Xiao Chaihutang， originating from the Treatise on Typhoid and Miscellaneous Diseases， is a classic formula for harmonizing the Shaoyang. It excels in regulating the pivotal mechanism and unblocking the triple energizer， corresponding to the pathogenesis of digestive system tumors characterized by the interlocking of deficiency， stasis， phlegm， and toxicity， as well as disharmony between Yin and Yang. This paper systematically reviews research findings from China and abroad over the past decade， exploring the anti-tumor effects of Xiao Chaihutang on digestive system tumors from three dimensions： theoretical rationale， clinical efficacy， and molecular mechanisms. At the level of principle and method， Xiao Chaihutang takes "harmonization" as its core therapeutic guideline. By reconciling the exterior and interior to restore the Shaoyang pivot， harmonizing Yin and Yang to improve the tumor microenvironment， and regulating the liver and spleen to consolidate and protect the foundation of postnatal essence， it promotes the restoration of the body's dynamic balance of Yin and Yang. Clinical studies have demonstrated that Xiao Chaihutang， used alone or in combination with modern medical therapies， shows definite efficacy against digestive system tumors such as hepatocellular carcinoma， pancreatic carcinoma， and gastrointestinal carcinoma. It can significantly improve patients' quality of life， inhibit tumor progression， effectively relieve concomitant symptoms such a s cancer-related fever， anxiety， depression， and insomnia， and alleviate postoperative embolic syndromes as well as adverse reactions to radiotherapy and chemotherapy. Experimental studies have revealed that Xiao Chaihutang can inhibit tumor cell proliferation， induce apoptosis， arrest the cell cycle， suppress tumor cell invasion and metastasis， and improve the tumor microenvironment. Through the above analysis， this study elucidates the current clinical and experimental research status of Xiao Chaihutang in the treatment of digestive system tumors， aiming to provide theoretical support for its precise clinical application. On this basis， it further explores key issues in the identification of pharmacodynamic substances and the accumulation of evidence in evidence-based medicine， thereby offering a new perspective for the innovative development of integrative Chinese and Western medicine in synergistic cancer therapy.

ObjectiveTo investigate the association of particulate matter and ozone with the prevalence of non-alcoholic fatty liver disease (NAFLD) in a district of Shanghai, and to provide epidemiological evidence for the further identification of early health hazards of air pollution and for the prevention and control of NAFLD. MethodsBased on Songjiang Sub-cohort of Shanghai Natural Population Cohort, a cross-sectional survey design was used to recruit participants from 2016 to 2017. Annual average exposure levels to air pollution from 2009 to 2017 were matched to the participant’s residential address using a high-resolution and high-quality ambient air pollutants dataset in China. NAFLD was diagnosed according to the “Guidelines for the prevention and treatment of metabolism⁃associated (non⁃alcoholic) fatty liver disease” by the Chinese Medical Association. Multivariate logistic regression models were employed to analyze the association between air pollution and the prevalence of NAFLD, and stratified analyses were used to compare differences by age, gender, obesity, and lifestyle habits within subgroups. ResultsA total of 32 791 individuals were included in the study. The prevalence of NAFLD among community residents in suburban Shanghai was 38.88%. For every 1 μg·m^-3 increase in PM₁, PM_2.5, PM₁₀, or O₃, the risk of NAFLD increased correspongdinglt, with the odds ratios (95%CI) of 1.071 (1.043‒1.099), 1.065 (1.042‒1.089), 1.041 (1.027‒1.055), or 1.061 (1.032‒1.091), respectively. There were differences in effects across different gender, age, and obesity status subgroups. ConclusionPM₁, PM_2.5, PM₁₀, and O₃ are positively associated with an increased risk of NAFLD. Stratified analyses reveal that individuals aged 65 years old or above exhibited greater susceptibility to PM₁, PM_2.5, and O₃, whereas those aged less than 65 years old are more vulnerable to PM₁₀. Males are more sensitive to PM₁ and O₃, and females are more susceptible to PM_2.5 and PM₁₀. The association between air pollutant exposure and NAFLD risk is more pronounced among obese participants compared to that in non-obese counterparts.

