Huanglian Jiedutang （HLJDT）， as a classical formula for clearing heat and removing toxins， has been widely applied in the treatment of various clinical diseases in recent years， particularly during the fire-heat stage of stroke， where it has attracted considerable attention. Based on previous studies， this paper systematically elaborates on the research progress on the active components of HLJDT， its clinical application in ischemic stroke， and advances in studies on its mechanisms of action. Modern pharmacological studies have demonstrated that HLJDT contains multiple active components， including baicalin， geniposide， and berberine. In the treatment of ischemic stroke， these components exert therapeutic effects through multi-target， multi-pathway， and multi-level mechanisms. Clinical studies have shown that HLJDT can increase cerebral blood flow， reduce cerebral infarct volume， and improve post-stroke physical dysfunction in patients with ischemic stroke. Experimental studies have indicated that HLJDT can improve neurological function scores and increase cerebral perfusion in experimental stroke models. In addition， the mechanisms underlying the anti-ischemic stroke effects of HLJDT may be related to anti-inflammatory and antioxidant activities， promotion of angiogenesis， and regulation of amino acid and energy metabolism. Although existing studies have confirmed that HLJDT exhibits multi-target and multi-pathway synergistic therapeutic characteristics， further large-sample randomized controlled trials are still needed to verify its long-term efficacy and to further elucidate the dynamic interaction network among components， targets， and pathways. Combined with network pharmacology and molecular docking analyses， this study further clarifies the synergistic targets of the core components （berberine， baicalin， and geniposide）， providing a theoretical basis for in-depth research and clinical translation of HLJDT in the treatment of ischemic stroke.

Objective:To investigate the clinical efficacy of the upper eyelid orbicularis oculi muscle bicuspid flap in the correction of excessive width deformities following incisional double eyelid blepharoplasty.Methods:A retrospective analysis was conducted on 30 female patients with excessive width deformities after incisional double eyelid surgery, treated at Sichuan Provincial People′s Hospital between June 2022 and June 2023. The patients′ ages ranged from 30 to 55 (43.1±6.9) years. All patients underwent primary correction using the upper eyelid orbicularis oculi muscle bicuspid flap technique. Preoperative incision lines were designed, and intraoperatively, previous adhesions were thoroughly released. Residual orbicularis oculi muscle was identified superficial to the orbital septum, and both superficial and deep surfaces of the muscle were dissected. The transitional zone between the orbicularis oculi and frontalis muscle was transversely transected deep to the orbital rim, while preserving the medial and lateral attachments of the orbicularis oculi to create a double-pedicle flap. After flap creation, it was repositioned inferiorly to the anterior surface of the tarsal plate along the incision line. This maneuver prevented direct adhesion between the skin and the levator palpebrae superioris muscle and established a tissue step-off, thereby forming a new, natural double eyelid fold. Outcomes were evaluated at 6 months postoperatively, including double eyelid width, fold morphology, scar appearance, complications, and patient satisfaction.Results:The postoperative double eyelid width was (1.9±0.4) mm, significantly reduced from the preoperative width of (5.7±0.9) mm ( P<0.001). The postoperative morphological score was (-0.1±0.6), significantly improved compared to the preoperative score of (-2.4±0.9) ( P<0.001). There was no statistically significant difference in scar scores before (1.7±1.3) and after (1.6±0.8) surgery ( P=0.459). Overall patient satisfaction was 90% (27/30). No major complications such as infection, upper eyelid hollowing, multiple folds, obvious scarring, significant hematoma, persistent bleeding, or lagophthalmos occurred; all patients achieved primary healing. Three patients exhibited mild bilateral asymmetry, and two reported a foreign body sensation in the eye. Conclusions:The upper eyelid orbicularis oculi muscle bicuspid flap is an effective technique for correcting excessive width deformities following incisional double eyelid surgery. It results in reduced eyelid width, natural fold formation, minimal complications, and high patient satisfaction.

