ObjectiveTo explore the improving effect of Huangqi Chifengtang（HCT） on atherosclerosis（AS）， and elucidate its mechanism in relation to adenosine monophosphate-activated protein kinase（AMPK）/peroxisome proliferator-activated receptor α（PPARα） signaling pathway and nucleotide-binding oligomerization domain（NOD）-like receptor thermal protein domain associated protein 3（NLRP3） inflammasome. MethodsEight C57BL/6J mice were set as the normal group， and 32 ApoE^-/- mice were randomly divided into the model group， the positive drug group（atorvastatin， 5 mg·kg^-1·d^-1）， HCT low- and high-dose groups（1.95， 3.90 g·kg^-1·d^-1）. ApoE^-/- mice were fed with high-fat and high-cholesterol feed to establish an AS mouse model. After modeling， they were orally administered corresponding dose of drugs for 28 days， while the normal and model groups received an equal volume of physiological saline via oral gavage. Hematoxylin-eosin（HE） staining was used to observe the pathological status of the aorta and liver in mice， Biochemical testing and enzyme-linked immunosorbent assay（ELISA） were used to detect the levels of total cholesterol（TC）， triglycerides（TG）， low-density lipoprotein cholesterol（LDL-C）， alanine aminotransferase（ALT）， aspartate aminotransferase（AST）， C-reactive protein（CRP）， interleukin（IL）-1β， IL-18 in the serum， as well as superoxide dismutase（SOD）， malondialdehyde（MDA）， and reduced glutathione（GSH） in the liver. Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） was used to measure the mRNA expression levels of NLRP3， apoptosis-associated speck-like protein（ASC）， cysteinyl aspartate specific proteinase-1（Caspase-1）， Toll-like receptor 4（TLR4） in the aorta， and fatty acid synthase（FAS）， stearoyl-CoA desaturase 1（SCD1）， PPARα， and carnitine palmitoyltransferase 1A（CPT1A） in the liver. Immunohistochemistry was used to determine the protein expressions of NLRP3， Caspase-1， and ASC in the aorta， and Western blot was used to measure the protein expressions of AMPK， p-AMPK， sterol regulatory element binding protein-1c（SREBP-1c）， CPT1A， and FAS in the liver. ResultsCompared with the normal group， the model group showed a significant increase in lipid plaque deposition in the aorta and lipid accumulation in the liver， the levels of TC， TG， LDL-C， AST， ALT， IL-1β， IL-18 and CRP in the serum were significantly increased（P<0.01）， and the mRNA and protein expressions of aortic TLR4， NLRP3， Caspase-1 and ASC were significantly upregulated（P<0.01）. The levels of SOD and GSH in the liver were significantly reduced， while the level of MDA was significantly increased（P<0.01）. The mRNA expressions of FAS and SCD1 in the liver were significantly downregulated， while the mRNA expressions of PPARα and CPT1A were significantly upregulated. The protein expressions of p-AMPK/AMPK and CPT1A in the liver were significantly reduced， while the expressions of SREBP-1c and FAS proteins were significantly increased（P<0.01）. Compared with the model group， the low- and high-dose HCT groups showed significant improvements in aortic plaques and hepatic lipid deposition. The levels of TC， LDL-C， AST， IL-1β and IL-18 in the serum of the low-dose HCT group， as well as TC， TG， LDL-C， AST， ALT， IL-1β， IL-18 and CRP in the serum of the high-dose HCT group， were significantly reduced（P<0.01）. The mRNA expressions of TLR4， NLRP3 and Caspase-1 in the aorta of the low-dose HCT group， as well as TLR4， NLRP3， Caspase-1 and ASC in the aorta of the high-dose HCT group， were significantly downregulated（P<0.01）. The protein expressions of Caspase-1 and ASC in the aorta of the low-dose HCT group， as well as NLRP3， Caspase-1 and ASC in the high-dose HCT group， were significantly downregulated（P<0.01）. The levels of SOD and GSH in the liver of the low- and high-dose HCT groups were significantly increased， while the level of MDA in the high-dose HCT group was significantly decreased（P<0.05， P<0.01）. In the HCT-treated group， the mRNA expressions of FAS and SCD1 in the liver were significantly upregulated， while the mRNA expressions of PPARα and CPT1A were significantly downregulated， the protein expressions of p-AMPK/AMPK and CPT1A in the liver were significantly increased， while the protein expressions of SREBP-1c and FAS were significantly decreased（P<0.05， P<0.01）. ConclusionHCT can improve lipid metabolism by activating the AMPK/PPARα pathway and inhibit NLRP3 inflammasome-mediated inflammatory responses， thereby reducing hepatic lipid deposition and AS plaque formation.

To explore the advantages of traditional Chinese medicine （TCM） and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications （DMC）， refine key pathophysiological insights and treatment principles， and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine， hosted by the China Association of Chinese Medicine， was held in Beijing， 2024. Experts in TCM， Western medicine， and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis， diagnostic and treatment challenges， and mechanism research related to DMC， ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development， research prioritization， and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM， strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.