Platelets are indispensable for physiological hemostasis and pathological thrombus formation, and platelet adhesion to endothelial collagen is a critical initial step in thrombus formation, often overlooked in current antiplatelet therapies. This study aims to elucidate how ginsenoside CK enhances hemodynamic circulation, alleviates stasis, and proposes therapeutic mechanisms. Inspired by the effects on improving microcirculatory disturbances in an acute soft tissue injury model, CK was identified as a PHD2 inhibitor, effectively suppressing platelet adhesion to collagen. It was proposed that targeting PHD2 regulates collagen hydroxylation modification, thereby influencing the formation of its three-dimensional structure, reducing the binding affinity between VWF and collagen, and ultimately suppressing thrombotic events. The efficacy of this mechanism was subsequently confirmed through a mouse DIC model, demonstrating the feasibility of CK in alleviating circulatory disorders. It is worth noting that when Phd2 was knocked down in mice's lungs, pulmonary embolism was significantly reduced. Additionally, PHD2 inhibitors approved for other diseases have exhibited similar anti-thrombotic effects. Moreover, when PHD2 inhibitors were combined with aspirin, they more effectively inhibited arterial thrombosis in rats. The findings offer valuable insights into potential targets for developing antiplatelet drugs or expanding therapeutic applications for existing PHD2 inhibitors in treating thrombotic diseases.

Objective To explore the active components,therapeutic targets,and molecular mechanisms of Shaoyao Decoction in the treatment of ulcerative colitis(UC)using network pharmacology techniques,bioinformatics methods,and experimental approaches.Methods Screening active components of Shaoyao Decoction and predicting their targets using databases such as PubChem,screening HCC-related disease targets through the NCBI database,constructing a PPI network,conducting GO functional enrichment and KEGG pathway analysis to identify potential biological processes and signaling pathways involved,and validating with molecular docking using AutoDock Tools.Forty male C57BL/6J mice were randomly divided into normal,model,Mesalazine,and Shaoyao Tang groups based on body weight.Except for the normal group,all other groups were induced with ulcerative colitis(UC)by providing 2.5%dextran sulfate sodium(DSS)in drinking water for 5 days.After continuous intragastric administration for 7 days,the mice were sacrificed.The levels of cytokines such as IL-2,IL-1β,IL-6,and TNF-α in colon tissues were measured by ELISA,and pathological sections of colon tissue samples were observed.Results The study identified 20 active components and 945 targets of Shaoyao Tang,among which 609 were related to UC.Through PPI network analysis,22 key targets including VEGFA,AKT1,PTGS2,and STAT3 were determined.GO analysis revealed 409 enriched terms,involving negative regulation of inflammatory response to antigenic stimulus,positive regulation of inflammatory response,etc.KEGG analysis discovered 136 significantly enriched pathways,including the NF-κB signaling pathway,Toll-like receptor signaling pathway(related to inflammation and immunity),VEGF signaling pathway,and ErbB signaling pathway(related to cell proliferation and apoptosis).Molecular docking revealed that the active ingredients exhibited strong affinity with target proteins such as IL-6,TNF,TLR4,IL-2,IL-1B,and PTGS2,forming stable conformations.The final ELISA results demonstrated that the levels of multiple inflammatory cytokines in the colon tissue of DSS-induced ulcerative colitis(UC)mouse models were significantly elevated,with notable upregulation of IL-2,IL-1β,IL-6,and TNF-α compared to the normal group(P<0.05).Following drug intervention,both the Mesalazine group and the Shaoyao Decoction group exhibited significant anti-inflammatory effects,effectively reducing the expression levels of the aforementioned inflammatory cytokines in the colon tissue(P<0.05).Notably,compared to the Mesalazine group,Shaoyao Decoction demonstrated a more pronounced regulatory effect on inflammatory cytokines(P<0.05).Conclusion In this study,the innovative integration of network pharmacology prediction,molecular docking validation and key inflammatory factor assay systematically elucidated the"multi-component-multi-target-multi-pathway"anti-inflammatory mode of Paeonia lactiflora broth in the treatment of UC.The experiments demonstrated that Paeonia lactiflora broth could regulate the release of pro-inflammatory cytokines by regulating the levels of IL-2,IL-1β,IL-6,TNF-α cytokines and other related cytokines to reduce the inflammation of the colon and improve the damage of colon tissues in mice with UC.

