Functional dyspepsia (FD), characterized by persistent or recurrent dyspeptic symptoms without identifiable organic, systemic or metabolic causes, is an increasingly recognized global health issue. The objective of this guideline is to equip clinicians and nursing professionals with evidence-based strategies for the management and treatment of adult patients with FD using traditional Chinese medicine (TCM). The Guideline Development Group consulted existing TCM consensus documents on FD and convened a panel of 35 clinicians to generate initial clinical queries. To address these queries, a systematic literature search was conducted across PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, China Biology Medicine (SinoMed) Database, Wanfang Database, Traditional Medicine Research Data Expanded (TMRDE), and the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS). The evidence from the literature was critically appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The strength of the recommendations was ascertained through a consensus-building process involving TCM and allopathic medicine experts, methodologists, pharmacologists, nursing specialists, and health economists, leveraging their collective expertise and empirical knowledge. The guideline comprises a total of 43 evidence-informed recommendations that span a range of clinical aspects, including the pathogenesis according to TCM, diagnostic approaches, therapeutic interventions, efficacy assessments, and prognostic considerations. Please cite this article as: Zhang SS, Zhao LQ, Hou XH, Bian ZX, Zheng JH, Tian HH, Yang GH, Hong WS, He YY, Liu L, Shen H, Li YP, Xie S, Shu J, Zeng BF, Li JX, Liu Z, Xiao ZH, Xiao JD, Zheng PY, Huang SG, Chen SL, Fei GJ. International clinical practice guideline on the use of traditional Chinese medicine for functional dyspepsia (2025). J Integr Med. 2025; 23(5):502-518.
Dyspepsia/drug therapy* ; Humans ; Medicine, Chinese Traditional/methods* ; Practice Guidelines as Topic ; Drugs, Chinese Herbal/therapeutic use*

OBJECTIVE: The study aim was to investigate the effects of exposure to multiple environmental organic pollutants on cardiopulmonary health with a focus on the potential mediating role of oxidative stress. METHODS: A repeated-measures randomized crossover study involving healthy college students in Beijing was conducted. Biological samples, including morning urine and venous blood, were collected to measure concentrations of 29 typical organic pollutants, including hydroxy polycyclic aromatic hydrocarbons (OH-PAHs), bisphenol A and its substitutes, phthalates and their metabolites, parabens, and five biomarkers of oxidative stress. Health assessments included blood pressure measurements and lung function indicators. RESULTS: Urinary concentrations of 2-hydroxyphenanthrene (2-OH-PHE) ( β = 4.35% [95% confidence interval ( CI): 0.85%, 7.97%]), 3-hydroxyphenanthrene ( β = 3.44% [95% CI: 0.19%, 6.79%]), and 4-hydroxyphenanthrene (4-OH-PHE) ( β = 5.78% [95% CI: 1.27%, 10.5%]) were significantly and positively associated with systolic blood pressure. Exposures to 1-hydroxypyrene (1-OH-PYR) ( β = 3.05% [95% CI: -4.66%, -1.41%]), 2-OH-PHE ( β = 2.68% [95% CI: -4%, -1.34%]), and 4-OH-PHE ( β = 3% [95% CI: -4.68%, -1.29%]) were negatively associated with the ratio of forced expiratory volume in the first second to forced vital capacity. These findings highlight the adverse effects of exposure to multiple pollutants on cardiopulmonary health. Biomarkers of oxidative stress, including 8-hydroxy-2'-deoxyguanosine and extracellular superoxide dismutase, mediated the effects of multiple OH-PAHs on blood pressure and lung function. CONCLUSION Exposure to multiple organic pollutants can adversely affect cardiopulmonary health. Oxidative stress is a key mediator of the effects of OH-PAHs on blood pressure and lung function.
