Metabolic syndrome （MS） is a clinical syndrome characterized by obesity， insulin resistance， and dyslipidemia， and chronic inflammation is closely associated with its pathogenesis. The imbalance between pro-inflammatory and anti-inflammatory macrophage polarization， as one of the core pathological mechanisms of chronic inflammation， is a crucial driver of MS progression. According to Essential Questions in Yellow Emperor's Inner Canon： Distinctive Theory on Meridians and Diseased Pulses， "the spleen Qi dispersing essence... along all the meridians and collaterals". When the spleen fails in transportation and transformation， the distribution of refined essence becomes disordered， leading to internal accumulation of phlegm-dampness， forming a dynamic pathological state of "root deficiency with branch excess". Accordingly， the core traditional Chinese medicine （TCM） pathogenesis of MS is closely related to "spleen failing in transportation and transformation coupled with the internal accumulation of phlegm-dampness"； however， its modern biological basis remains elusive. Therefore， based on the theory of "spleen Qi dispersing essence" and recent advances in immunometabolism， this paper explored the modern scientific connotation of the TCM pathogenesis of MS from the perspective of macrophage polarization driven by glucose metabolic reprogramming. Through theoretical analysis and literature integration， it was proposed that mitochondrial oxidative phosphorylation participates in the energy metabolism process of "spleen Qi dispersing essence". The dysfunction of the spleen's transportation and transformation prompts macrophage metabolism to shift toward glycolysis， resulting in the accumulation of lactate and succinate， which represents the microscopic manifestation of "refined essence deviating from proper transformation" and can be defined as "microscopic phlegm-dampness". These metabolites subsequently drive M1 macrophage polarization via the hypoxia-inducible factor-1α （HIF-1α）/nuclear factor-κB （NF-κB） signaling pathway， triggering the release of pro-inflammatory cytokines and inducing systemic chronic low-grade inflammation， ultimately manifesting as insulin resistance， lipid metabolic disorders， and other core components of MS， thus achieving immune amplification from local "microscopic phlegm-dampness" to systemic "internal accumulation of phlegm-dampness". Therefore， macrophage polarization driven by glucose metabolic reprogramming constitutes an important biological link connecting the TCM concept of "spleen failing to disperse essence" with the pathology of MS. Furthermore， this paper reviewed the potential mechanisms by which TCM herbal formulas and their monomeric components that "restore spleen transportation and resolve phlegm-dampness" ameliorate MS by modulating macrophage metabolic remodeling， thereby providing novel biological connotations for the modern interpretation of the theory of "spleen Qi dispersing essence". Future research should integrate multi-omics technologies with disease-syndrome animal models to elucidate the regulatory network of formulas that "restore spleen transportation and resolve phlegm-dampness". Additionally， the feasibility of utilizing macrophage metabolic phenotypes as objective diagnostic biomarkers for the phlegm-dampness syndrome in MS warrants further investigation.

Metabolic syndrome （MS） is a clinical syndrome characterized by obesity， insulin resistance， and dyslipidemia， and chronic inflammation is closely associated with its pathogenesis. The imbalance between pro-inflammatory and anti-inflammatory macrophage polarization， as one of the core pathological mechanisms of chronic inflammation， is a crucial driver of MS progression. According to Essential Questions in Yellow Emperor's Inner Canon： Distinctive Theory on Meridians and Diseased Pulses， "the spleen Qi dispersing essence... along all the meridians and collaterals". When the spleen fails in transportation and transformation， the distribution of refined essence becomes disordered， leading to internal accumulation of phlegm-dampness， forming a dynamic pathological state of "root deficiency with branch excess". Accordingly， the core traditional Chinese medicine （TCM） pathogenesis of MS is closely related to "spleen failing in transportation and transformation coupled with the internal accumulation of phlegm-dampness"； however， its modern biological basis remains elusive. Therefore， based on the theory of "spleen Qi dispersing essence" and recent advances in immunometabolism， this paper explored the modern scientific connotation of the TCM pathogenesis of MS from the perspective of macrophage polarization driven by glucose metabolic reprogramming. Through theoretical analysis and literature integration， it was proposed that mitochondrial oxidative phosphorylation participates in the energy metabolism process of "spleen Qi dispersing essence". The dysfunction of the spleen's transportation and transformation prompts macrophage metabolism to shift toward glycolysis， resulting in the accumulation of lactate and succinate， which represents the microscopic manifestation of "refined essence deviating from proper transformation" and can be defined as "microscopic phlegm-dampness". These metabolites subsequently drive M1 macrophage polarization via the hypoxia-inducible factor-1α （HIF-1α）/nuclear factor-κB （NF-κB） signaling pathway， triggering the release of pro-inflammatory cytokines and inducing systemic chronic low-grade inflammation， ultimately manifesting as insulin resistance， lipid metabolic disorders， and other core components of MS， thus achieving immune amplification from local "microscopic phlegm-dampness" to systemic "internal accumulation of phlegm-dampness". Therefore， macrophage polarization driven by glucose metabolic reprogramming constitutes an important biological link connecting the TCM concept of "spleen failing to disperse essence" with the pathology of MS. Furthermore， this paper reviewed the potential mechanisms by which TCM herbal formulas and their monomeric components that "restore spleen transportation and resolve phlegm-dampness" ameliorate MS by modulating macrophage metabolic remodeling， thereby providing novel biological connotations for the modern interpretation of the theory of "spleen Qi dispersing essence". Future research should integrate multi-omics technologies with disease-syndrome animal models to elucidate the regulatory network of formulas that "restore spleen transportation and resolve phlegm-dampness". Additionally， the feasibility of utilizing macrophage metabolic phenotypes as objective diagnostic biomarkers for the phlegm-dampness syndrome in MS warrants further investigation.

