SiHa cells and HeLa cells was significantly reduced after transfection with hsa_circ_0004904 at 24,48,and 72 hours(P<0.05).Conclusions:Differentially expressed circRNAs were identi-fied in cervical cancer patients with lymph node metastasis.Silencing these circRNAs significantly inhibited the proliferation of cervical cancer cells,suggesting their potential involvement in the progression of lymph node me-tastasis.These circRNAs may serve as specific biomarkers for predicting lymph node metastasis.

Objective:To explore the early clinical effect of arthroplasty with rotating hinge knee prosthesis in the treatment of severe knee deformity.Methods:A retrospective study was conducted on 55 patients who underwent primary rotating hinge knee arthroplasty at Shanghai Sixth People's Hospital from January 2017 to October 2023, including 19 male patients and 36 female patients, with an average age of 60.9±9.0 years (ranging from 31 to 74 years). The four main indications were end-stage deformity of osteoarthritis (valgus/varus>20°, 16 cases), post-traumatic joint deformity (15 cases), severe joint ligament instability (12 cases), and neuromuscular or immune diseases (12 cases). The patients were divided into two age groups: ≥60 years old group (32 cases) and <60 years old group (23 cases). Various pre-operative and post-operative data, including knee society score (KSS), range of motion (ROM), forgotten joint score (FJS), degree of force line offset and post-operative complications, were collected and compared.Results:All the 55 cases successfully underwent the operation. The operation time was 102.3±15.8 min. The intraoperative blood loss was 63±23.7 ml. The follow-up time was 37.2±7.9 months. KSS clinical score increased from 27.5(12, 45) before surgery to 90.5(85, 95) after surgery ( P<0.001) and the mean score of KSS function increased from 50.4(45, 60) before surgery to 84.3(85, 95) after surgery ( P<0.001), both with significant difference ( P<0.05). Similarly, the average postoperative ROM improved from 97.2°±34.4° to 120.1°±10.9°with significant difference ( P<0.05). The postoperative FJS was 81.0±6.6. Up to the last follow-up, the implant survival rate was 98%[95% CI(90.4%, 99.6%)]. For the all four groups of end-stage deformity of osteoarthritis, post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases, both the KSS score and the ROM of the knee joint were significantly improved. There was no significant difference in neither the KSS score or the ROM of the knee joint between the ≥60 years old group and the <60 years old group ( P>0.05). The incidence of complications was 24% (13/55). The complication rates for patients with end-stage deformity of osteoarthritis, post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases were 12.5% (2/16), 20% (3/15), 25% (3/12), and 41.7% (5/12) respectively, without significant difference. The incidence of complications in elderly patients (85%, 11/13) was much higher than that in younger patients (5%, 2/42),with significant difference ( P<0.05). Conclusions:For end-stage deformity of osteoarthritis (valgus or varus >20°), post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases, the rotating hinge knee can provide good clinical improvement effects. For neuromuscular or immune diseases, the incidence of complications was relatively high. The therapeutic effect of patients over 60 years old showed no significant difference in the early postoperative efficacy compared with younger patients, but the complications of elderly patients were much higher than those of younger patients.

