Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is the primary cause of mortality in sepsis, with its core pathophysiological mechanism being severe ischemia and hypoxia in critical units—composed of microcirculation and the mitochondria of functional cells—resulting from disruptions in blood flow and oxygen flow following a dysregulated host response. Due to the systemically convergent yet clinically heterogeneous nature of the host response, current understanding and management strategies for hemodynamics remain inconsistent, often leading to inadequate resuscitation or overtreatment. To improve the quality of care, based on a systematic review of the "blood flow-oxygen flow" theory, an expert panel emphasizes reevaluating septic shock from an integrated perspective of blood flow and oxygen flow, and has formulated the Expert Consensus on Blood Flow and Oxygen Delivery Phenotyping and Clinical Management of Septic Shock (2025). The consensus proposes that clinical typing of blood flow-oxygen flow should comprehensively consider cardiac function, vascular tone, oxygen flow utilization status in critical units, and disease trajectory, while optimizing subtype identification by integrating host response phenotypes and artificial intelligence technologies. It advocates establishing a continuous assessment system through multi-site oxygen flow monitoring for organ perfusion, peripheral perfusion monitoring, and critical care ultrasound. Under the framework of the "critical care triangle", the consensus promotes the implementation of individualized, bundled management strategies, providing guidance for multiple management points to restore blood flow-oxygen flow matching, reduce the risk of organ failure, and decrease patient mortality.

Liver cancer is one of the most common malignant tumors in the digestive system and ranks sixth among newly diagnosed malignant tumors worldwide. Transforming growth factor-β （TGF-β） regulates cell differentiation， proliferation， apoptosis， and other physiological and pathological mechanisms and exerts cancer-suppressive and pro-cancerous dual effects in the process of tumor development. In recent years， with the continuous exploration of the mechanism of liver cancer， it has been found that the conversion of the cancer-suppressive effect into a pro-cancerous effect of this pathway plays a key role in the development of liver cancer. Traditional Chinese medicine （TCM） provides a unique perspective for the classification， diagnosis， and treatment of liver cancer with its comprehensive regulatory effects of multi-components， multi-targets， and multi-pathways. This paper summarized that the cancer-suppressive mechanisms of the TGF-β signaling pathway included promoting cancer cell cycle arrest， apoptosis， autophagy， et al， while the pro-cancerous mechanisms included promoting cancer cell proliferation， invasion and metastasis， immunosuppression， angiogenesis， et al. The TCM compounds intervening this pathway were sorted out， including Jianpi Huayu compound， Fuyang Baoyuan compound， Yipi Yanggan compound， Fuzheng Jiedu compound， compound Astragalus and Salvia， Biejia Jianwan， Dahuang Zhechong pill， and Qingxiang powder. The single TCMs mainly included Schizocapsa plantaginea， Dendrobii Caulis， Gleditsia sinensis， and Dracaena cochinchinensis. The active ingredients of TCM are mainly concentrated on flavonoids， alkaloids， glycosides， phenolics， terpenoids， polysaccharides， and other kinds of compounds. At the same time， it summarized that the liver cancer inhibition mechanism of TCM by regulating this pathway mainly included promoting apoptosis of liver cancer cells， blocking the cell cycle， and inhibiting liver cancer cell proliferation， migration， invasion， angiogenesis， immune escape， etc. The mechanism aims to give full play to the advantages of TCM and precisely regulate the TGF-β signal， thereby exerting positive anti-tumor effects， opening up a new direction for the precise targeted treatment of liver cancer， and providing a scientific basis and a new strategy for the application of TCM in the treatment of liver cancer.