ObjectiveTo analyze the distribution characteristics of traditional Chinese medicine （TCM） constitution and factors associated with hyperuricemia （HUA） in the HUA population， providing a reference for persona-lized prevention and management of HUA. MethodsA cross-sectional study was conducted among individuals who had completed both serum uric acid （SUA） testing and TCM constitution identification during health examinations. According to SUA levels， participants were divided into a hyperuricemia group and a normal SUA group； according to the constitution identification results， participants were classified into balanced constitution， single biased constitution， and mixed constitution. The distribution characteristics of TCM constitution were compared between the two groups； participants in the hyperuricemia group were stratified by sex and age （≥18 years and ＜40 years， ≥40 years）， and the distribution characteristics of TCM constitution were compared across different sex and age groups. Logistic regression was used to analyze factors associated with HUA， with further stratified analyses by sex and age. ResultsA total of 10 920 participants were included， comprising 4170 cases （38.19%） in the hyperuricemia group and 6750 cases （61.81%） in the normal serum uric acid group. According to TCM constitution， there were 420 cases （3.85%） with balanced constitution， 6108 cases （55.93%） with single biased constitution， and 4392 cases （40.22%） with mixed constitution. In the hyperuricemia group， there were 80 cases （19.05%） with balanced constitution； 2275 cases （37.25%） with single biased constitution， among which damp-heat constitution （1205 cases， 52.97%）， phlegm-dampness constitution （500 cases， 21.98%）， and qi-stagnation constitution （181 cases， 7.96%） accounted for relatively high proportions； and 1815 cases （41.33%） with mixed constitution， among which mixed constitution involving phlegm-dampness （51.35%， 932 cases）， mixed constitution involving blood stasis （47.00%， 853 cases）， and mixed constitution involving damp-heat （41.21%， 748 cases） accounted for relatively high proportions. Logistic regression showed that qi-stagnation constitution （OR=1.68）， mixed constitution involving qi-stagnation （OR=1.53）， mixed constitution involving phlegm-dampness （OR=1.55）， and mixed constitution involving blood stasis （OR=1.50） were independently associated with HUA （P＜0.05）. Sex-stratified analysis showed that mixed constitution involving phlegm-dampness was positively associated with HUA risk in females； age-stratified analysis showed that， among individuals aged ≥18 and ＜40 years， qi-stagnation constitution， mixed constitution involving qi stagnation， and mixed constitution involving phlegm-dampness were positively associated with HUA risk （all P＜0.05）. ConclusionThe prevalence of HUA differs markedly by sex and age. Mixed constitution accounts for a higher proportion of HUA patients. Qi-stagnation constitution， mixed constitution involving qi stagnation， mixed constitution involving phlegm-dampness， and mixed constitution involving blood stasis are associated with HUA. Notably， the specific association of mixed constitution involving phlegm-dampness in females and qi-stagnation constitution in young adults is particularly prominent.