Objective:To investigate the clinical efficacy of the upper eyelid orbicularis oculi muscle bicuspid flap in the correction of excessive width deformities following incisional double eyelid blepharoplasty.Methods:A retrospective analysis was conducted on 30 female patients with excessive width deformities after incisional double eyelid surgery, treated at Sichuan Provincial People′s Hospital between June 2022 and June 2023. The patients′ ages ranged from 30 to 55 (43.1±6.9) years. All patients underwent primary correction using the upper eyelid orbicularis oculi muscle bicuspid flap technique. Preoperative incision lines were designed, and intraoperatively, previous adhesions were thoroughly released. Residual orbicularis oculi muscle was identified superficial to the orbital septum, and both superficial and deep surfaces of the muscle were dissected. The transitional zone between the orbicularis oculi and frontalis muscle was transversely transected deep to the orbital rim, while preserving the medial and lateral attachments of the orbicularis oculi to create a double-pedicle flap. After flap creation, it was repositioned inferiorly to the anterior surface of the tarsal plate along the incision line. This maneuver prevented direct adhesion between the skin and the levator palpebrae superioris muscle and established a tissue step-off, thereby forming a new, natural double eyelid fold. Outcomes were evaluated at 6 months postoperatively, including double eyelid width, fold morphology, scar appearance, complications, and patient satisfaction.Results:The postoperative double eyelid width was (1.9±0.4) mm, significantly reduced from the preoperative width of (5.7±0.9) mm ( P<0.001). The postoperative morphological score was (-0.1±0.6), significantly improved compared to the preoperative score of (-2.4±0.9) ( P<0.001). There was no statistically significant difference in scar scores before (1.7±1.3) and after (1.6±0.8) surgery ( P=0.459). Overall patient satisfaction was 90% (27/30). No major complications such as infection, upper eyelid hollowing, multiple folds, obvious scarring, significant hematoma, persistent bleeding, or lagophthalmos occurred; all patients achieved primary healing. Three patients exhibited mild bilateral asymmetry, and two reported a foreign body sensation in the eye. Conclusions:The upper eyelid orbicularis oculi muscle bicuspid flap is an effective technique for correcting excessive width deformities following incisional double eyelid surgery. It results in reduced eyelid width, natural fold formation, minimal complications, and high patient satisfaction.

Diagnostic criteria, as a critical component of clinical practice guidelines, play a direct role in guiding clinicians' diagnostic and treatment decisions. Although China has increasingly emphasized the development and updating of clinical guidelines in recent years, research focusing on the diagnostic criteria within these guidelines remains limited. This paper aims to explore the types of diagnostic criteria, the issues they present, and the processes involved in their formulation. Based on this analysis, suggestions are proposed to improve the recommendation and application of diagnostic criteria in Chinese guidelines.

Diagnostic criteria, as a critical component of clinical practice guidelines, play a direct role in guiding clinicians' diagnostic and treatment decisions. Although China has increasingly emphasized the development and updating of clinical guidelines in recent years, research focusing on the diagnostic criteria within these guidelines remains limited. This paper aims to explore the types of diagnostic criteria, the issues they present, and the processes involved in their formulation. Based on this analysis, suggestions are proposed to improve the recommendation and application of diagnostic criteria in Chinese guidelines.