Objective To investigate the value of prone-position MRI of lumbar spine for diagnosing pediatric occult tethered cord syndrome(OTCS).Methods A total of 67 children with suspected tethered cord syndrome(TCS)and confirmed OTCS by surgery were prospectively enrolled as OTCS group,while 73 healthy subjects were recruited as control group.Supine-and prone-position lumbar MR examinations were performed in both groups.The position of filum terminale on prone axial T2WI and the presence or absence of"sunset sign"(i.e.filum terminale located within the dorsal 1/2 of spinal canal on prone axial T2WI)were observed,spinal cord conus mobility was calculated.The efficacy of"sunset sign"for diagnosing OTCS in children was calculated through comparison between groups.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to evaluate the diagnostic efficacy of spinal cord conus mobility.Results On prone-position axial T2WI,"sunset sign"was found in 58 cases(58/67,86.57％)but not in 9 cases(9/67,13.43％)in OTCS group,which was not even observed in control group.The sensitivity of"sunset sign"for diagnosing pediatric OTCS was 86.57％(58/67),with specificity of 100％(73/73),positive predictive value of 100％(58/58)and negative predictive value of 89.02％(73/82).The spinal cord conus mobility was(19.30±5.89)％in OTCS group and(31.71±6.58)％in control group,being statistically different between groups(t=-11.722,P＜0.001).The sensitivity,specificity and AUC of spinal cord conus mobility for diagnosing pediatric OTCS was 80.60％,90.41％and 0.920,respectively.Conclusion Prone-position MRI of lumbar spine could be used in diagnosing pediatric OTCS.

Objective To explore the active components,therapeutic targets,and molecular mechanisms of Shaoyao Decoction in the treatment of ulcerative colitis(UC)using network pharmacology techniques,bioinformatics methods,and experimental approaches.Methods Screening active components of Shaoyao Decoction and predicting their targets using databases such as PubChem,screening HCC-related disease targets through the NCBI database,constructing a PPI network,conducting GO functional enrichment and KEGG pathway analysis to identify potential biological processes and signaling pathways involved,and validating with molecular docking using AutoDock Tools.Forty male C57BL/6J mice were randomly divided into normal,model,Mesalazine,and Shaoyao Tang groups based on body weight.Except for the normal group,all other groups were induced with ulcerative colitis(UC)by providing 2.5%dextran sulfate sodium(DSS)in drinking water for 5 days.After continuous intragastric administration for 7 days,the mice were sacrificed.The levels of cytokines such as IL-2,IL-1β,IL-6,and TNF-α in colon tissues were measured by ELISA,and pathological sections of colon tissue samples were observed.Results The study identified 20 active components and 945 targets of Shaoyao Tang,among which 609 were related to UC.Through PPI network analysis,22 key targets including VEGFA,AKT1,PTGS2,and STAT3 were determined.GO analysis revealed 409 enriched terms,involving negative regulation of inflammatory response to antigenic stimulus,positive regulation of inflammatory response,etc.KEGG analysis discovered 136 significantly enriched pathways,including the NF-κB signaling pathway,Toll-like receptor signaling pathway(related to inflammation and immunity),VEGF signaling pathway,and ErbB signaling pathway(related to cell proliferation and apoptosis).Molecular docking revealed that the active ingredients exhibited strong affinity with target proteins such as IL-6,TNF,TLR4,IL-2,IL-1B,and PTGS2,forming stable conformations.The final ELISA results demonstrated that the levels of multiple inflammatory cytokines in the colon tissue of DSS-induced ulcerative colitis(UC)mouse models were significantly elevated,with notable upregulation of IL-2,IL-1β,IL-6,and TNF-α compared to the normal group(P<0.05).Following drug intervention,both the Mesalazine group and the Shaoyao Decoction group exhibited significant anti-inflammatory effects,effectively reducing the expression levels of the aforementioned inflammatory cytokines in the colon tissue(P<0.05).Notably,compared to the Mesalazine group,Shaoyao Decoction demonstrated a more pronounced regulatory effect on inflammatory cytokines(P<0.05).Conclusion In this study,the innovative integration of network pharmacology prediction,molecular docking validation and key inflammatory factor assay systematically elucidated the"multi-component-multi-target-multi-pathway"anti-inflammatory mode of Paeonia lactiflora broth in the treatment of UC.The experiments demonstrated that Paeonia lactiflora broth could regulate the release of pro-inflammatory cytokines by regulating the levels of IL-2,IL-1β,IL-6,TNF-α cytokines and other related cytokines to reduce the inflammation of the colon and improve the damage of colon tissues in mice with UC.

