Aim To explore the mechanism of the co-lonic mucosa of rats with irritable bowel syndrome(IBS)by regulating the Tongxie Yaofang on mecha-nism of short chain fatty acids(SCFAs)and 5-hydroxytryptamine(5-HT)conversion metabolism.Methods The IBS model rats were established by colorectal stimulating baby rats combined with tempora-ry separation of baby rats and female rats.The IBS rats were divided into low-dose Tongxie Yaofang group,high-dose group,model control group,and normal control group.Transmission electron microscopy was used to observe the ultrastructure of the intestinal mu-cosa;ELISA was used to detect the levels of DAO,D-LA,ET,5-HT and 5-HTP in serum;gas chromatogra-phy was used to detect the levels of SCFAs(acetic,propionic and butyric acids)in feces;immunohisto-chemistry was used to detect the expression levels of TPH1,TRPA,5-HTP,5-HT,TGR5,TLR2,5-HT4R and SERT;Western blot was used to detect the expres-sion of intestinal mucosal tight junction proteins Clau-din-1,ZO-1 and Hcy,and the expressions of TPH1,TRPA,TGR5,TLR2 and SERT in colon tissues were further validated.Results Tongxie Yaofang signifi-cantly increased the protein expression of Claudin-1 and ZO-1 of IBS model rats(P＜0.01),decreased Hcy protein expression(P＜0.01),and reduced lev-els of DAO,D-LA,ET,5-HT and 5-HTP in serum(P＜0.05,P＜0.01).It reduced acetic acid,propionic acid and butyric acid content in feces(P＜0.05,P＜0.01),decreased colonic tissue TPH1,TRPA,5-HTP,5-HT,TGR5,TLR2,5-HT4R expression(P＜0.05,P＜0.01),and increased SERT expression(P＜0.05,P＜0.01).Conclusion Tongxie Yaofang improves the pathology of IBS by promoting the expres-sion of intestinal tight junction proteins,regulating the expression of related proteins in the SCFAs-5-HT trans-lational metabolic system,and repairing the intestinal mucosal barrier function.

AIM To explore the clinical effects of Supplemented Baihe Gujin Decoction on elderly patients with postoperative pulmonary infection following non-small cell lung cancer surgery.METHODS Ninety-two patients were randomly assigned into control group(46 cases)for 1-week intervention of conventional treatment,and observation group(46 cases)for 1-week intervention of both Supplemented Baihe Gujin Decoction and conventional treatment.The changes in clinical effects,TCM syndrome scores,immune function indices(CD3+,CD4+,CD8+,CD4+/CD8+),inflammatory indices(CRP,PCT,TNF-α),serum indices(sTREM-1,CD40L,NLR)and incidence of adverse reactions were detected.RESULTS The observation group demonstrated higher total effective rate than the control group(P＜0.05).After the treatment,the two groups displayed decreased TCM syndrome scores,CD8+,inflammatory indices,serum indices(P＜0.05),and increased CD3+,CD4+,CD4+/CD8+(P＜0.05),especially for the observation group(except for CD4+,CD8+)(P＜0.05).CONCLUSION For the elderly patients with postoperative pulmonary infection following non-small cell lung cancer surgery,Supplemented Baihe Gujin Decoction can safely and effectively relieve clinical symptoms,enhance immune functions,reduce serum sTREM-1,CD40L levels and NLR,and control inflammatory responses.

Recent studies have shown that the physiological homeostasis of oral mucosal cells is regulated by the circadian clock.Dis-ruption or dysfunction of the circadian clock is closely associated with the development of oral squamous cell carcinoma(OSCC).Research based on the circadian clock offers a novel perspective on the pathogenesis and therapeutic strategies for OSCC.However,there is current-ly limited research on this topic,and people generally have insufficient understanding and recognition of the circadian clock.Given the complexity and challenges of circadian clock which is the fourth dimension of medical research,we organize relevant experts based on summarizing the current research results of circadian clock in the pathogenesis and precision diagnosis and treatment of OSCC,combining the scientific principles of the circadian clock's role and their long-term research experience,then summarizes and recommends the con-sensus opinions for the research of circadian clock in the pathogenesis mechanism and precision diagnosis and treatment of human OSCC,with the hope of providing guidance for the basic research and clinical application of circadian clock or circadian rhythm in the pathogene-sis mechanism and precision diagnosis and treatment of oral and maxillofacial squamous cell carcinoma.