ObjectiveTo understand the development stages and use of policy tools of general practitioner policies in China since it was first proposed, to summarize the experience and explore the shortcomings, so as to provide references for the adjustment and optimization of China’s general practitioner policies. MethodsContent analysis and mathematical statistics analysis were used to conduct a quantitative research on 111 policy documents with 422 policy items involving general practitioners at the national level from 1997 to 2023, through a three-dimensional analysis framework integrating policy tools, human capital process and policy development stages. ResultsCapacity‑building policy tools were most frequently used in general practitioner policies, and the policy tools gradually shifted from mandate to inducement. The general practitioner policies paid less attention to the career selection link, but paid full attention to every segment of human capital links, with a comprehensive application of policy tools observed in the integrated development stage, despite the existence of unbalanced internal distribution. ConclusionIt is suggested to promote the use of incentive policy tools and to explore multiple approaches based on incentive theory; pay attention to the career selection link for guiding the employment of general practitioners; take the appropriateness between the policy tools and human capital process into comprehensive consideration, striking a dynamic balance of the internal structure of general practitioner policies.

ObjectiveTo analyze the characteristics of policy texts related to the physician periodic assessment system in China, providing references for the improvement of the system. MethodsContent analysis was employed, examining 116 policy documents from three dimensions: policy process, policy themes, and policy tools. ResultsA total of 298 codes were obtained. The number of policies related to the periodic assessment of physicians showed an overall trend of increasing first and then decreasing, with the peak annual issuance period between 2011 and 2021, and the average number of policy texts showing a downward trend. Policy documents were summarized into 3 levels: physician periodic assessment work, individual behavior, and institutional systems, encompassing a total of 8 categories of themes. The proportion of supply-oriented, environmental-oriented, and demand-oriented policy tools were 4.03%, 60.40%, and 35.57%, respectively. Moreover, environmental-oriented tools continued to dominate over time, followed by demand-oriented tools, with supply-oriented tools being the least. ConclusionThe policy themes are relatively broad and difficult to implement, focusing on establishing regulations while neglecting resource provision, and failing to continuously improve the construction of the system. It is recommended to clearly define the scope of the periodic assessment management, improve supporting systems, increase resource supply, and continuously promote the execution of assessments and policy revisions.

Objective To observe the effects of Ditan Yizhi Decoction on mitochondrial dynamics-mediated glucose metabolism in vascular dementia(VaD)rats based on the ROS/Drp1 axis;To explore its mechanism in treating VaD.Methods Ten male SD rats were randomly selected from 70 as the sham-operation group,and VaD models were prepared using the modified bilateral common carotid artery permanent ligation method for the remaining rats.The successfully modeled rats were randomly divided into model group,positive drug group(donepezil hydrochloride),inhibitor group(Mdivi-1)and Ditan Yizhi Decoction low-,medium-and high-dosage groups(12.86,25.725,51.45 g/kg),and intervened with corresponding method for 4 consecutive weeks.Morris water maze experiment was used to assess the learning memory ability of rats,HE and Nissl staining were used to observe the morphology of hippocampal tissue,transmission electron microscopy was used to observe the mitochondrial ultrastructure of hippocampal neurons,DHE fluorescent probe was used to detect the content of ROS in hippocampal neurons,Western blot was used to detect the expressions of Drp1,p-Drp1,Mfn2,Opa1,HK1,PKM2,GLUT1 and LDHA,the contents of serum IL-1β,IL-6 and TNF-α were detected by ELISA.Results Compared with the sham-operation group,rats in the model group had a prolonged escape latency(P<0.01)and a reduced number of crossing platforms(P<0.01);neuronal gaps in the CA1 region of the hippocampus were enlarged,with irregular cell morphology and blurred borders,neuronal consolidation,lysis and fragmentation of Nissl bodies and reduced number of Nissl bodies,swelling and deformation of mitochondria,disorganization of the cristae,and disruption of the bilayer membrane structure;the content of ROS in CA1 region of the hippocampus was elevated,the protein expressions of Mfn2 and Opa1 significantly decreased(P<0.01),the expressions of p-Drp1,HK1,PKM2,GLUT1,LDHA proteins significantly increased(P<0.01),and serum contents of IL-1β,IL-6 and TNF-α significantly increased(P<0.01).Compared with the model group,the escape latency was significantly shortened in Ditan Yizhi Decoction groups,positive drug group and inhibitor group(P<0.01),and the number of crossing platforms increased(P<0.05,P<0.01);the number of neurons in the hippocampal CA1 region increased,with normal morphology,orderly arrangement,abundant Nissl bodies,recovered mitochondrial morphology,and decreased rupture;the ROS content in hippocampal CA1 region decreased(P<0.01),while the expressions of Mfn2 and Opa1 proteins increased(P<0.01),the expressions of p-Drp1,HK1,PKM2,GLUT1 and LDHA proteins decreased(P<0.01),and the serum contents of IL-1β,IL-6 and TNF-α decreased(P<0.05).Conclusion Ditan Yizhi Decoction can improve cognitive impairment and neuronal morphology in VaD rats,and the mechanism maybe related to regulation of mitochondrial dynamics through the ROS/Drp1 axis,attenuating glycometabolic disorders,and reducing inflammatory response.