Objective To investigate the relationship between asprosin(Asp)and angiopoietin-like protein 3(ANGPTL3)levels and Diabetic Peripheral Vascular diseases in type 2diabetes mellitus Disease,DPVD)to evaluate their predictive value for DPVD.Methods A total of 141 patients with type 2diabetes who met the inclusion criteria were included and divided into non-DPVD group(n=71)and DPVD group(n=70),and healthy subjects in the same period were selected as normal control group(n=37).General data and expression levels of Asp and ANGPTL3 in the three groups were compared.Spearman correlation analysis was used to explore the correlation between Asp and ANGPTL3 levels and clinical indicators,and Logistic regression was used to analyze the influencing factors of DPVD.The predictive value of serum Asp and ANGPTL3 levels to DPVD was analyzed by receiver operating characteristic curve(ROC).Results Compared with non-DPVD group,the levels of asprosin and angiopoietin-like protein 3 in DPVD group were higher(all P＜0.05).Spearman correlation analysis showed that Asp level was positively correlated with age,SBP,FBG,LDL-C and ANGPTL3(all P＜0.05).ANGPTL3 level was positively correlated with age,SBP,DBP,FBG,TC,TG,LDL-C and Asp(all P＜0.05).Age,course of disease,HbA1c,TG,LDL-C,FCP,Asp and ANGPTL3 were the influencing factors of DPVD(all P＜0.05),while course of disease,TG,Asp and ANGPTL3 were the independent influencing factors of DPVD(all P＜0.05).ROC curve results showed that Asp and ANGPTL3 levels alone predicted DPVD AUC of 0.679 and 0.706,corresponding sensitivity of 88.7％and 78.9％,specificity of 47.1％and 55.7％,respectively.The combined prediction of Asp and ANGPTL3 levels for DPVD was 0.777 AUC,80.3％sensitivity and 64.3％specificity.Conclusion Asp and ANGPTL3have certain predictive value for DPVD,and their combined predictive value is higher.

BACKGROUND:When exercising in a cold environment,the body's inflammatory response is affected by both low temperature and exercise intervention,and its impact and mechanism remain to be explored.OBJECTIVE:To explore the effects and mechanisms of cold water swimming on inflammatory response of rats based on transcriptome sequencing technology.METHODS:40 male SD rats were randomly divided into room temperature control group,room temperature swimming group,cold water control group,and cold water swimming group,with 10 rats in each group.The room temperature control group had no intervention and was free to eat.The room temperature swimming group received swimming at 30 min/time,6 times/week,for 5 weeks;the water temperature was(28±2)℃,and the water depth was 35 cm.In the cold water control group,the rats were placed in a water tank with a depth of 3 cm;the water temperature was(18±2)℃,and they were free to move.The cold water swimming group received swimming at 30 min/time,6 times/week,for 5 weeks;the water temperature was(18±2)℃,and the water depth was 35 cm.Enzyme-linked immunosorbent assay was used to detect the levels of serum interleukin-6,tumor necrosis factor-α,and high-sensitivity C-reactive protein.Based on the transcriptome sequencing results,differentially expressed genes were screened to draw Venn diagrams and heat maps,and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis were performed.The protein-protein interaction network was used to screen core genes.RT-qPCR was used to detect the mRNA expression of IRF7,OAS2,and OASL in rat spleen tissue.RESULTS AND CONCLUSION:(1)The ELISA results showed that compared with the room temperature control group,the levels of various inflammatory indicators in the room temperature swimming group and the cold water swimming group were significantly increased(P＜0.05),and there was no significant difference in the cold water control group.Compared with the room temperature swimming group,there was no significant difference in the expression of inflammatory indicators in the cold water swimming group.Compared with the cold water control group,the expressions of interleukin-6 and tumor necrosis factor-α in the cold water swimming group showed an upward trend,and high-sensitivity C-reactive protein increased significantly(P＜0.05).(2)Transcriptome analysis:Venn diagram showed that there were 39 differentially expressed genes affected by the dual factors of temperature and exercise intervention.Cluster heat map analysis results showed that the overall gene expression trends of the room temperature swimming group and the cold water swimming group were similar,and the cold water control group showed an opposite trend.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis results showed that differentially expressed genes were enriched in the immune system,locomotion,nucleic acid-binding transcription factor activity,NOD-like receptor signaling pathways and other pathways.The number of genes enriched in the NOD-like receptor signaling pathway was relatively large,and the q value was small,which may be a key pathway.The protein-protein interaction network screened out IRF7,OAS2,OASL,IFIT2,IFIT3 and other core genes.(3)RT-qPCR verification results showed that compared with the room temperature control group,the expressions of IRF7,OAS2 and OASL were significantly increased in the room temperature swimming group and the cold water swimming group(P＜0.01),and there was no significant difference in the cold water control group.Compared with the cold water control group,the expression of each gene was significantly increased in the cold water swimming group(P＜0.01).(4)It is concluded that cold water swimming can promote inflammatory response,and its mechanism may be regulated through the NOD-like receptor signaling pathway.