Humans ; Oxidative Stress/drug effects* ; Male ; Cross-Over Studies ; Female ; Young Adult ; Environmental Pollutants/toxicity* ; Environmental Exposure/adverse effects* ; Biomarkers/blood* ; Adult ; Blood Pressure/drug effects* ; Polycyclic Aromatic Hydrocarbons/urine* ; Beijing

Objective To analyze the metabolomics characteristics of chronic atrophic gastritis(CAG)patients with liver-stomach qi stagnation and spleen-stomach weakness syndromes based on non-targeted metabolomics technology,and to identify the serum differentiated metabolites related to traditional Chinese medicine(TCM)syndrome of CAG patients,so as to provide a reference for the objectification of syndrome differentiation.Methods Sixty patients with CAG were included,including 30 cases of liver-stomach qi stagnation syndrome and 30 cases of spleen-stomach weakness syndrome.Fasting blood of 5 mL was collected from the cubital vein of patients in the two groups,and the serum levels of metabolites were detected by ultra-high-performance liquid chromatography-mass spectrometry(UPLC-MS)methods.The principal component analysis(PCA),orthogonal partial least squares-discriminant analysis(OPLS-DA),and cluster analysis were used to screen the differentiated metabolites of CAG patients with liver-stomach qi stagnation syndrome and spleen-stomach weakness syndrome.Finally,metabolite pathway analysis was performed for the obtained differentiated metabolites using the KEGG database.Results The results for the screening of differentiated metabolites showed that significant differences of amino acid derivatives and small peptide metabolites were presented between CAG patients with liver-stomach qi stagnation syndrome and CAG patients with spleen-stomach weakness syndrome.The amino acid derivatives consisted of N-acetylglycine,histamine,O-phosphoserine,selenomethylselenocysteine,and methyl-tyrosine.And the small peptide metabolites consisted of tyrosine-leucine-phenylalanine,histidine-alanine-glutamate-lysine,L-asparagine-L-proline-L-serine,and L-isoleucine-L-isoleucine.Conclusion Differences in amino acid metabolism exist between CAG patients with liver-stomach qi stagnation syndrome and those with spleen-stomach weakness syndrome,and metabolites such as N-acetylglycine,intermethyltyrosine,and O-phosphoserine may be the potential biomarkers for distinguishing liver-stomach qi stagnation syndrome from spleen-stomach weakness syndrome in CAG patients.

Multisystem inflammatory syndrome in children(MIS-C)is a complex syndrome characterized by multi-organ involvement that has emerged in the context of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)outbreak.The clinical presentation of MIS-C is similar to Kawasaki disease but predominantly presents with fever and gastrointestinal symptoms,and severe cases can involve toxic shock and cardiac dysfunction.Epidemiological findings indicate that the majority of MIS-C patients test positive for SARS-CoV-2 antibodies.The pathogenesis and pathophysiology of MIS-C remain unclear,though immune dysregulation following SARS-CoV-2 infection is considered a major contributing factor.Current treatment approaches for MIS-C primarily involve intravenous immunoglobulin therapy and symptomatic supportive care.This review article provides a comprehensive overview of the definition,epidemiology,pathogenesis,clinical presentation,diagnosis,treatment,and prognosis of MIS-C.

