Hygroscopicity research has long been a key focus and hot topic in Chinese materia medica（CMM）. Elucidating hygroscopic mechanisms plays a vital role in formulation design， process optimization， and storage condition selection. Hygroscopic models serve as essential tools for characterizing CMM hygroscopic mechanisms， with various types available. The double exponential model is a kinetic mathematical model constructed based on the law of conservation of energy and Fick's first law of diffusion， tailored to the physical properties of CMM extracts. In recent years， this model has been extensively applied to simulate the dynamic moisture absorption behavior of CMM extracts and solid dosage forms under varying humidity conditions. It has revealed the correlation between moisture absorption kinetic parameters and material properties， offering a new perspective for characterizing the moisture uptake behavior of CMM. This paper systematically reviews the application progress of this model in the field of CMM， analyzes its advantages， disadvantages， and challenges in this domain， and explores its potential application trends in other fields. It aims to provide references for elucidating the moisture absorption mechanisms of CMM and researching moisture-proofing technologies， while also offering insights for its broader application in food and polymer materials.

Chronic mucocutaneous candidiasis (CMC) is an infectious phenotype characterized by recurrent or persistent infections caused by Candida species that affect the skin, nails, oral, and genital mucosae for a duration exceeding six months. Current research suggests that CMC is an immunodeficiency disease with a complex pathogenesis. Patients with CMC have various defects in nonspecific and/or specific immunity against Candida infection, resulting in the inability of patients to defend themselves against Candida infection. CMC can be stratified into primary CMC and secondary CMC based on etiology. Primary CMC is often associated with genetic mutations leading to immunodeficiencies in T helper cell 17 and interleukin-17, whereas secondary CMC is frequently linked to factors such as human immunodeficiency virus infection, diabetes mellitus, and immunosuppressive therapy. Primary CMC typically manifests as Candida infections, with distinct genetic mutations often correlating to varied concomitant symptoms. Secondary CMC may present with not only superficial mucosal Candida infections and manifestations of the underlying primary disease but also with invasive fungal infections. Diagnosing CMC requires an integration of medical history and clinical presentation, supplemented by the outcomes of auxiliary diagnostic procedures, including microscopic examination of fungal smear, fungal culture, immunological testing, and genetic sequencing and analysis. Furthermore, confirming primary CMC requires exclusion of the aforementioned secondary factors. At present, antifungal drugs such as triazoles, echinocandins, and polyenes are the main treatment for CMC. Moreover, immunotherapy with biologics such as Janus kinase (JAK) inhibitors provides more options for the clinical treatment of patients with CMC. Gene therapy also has potential clinical application value. In this review, we discuss the etiologies, pathogenesis, clinical manifestations, diagnosis, and treatments of CMC, aiming to provide a reference for the clinical diagnosis and treatment of CMC.

Introduction: With surgical advancements and improved implants and instrumentation, nailing is the procedure of choice in subtrochanteric fractures. However, failure in achieving reduction of the multidirectional displacement of the fragments prior to passing the nail, contributes to delayed/non-unions at the fracture site leading to implant failures. In this study, we aim to analyse the factors affecting union of closed subtrochanteric fractures treated by nailing. Materials and methods: In this retrospective study, closed subtrochanteric fractures treated with cephalomedullary nailing between 2015 and 2019 were included. Demographic, surgical and radiological data were retrieved and analysed. A total of 60 cases were eligible to be included in the study. Results: Majority of patients were male (50), with a mean age of 46.07±16.40 years. Twenty-two fractures were multifragmentary having a separate butterfly fragment. In 27 patients mini-open technique was used to get the anatomical alignment and to hold reduction until fixation. Overall, the mean time for union was 7.63±5.85 months. We had nine delayed unions and eight non-unions. Varus alignment in the coronal plane of more than 8.5° was the only significant factor associated with delayed or non-union apart from loss of medial continuity. Conclusion: We recommend achieving fracture reduction with less than 8.5° of varus malalignment in the coronal plane. Varus malalignment is poorly tolerated in fractures at this region. To achieve this, we suggest having a very low threshold to minimally open the fracture site for reduction of these fractures, which does not have any negative effect on the fracture union.

Chronic eczema has a high prevalence in China， significantly impacting patients’ quality of life. Leveraging the unique advantages of pattern identification/syndrome differentiation and treatment， along with a holistic approach， traditional Chinese medicine （TCM）， which integrates internal and external therapies， has been widely applied in the management of chronic eczema. It has demonstrated significant efficacy and distinctive strengths in alleviating symptoms， reducing recurrence rates， maintaining disease stability， and enhancing patients’ quality of life. Oral administration of TCM（e.g. modified Longdan xiegan decoction） can improve patients’ clinical symptoms through systemic regulation. External use of TCM can directly act on the skin lesion with the help of steaming and washing， hydropathic compress， ointment and other forms. At the same time， it can effectively relieve the clinical symptoms of chronic eczema by combining with non-drug therapies such as acupuncture， moxibustion， acupoint catgut embedding， blood-letting puncture and cupping. In addition， characteristic therapies such as oral administration of TCM combined with external treatment， a combination of various external treatments and a combination of Chinese and Western medicine have also demonstrated certain advantages in regulating immune function， alleviating skin lesions， and relieving itching symptoms. These therapies cooperate with each other， creating a synergistic effect that treats both the symptoms and the root cause simultaneously. It is suggested that more high-quality， large-scale clinical research should be conducted in the future to systematically confirm the therapeutic advantages of TCM and further explore the specific molecular mechanism of action.