Objective:To investigate the expression pattern,clinical significance,and the regulatory role of 2',5'-oligoadenylate synthetase 1(OAS1)in the proliferation of pancreatic ductal adenocarcinoma(PDAC)cells.Methods:Public databases such as Gene Expression Omnibus(GEO)and The Cancer Genome Atlas(TCGA)were used to analyze the expression of OAS1 in pancreatic cancer tissues.Immunohistochemical staining was applied to validate the expression level of OAS1 in PDAC tissue microarrays,and the association between OAS1 expression level and the prognosis of patients was analyzed.Real-time fluorescence quantitative PCR was performed to examine the expression level of OAS1 mRNA in different PDAC cell lines.CCK-8 assay and colony formation assay was used to assess the effect of OAS1 on the proliferation of PDAC cells after OAS1 silencing in Patu-8988 and PDC0034 cells by siRNA treatment.Further,Gene Set enrichment analysis(GSEA)was performed to screen for possible molecular mechanism of the regulatory role of OAS1 in PDAC.Cell viability and cholesterol level was analyzed after treatment with mTOR signaling activator MHY1485 in OAS1-silenced Patu-8988 and PDC0034 cells in order to verify the underlying mechanism of the regulatory role of OAS1 in PDAC cell proliferation.Results:Database analysis showed significant upregulation of OAS1 expression in pancreatic cancer tissues(P<0.05).Immunohistochemical staining results from PDAC tissue microarray showed that OAS1 expression was significantly upregulated in PDAC tissues compared with the paired paracancerous tissues,and high OAS1 expression was associated with poor prognosis(P<0.05).Real-time fluorescence quantitative PCR and Western blotting analysis show that OAS1 expression was higher in PDAC cells lines compared with normal ductal cells of the pancreas.The proliferative activity of PDAC cells decreased significantly after OAS1 silencing in Patu-8988 and PDC0034 cells(P<0.001).GSEA results indicated that OAS1 may affect PDAC cell proliferation through mTOR signaling pathway and cholesterol metabolism associated pathway.The mTOR signaling pathway may be inhibited and the total cellular cholesterol decreased after OAS1 silencing.Treatment with mammalian target of rapamycin(mTOR)activator MHY1485 partially reversed the inhibitory effect of OAS1 silencing on the proliferation and cholesterol metabolism of PDAC cells.Conclusion:OAS1 expression is upregulated in PDAC tumor tissues and cells and is associated with poor prognosis.OAS1 may promote the proliferation of pancreatic cancer cells by enhancing cholesterol metabolism through activation of the mTOR signaling pathway.

Objective:To investigate the expression pattern,clinical significance,and the regulatory role of 2',5'-oligoadenylate synthetase 1(OAS1)in the proliferation of pancreatic ductal adenocarcinoma(PDAC)cells.Methods:Public databases such as Gene Expression Omnibus(GEO)and The Cancer Genome Atlas(TCGA)were used to analyze the expression of OAS1 in pancreatic cancer tissues.Immunohistochemical staining was applied to validate the expression level of OAS1 in PDAC tissue microarrays,and the association between OAS1 expression level and the prognosis of patients was analyzed.Real-time fluorescence quantitative PCR was performed to examine the expression level of OAS1 mRNA in different PDAC cell lines.CCK-8 assay and colony formation assay was used to assess the effect of OAS1 on the proliferation of PDAC cells after OAS1 silencing in Patu-8988 and PDC0034 cells by siRNA treatment.Further,Gene Set enrichment analysis(GSEA)was performed to screen for possible molecular mechanism of the regulatory role of OAS1 in PDAC.Cell viability and cholesterol level was analyzed after treatment with mTOR signaling activator MHY1485 in OAS1-silenced Patu-8988 and PDC0034 cells in order to verify the underlying mechanism of the regulatory role of OAS1 in PDAC cell proliferation.Results:Database analysis showed significant upregulation of OAS1 expression in pancreatic cancer tissues(P<0.05).Immunohistochemical staining results from PDAC tissue microarray showed that OAS1 expression was significantly upregulated in PDAC tissues compared with the paired paracancerous tissues,and high OAS1 expression was associated with poor prognosis(P<0.05).Real-time fluorescence quantitative PCR and Western blotting analysis show that OAS1 expression was higher in PDAC cells lines compared with normal ductal cells of the pancreas.The proliferative activity of PDAC cells decreased significantly after OAS1 silencing in Patu-8988 and PDC0034 cells(P<0.001).GSEA results indicated that OAS1 may affect PDAC cell proliferation through mTOR signaling pathway and cholesterol metabolism associated pathway.The mTOR signaling pathway may be inhibited and the total cellular cholesterol decreased after OAS1 silencing.Treatment with mammalian target of rapamycin(mTOR)activator MHY1485 partially reversed the inhibitory effect of OAS1 silencing on the proliferation and cholesterol metabolism of PDAC cells.Conclusion:OAS1 expression is upregulated in PDAC tumor tissues and cells and is associated with poor prognosis.OAS1 may promote the proliferation of pancreatic cancer cells by enhancing cholesterol metabolism through activation of the mTOR signaling pathway.

