Dry eye （DE） is a prevalent multifactorial disease of the ocular surface， clinically characterized by tear film homeostasis imbalance accompanied by related ocular surface symptoms. Specifically， the tear film is a thin liquid layer of tears covering the cornea and conjunctiva through blinking， while tear film homeostasis serves as the foundation for maintaining normal ocular surface structure and function. Insufficient tear secretion and excessive tear film evaporation lead to tear hyperosmolarity and the production of inflammatory mediators， disrupting tear film homeostasis and subsequently forming DE. Additionally， cascade reactions are triggered， resulting in a "vicious cycle of DE" that exacerbates the disease severity and prolongs its duration. Therefore， for DE treatment， it is crucial to restore tear film homeostasis and terminate this vicious cycle. Traditional Chinese medicine （TCM）， which differentiates and treats DE based on systemic conditions， often achieves favorable therapeutic outcomes， offering additional treatment options for DE. Studies have demonstrated that TCM can alleviate DE by regulating tear film homeostasis and terminating the vicious cycle. This review systematically summarizes recent basic experimental research in China and abroad on TCM in alleviating DE by regulating tear film homeostasis， aiming to provide a theoretical basis for clinical treatment and an insight for research design.

ObjectiveTo establish a mouse model of particulate matter 2.5 （PM_2.5）-induced dry eye and investigate whether Chufeng Yisuntang can ameliorate the PM_2.5-induced ocular surface damage by regulating the reactive oxygen species （ROS）/p38 mitogen-activated protein kinase （p38 MAPK） signaling pathway. MethodsSixty 8-week-old male C57BL/6J mice were used. Ten were randomly selected as the control group. The remaining 50 mice received topical instillation of 1 drop （0.1 mL） of 5 g·L^-1 PM_2.5 suspension in both eyes， four times daily. Successfully modeled mice were randomized into four groups （n=10）： Model， p38 MAPK inhibitor， Chufeng Yisuntang， and combination （Chufeng Yisuntang at 7.3 g·kg^-1 + p38 MAPK inhibitor SB203580 at 5 mg·kg^-1）. Chufeng Yisuntang was administered via gavage， and the inhibitor group via intraperitoneal injection. The control and model groups received equal volumes of distilled water by gavage. All treatments lasted for 4 weeks. General conditions were dynamically observed. Tear secretion， tear film break-up time， and corneal fluorescein staining were assessed. After intervention for 4 weeks， hematoxylin and eosin （HE） staining was used to examine the histopathological changes. Enzyme-linked immunosorbent assay （ELISA） was adopted to measure serum levels of ROS， malondialdehyde （MDA）， superoxide dismutase （SOD） 1， and SOD2. Western blot and Real-time PCR were employed to determine the protein and gene levels， respectively， of p38 MAPK， B-cell lymphoma-2 （Bcl-2）， Bcl-2-associated X protein （Bax）， and cysteinyl aspartate-specific proteinase-3 （Caspase-3） in the corneal tissue. ResultsCompared with the control group， the model group exhibited reduced tear secretion volume and tear film breakup time， along with increased corneal fluorescein staining scores （P<0.01）. Compared with the model group， the Chufeng Yisuntang group， p38 MAPK inhibitor group， and combination group demonstrated increased tear secretion volume and tear film breakup time， along with decreased corneal fluorescein staining scores （P<0.01）. HE staining revealed that compared with the control group， the model group exhibited marked increases in corneal epithelial cell layers and epithelial thickness， along with reduced meibomian gland acini and intensely stained， densely packed nuclei around the acini. Compared with the model group， the Chufeng Yisuntang group， p38 MAPK inhibitor group， and combination group showed intact corneal structure， improved cell morphology， and reduced damage severity. ELISA revealed elevated ROS and MDA levels （P<0.01） and decreased SOD1 and SOD2 levels （P<0.01） in the model group compared with the control group. Compared with the model group， Chufeng Yisuntang， p38 MAPK inhibitor， and the combination lowered ROS and MDA levels （P<0.01）， while raising SOD1 and SOD2 levels （P<0.05， P<0.01）. Western blot revealed that compared with the control group， the model group exhibited increased protein levels of p38 MAPK， Bax， and Caspase-3 （P<0.01） and reduced protein level of Bcl-2 （P<0.01）. Compared with the model group， Chufeng Yisuntang， p38 MAPK inhibitor， and the combination down-regulated the protein levels of p38 MAPK， Bax， and Caspase-3 （P<0.01）， while up-regulating the protein level of Bcl-2 （P<0.01）. Compared with the Chufeng Yisuntang group， the combination group exhibited decreased protein levels of p38 MAPK， Bax， and Caspase-3 （P<0.01） and increased protein level of Bcl-2 （P<0.01）. Real-time PCR revealed that compared with the control group， the model group exhibited upregulated mRNA levels of p38 MAPK， Bax， and Caspase-3 （P<0.01）， and downregulated mRNA level of Bcl-2 （P<0.01）. Compared with the model group， Chufeng Yisuntang， p38 MAPK inhibitor， and the combination down-regulated the mRNA levels of p38 MAPK， Bax， and Caspase-3 （P<0.01）， while up-regulating the mRNA level of Bcl-2 （P<0.05， P<0.01）. Compared with the Chufeng Yisuntang group， the combination group exhibited decreased mRNA levels of p38 MAPK， Bax， and Caspase-3 expression （P<0.05， P<0.01） and increased mRNA level of Bcl-2 （P<0.01）. ConclusionChufeng Yisuntang may partially protect against PM_2.5-induced corneal injury by inhibiting the ROS/p38 MAPK pathway， enhancing antioxidant defense， and reducing epithelial apoptosis.

ObjectiveTo investigate the mechanisms of Runmu Dihuang decoction （RMDHD） in treating perimenopausal dry eye with liver-kidney Yin deficiency syndrome based on the silent information regulator 3 （SIRT3）/hypoxia-inducible factor-1α （HIF-1α）/nuclear factor-κB （NF-κB） signaling pathway. MethodsSixty female Sprague-Dawley rats were randomly divided into six groups （n=10 per group）： Sham operation group， model group， sodium hyaluronate eye drop group， and low-， medium-， and high-dose RMDHD groups （5.625， 11.25， 22.50 g·kg^-1）. Except for the sham operation group， all rats underwent bilateral ovariectomy and were administered 0.1% benzalkonium chloride eye drops combined with long-term chronic irritation to establish a perimenopausal dry eye model with liver-kidney Yin deficiency syndrome. Drug administration began in the 11th week after modeling and continued for 21 days. General conditions， screen-grip test scores， tear secretion volume， tear film breakup time （TFBUT）， and corneal fluorescein staining were recorded. Serum levels of reactive oxygen species （ROS）， follicle-stimulating hormone （FSH）， estradiol （E₂）， and progesterone （PROG） were measured by enzyme-linked immunosorbent assay （ELISA）. Pathological changes in the lacrimal glands， corneas， and uteri were observed using hematoxylin-eosin （HE） staining. Protein expression levels of SIRT3， HIF-1α， phosphorylated NF-κB p65 （p-NF-κB p65）， and total NF-κB p65 in the lacrimal glands were detected by Western blot. The expression of inflammatory cytokines interleukin-1β （IL-1β） and tumor necrosis factor-α （TNF-α） in the lacrimal glands was assessed by immunohistochemistry （IHC）. ResultsAfter model establishment， no significant differences were observed among the groups except the sham operation group. Compared with the sham operation group， the other groups exhibited slowed movement， dull responses， increased irritability， reduced body weight， elevated rectal temperature， decreased screen-grip test scores， reduced tear secretion， and significantly shortened TFBUT （P<0.05）. After treatment， compared with the model group， the sodium hyaluronate eye drop group and all RMDHD groups showed improved general conditions， significantly increased tear secretion （P<0.05）， prolonged TFBUT （P<0.05）， and elevated screen-grip test scores （P<0.05）. Serum ROS and FSH levels were significantly decreased， while E₂ and PROG levels were significantly increased （P<0.05）. Pathological damage to the cornea， lacrimal glands， and uterus was ameliorated. In addition， protein expression levels of SIRT3 and HIF-1α in the lacrimal glands were significantly upregulated （P<0.05）， whereas the expression of p-NF-κB p65， IL-1β， and TNF-α was significantly downregulated （P<0.05）. ConclusionRMDHD increases tear secretion and TFBUT， improves lacrimal gland and corneal injury， and alleviates dry eye symptoms in a perimenopausal dry eye rat model with liver-kidney Yin deficiency syndrome. The underlying mechanism may be related to regulation of the SIRT3/HIF-1α/NF-κB signaling pathway， inhibition of oxidative stress and inflammatory responses， and reduction of ocular surface tissue damage.