Liver cancer is one of the most common malignant tumors in the digestive system and ranks sixth among newly diagnosed malignant tumors worldwide. Transforming growth factor-β （TGF-β） regulates cell differentiation， proliferation， apoptosis， and other physiological and pathological mechanisms and exerts cancer-suppressive and pro-cancerous dual effects in the process of tumor development. In recent years， with the continuous exploration of the mechanism of liver cancer， it has been found that the conversion of the cancer-suppressive effect into a pro-cancerous effect of this pathway plays a key role in the development of liver cancer. Traditional Chinese medicine （TCM） provides a unique perspective for the classification， diagnosis， and treatment of liver cancer with its comprehensive regulatory effects of multi-components， multi-targets， and multi-pathways. This paper summarized that the cancer-suppressive mechanisms of the TGF-β signaling pathway included promoting cancer cell cycle arrest， apoptosis， autophagy， et al， while the pro-cancerous mechanisms included promoting cancer cell proliferation， invasion and metastasis， immunosuppression， angiogenesis， et al. The TCM compounds intervening this pathway were sorted out， including Jianpi Huayu compound， Fuyang Baoyuan compound， Yipi Yanggan compound， Fuzheng Jiedu compound， compound Astragalus and Salvia， Biejia Jianwan， Dahuang Zhechong pill， and Qingxiang powder. The single TCMs mainly included Schizocapsa plantaginea， Dendrobii Caulis， Gleditsia sinensis， and Dracaena cochinchinensis. The active ingredients of TCM are mainly concentrated on flavonoids， alkaloids， glycosides， phenolics， terpenoids， polysaccharides， and other kinds of compounds. At the same time， it summarized that the liver cancer inhibition mechanism of TCM by regulating this pathway mainly included promoting apoptosis of liver cancer cells， blocking the cell cycle， and inhibiting liver cancer cell proliferation， migration， invasion， angiogenesis， immune escape， etc. The mechanism aims to give full play to the advantages of TCM and precisely regulate the TGF-β signal， thereby exerting positive anti-tumor effects， opening up a new direction for the precise targeted treatment of liver cancer， and providing a scientific basis and a new strategy for the application of TCM in the treatment of liver cancer.

Hepatocellular carcinoma（HCC）， as one of the common malignant tumours， has seen a continuous rise in incidence and mortality worldwide， posing a serious threat to human health. However， traditional treatments have certain limitations， therefore， the exploration of new therapeutic strategies is particularly urgent. In recent years， with in-depth research on the regulatory mechanisms of microRNA（miRNA） in tumour occurrence and development， it has become new targets for HCC diagnosis and treatment. As a traditional treatment method， Chinese medicine， due to its multi-component， multi-pathway， and multi-target overall regulatory characteristics， shows broad prospects in treating HCC by regulating miRNAs. Accordingly， this paper reviews recent studies on the role of miRNAs in HCC and research advances in traditional Chinese medicine interventions， finding that various miRNAs play key roles in HCC cell cycle regulation， proliferation and apoptosis， invasion and metastasis， immune microenvironment， and drug resistance. It summarises how active ingredients， extracts， medicinal pairs， and formulas of Chinese medicine act on specific miRNAs to regulate their downstream target gene expression， affecting the malignant behaviour of HCC cells and exerting anti-cancer effects. This study aims to provide a theoretical basis for miRNAs as potential biomarkers and therapeutic targets for HCC， as well as to offer new ideas for developing miRNA-based targeted Chinese medicine therapies.

ObjectiveTo evaluate the impact of yang-reinforcing and blood-activating therapy on the long-term prognosis for patients with dilated cardiomyopathy （DCM） of yang deficiency and blood stasis syndrome. MethodsA retrospective cohort study was conducted involving 371 DCM patients with yang deficiency and blood stasis syndrome. The yang-reinforcing and blood-activating therapy was defined as the exposure factor. Patients were categorized into exposure group （186 cases） and non-exposure group （185 cases） according to whether they received yang-reinforcing and blood-activating therapy combined with conventional western medicine for 6 months or longer. The follow-up period was set at 48 months， and the Kaplan-Meier survival analysis was used to assess the cumulative incidence of major adverse cardiovascular events （MACE） in both groups. Cox regression analysis was used to explore the impact of yang-reinforcing and blood-activating therapy on the risk of MACE， and subgroup analysis was performed. Changes in traditional Chinese medicine （TCM） syndrome score， left ventricular ejection fraction （LVEF）， left ventricular fractional shortening （LVFS）， left ventricular end-diastolic diameter （LVEDD）， and Minnesota Living with Heart Failure Questionnaire （MLHFQ） score were compared between groups at the time of first combined use of yang-reinforcing and blood-activating therapy （before treatment） and 1 year after receiving the therapy （after treatment）. ResultsMACE occurred in 31 cases （16.67%） in the exposure group and 47 cases （25.41%） in the non-exposure group. The cumulative incidence of MACE in the exposure group was significantly lower than that in the non-exposure group ［HR=0.559， 95%CI（0.361，0.895）， P=0.014］. Cox regression analysis showed that yang-reinforcing and blood-activating therapy was an independent factor for reducing the risk of MACE in DCM patients ［HR=0.623， 95%CI（0.396，0.980）， P=0.041］， and consistent results were observed in different subgroups. Compared with pre-treatment， the exposure group showed decreased TCM syndrome score and MLHFQ score， reduced LVEDD， and increased LVEF and LVFS after treatment （P＜0.05）； in the non-exposure group， TCM syndrome score decreased， LVEF and LVFS increased， and LVEDD reduced after treatment （P＜0.05）. After treatment， the exposure group had higher LVEF and LVFS， smaller LVEDD， and lower TCM syndrome score and MLHFQ score compared with the non-exposure group （P＜0.05）. ConclusionCombining yang-reinforcing and blood-activating therapy with conventional western medicine can reduce the risk of MACE in DCM patients with yang deficiency and blood stasis syndrome， meanwhile improving their clinical symptoms， cardiac function， and quality of life.