Aim To explore the mechanism of the co-lonic mucosa of rats with irritable bowel syndrome(IBS)by regulating the Tongxie Yaofang on mecha-nism of short chain fatty acids(SCFAs)and 5-hydroxytryptamine(5-HT)conversion metabolism.Methods The IBS model rats were established by colorectal stimulating baby rats combined with tempora-ry separation of baby rats and female rats.The IBS rats were divided into low-dose Tongxie Yaofang group,high-dose group,model control group,and normal control group.Transmission electron microscopy was used to observe the ultrastructure of the intestinal mu-cosa;ELISA was used to detect the levels of DAO,D-LA,ET,5-HT and 5-HTP in serum;gas chromatogra-phy was used to detect the levels of SCFAs(acetic,propionic and butyric acids)in feces;immunohisto-chemistry was used to detect the expression levels of TPH1,TRPA,5-HTP,5-HT,TGR5,TLR2,5-HT4R and SERT;Western blot was used to detect the expres-sion of intestinal mucosal tight junction proteins Clau-din-1,ZO-1 and Hcy,and the expressions of TPH1,TRPA,TGR5,TLR2 and SERT in colon tissues were further validated.Results Tongxie Yaofang signifi-cantly increased the protein expression of Claudin-1 and ZO-1 of IBS model rats(P＜0.01),decreased Hcy protein expression(P＜0.01),and reduced lev-els of DAO,D-LA,ET,5-HT and 5-HTP in serum(P＜0.05,P＜0.01).It reduced acetic acid,propionic acid and butyric acid content in feces(P＜0.05,P＜0.01),decreased colonic tissue TPH1,TRPA,5-HTP,5-HT,TGR5,TLR2,5-HT4R expression(P＜0.05,P＜0.01),and increased SERT expression(P＜0.05,P＜0.01).Conclusion Tongxie Yaofang improves the pathology of IBS by promoting the expres-sion of intestinal tight junction proteins,regulating the expression of related proteins in the SCFAs-5-HT trans-lational metabolic system,and repairing the intestinal mucosal barrier function.

The glymphatic system(GS)is a unique toxic sub-stance clearance system in brain,which is very important for maintaining the microenvironment stability of the central nervous system.The polarization distribution of aquaporin 4(AQP4)lo-cated in the terminal foot of astrocytes affects the function of GS and participates in the pathological progress of many neurodegen-erative diseases,but the detailed regulation mechanism of AQP4 polarization distribution has not been systematically summarized.Therefore,this paper systematically combs the mechanism of reg-ulating the polarization distribution of AQP4 from the perspective of the composition integrity of dystrophin-glycoprotein complex(DGC)and basement membrane foot complex,and summarizes the potential drug and non-drug therapies for targeted regulation of AQP4 polarization distribution at present,aiming at providing new target reference and theoretical basis for targeted regulation of AQP4 polarization to prevent and treat neurodegenerative dis-eases.

Hypothermia is a clinical syndrome characterized by core body temperature<35℃,caused by significant heat loss from body surface in cold environment.As a systemic cold injury,it can be lethal if treatment is delayed.Emergent diagnosis and treatment of hypothermia are expected to improve the prognosis of patients.In 2005,the U.S.Army Research Institute of Environmental Medicine(USARIEM)issued guidelines for the prevention and management of cold injuries,but there has been no corresponding standard in China.Therefore,Emergency Branch of Chinese Medical Rescue Association,Emergency Medical Equipment Society of China Association of Medical Equipment,Integrated Rehabilitation Medical Branch of Chinese Medical Rescue Association,and Pre-Hospital Emergency Care Working Committee of Chinese Aging Well Association jointly developed the Chinese Expert Consensus on Emergent Treatment of Hypothermia(2025 edition).The consensus covers the pathophysiology,etiology and epidemiology,diagnosis and severity grading,prehospital treatment,and in-hospital treatment of hypothermia,including 15 recommendations in total,aiming to provide guidance for the relevant clinical rescue work.