OBJECTIVE To preliminarily investigate the antiasthmatic effect and mechanism of Ephedrae Herba-Armeniacae Semen Amarum herb pair on the respiratory center. METHODS Male SD rats were randomly divided into blank group， model group， dexamethasone group （positive control）， and Ephedrae Herba-Armeniacae Semen Amarum 2∶1， 1∶1 and 1∶2 groups. Rats in each group were administered different ratios of the herb pair decoction [all at 18 g （crude drug）/kg]， dexamethasone suspension （0.5 mg/kg）， or normal saline intragastrically twice daily for seven consecutive days. Forty minutes after the last administration， medicated cerebrospinal fluid was collected to determine the content of effective components entering the brain. One and a half hours after the last administration， the nucleus tractus solitarius （NTS） was located using a stereotaxic apparatus. Histamine phosphate （1 μL） was injected into the NTS region at a constant rate of 1 μL/min using a 10 μL microsyringe to induce excitation of the respiratory center in rats； the blank group was injected with normal saline. The contents of neurotransmitters [nerve growth factor （NGF）， substance P （SP）， norepinephrine （NA）， 5-hydroxytryptamine （5-HT） and acetylcholine （Ach）] in the medulla oblongata brain tissue were detected. The mRNA expressions of neurokinin-1 receptor （NK-1R）， p38 mitogen-activated protein kinase （MAPK）， and c-fos in the medulla oblongata， as well as the protein expressions of NK-1R， p38 MAPK， and c-fos in the NTS region， were determined. RESULTS The main active components of Ephedrae Herba-Armeniacae Semen Amarum herb pair entering the brain were ephedrine， pseudoephedrine， and methylephedrine. Compared with blank group， the contents of NGF， SP， NA， 5-HT and Ach， and the relative expression levels of NK-1R， p38 MAPK， and c-fos mRNA and protein were significantly increased in the model group （ P ＜0.01）. Compared with model group， Ephedrae Herba-Armeniacae Semen Amarum herb pair groups with different ratios significantly reduced the neurotransmitter contents and the relative expression levels of NK-1R， p38 MAPK， and c-fos mRNA and protein （ P ＜0.01）， with the 2∶1 Ephedrae Herba-Armeniacae Semen Amarum herb pair and 1∶1 mass ratios showing relatively better effects. CONCLUSIONS Ephedrae Herba alkaloids are the main active components in affecting the function of the respiratory center. The herb pair groups with a larger proportion of Ephedrae Herba exhibit stronger effects. Ephedrae Herba-Armeniacae Semen Amarum herb pair can reduce the excitability of the respiratory center by down-regulating the expression of the NK-1R/MAPK/c-fos pathway in the NTS and decreasing the abnormal release of neurotransmitters such as NGF and SP.

Based on the "regulating the pivot and unblocking the stomach" theory， this article proposes that the core pathogenesis of bile reflux gastritis （BRG） is disharmony of the three pivots and imbalance between the gallbladder and the stomach. Specifically， the pivot of zang-fu （脏腑） organs （spleen and stomach） exhibits abnormal ascending and descending functions， while the pivot of opening and closing （shaoyang） shows impaired flow， and the pivot of mind （heart and brain） has disordered regulation. These three pivots interact， ultimately leading to bile reflux attacking the stomach， injuring the gastric mucosa， and causing symptoms such as epigastric distension， pain， acid regurgitation， and heartburn. Clinically， the treatment principle is unblocking and regulating the three pivots， harmonizing the gallbladder and descending stomach qi， which closely follows the different pathomechanisms of three-pivot dysregulation， applying treatment according to syndrome differentiation. The regulation of the pivot of zang-fu organs focuses on fortifying the spleen and harmonzing stomach， raising the clear and directing the turbid downward. The regulation of the opening-and-closing pivot emphasizes harmonizing shaoyang， promoting gallbladder function and bowel movement. The regulation of the mind pivot centers on calming the heart and the mind， and harmonizing the stomach to ensure smooth qi flow. "Unblocking and regulating three pivots" method aims to restore the physiological functions of the gallbladder and stomach， providing a conceptual framework for the clinical management of BRG.