ObjectiveTo explore the effect of transcutaneous electrical acupoint stimulation （TEAS） on stress response in patients undergoing unilateral biportal endoscopy （UBE） and to identify optimal TEAS parameters. MethodsA total of 96 patients undergoing UBE were randomly grouped into total intravenous anesthesia （TIVA） group， acupuncture-assisted anesthesia with continuous waves （AACW） group， and acupuncture-assisted anesthesia with sparse-dense waves （AASDW） group， with 32 patients per group. All groups were given a standardized TIVA protocol. In the AACW group （100 Hz continuous wave stimulation） and the AASDW group （2/100 Hz sparse-dense wave stimulation）， TEAS intervention was applied to both bilateral Zusanli （ST36） and Sanyinjiao （SP6） 30 minutes before TIVA induction and continued until the end of the surgery. In the TIVA group， electrodes were only connected without electrical stimulation. The stress response indicators including cortisol （Cor） and adrenocorticotropic hormone （ACTH）， heart rate （HR）， mean arterial pressure （MAP）， and bispectral index （BIS） at before anesthesia induction （T0）， after tracheal intubation （T1）， during laminectomy （T2）， and 1 hour after surgery （T3） were compared across groups. The operation duration， anesthesia duration， extubation and recovery duration were recorded， as well as pain intensity including visual analogue scale （VAS）， and sedation level （by Ramsay sedation score） at 2， 6， 12 hours after surgery， and postoperative complications. ResultsThe AACW group and AASDW group had lower ACTH and COR levels at T1， T2 and T3， as well as lower HR and MAP levels at T1 and T2 than TIVA group， with AASDW group being lower than AACW group （P＜0.05）. At T3， the AASDW group had higher BIS than TIVA group and AACW group （P＜0.05）. No significant difference in operation duration was observed （P＞0.05）. The AACW group and AASDW group had shorter anesthesia， extubation and recovery duration than TIVA group， with AASDW group being the shortest （P＜0.05）. The VAS scores at 2 h， 6 h， and 12 h after surgery in the AACW and AASDW groups were lower than those in the TIVA group， with the AASDW group showing significantly lower scores than the AACW group （P＜0.05）. The Ramsay sedation scores in the AASDW group were lower than those in the AACW group at 2 h and 6 h after surgery （P＜0.05）. The total incidence of complications in the AASDW group was 6.25% （2/32）， significantly lower than 28.13% （9/32） in the TIVA group （P＜0.05）. ConclusionTEAS can effectively suppresses stress response in patients undergoing UBE， with the 2/100 Hz sparse-dense wave parameter being most effective， which can stabilize hemodynamics， accelerate recovery， improve postoperative sedation and analgesia quality， and reduces complications.