Objective To comparatively analyze the clinical characteristics of primary bilateral macronodular adrenal hyperplasia(PBMAH)and adrenal cortisol-producing Adenoma(CPA),and enhance the understanding of two diseases.Methods The clinical data of 85 PBMAH patients(PBMAH group)and 195 CPA patients(CPA group)diagnosed at Department of Endocrinology,the First Medical Center of Chinese PLA General Hospital,from September 2014 to August 2024 were retrospectively analyzed.The demographic characteristics,comorbidities,biochemical indicators,adrenocorticotropic hormone-cortisol(ACTH-F)levels,and adrenal imaging features and treatment conditions were compared between the two groups.Results(1)General characteristics:Compared with CPA group,PBMAH group had older age at diagnosis and a higher proportion of male patients.(2)Clinical characteristics:Compared with CPA group,PBMAH group had a longer disease duration,a higher proportion of subclinical Cushing's syndrome(CS),and a higher proportion of hypertension,impaired glucose tolerance/diabetes,bone mass reduction or osteoporosis,with higher serum potassium levels,and the differences were statistically significant(P<0.01).(3)Hormone levels:Both PBMAH and CPA groups showed ACTH-F rhythm disorder,significantly increased cortisol levels and suppressed ACTH.Compared with PBMAH group,CPA group had stronger autonomous cortisol secretion ability,manifested by increased midnight serum cortisol(F0:00),16:00 serum cortisol(F16:00),24-hour urinary free cortisol(24 h UFC)levels and lower 8:00 serum ACTH(ACTH8:00)and 16:00 serum ACTH(ACTH16:00)(P<0.01).After low-dose dexamethasone suppression test(LDDST),CPA group showed lower suppression rates of ACTH and cortisol,and higher proportions of paradoxical elevation in serum cortisol and 24 h UFC compared with PBMAH(P<0.01).Conclusions PBMAH has a longer disease course and higher proportions of comorbid metabolic disorders than CPA,mostly manifested as subclinical Cushing's syndrome.CPA has stronger autonomous cortisol secretion ability,with cortisol less likely to be suppressed after LDDST and more obvious paradoxical elevation of cortisol and 24 h UFC.

Objective To investigate the clinical and pathological characteristics of adrenal cortical carcinoma(ACC),compare differences between hypercortisolism and non-functional ACC,and assess the diagnostic value of indicators such as Ki-67 index.Methods The clinical data of 57 ACC patients admitted to the First Medical Center of Chinese PLA General Hospital from January 2015 to March 2025 were retrospectively analyzed.According to the results of endocrine function assessment,47 of these patients were divided into hypercortisolism group(n=19)and non-functional group(n=28).The differences in clinical and pathological characteristics between the two groups were compared,and non-parametric tests and Spearman correlation analysis were used to explore the relationship between Ki-67 index and tumor stage as well as imaging features.Results Among the 57 patients,there were 20 males and 37 females,with a male-to-female ratio of 1:1.85.The age ranged from 16 to 76 years,and the age at diagnosis was(48.7±13.3)years.The tumor diameter was(10.53±4.14)cm.The tumors were located on the right side in 12 cases(21.1%),on the left side in 34 cases(59.6%),and bilaterally in 11 cases(19.3%).Among them,16 cases(28.1%)were complicated with glucose metabolism disorders,31 cases(54.3%)had hypertension,and 20 cases(35.1%)had hypokalemia.According to ENSAT staging,there were 0 cases in stage Ⅰ,15 cases(26.3%)in stage Ⅱ,24 cases(42.1%)in stage Ⅲ,and 18 cases(31.6%)in stage Ⅳ.Endocrine function assessment was completed in 47 of the 57 patients,including 28 cases(59.6%)of non-functional ACC and 19 cases(40.4%)of hypercortisolism(including 1 case of hypercortisolism combined with increased sex hormone secretion).Compared with non-functional group,hypercortisolism group had a significantly higher prevalence of hypertension(P=0.014),later ENSAT stage(P=0.010),and a higher proportion of hypervascularization(P=0.048).The median Ki-67 index was 20%(10%-40%),showing no significant correlation with either the maximum tumor diameter or SUVmax value,but it was related to ENSAT staging,with Ki-67 index in stageⅣ patients being significantly higher than that in stage Ⅱ(P=0.032).Immunohistochemistry results showed that the positive rate of Inhibin-α was 84.8%,and the positive rate of Melan-A was 40.9%.Conclusions ACC is a rare malignant endocrine tumor.ACC patients with hypercortisolism are more likely to be complicated with hypertension,have later staging,and more common hypervascular manifestations.Clinically,their endocrine function should be prioritized for assessment,and more active treatment strategies should be adopted.Diagnosis should be combined with imaging characteristics(such as hypervascularization)and immunohistochemical indicators(Ki-67,Inhibin-α,Melan-A).The significant increase in Ki-67 is in the advanced stage can serve as an important prognostic indicator to guide individualized treatment.