Based on the traditional Chinese medicine theory that "all pain， itching， and sores are related to the heart"， this paper proposes treating recurrent aphthous ulcers from the perspective of the heart. It suggests that excessive heart fire and tissue erosion due to flaming fire in the heart meridian constitute the core pathogenesis of this condition. Hyperactive heart fire is identified as the key pathogenic factor， while heart yin deficiency， obstruction of the heart collaterals， and malnourishment of the heart spirit are considered significant contributing factors. Clinically， the treatment follows the principle of clearing heart fire as the main strategy， supplemented by nourishing yin， activating collaterals， and calming the spirit. The self-formulated Qingxin Yuchuang Formulation （清心愈疮方） serves as the base prescription， with flexible modifications incorporating the Yuyin Formulation （育阴方）， Huoxue Formulation （活血方）， and Yu'an Formulation （郁安方） to address specific syndromes involving heart yin deficiency， collateral blockage， and emotional disturbance.

Idiopathic pulmonary fibrosis (IPF) is a progressive disease lacking effective therapy. Metformin, an antidiabetic medication, has shown promising therapeutic properties in preclinical fibrosis models; however, its precise cellular targets and associated mechanisms in fibrosis resolution remain incompletely defined. Most research on metformin's effects has focused on mesenchymal and inflammatory responses with limited attention to epithelial cells. In this study, we utilized Sftpc lineage-traced and Fgfr2b conditional knockout mice, along with BMP2/PPARγ and AMPK inhibitors, to explore metformin's impact on alveolar epithelial cells in a bleomycin-induced pulmonary fibrosis model and cell culture. We found that metformin increased the proliferation and differentiation of alveolar type 2 (AT2) cells, particularly the recently identified injury-activated alveolar progenitors (IAAPs)-a subpopulation characterized by low SFTPC expression but enriched for PD-L1. Single-cell RNA sequencing revealed a reduction in apoptosis among mature AT2 cells. Interestingly, metformin's therapeutic effects were not significantly affected by BMP2 or PPARγ inhibition, which blocked the lipogenic differentiation of myofibroblasts. However, Fgfr2b deletion in Sftpc lineage cells significantly impaired metformin's ability to promote fibrosis resolution, a process linked to AMPK signaling. In conclusion, metformin alleviates fibrosis by directly activating AT2 cells, especially the IAAPs, through a mechanism that involves AMPK and FGFR2b signaling, but is largely independent of BMP2/PPARγ pathways.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective:To analyze the characteristics of patients with pneumoconiosis complicated with chronic obstructive pulmonary disease (COPD), and to explore the comorbidity of pneumoconiosis and COPD and its influencing factors.Methods:From October to December 2022, 255 pneumoconiosis patients admitted to an occupational disease prevention and control hospital from January 2018 to December 2021 were selected as the study subjects. According to whether the pneumoconiosis patients were complicated with COPD or not, they were divided into pneumoconiosis and COPD comorbidity group and pneumoconiosis group. The general condition and dust exposure of the two groups of patients were analyzed, and the relationship between different types and different periods of pneumoconiosis and COPD comorbidity was analyzed by multivariate logistic regression.Results:A total of 255 subjects were collected, including 64 patients with comorbidity of pneumoconiosis and COPD, and the comorbidity rate was 25.1%. There were 186 males (72.9%) and 69 females (27.1%), ranging in age from 35 to 90 (63.79±11.79) years, and working age from 1 to 45 (20.31±10.57) years. The comorbidity of pneumoconiosis and COPD increased with the increase of working age (χ 2trend=8.19, P=0.004), and the comorbidity rate for COPD with working age of more than 30 years was 37.7% (23/61). The comorbidity rate of pneumoconiosis and COPD also increased with the increase of the stage of pneumoconiosis (χ 2trend=13.14, P<0.001), and the comorbidity rate of pneumoconiosis and COPD in the stage Ⅲ was as high as 44.0% (11/25). The cumulative dust exposure was negatively correlated with forced expiratory volume in one second/forced vital capacity (FEV 1/FVC), and the linear regression equation y=-0.04 x+78.4. Multivariate logistic regression analysis showed that the length of services ≥30 years ( OR=3.30, 95% CI: 1.15-9.52) and stageⅡ ( OR=3.05, 95% CI: 1.03-9.04) were the risk factors for comorbidity between pneumoconiosis and COPD ( P<0.05) . Conclusion:The comorbidity rate of pneumoconiosis and COPD is high. Working age, pneumoconiosis stage and cumulative dust exposure are the main influencing factors of pneumoconiosis and COPD comorbidity, so more attention should be paid to the comorbidity of pneumoconiosis and COPD.