Objective: To investigate the protective effects of Gouqizi (Lycii Fructus, GQZ)-Danshen (Salviae Miltiorrhizae Radix et Rhizoma, DS) against hydrogen peroxide (H2O2)-induced oxidative injury in 661W retinal photoreceptor cells and to explore whether these effects involve angiopoietin-like 4 (ANGPTL4). Methods: Liquid chromatography-mass spectrometry (LC-MS) was used to identify the major components of GQZ-DS aqueous extract. An H2O2-induced oxidative injury model was established in 661W cells. Working concentrations of H2O2 and GQZ-DS were determined using the cell counting kit-8 (CCK-8) assay. Cells were subjected to GQZ-DS, ANGPTL4 knockdown, or ANGPTL4 overexpression as indicated. Flow cytometry was used to analyze cell cycle distribution, apoptotic rate, and intracellular reactive oxygen species (ROS). Colorimetric determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity using the thiobarbituric acid (TBA) method was performed. The protein expression level of ANGPTL4 was assessed by immunofluorescence. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was performed to quantify the mRNA level of ANGPTL4. Western blot was used to detect the protein levels of ANGPTL4 and cleaved caspase-3. Results: LC-MS identified five major constituents in the GQZ-DS aqueous extract: 2-O-β-D-glucopyranosyl-L-ascorbic acid, rutin, D-galactose, salvianolic acid A, and tanshinone IIA. The CCK-8 method selected 300 μmol/L H2O2 as the oxidative stress condition for experiments, and 0.05 and 0.1 g/mL were selected as the low and high doses of GQZ-DS, respectively, for subsequent experiments. The intervention with H2O2 resulted in reduced cell viability, elevated ROS and MDA levels, decreased SOD activity, increased apoptotic rate, upregulated cleaved caspase-3 expression, and G0/G1 phase cell cycle arrest of 661W cells. Both low and high doses of GQZ-DS alleviated these alterations, with high dose exhibiting stronger protective effects (P < 0.05 or P < 0.01). GQZ-DS also downregulated ANGPTL4 expression at both the mRNA and protein levels. Following plasmid transfection of cells, the study further revealed that ANGPTL4 knockdown mitigated oxidative stress and apoptosis-related injury, whereas ANGPTL4 overexpression exacerbated these pathological changes. Moreover, GQZ-DS partially reversed the degree of cellular oxidative damage induced by ANGPTL4 overexpression. Conclusion GQZ-DS can alleviate the H2O2-induced oxidative injury of 661W retinal photoreceptor cells, and the effects are related to the down-regulation of ANGPTL4 expression.