Objective To investigate the value of prone-position MRI of lumbar spine for diagnosing pediatric occult tethered cord syndrome(OTCS).Methods A total of 67 children with suspected tethered cord syndrome(TCS)and confirmed OTCS by surgery were prospectively enrolled as OTCS group,while 73 healthy subjects were recruited as control group.Supine-and prone-position lumbar MR examinations were performed in both groups.The position of filum terminale on prone axial T2WI and the presence or absence of"sunset sign"(i.e.filum terminale located within the dorsal 1/2 of spinal canal on prone axial T2WI)were observed,spinal cord conus mobility was calculated.The efficacy of"sunset sign"for diagnosing OTCS in children was calculated through comparison between groups.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to evaluate the diagnostic efficacy of spinal cord conus mobility.Results On prone-position axial T2WI,"sunset sign"was found in 58 cases(58/67,86.57％)but not in 9 cases(9/67,13.43％)in OTCS group,which was not even observed in control group.The sensitivity of"sunset sign"for diagnosing pediatric OTCS was 86.57％(58/67),with specificity of 100％(73/73),positive predictive value of 100％(58/58)and negative predictive value of 89.02％(73/82).The spinal cord conus mobility was(19.30±5.89)％in OTCS group and(31.71±6.58)％in control group,being statistically different between groups(t=-11.722,P＜0.001).The sensitivity,specificity and AUC of spinal cord conus mobility for diagnosing pediatric OTCS was 80.60％,90.41％and 0.920,respectively.Conclusion Prone-position MRI of lumbar spine could be used in diagnosing pediatric OTCS.

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

OBJECTIVE:To investigate the effects of different doses of tanshinone ⅡAon hemodynamics in patients underwent non-extracorporeal circulation coronary artery bypass grafting(NECCABG). METHODS:A total of 66 patients underwent selective NECCABG during Nov. 2016-Apr. 2017 were selected and divided into control group(33 cases)and observation group(33 cases) according to random number tablet. Both groups were given Tanshinone ⅡAsodium sulfonate injection with loading dose of 0.4 μg/kg for 10 min at the beginning of surgery. Control group was given Tanshinone ⅡAsodium sulfonate injection 0.2 μg/(kg·h) continuously till the end of surgery;observation group was given 0.4 μg/(kg·h)continuously till the end of surgery. HR,MAP, central venous pressure(CVP),mean pulmonary arterial pressure(MPAP),pulmonary capillary wedge pressure(PCWP),cardiac index(CI),systemic vascular resistance index(SVRI),pulmonary circulation resistance index(PVRI)and the occurrence of ADR were observed in 2 groups before anesthesia induction(T0),5 min after tracheal intubation(T1),at the moment of sternum cut(T2),at the end of anastomosis of anterior descending branch(T3),at the end of anastomosis of right coronary artery(T4),at the end of operation(T5). RESULTS:At T0,there was no statistical significance in HR,MAP,CVP,MPAP,PCWP, CI,SVRI or PVRI between 2 groups(P>0.05). At T1-T5, HR,MAP,CVP,MPAP,PCWP,SVRI and PVRI of control group were significantly higher than at T0,with statistical significance(P<0.05). There was no statistical significance in CI of control group among at T1-T5and with at T0;there was no statistical significance in HR,MAP,CVP,MPAP,PCWP,SVRI or PVRI of observation group between at T1-T5with at T0 (P>0.05). At T1-T5,CI of observation group was significantly higher than at T0and than control group;HR,MAP,CVP, MPAP,PCWP,SVRI and PVRI were significantly lower than control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups during medication. CONCLUSIONS:Tanshinone ⅡA0.4 μg/(kg·h)is helpful to keep hemodynamics stable and improve heart function in patients with NECCABG with good safety.

Precision medicine pointed out the future direction for medicine,providing new opportunities for the development of TCM,putting forward higher requirements and encountering severe challenges of the quality research of TCM.In view of the core connotation of precision medicine and the characteristics of TCM,we presented the precision connotation of quality based on the basic attributes,the clinical application and function characteristics of TCM in accordance with the thinking mode and method of the transformation research.In this article,we indicated the research approach for the scientific evaluation and effective control of quality based on the precise cognition of TCM.