Objective:To analyze the genetic characteristics of varicella-zoster virus（VZV）in Anhui province from 2022 to 2023.Methods:Vesicle fluid and throat swab samples were collected from suspected varicella patients in Anhui province during 2022—2023. Fresh vesicle fluid samples were selected for VZV isolation，and real-time PCR was used for VZV nucleic acid detection. For positive samples，the region containing five single nucleotide polymorphism（SNP）sites in the open reading frame 22（ORF22）fragment was amplified，and PCR products were sequenced to identify viral genotypes. Reference sequences of VZV genotypes were downloaded from GenBank，sequence alignment and phylogenetic tree analysis were performed using Sequencher and MEGA5.0 software. Additionally，four SNP sites in ORF38 and ORF62 fragments were detected to distinguish vaccine strains from wild strains.Results:Among 96 samples from suspected varicella cases，55 of 61 vesicle fluid samples and 21 of 35 throat swab samples were positive for VZV nucleic acid. The virus isolation rate for vesicle fluid samples was 14.75%. Genetic sequencing was successful for 51 strains，all of which were wild strains belonging to the clade 2 genetic branch. Compared with the reference strain of clade 2，the nucleotide and amino acid homologies of the ORF22 fragment were 99.46%~100% and 98.39%~100%，respectively. One strain（2023VZVCZ45）exhibited an A→G mutation at site 37916.Conclusion:The prevalent VZV strains detected in Anhui province during 2022—2023 were all wild strains of clade 2，with no vaccine-associated cases identified.

Objective:To develop habitat radiomics models to predict early treatment responses to the hepatic arterial infusion chemotherapy (HAIC) combined with targeted therapy or immunotherapy in advanced hepatocellular carcinoma (HCC) patients, and to guide clinical diagnosis and treatment.Methods:From October 2021 to Decemeber 2023, at Army Characteristic Medical Center of PLA (Chongqing Daping Hospital) and the First Affiliated Hospital of Chongqing Medical University, 94 patients with advanced HCC who received HAIC combined with targeted therapy or immunotherapy were retrospectively enrolled. According to the treatment results, the patients were divided into response group and non-response group. Univariate and multivariate logistic regression were performed to analyze the clinical data of the patients. Based on contrast-enhanced CT images, tumor habitats were delineated and habitat features were extracted with k-means clustering, and the imaging features of arterial and venous phases were also extracted. The least absolute shrinkage and selection operator (LASSO) was used for dimensionality reduction. Feature selection was performed using LASSO to reduce dimensions, and then the selected features were further refined through stepwise logistic regression analysis.Binary logistic regression models were conducted to develop the habitat radiomics model, arterial phase radiomics model (APRM), venous phase radiomics model (VPRM), clinical data model, as well as the combination of radiomics model and clinical data model to predict early treatment (after 2 treatment cycles) response. Receiver operating characteristic curves (ROC) were plotted, and model performance was evaluated by the area under the curve (AUC), calibration curves, and decision curve. The models were validated through Bootstrap methods (1 000 times). DeLong test was used to compare AUC values.Results:The results of cluster analysis identified 3 characteristic habitats in HCC imaging: low-, medium-, and high-enhancement tumor habitats. The proportion of high-enhancement habitats was higher than that in the non-response group. A predictive model was established based on the proportions of these 3 habitats. Based on the proportion of low-, medium-, and high-enhancement habitats within the tumor, a habitat radiomics model was constructed. After LASSO selection and logistic regression analysis, 3 arterial phase and 3 venous phase radiomic features were selected to build the APRM and VPRM, respectively. Logistic regression analysis identified the following factors for the clinical data model: comorbidities ( OR=0.275, P=0.031), maximum tumor diameter ( OR=1.149, P=0.019), red blood cell count ( OR=0.463, P=0.022), alpha fetoprotein >400 μg/L ( OR=3.452, P=0.017), and tyrosine kinase inhibitor therapy ( OR=3.072, P=0.048). Among the single predictive model′s comparison, the AUC of habitat radiomics model was 0.860 (95% confidence interval(95% CI): 0.789 to 0.932), while those of the APRM、VPRM and clinical data model were 0.850 (95% CI: 0.773 to 0.926), 0.855 (95% CI: 0.782 to 0.928), and 0.774 (95% CI: 0.681 to 0.867), respectively, and there were no statistically significant among these models (all P>0.05). Among the combination models, the AUC of the habitat rediomic-clinical data combination model was 0.881 (95% CI: 0.814 to 0.947); the AUC of arterial phase rediomic-clinical data combination model was 0.897 (95% CI: 0.833 to 0.961); and the AUC of venous phase rediomic-clinical data combination model was 0.888 (95% CI: 0.826 to 0.951), but there were no statistically significant among the 3 models (all P>0.05). The calibration curve showed that the habitat rediomic-clinical data combination model had the most accurate predictive probability. Internal validation showed that the AUC of habitat rediomic-clinical data combination model was 0.848 (95% CI: 0.772 to 0.922), and the predictive performance was better than that of the clinical-data model (0.733 (95% CI: 0.670 to 0.863)). Conclusion:The habitat radiomics model based on enhanced CT can effectively predict early treatment responses to the HAIC combined with targeted therapy or immunotherapy in advanced HCC patients, which provides theoretical basis for individualized treatment in advanced HCC.