Objective:To explore the effect of Zhisanzhen acupuncture on cognition ability and apoptosis in the hippocampus using a murine model of cerebral ischemia.Methods:Thirty-two male C57 mice were randomly divided into a control group, a model group, a sham acupuncture group and a Zhisanzhen group, each of 8. All except the control group received middle cerebral artery occlusion and reperfusion (MCAO/R) surgery. Successful modeling was confirmed using Bederson scoring and 2, 3, 5-triphenyltetrazolium chloride staining. Beginning 24 hours after successful modeling, the Zhisanzhen group was given 30 minutes of acupuncture at the Shenting and bilateral Benshen points with the injection 3mm deep daily for five days The sham acupuncture group was given acupuncture at 5 mm next to the Shenting and bilateral Benshen points 3mm deep. Twenty-four hours after the last session of acupuncture, the rats′ cognition was tested using a water maze. After the experiment the hippocampus was sampled on the affected side and any apoptosis of hippocampal neurons was detected using the terminal deoxynucleotidyl transferase nick-end labeling (TUNEL) assays. Changes in caspase-3, cleaved caspase-3 protein and p38 mitogen-activated protein kinase (MAPK) protein in the hippocampal tissue were evaluated using western blotting. The total serine phosphorylation level of caspase-3 protein was detected using immunoprecipitation.Results:Compared to the model and the sham groups, the average escape latency in the Zhisanzhen group was significantly shorter and the times crossing the platform was significantly greater. There were significantly fewer TUNEL-positive cells in the Zhisanzhen group on average, and less caspase-3 and cleaved caspase-3, but significantly more p38-MAPK and greater serine phosphorylation of its substrate caspase-3.Conclusion:Zhisanzhen acupuncture can ameliorate recognition difficulties after cerebral ischemia. It promotes phosphorylation of caspase-3, limiting its cleavage and activation, and decreasing neuron apoptosis in the hippocampus.

Objective:To develop and validate a predictive model of 28-day mortality in sepsis based on lactate dehydrogenase-to-albumin ratio (LAR).Methods:Sepsis patients diagnosed in the department of intensive care medicine of the First Affiliated Hospital of Soochow University from August 1, 2017 to September 1, 2022 were retrospective selected. Clinical data, laboratory indicators, disease severity scores [acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment (SOFA)] were collected. Patients were divided into death group and survival group according to whether they died at 28 days, and the difference between the two groups was compared. The dataset was randomly divided into training set and validation set according to 7∶3. Lasso regression method was used to screen the risk factors affecting the 28-day death of sepsis patients, and incorporating multivariate Logistic regression analysis (stepwise regression) were included, a prediction model was constructed based on the independent risk factors obtained, and a nomogram was drawn. The nomogram prediction model was established. Receiver operator characteristic curve (ROC curve) was drawn to analyze and evaluate the predictive efficacy of the model. Hosmer-Lemeshow test, calibration curve and decision curve analysis (DCA) were used to evaluate the accuracy and clinical practicability of the model, respectively.Results:A total of 394 patients with sepsis were included, with 248 survivors and 146 non-survivors at 28 days. Compared with the survival group, the age, proportion of chronic obstructive pneumonia, respiratory rate, lactic acid, red blood cell distribution width, prothrombin time, activated partial thromboplastin time, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, blood potassium, blood phosphorus, LAR, SOFA score, and APACHEⅡ score in the death group were significantly increased, while oxygenation index, monocyte count, platelet count, fibrinogen, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and blood calcium were significantly reduced. In the training set, LAR, age, oxygenation index, blood urea nitrogen, lactic acid, total cholesterol, fibrinogen, blood potassium and blood phosphorus were screened by Lasso regression. Multivariate Logistic regression analysis finally included LAR [odds ratio ( OR) = 1.029, 95% confidence interval (95% CI) was 1.014-1.047, P < 0.001], age ( OR = 1.023, 95% CI was 1.005-1.043, P = 0.012), lactic acid ( OR = 1.089, 95% CI was 1.003-1.186, P = 0.043), oxygenation index ( OR = 0.996, 95% CI was 0.993-0.998, P = 0.002), total cholesterol ( OR = 0.662, 95% CI was 0.496-0.865, P = 0.003) and blood potassium ( OR = 1.852, 95% CI was 1.169-2.996, P = 0.010). A total of 6 predictor variables were used to establish a prediction model. ROC curve showed that the area under the curve (AUC) of the model in the training set and validation set were 0.773 (95% CI was 0.715-0.831) and 0.793 (95% CI was 0.703-0.884), which was better than APACHEⅡ score (AUC were 0.699 and 0.745) and SOFA score (AUC were 0.644 and 0.650), and the cut-off values were 0.421 and 0.309, the sensitivity were 62.4% and 82.2%, and the specificity were 82.2% and 68.9%, respectively. The results of Hosmer-Lemeshow test and calibration curve showed that the predicted results of the model were in good agreement with the actual clinical observation results, and the DCA showed that the model had good clinical application value. Conclusion:The prediction model based on LAR has a good predictive value for 28-day mortality in patients with sepsis and can guide clinical decision-making.