Objective:To systematically evaluate the effectiveness of manual lymphatic drainage (MLD) in the prevention and treatment of breast cancer-related lymphedema (BCRL).Methods:Randomized controlled trials (RCTs) on the application of MLD for lymphedema after breast cancer surgery were retrieved from PubMed, Embase, Web of Science, CNKI, and Wanfang databases. The search covered studies published in English and Chinese from January 1, 2000 to February 1, 2024. Literature management and screening were conducted using EndNote X9 software based on inclusion and exclusion criteria. Relevant data from the final included studies for the meta-analysis were extracted. The outcome measures included the incidence of BCRL, reduced values in upper limb volume or circumference in BCRL patients, and the incidence of axillary web syndrome (AWS). Meta-analysis was performed using RevMan 5.4 software. The incidence of BCRL and AWS was expressed as relative risk ( RR) with 95% confidence intervals ( CI), and the Mantel-Haenszel method was used to calculate pooled effect sizes. For the reduction in limb volume or circumference in BCRL patients, standard mean difference ( SMD) with 95% CI was used, and the inverse variance method was applied to calculate pooled effect sizes. A P-value of <0.05 was considered statistically significant. The I2statistic was used to assess heterogeneity among studies; a fixed-effect model was applied when I2<50%, and a random-effects model was used when I2≥50%. Results:A total of 760 studies were retrieved, and 12 RCTs involving 2 279 post-breast cancer surgery patients were ultimately included. Among them, 1 132 patients in the control group received conventional treatment or combined compression bandaging, while 1 147 patients in the experimental group received MLD in addition to the control group interventions. Moderate to high heterogeneity was observed among the studies ( I2>50%, P<0.05), and a random-effects model was used for the analysis of all outcome measures between the two groups. The result showed that compared to the control group, the experimental group had a lower incidence of BCRL ( RR=0.35, 95% CI: 0.20-0.64, Z=3.42, P<0.001), the reduction in limb volume or circumference measurements increased( SWD=-1.28, 95% CI: -2.45~-0.10, Z=2.13, P=0.030), and a lower incidence of AWS ( RR=0.20, 95% CI: 0.07-0.55, Z=3.11, P=0.002). Conclusion:MLD can significantly prevent the occurrence of lymphedema and AWS in patients after breast cancer surgery, and for patients who have already developed lymphedema, MLD can also effectively reduces the degree of swelling. However, more high quality clinical studies are still needed for further verification.

Objective To investigate the mechanism of action of the Astragalus-Chinese yam combination in treating cancer-related fatigue(CRF)in mice.Methods The active components and related targets of Astragalus-Chinese yam were obtained from the traditional Chinese medicine systems pharmacology database and analysis platform.CRF-associated targets were identified using the GeneCards database.Intersecting targets were analyzed using the DAVID database for gene ontology and kyoto encyclopedia of genes and genomes enrichment analyses.A network diagram depicting"drug-active component-intersecting targets-disease"was constructed using Cytoscape software,and a protein-protein interaction network was created to identify the top five core target proteins based on degree values.Molecular docking simulations were performed using Autodock Vina software.Twenty-five mice were divided randomly into a blank group and a modeling group in a 1∶4 ratio.After successfully establishing the CRF model using Lewis lung cancer cells,mice in the modeling group were further divided into model,Chinese yam(0.2 g/kg),Astragalus(0.6 g/kg),and Astragalus-Chinese yam combination groups(0.3+0.1 g/kg)(n=5 mice per group).The treatments were administered by gavage twice daily for 14 consecutive days.Grip-strength and forced-swimming tests were conducted.The mice were then euthanized and tissues were collected.The gastrocnemius muscles were weighed and stained with hematoxylin and eosin to reveal the muscle fiber morphology.Results A total of 23 effective active components of Astragalus-Chinese yam were identified through network pharmacology analysis,with 199 intersecting drug-disease targets.These targets mainly participated in biological processes such as protein phosphorylation through cellular components(cytoplasm,membrane,nucleus)and performed molecular functions such as protein binding.A total of 155 signaling pathways,including pathway in cancer and the phosphatidylinositol 3-kinase-protein kinase B signaling pathway,were involved in CRF.The critical targets of Astragalus-Chinese yam for CRF included serine/threonine kinase,tumor necrosis factor,epidermal growth factor receptor,B-cell lymphoma 2,and caspase 3.The active components quercetin and diosgenin interacted with the highest number of targets and demonstrated binding energies＜-5.0 kJ/mol with the five core targets,indicating strong ligand-receptor binding affinity.Mice in the Chinese yam and Astragalus groups exhibited increased grip strength and prolonged swimming times compared with the model group.Gastrocnemius muscle volume and mass were increased,with well-organized muscle fibers and clear boundaries,and the effects were even more pronounced in the Astragalus-Chinese yam combination group.Conclusions Astragalus-Chinese yam treats CRF via a multi-target,multi-pathway approach,enhancing muscle strength and endurance in mice,improving gastrocnemius muscle volume and mass,and alleviating muscle atrophy,thereby mitigating the associated symptoms of CRF in mice.