Objective To analyze the difference of psoas major muscle morphology and pain degree in patients with different types of lumbar disc herniation ( LDH ) by quantitative CT, and to further explore the relationship between psoas major muscle morphology and pain degree. Methods A total of 120 patients with LDH admitted to our hospital from January to December 2025 were enrolled as study subjects. Based on clinical symptoms and lesion location, they were divided into a simple lower extremity pain group and a lumbar and leg pain group. All patients underwent lumbar CT examination. The psoas major muscle index was used as a CT quantitative parameter, which was calculated as the mean of the maximum cross-sectional areas of both psoas major muscles divided by the cross-sectional area of the L5 vertebral body. This index was measured to reflect psoas major muscle morphology. Pain severity was assessed using the visual analogue scale (VAS). Differences in psoas major muscle morphology and pain severity between the two groups were compared. A Pearson correlation analysis was used to examine the relationship between the psoas major muscle index and pain severity. A linear regression model was used to analyze the independent risk factors affecting pain severity. Results There were no statistically significant differences in sex, age, or body mass index between the two groups (P>0.05). The disease duration was longer and the incidence of anxiety and depression was higher in the lumbar and leg pain group than those in the simple lower extremity pain group (P<0.05). Compared with the simple lower extremity pain group, the lumbar and leg pain group showed lower psoas major muscle index [(0.53 ± 0.05) vs. (0.61 ± 0.07)] and higher VAS score [(4.67 ± 1.10) vs. (3.02 ± 0.89)], and the differences were statistically significant (P<0.05). Pearson correlation analysis revealed a negative correlation between the psoas major muscle index and the VAS score (r=−0.288, P<0.05). Linear regression model analysis indicated that the independent risk factors affecting the VAS score were age, disease duration, LDH type, and the psoas major muscle index. Conclusion Compared with LDH patients with simple lower extremity pain, those with lumbar and leg pain demonstrate a longer disease duration, a higher incidence of anxiety and depression, and a higher severity of psoas major muscle atrophy and pain. The severity of pain is associated with not only advanced age and prolonged disease duration but also the LDH type and psoas major muscle atrophy.

Objective To analyze the difference of psoas major muscle morphology and pain degree in patients with different types of lumbar disc herniation ( LDH ) by quantitative CT, and to further explore the relationship between psoas major muscle morphology and pain degree. Methods A total of 120 patients with LDH admitted to our hospital from January to December 2025 were enrolled as study subjects. Based on clinical symptoms and lesion location, they were divided into a simple lower extremity pain group and a lumbar and leg pain group. All patients underwent lumbar CT examination. The psoas major muscle index was used as a CT quantitative parameter, which was calculated as the mean of the maximum cross-sectional areas of both psoas major muscles divided by the cross-sectional area of the L5 vertebral body. This index was measured to reflect psoas major muscle morphology. Pain severity was assessed using the visual analogue scale (VAS). Differences in psoas major muscle morphology and pain severity between the two groups were compared. A Pearson correlation analysis was used to examine the relationship between the psoas major muscle index and pain severity. A linear regression model was used to analyze the independent risk factors affecting pain severity. Results There were no statistically significant differences in sex, age, or body mass index between the two groups (P>0.05). The disease duration was longer and the incidence of anxiety and depression was higher in the lumbar and leg pain group than those in the simple lower extremity pain group (P<0.05). Compared with the simple lower extremity pain group, the lumbar and leg pain group showed lower psoas major muscle index [(0.53 ± 0.05) vs. (0.61 ± 0.07)] and higher VAS score [(4.67 ± 1.10) vs. (3.02 ± 0.89)], and the differences were statistically significant (P<0.05). Pearson correlation analysis revealed a negative correlation between the psoas major muscle index and the VAS score (r=−0.288, P<0.05). Linear regression model analysis indicated that the independent risk factors affecting the VAS score were age, disease duration, LDH type, and the psoas major muscle index. Conclusion Compared with LDH patients with simple lower extremity pain, those with lumbar and leg pain demonstrate a longer disease duration, a higher incidence of anxiety and depression, and a higher severity of psoas major muscle atrophy and pain. The severity of pain is associated with not only advanced age and prolonged disease duration but also the LDH type and psoas major muscle atrophy.