Purpose To investigate the value of 99Tcm-(methoxyisobutvlisonitrile,MIBI)bone uptake on hungry bone syndrome(HBS)in renal secondary hyperparathyroidism(SHPT)after parathyroidectomy.Materials and Methods From June 2014 to December 2021,106 renal SHPT patients who underwent successful parathyroidectomy in Jiangyin Hospital Affiliated Nantong University were retrospectively enrolled.Visual analysis was used to evaluate the abnormal bone uptake of 99Tcm-MIBI.The patients were divided into HBS group and non-HBS group based on whether occurred HBS.The clinical features,laboratory indicators and 99Tcm-MIBI bone uptake were compared between the two groups.Results Of 106 renal SHPT patients,42(39.62%)patients with bone uptake on visual assessment,showed diffusely increased tracer accumulation,particularly in sternum,clavicle and ribs.The age in HBS group was younger than that in non-HBS group(t=-3.058),the alkaline phosphatase and parathyroid hormone level in HBS group were higher than that in non-HBS group(Z=-5.148,-2.218),the serum corrected calcium in HBS group was lower than that in non-HBS group(Z=-2.102),the positive rate and number of 99Tcm-MIBI bone uptake in HBS group was 50%and 2(1,3),which was higher than that of 28%and 1(1,1)in non-HBS group(χ2=5.344,Z=-2.970),respectively,all showed statistically significant difference(all P<0.05).Conclusion Renal SHPT patient with HBS after parathyroidectomy is commonly related to a high level of alkaline phosphatase and parathyroid hormone,and more likely to develop abnormal 99Tcm-MIBI bone uptake.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the distribution and antimicrobial resistance profiles of the common pathogens isolated from urine from 2015 to 2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods The bacterial strains were isolated from urine and identified routinely in 51 hospitals across China in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Antimicrobial susceptibility was determined by Kirby-Bauer method,automatic microbiological analysis system and E-test according to the unified protocol.Results A total of 261 893 nonduplicate strains were isolated from urine specimen from 2015 to 2021,of which gram-positive bacteria accounted for 23.8％(62 219/261 893),and gram-negative bacteria 76.2％(199 674/261 893).The most common species were E.coli(46.7％),E.faecium(10.4％),K.pneumoniae(9.8％),E.faecalis(8.7％),P.mirabilis(3.5％),P.aeruginosa(3.4％),SS.agalactiae(2.6％),and E.cloacae(2.1％).The strains were more frequently isolated from inpatients versus outpatients and emergency patients,from females versus males,and from adults versus children.The prevalence of ESBLs-producing strains in E.coli,K.pneumoniae and P.mirabilis was 53.2％,52.8％and 37.0％,respectively.The prevalence of carbapenem-resistant strains in E.coli,K.pneumoniae,P.aeruginosa and A.baumannii was 1.7％,18.5％,16.4％,and 40.3％,respectively.Lower than 10％of the E.faecalis isolates were resistant to ampicillin,nitrofurantoin,linezolid,vancomycin,teicoplanin and fosfomycin.More than 90％of the E.faecium isolates were ressitant to ampicillin,levofloxacin and erythromycin.The percentage of strains resistant to vancomycin,linezolid or teicoplanin was＜2％.The E.coli,K.pneumoniae,P.aeruginosa and A.baumannii strains isolated from ICU inpatients showed significantly higher resistance rates than the corresponding strains isolated from outpatients and non-ICU inpatients.Conclusions E.coli,Enterococcus and K.pneumoniae are the most common pathogens in urinary tract infection.The bacterial species and antimicrobial resistance of urinary isolates vary with different populations.More attention should be paid to antimicrobial resistance surveillance and reduce the irrational use of antimicrobial agents.