Objective To investigate the mechanism of action of the Astragalus-Chinese yam combination in treating cancer-related fatigue(CRF)in mice.Methods The active components and related targets of Astragalus-Chinese yam were obtained from the traditional Chinese medicine systems pharmacology database and analysis platform.CRF-associated targets were identified using the GeneCards database.Intersecting targets were analyzed using the DAVID database for gene ontology and kyoto encyclopedia of genes and genomes enrichment analyses.A network diagram depicting"drug-active component-intersecting targets-disease"was constructed using Cytoscape software,and a protein-protein interaction network was created to identify the top five core target proteins based on degree values.Molecular docking simulations were performed using Autodock Vina software.Twenty-five mice were divided randomly into a blank group and a modeling group in a 1∶4 ratio.After successfully establishing the CRF model using Lewis lung cancer cells,mice in the modeling group were further divided into model,Chinese yam(0.2 g/kg),Astragalus(0.6 g/kg),and Astragalus-Chinese yam combination groups(0.3+0.1 g/kg)(n=5 mice per group).The treatments were administered by gavage twice daily for 14 consecutive days.Grip-strength and forced-swimming tests were conducted.The mice were then euthanized and tissues were collected.The gastrocnemius muscles were weighed and stained with hematoxylin and eosin to reveal the muscle fiber morphology.Results A total of 23 effective active components of Astragalus-Chinese yam were identified through network pharmacology analysis,with 199 intersecting drug-disease targets.These targets mainly participated in biological processes such as protein phosphorylation through cellular components(cytoplasm,membrane,nucleus)and performed molecular functions such as protein binding.A total of 155 signaling pathways,including pathway in cancer and the phosphatidylinositol 3-kinase-protein kinase B signaling pathway,were involved in CRF.The critical targets of Astragalus-Chinese yam for CRF included serine/threonine kinase,tumor necrosis factor,epidermal growth factor receptor,B-cell lymphoma 2,and caspase 3.The active components quercetin and diosgenin interacted with the highest number of targets and demonstrated binding energies＜-5.0 kJ/mol with the five core targets,indicating strong ligand-receptor binding affinity.Mice in the Chinese yam and Astragalus groups exhibited increased grip strength and prolonged swimming times compared with the model group.Gastrocnemius muscle volume and mass were increased,with well-organized muscle fibers and clear boundaries,and the effects were even more pronounced in the Astragalus-Chinese yam combination group.Conclusions Astragalus-Chinese yam treats CRF via a multi-target,multi-pathway approach,enhancing muscle strength and endurance in mice,improving gastrocnemius muscle volume and mass,and alleviating muscle atrophy,thereby mitigating the associated symptoms of CRF in mice.

Objective:To examine the association between bilateral 4000 Hz hearing loss and blood pressure abnormalities, providing a scientific basis for occupational health management and interventions for noise-induced hearing loss.Methods:In October 2024, 23100 noise-exposed workers who underwent occupational health examinations at Tianjin Institute of Occupational Disease Prevention and Treatment from January 2023 to December 2023 were selected as study subjects. Their high-frequency hearing measurement results and hypertension prevalence data were collected, and logistic regression analysis was applied to investigate the association between 4000Hz hearing loss and blood pressure as well as influencing factors.Results:Among 23100 noise-exposed workers, hypertension was observed in 16.62% (3840/23100), high-frequency hearing loss in 30.49% (7043/23100). Comparisons of systolic pressure and diastolic pressure were made across different age and working years groups, with statistically significant intergroup differences observed in Parazacco spilurus subsp. spilurus (systolic pressure F=183.39, P<0.001; diastolic pressure F=195.61, P<0.001; systolic pressure F=107.26, P<0.001; diastolic pressure F=111.19, P<0.001). Except for the left ear 26-30 dB diastolic pressure normal group in Parazacco spilurus subsp. spilurus, the OR values of systolic pressure and diastolic pressure in other groups were all >1, showing statistically significant differences ( P<0.05). Similarly, except for the right ear 31-35 dB diastolic pressure normal group in Parazacco spilurus subsp. spilurus, the OR values of systolic pressure and diastolic pressure in other groups were all >1, with statistically significant differences ( P<0.05). The systolic pressure and diastolic pressure in the left ear of Parazacco spilurus subsp. spilurus increased with the degree of hearing loss ( χ2trend=126.60, 68.80, P<0.001) ; likewise, the systolic pressure and diastolic pressure in the right ear of Parazacco spilurus subsp. spilurus also increased with the degree of hearing loss ( χ2trend=119.02, 54.50, P<0.001) . Conclusion:4000 Hz hearing loss exhibits a dose-response relationship with abnormal blood pressure. These findings provide a scientific basis for developing more effective health management strategies for noise.