Objective To characterize multimodal metabolic disorders in subclinical Cushing's syndrome(SCS)patients with different cortisol levels,providing a reference for clinical diagnosis and treatment.Methods A retrospective analysis was conducted on the clinical data of 165 SCS patients diagnosed at the First Medical Center of Chinese PLA General Hospital due to adrenal masses from January 2014 to October 2024.Using the serum cortisol levels after the midnight 1 mg dexamethasone suppression test(1 mg DST)as the cut-off point,SCS patients were divided into high-level group(1 mg DST-F>138 nmol/L,n=96)and low-level group(50 nmol/L<1 mg DST-F≤138 nmol/L,n=69).The differences in age,gender,body mass index(BMI),blood pressure,glucolipid metabolism indices,electrolytes,hormone levels,and imaging features of adrenal adenoma(such as CT values)were compared between the two groups.Multivariate linear regression was used to analyze the correlation between CT values and metabolic indices.Results Compared with low-level group,patients in high-level group were younger(54.0±11.3 vs.57.7±10.3,P=0.034),while there were no statistically significant differences in gender ratio or BMI between the two groups(P>0.05).Both groups exhibited decreased adrenocorticotropic hormone(ACTH)levels and disrupted circadian rhythm.Compared with low-level group,high-level group showed significantly higher F0:00 levels[250.00(170.07,422.53)nmol/L vs.110.00(82.74,133.90)nmol/L]and 24-hour urinary free cortisol(24 h UFC)[568.40(377.80,875.45)nmol/24 h vs.369.40(265.40,494.69)nmol/24 h](P<0.001),with no significant differences in serum F8:00,or 1 mg DST ACTH0:00 levels(P>0.05).Except for the fasting C-peptide level in the high-level group being higher than that in low-level group[(2.88±1.01)ng/ml vs.(2.46±0.78)ng/ml,P=0.024],there were no significant differences in blood pressure,blood lipids,glycated hemoglobin(HbA1c),fasting blood glucose,fasting insulin,serum electrolytes,uric acid,and other indices between the two groups(P>0.05).The CT value of adrenal adenoma during contrast-enhanced scanning was higher in high-level group[80.00(17.80,93.00)Hu vs.52.00(35.50,75.00)Hu,P=0.006]compared with low-level group.Multivariate linear regression analysis revealed that diastolic blood pressure was positively correlated with CT values of adrenal adenomas in both plain scanning(β=0.49,95%CI 0.09-0.90)and contrast-enhanced scanning(β=2.08,95%CI 0.76-3.39),while triglyceride levels were negatively correlated with plain scanning CT values(β=-5.77,95%CI-10.88--0.66).Conclusion Patients with SCS at different cortisol levels differ in age,fasting C-peptide levels,and CT values.CT values may serve as potential imaging markers to assess metabolic risk in SCS patients.

With the rapid development of generative artificial intelligence(GAI)technologies,their widespread application in academic research and writing is continuously expanding the boundaries of sci-entific inquiry.However,this trend has also raised a series of ethical and regulatory challenges,inclu-ding issues related to authorship,content authenticity,citation accuracy,and accountability.In light of the growing involvement of AI in generating academic content,establishing an open,controllable,and trustworthy ethical governance framework has become a key task for safeguarding research integrity and maintaining trust within the academic community.This expert consensus outlines ethical requirements across key stages of AI-assisted academic writing-including topic selection,data management,citation practices,and authorship attribution.It aims to clarify the boundaries and ethical obligations surrounding AI use in academic writing,ensuring that technological tools enhance efficiency without compromising in-tegrity.The goal is to provide guidance and institutional support for building a responsible and sustainable research ecosystem.