Objective To analyze the difference of psoas major muscle morphology and pain degree in patients with different types of lumbar disc herniation ( LDH ) by quantitative CT, and to further explore the relationship between psoas major muscle morphology and pain degree. Methods A total of 120 patients with LDH admitted to our hospital from January to December 2025 were enrolled as study subjects. Based on clinical symptoms and lesion location, they were divided into a simple lower extremity pain group and a lumbar and leg pain group. All patients underwent lumbar CT examination. The psoas major muscle index was used as a CT quantitative parameter, which was calculated as the mean of the maximum cross-sectional areas of both psoas major muscles divided by the cross-sectional area of the L5 vertebral body. This index was measured to reflect psoas major muscle morphology. Pain severity was assessed using the visual analogue scale (VAS). Differences in psoas major muscle morphology and pain severity between the two groups were compared. A Pearson correlation analysis was used to examine the relationship between the psoas major muscle index and pain severity. A linear regression model was used to analyze the independent risk factors affecting pain severity. Results There were no statistically significant differences in sex, age, or body mass index between the two groups (P>0.05). The disease duration was longer and the incidence of anxiety and depression was higher in the lumbar and leg pain group than those in the simple lower extremity pain group (P<0.05). Compared with the simple lower extremity pain group, the lumbar and leg pain group showed lower psoas major muscle index [(0.53 ± 0.05) vs. (0.61 ± 0.07)] and higher VAS score [(4.67 ± 1.10) vs. (3.02 ± 0.89)], and the differences were statistically significant (P<0.05). Pearson correlation analysis revealed a negative correlation between the psoas major muscle index and the VAS score (r=−0.288, P<0.05). Linear regression model analysis indicated that the independent risk factors affecting the VAS score were age, disease duration, LDH type, and the psoas major muscle index. Conclusion Compared with LDH patients with simple lower extremity pain, those with lumbar and leg pain demonstrate a longer disease duration, a higher incidence of anxiety and depression, and a higher severity of psoas major muscle atrophy and pain. The severity of pain is associated with not only advanced age and prolonged disease duration but also the LDH type and psoas major muscle atrophy.

Objective To investigate the impacts of percutaneous endoscopic interlaminar discectomy(PEID)on pain level and lumbar function in patients with lumbar disc herniation(LDH).Methods From January 2022 to August 2023,84 patients were diagnosed with L4/5 LDH based on clinical data and imaging information were selected as the study subjects.And they were assigned into 42 cases in experimental group and 42 cases in traditional groups complying with treatment methods.The traditional group underwent traditional open approach treatment,while the experimental group underwent PEID.The surgical indicators(including hospitalization time,surgical time,bed rest time,and intraoperative fluoroscopy frequency),the levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were compared between the two groups,the visual analogue scale(VAS)score and Oswestry disability index(ODI)were used to quantify the pain level of waist and lower limbs and lumbar function,and the excellent and good rate of clinical satisfaction and the incidence of complications were compared.Results The hospitalization time and bed rest time of the experimental group were obviously shorter than those of the traditional group,while the fluoroscopy frequency was less than that of the traditional group,and surgical time was longer than that of the traditional group,the differences were statistically significant(P＜0.05).After treatment,the pain VAS score and ODI of waist and lower limbs,the IL-6,and TNF-α in the two groups were lower than those before treatment,the experimental group was lower than the traditional group,the differences were statistically significant(P＜0.05).The excellent and good rate of the experimental group and the traditional group were 88.10％and 83.33％,respectively,with no statistically significant difference(P＞0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P＞0.05).Conclusion PEID surgery can effectively alleviate nerve compression,alleviate pain of waist and lower limbs,promote the recovering of lumbar function,and facilitate postoperative recovery in LDH patients.