Objective To investigate whether ginsenoside Rg3 can ameliorate glomerular endothelial injury in diabetic nephropathy(DN)mice through Ras homologous gene family member A(Rho A)/Rho-associated coiled-coil forming protein kinase,(ROCK1)/NLR family pyrin domain protein 3(NLRP3)pathway.Methods Forty mice were randomly divided into 4 groups:control group,DN group,ginsenoside(ginsenoside Rg3)group and RhoA/ROCK pathway inhibition(FD)group,with 10 mice in each group.Fasting blood glucose(FBG)was measured by glucose meter.The levels of urinary protein,urea nitrogen(BUN)and serum creatinine(SCr)were detected by ELISA.PAS staining was used to detect glomerular morphology and structure and to evaluate glomerular injury index(GDI).The expression of platelet-endothelial cell adhesion molecule(PECAM-1 or CD31),von Willefibrilia factor(vWF),RhoA,ROCK and NLRP3 protein related to pyrodeath were detected by immunofluorescence staining.Western blotting detected the expression of intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),the inflammatory factor interleukin-1β(IL-1β)and IL-18 protein in the glomerulus.Results Compared with the control group,the levels of FPG,urinary protein,BUN and SCr in DN group were increased,and the differences were statistically significant(t=17.59～43.81,all P<0.05).The glomerular structure was significantly damaged and GDI was increased(t=20.73,P<0.05).The expressions of CD31,RhoA,ROCK and NLRP3 in glomeruli were increased,while the expression of vWF was decreased.The expressions of ICAM-1,VCAM-1,IL-1β and IL-18 in renal tissues were increased,and the differences were statistically significant(t=27.95～40.10,all P<0.05).Compared with the DN group,the levels of FPG,urinary protein,BUN and SCr in ginsenoside group were decreased,and the differences were statistically significant(t=14.87～20.33,all P<0.05).The damage of glomerular structure was improved and GDI was decreased(t=19.80,P<0.05),the expression of CD31,RhoA,ROCK and NLRP3 in glomerular was decreased,and the expression of vWF was increased.The expressions of ICAM-1,VCAM-1,IL-1β and IL-18 in renal tissues of FD group were decreased,and the differences were statistically significant(t=12.62～39.68,all P<0.05).Conclusion Ginsenosides Rg3 can improve the level of glomerular endothelial injury and pyroptosis in DN mice by down-regulating RhoA/ROCK/NLRP3 pathway.

The advanced platelet-rich fibrin(A-PRF)and concentrated growth factor(CGF)are platelet concentrates(PCs)obtained through the collection of venous blood from the patient and using different centrifugation procedures.Both are rich in growth factors,and the internal fibrin structure within them serves as a natural three-dimensional scaffold for the release of growth factors.They possess characteristics such as low cost,high safety and superior regenerative potential.Currently,they have gained wide-spread attention in the field of regeneration and repair of soft and hard tissues in oral implantation.This review provides the progress of A-PRF and CGF research,focusing on their preparation methods,application methods,potential regeneration mechanisms and a comparison of components and scaffold structures promoting alveolar bone defect repair between A-PRF and CGF.