ObjectiveTo explore the mechanism of Tibetan medicine Ershiwuwei Guijiuwan against osteoporosis in ovariectomized rats through the classical Wnt/β-catenin signaling pathway. MethodForty-eight 3-month-old SD female rats were randomized into model group （equivalent volume of normal saline）， sham operation group （equivalent volume of normal saline）， estradiol group （0.1 mg·kg^-1 estradiol valerate）， and high-， medium-， low-dose Ershiwuwei Guijiuwan groups （800， 400， 200 mg·kg^-1， respectively）. For the modeling， some adipose tissue near the ovaries was removed in the sham operation group， and ovaries were excised in other groups. Administration （ig， once a day） started two weeks after the operation and lasted 12 weeks. After sampling， based on hematoxylin and eosin （HE） staining， the morphological changes of the right femur and lumbar spine of the rats were observed. The enzyme-linked immunosorbent assay （ELISA） was performed to detect the serum levels of rat tartrate-resistant acid phosphatase 5b （TRAP5b）， collagen type Ⅰ C-terminal peptide （CTX-Ⅰ）， bone alkaline phosphatase （BALP）， amino-terminal propeptide of type Ⅰ procollagen （PINP）， and bone Gla-protein （BGP）. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was performed to examine the mRNA expression of β-catenin and Runt-related transcription factor 2 （Runx2） in femur， and Western blot to detect the protein expression of β-catenin， Runx2， and low-density lipoprotein receptor-related protein-5 （Lrp-5）. ResultCompared with the sham operation group， the model group showed disordered and sparse bone trabecula with fewer connections， decrease in serum levels of BALP， BGP， and PINP （P<0.01）， increase in levels of CTX-Ⅰ and TRAP5b （P<0.01）， reduction in mRNA expression of β-catenin and Runx2 in femoral tissue （P<0.01） and protein expression of Lrp-5， β-catenin， and Runx2 （P<0.01）. Compared with the model group， estradiol and each dose of Ershiwuwei Guijiuwan increased the volume of bone trabecula， made thebone trabecula closely arranged， reduced the loss of the trabecular meshwork， raised the serum levels of BALP and BGP （P<0.01）， and lowered TRAP5b level （P<0.01）. PINP level was significantly increased in the high-dose Ershiwuwei Guijiuwan group and estradiol group （P<0.01） and CTX-Ⅰ level was significantly decreased in the high-dose Erwenwuwei Guijiuwan group and the estradiol group （P<0.01） compared with those in the model group. The mRNA expression of β-catenin in femoral tissue and protein expression of Lrp-5 and β-catenin in estradiol group and three Ershiwuwei Guijiuwan groups were significantly increased （P<0.05， P<0.01）， and the levels of Runx2 mRNA and protein were significantly increased in the high-dose Ershiwuwei Guijiuwan group and the estradiol group （P<0.01） compared with those in the model group. ConclusionTibetan medicine Ershiwuwei Guijiuwan is effective for the osteoporosis in ovariectomized rats， which may be related to the classic Wnt/β-catenin signaling pathway. It affects bone metabolism by up-regulating the expression of osteogenesis-related genes in the signaling pathway.