BACKGROUND:Finite element modeling,as an important engineering analysis technique,has been widely used in various fields of bioengineering research.However,there is little literature on what material properties should be selected for each anatomical structure of the knee joint finite element modeling at different ages for different research purposes.OBJECTIVE:To summarize the material properties of knee joint finite element models at different ages based on previous knee joint finite element studies.METHODS:The search terms were"knee,finite element,material selection,ligament injury,osteoarthritis,elderly,children,young people"in Chinese and English.Articles were searched on CNKI and PubMed,with a timeframe of 1950 to 2024.According to inclusion and exclusion criteria,108 articles were finally included for summary.RESULTS AND CONCLUSION:Children's knee bone density will increase with age,reaching peaks in adulthood.From middle-aged to the age,the elastic modulus of knee joint femur,tibia,fibula,and patella will decrease with age,and then return to the elastic modulus of childhood.The elastic modulus of children and adult cartilage is basically the same,and the elastic modulus of the elderly increases.With the increase of age,the elastic modulus of the knee ligament will decrease to a certain extent,but there is no significant difference in the elastic modulus of the knee ligament of young people and the elderly.With the increase of age,the loss of mechanical integrity of the knee meniscus will damage the biomechanical function of the tissue and disturb the various anisotropic biomechanical responses that are effectively carried and transmitted by the tissue.Knee joint finite element modeling can be used to deeply understand the biomechanical characteristics of the knee joints,develop new implanted materials,predict knee joint diseases,improve surgical technology,and guide patients to rehabilitate exercise.

Objectives:To investigate the enhancement of tumor penetration and photodynamic therapy (PDT) efficacy in triple-negative breast cancer by hyaluronidase (HAase) using a novel pH-responsive IR780-loaded photosensitive micelle.Methods:The pH-responsive IR780-loaded photosensitive micelles were prepared using the nanoprecipitation method, and their morphology, size, and encapsulation efficiency were characterized. The in vitro stability and pH-responsive drug release of the micelles were also evaluated. The cytotoxicity of the micelles on triple-negative breast cancer cells (MDA-MB-231) was assessed using a cell counting kit. A nude mouse breast cancer model was established, and HAase was injected intratumorally 24 hours before intravenous injection of the photosensitive micelles. The effect of HAase on the biodistribution and tumor uptake of the micelles was detected using small animal in vivo imaging. CD31 and HIF-1α immunofluorescence staining were performed to investigate the mechanism of HAase-enhanced tumor penetration. The body weight and tumor volume of the mice were measured, and necrosis and apoptosis of tumor tissues were assessed using HE staining and TUNEL staining, respectively. Results:Transmission electron microscopy showed that the micelles had a uniform particle size of approximately 60-70 nm, with a hydrated particle size of (98.03±0.22) nm. The IR780 encapsulation efficiency was 74.15%, with a drug loading content of 2.07%. After 7 days at 4 ℃, there was no significant change in hydrated particle size ( P=0.062). The 24-hour release rates of the micelles in PBS at pH 7.4 and 6.5 were (2.41±0.21)% and (43.69±2.09)%, respectively, showing a significant difference ( P＜0.000 1). The cytotoxicity assay revealed that the cell viability in the micelles group without light exposure was significantly higer than that in the micelles group under light exposure [(97.00±5.38)% vs. (53.27±9.00)%, P=0.000 2]. The micelles were able to target and accumulate in the tumor tissue, and this accumulation increased significantly with HAase treatment. CD31 and HIF-1α immunofluorescence staining indicated that the CD31 signal was enhanced [(0.27±0.05)% vs. (4.57±0.27)%, P＜0.000 1] and the HIF-1α signal was reduced [(5.14±0.38)% vs. (0.08±0.04)%, P＜0.000 1] in the HAase-treated group compared to that in the micelle-only group. After 11 days of treatment with HAase combined with photosensitive micelles, there was no statistically significant difference in mouse body weight ( P＞0.05). However, the tumor volume inhibition rate in the HAase-micelle-mediated PDT group was significantly higher than that in the micelle-mediated PDT group [(87.66±6.37)% vs. (25.34±12.63)%, P=0.002]. Histological staining showed a significant increase in tumor cell necrosis and apoptosis in the HAase-micelle-mediated PDT group. Conclusion:HAase enhances the deep tumor penetration and targeted accumulation of pH-responsive IR780-loaded photosensitive micelles, significantly improves the efficacy of photodynamic therapy in triple-negative breast cancer.