Objectives:To evaluate the effectiveness of functionalized decellularized extracellular matrix(F-dECM)prepared from porcine auricular cartilage or porcine rib cartilage in repairing xenogeneic articular osteochondral defects.Methods:The por-cine auricular cartilage and rib cartilage were crushed and decellularized.Heparin modification and multi-factor loading were a-chieved through amide bond reaction.The physical characteristics of the particles were characterized by SEM observation and mer-cury intrusion.The chemical characteristics of the particles were characterized by tissue section staining and kit detection.The rabbit knee joint full-thickness defect models were established and implanted by different particles respectively.After 6 weeks and 12 weeks of operation,the samples were taken for gross observation,CT scanning and tissue sectioning to comprehensively evaluate the repair effect.Results:After heparin modification,the glycosaminoglycan lost during the decellularization process was replen-ished.Both heparinized auricular cartilage and costal cartilage presented a highly developed porous structure.Among them,the porosity and pore diameter of costal cartilage were both lower than those of auricular cartilage(P＜0.05).During the observation periods of 6 weeks and 12 weeks,the porcine costal cartilage F-dECM implantation group was superior to other experimental groups in knee joint repair effects(P＜0.05).Conclusion:Costal-derived F-dECM is a joint osteochondral defect repair material with application potential.

Objective:To explore the effect of multidisciplinary comprehensive nursing under the Green Intensive Nursing Model on the clinical outcomes of patients with post-traumatic epilepsy (PTE) .Methods:A convenience sampling method was used to select 120 patients with PTE admitted to the Department of Neurosurgery, Zhumadian Central Hospital, from January 2022 to May 2024. Patients were randomly divided into an intervention group ( n=60) and a control group ( n=60) using a computer-generated random number table. The control group received routine neurosurgical nursing, while the intervention group received multidisciplinary comprehensive nursing under the Green Intensive Nursing Model in addition to routine nursing. The Quality of Life in Epilepsy Inventory-31 (QOLIE-31), Hospital Anxiety and Depression Scale (HADS), Barthel Index, and Montreal Cognitive Assessment (MoCA) were used for evaluation. Seizure frequency, quality of life, anxiety and depression, activities of daily living, and cognitive-behavioral function were compared between the two groups after intervention. Results:At the 3-month follow-up, the intervention group had fewer seizures than the control group, and the difference was statistically significant ( P<0.05). After the intervention, the QOLIE-31 scores, Barthel Index, and MoCA scores of the intervention group were higher than those of the control group, while the HADS scores were lower, the differences were statistically significant ( P<0.05) . Conclusions:Multidisciplinary comprehensive nursing under the Green Intensive Nursing Model can reduce seizure frequency in PTE patients, improve their quality of life, decrease anxiety and depression, enhance daily living ability, and improve cognitive-behavioral function.

Objective To explore the potential categories of frailty development trajectories in patients undergoing cardiac surgery from pre-operation to 6 months post-operation,and analyze the influencing factors.Methods By a longitudinal study design,patients undergoing elective heart valve replacement surgery or coronary artery bypass grafting in a tertiary general hospital in Zunyi City from August 2022 to June 2023 were selected by the convenience sampling method.Tilburg frailty scale was used to investigate the frailty level of cardiac surgery patients 1 day before surgery(T0),1 month(T1),3 months(T2)and 6 months after surgery(T3).The growth mixture model was used to identify the trajectory categories,and the influencing factors of different frailty trajectories were analyzed by binary Logistic regression.Results 261 patients were enrolled at T0,with 22,9,and 3 patients lost at T1 to T3,and 227 patients were finally included in the analysis.There were 2 types of trajectories being identified as the low frailty decline group and the high frailty maintenance group.Age,use of sedative and analgesic drugs,pace,and depression were the factors influencing the frailty in cardiac surgery patients(P＜0.05).Conclusion There are 2 kinds of frailty development trajectories in patients undergoing cardiac surgery.Medical staff should fonnulate precise interventions and nursing measures according to the factors influencing frailty,so as to improve frailty degree and quality of life of patients undergoing cardiac surgery.

Systematically sort out the successful development experience and current shortcomings of various aspects of combined Chinese and Western medicine first aid,and on this basis,we discuss the development ideas of combined Chinese and Western medicine first aid.Based on the complementary advantages of the combination of Chinese and Western medicines in first aid,it takes the special diseases with bottlenecks in the efficacy of the current single system as an entry point,and further optimizes the combination of Chinese and Western medicines in first aid through the dynamic and sequential coordination of Chinese medicine's holistic conditioning and Western medicine's targeted treatment,and promotes the development of the synergistic strategy of the first aid of Chinese and Western medicines,so as to better play the advantageous roles of the combination of Chinese and Western medicines in first aid to enhance the clinical efficacy,reduce the toxicity and side-effects,and improve the prognosis of the diseases.We also strive to promote the improvement of the dosage form of traditional first aid prescriptions and the technical innovation of the production process,so as to realize the improvement of the key indexes such as the timeliness of the onset of action,the controllability of the quality,and the targeting of the efficacy of the Chinese medicinal preparations in the first aid,in order to better support and guarantee the medicines for the first aid of the combination of traditional Chinese and Western medicines.At the same time,we should also promote the systematic construction of the standardized operation specification and efficacy evaluation system of acupuncture and moxibustion,explore the integration of acupuncture and moxibustion with modern first aid,and optimize acupuncture and moxibustion intervention strategies in emergency departments to enhance the efficacy of first aid under the restriction of medical equipments.The proposal of these suggestions may provide some enlightenment in the development of the idea of integrating Chinese and Western medicine in emergency care,and may have some reference value for the development of emergency medicine model with Chinese characteristics.