Objectives: i) To assess the emotional health status and oral manifestations in pre-menopausal and post-menopausal women. ii) To evaluate the correlation between emotional health status and oral manifestations in pre-menopausal and post-menopausal women. iii) To assess the oral symptoms and emotional state of women in relation to the duration after cessation of menstruation. Methods: A total of 68 women were included and categorized into pre-menopausal (n = 34) and post-menopausal (n = 34) groups. postmenopausal women were further subdivided into three groups based on the duration of cessation of menstruation. After the women provided written informed consent, a questionnaire with binary (yeso) response options was used to document their emotional health, followed by a detailed case history and clinical examination to assess oral signs and symptoms. Results: A statistically significant (P < 0.05) correlation was detected between women’s menopausal status and emotional health status. Burning mouth syndrome was more prevalent among post-menopausal women, with the highest prevalence in Group 2 (33.30%), whereas Group 3 had the highest mean periodontal index and number of missing teeth. Conclusions Post-menopausal women frequently experience oral discomfort, including xerostomia, burning mouth, gustatory changes, and hyposalivation, which are associated with changes in emotional health. The early diagnosis of oral alterations is crucial and should be evaluated alongside other systemic changes. This study aimed to enhance interspecialty cooperation and understanding to improve the health of post-menopausal women.

Traditional surgery for spinal tumors involves midline incision, extensive dissection, muscle damage, blood loss, ligament injury, and bone removal, with an elevated risk of complications. In contrast, minimally invasive techniques cause less soft tissue trauma, bleeding, infections, cerebrospinal fluid leaks, while enabling shorter hospital stays, and yielding similar results compared to open surgery. There have been reports of prior studies have reported the full endoscopic excision of small intradural extramedullary tumors. Here we report a case of a large intradural extramedullary tumor treated with a full endoscopic translaminar approach and dural repair.

Purpose: Three-dimensional (3D)–printed models have been increasingly used in medical education, but most studies have focused on satisfaction or outcomes following isolated learning activities. This study aimed to explore students’ perceptions of learning, engagement, usability, and learning strategies after completing a series of neuroanatomy-related coloring activities using a low-cost 3D-printed model. Methods: This cross-sectional study involved Year 1 medical students at Duke-NUS Medical School. Students participated in 3 structured coloring activities using a modular 3D-printed brain model during a neuroanatomy session. An anonymous survey was administered 1 week after the third activity to assess students’ perceived learning value, engagement (behavioral, cognitive, emotional, and agentic), usability, and learning strategies using Likert-scale items and open-ended questions. Results: A total of 48 students completed the survey, and the instrument showed acceptable to high internal consistency. Students reported high perceived learning value, positive engagement across multiple domains during the coloring activity, and high usability of the model. Participation in the learning activities was associated with significantly higher behavioral and agentic engagement, perceived learning value, and greater use of learning strategies than non-participation. Overall, active manipulation and hands-on exploration were perceived as beneficial for learning. Conclusion Low-cost 3D-printed brain models may serve as valuable learning tools to complement existing anatomy teaching approaches when paired with well-designed learning activities. Students reported positive learning experiences and high engagement during the activities. These findings highlight the importance of sound pedagogical design and curriculum integration to maximize learning.

Introduction: Pheochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumors with high heritability. While most are benign, approximately 25% are malignant, defined by distant metastases. Molecular classification has identified three clusters, with Cluster 3 (Wnt-signaling) being exclusively somatic and associated with aggressive behavior. We report a rare case of metastatic malignant pheochromocytoma driven by a somatic DNMT3A mutation, highlighting its unique imaging characteristics and rapid clinical progression. Case: A 55-year-old female presented with paroxysmal hypertension, headache, and a 10-kg weight loss. Biochemical workup revealed markedly elevated 24-hour urine metanephrines (163 × ULN) and normetanephrines (47 × ULN). Imaging confirmed a 15-cm left adrenal mass with liver and widespread skeletal metastases. Functional imaging demonstrated a striking mixed avidity: liver metastases were predominantly fluorodeoxyglucoseavid (SUVmax 7.0), skeletal lesions showed high Ga-68 DOTATATE avidity (SUVmax 6.9), and the primary tumor exhibited the strongest avidity on 131 I-MIBG scan. Whole Exome Sequencing identified a rare pathogenic somatic variant in the DNMT3A gene (c.2645G>A) with no other germline or somatic mutations in known susceptibility genes. Despite adequate alpha-blockade and supportive care, the patient developed acute liver failure and coagulopathy, rendering her unfit for any form of invasive intervention and finally succumbing to the disease within 3 months of presentation. Conclusion This case underscores the aggressive nature of Cluster 3 PPGLs associated with DNMT3A mutations, which likely promote tumorigenesis via Wnt-pathway activation and epigenetic dysregulation. The discordant functional imaging reflects significant tumor heterogeneity, which may complicate diagnostic and therapeutic strategies. Given the rarity of DNMT3A-mutated PPGL (<1% of cases), this case report emphasizes the necessity of comprehensive molecular profiling in advanced disease to refine risk stratification and guide the development of precisionbased palliative management in rapidly progressive cases.