Objective:To analyze measurement results of serum allergen-specific immunoglobulin E (IgE) in patients with eczema/dermatitis.Methods:A retrospective analysis was conducted on serum allergen-specific immunoglobulin E (IgE) levels in 3 051 patients with eczema/dermatitis, who visited the allergy clinic of Huashan Hospital from April 1, 2021 to March 31, 2022. The serum allergen-specific IgE level was detected by using the Phadia allergen detection system, and positive rates of allergens were calculated to determine common inhaled allergens and food allergens in patients with eczema/dermatitis. Comparisons of enumeration data between groups were performed by chi-square test.Results:Among the 3 051 patients with eczema/dermatitis, there were 1 412 with atopic dermatitis and 1 639 were other eczema/dermatitis. Detection of serum allergen-specific IgE showed that 1 629 (53%) patients were positive for allergens, and the number of positive allergen-specific IgEs in each patient was 3.0 ± 1.6. The top 3 common inhaled allergens in patients with eczema/dermatitis were Dermatophagoides farinae (904/1 522, 59%) , Dermatophagoides pteronyssinus (891/1 513, 59%) and Alternaria alternata (206/1 068, 19%) , and the top 3 common food allergens were shrimps (251/1 432, 18%) , egg white (165/992, 17%) and cow milk (149/994, 15%) . Among the 3 051 patients, 25 (1%) were aged < 2 years, 571 (19%) aged 2 - 12 years, 285 (9%) aged 12 - 18 years, and 2 170 (71%) were aged > 18 years. The most common food allergens were both egg white in the age groups of < 2 years and 2 -12 years (77%, 37%, respectively) , and were both shrimps in the age groups of 12 - 18 years and > 18 years (31%, 17%, respectively) . Dermatophagoides pteronyssinus and Dermatophagoides farina were the top 2 common inhaled allergens in all age groups, with the positive rate ranging from 36% to 84%; in addition, the positive rate of molds was relatively high in the age group of 2 - 12 years (mold mixture: 37%; Alternaria alternata: 27%) . From April 2021 to March 2022, the positive rate of outdoor allergens ranged from 10% to 15% among outpatients in every month; the positive rates of tree pollen and grass pollen increased from April 2021, and peaked in October 2021. The patients with atopic dermatitis showed a significantly increased positive rate of allergens (73%) compared with those with other eczema/dermatitis (37%, χ2 = 389.36, P<0.001) , and the rank of common allergens in the patients with atopic dermatitis was basically the same as that in those with eczema/dermatitis. Conclusions:The common allergens were Dermatophagoides farina, Dermatophagoides pteronyssinus and Alternaria alternata in the patients with eczema/dermatitis. Food allergy was more common in infant patients, and inhalation allergy was more common in child, adolescent and adult patients. The positive rate of allergen-specific IgEs was markedly higher in the patients with atopic dermatitis than in those with other eczema/dermatitis.

Cell pyroptosis is a programmed death of inflammatory cells. Many members of the gasdermin family （the effector protein family that forms pores） participate in the pathological process of a variety of diseases， such as cancer， myocardial ischemia， renal injury， and osteoarthritis， mainly by activating cysteine aspartate-specific protease （Caspase） for polymerization and shear. Cell pyroptosis has bidirectional regulation. Induction of pyroptosis can promote cell clearance under pathological conditions （such as cancer and tumor cells）， but long-term induction of pyroptosis can lead to abnormal lipid and related vitamin metabolism in vivo. Regulating the balance between cell pyroptosis and proliferation is an important target for traditional Chinese medicine （TCM） treatment of diseases. The Yin-Yang theory runs through the whole process of TCM diagnosis and treatment， which is used to explain the physiological and pathological changes of human body and guide the theory， diagnosis and treatment of diseases and health care. The balance between cell proliferation and pyroptosis is essentially the embodiment of Yin-Yang balance at the cellular level， and the theory of Yin-Yang spontaneous harmonization dominates the balance. TCM intervention on cell pyroptosis is mainly reflected in promoting and inhibiting cell pyroptosis， which has the same significance as Yin-Yang regulation. Based on this theory， this paper revealed the relationship between TCM inhibiting and promoting cell pyroptosis through the Yin-Yang theory， to provide theoretical support for the modernization of the Yin-Yang theory and new goals for the diagnosis and treatment of diseases.