ObjectiveTo investigate the effect and mechanism of Qingre Sanzhuo decoction in treating gouty arthritis （GA） combined with hyperuricaemia （HUA）. MethodsSixty male SD rats were randomized into normal， model， colchicine （0.5 mg·kg^-1）， and low-， medium-， and high-dose （17， 34， 68 g·kg^-1， respectively） Qingre Sanzhuo decoction groups （n=10）. The rats in other groups except the normal group were treated with the modified method for the modeling of GA combined with HUA. The drug intervention groups were administrated with corresponding drugs by gavage in the afternoon every day and the normal group and the model group were administrated with an equal volume of sterile normal saline by gavage. The level of uric acid （SUA） in the serum was measured 2 h after the last administration. The degree of ankle joint swelling was calculated 0.5， 12， 24， 48 h after modeling， and joint inflammation was scored. The pathological changes of ankle joints were observed by hematoxylin-eosin staining， and the serum levels of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， C reactive protein （CRP）， and interleukin-18 （IL-18） were measured by enzyme-linked immunosorbent assay. Real-time PCR was performed to determine the mRNA levels of NOD-like receptor protein 3 （NLRP3）， apoptosis-associated speck-like protein containing CARD （ASC）， cysteinyl aspartate-specific protease-1 （Caspase-1）， gasdermin D （GSDMD）， and nuclear factor-kappa B （NF-κB） in the synovial tissue of ankle joints. Western blot was employed to determine the protein levels of NLRP3， ASC， and Caspase-1 in ankle joints. The immunohistochemical method was used to detect the expression of GSDMD and NF-κB in the synovial tissue of ankle joints. ResultsCompared with the normal group， the model group showed increased SUA in the serum （P<0.05）， ankle joint swelling and joint inflammation （P<0.05）， increased number of blood vessels in the synovium， inflammatory cell foci in the synovial bursa， elevated serum levels of TNF-α， IL-1β， CRP， and IL-18 （P<0.05）， and up-regulated mRNA and protein levels of NLRP3， ASC， Caspase-1， GSDMD， and NF-κB in the synovial tissue of ankle joints （P<0.05）. Compared with the model group， the medium- and high-dose Qingre Sanzhuo decoction groups showed reduced SUA in the serum （P<0.05）， alleviated ankle joint swelling and joint inflammation （P<0.05）， lowered serum levels of TNF-α， IL-1β， CRP， and IL-18 （P<0.05）， and down-regulated mRNA and protein levels of NLRP3， ASC， Caspase-1， GSDMD， and NF-κB in the synovial tissue of ankle joints （P<0.05）. However， in terms of ameliorating the pathological changes of ankle joints， only the high-dose Qingre Sanzhuo decoction group showed normal morphology of the synovial membrane of ankle joints and no obvious lesion in the articular cartilage. ConclusionQingre Sanzhuo decoction may play a role in preventing and controlling GA combined with HUA by down-regulating the activity of NLRP3/ASC/Caspase-1 pathway and inhibiting the expression of inflammatory cytokines， such as TNF-α， IL-1β， CRP， and IL-18.

In order to understand the difference and expression of genes in CEK cells before and af-ter baicalin interferes with IBV,further reveal and analyze the mechanism of baicalin interfering IBV replication in CEK cells in vitro.After IBV infected CEK cells for 2 h,9.75 mg/L baicalin liq-uid was added to interfere with CEK cells,which was recorded as the baicalin(H-IBV)group,and three replicate wells were set in the control group and the IBV(IBV)infection group.After 36 h culture,cell samples were collected and subject to transcriptome for sequencing.The results showed that there were 102 differentially expressed genes in H-IBV group compared with IBV in-fection group,among which 48 genes weresignificantly up-regulated and 54 genes were significantly down-regulated.Through functional annotation in GO and KEGG databases,it was found that dif-ferentially expressed genes were mainly annotated in biological processes such as cellular proces-ses,biological regulation,metabolism,and secondary pathways such as viral infectious diseases,signal transduction and interaction.Retinol metabolism pathway,phospholipid transfer to mem-brane,IL-27 mediated signaling pathway,MDA5/RIG-I and Toll-like receptor signaling pathway were significantly enriched in CEK cells,and the production of type Ⅰ interferon and interferon al-pha and the process of antiviral infection were also positively regulated.There were more differen-tial genes enriched in nucleic acid catalysis,immune system,and reaction,and interbiological reac-tion.Through the STRING network interaction map,it was found that most immune-related genes could form a 36-node interaction network centered on IRF7,TLR3 and STAT1.Therefore,com-pared with IBV group,the differentially expressed genes after baicalin treatment were mainly an-notated and enriched in the biological process,and the immune system and response were en-hanced,mainly through the positive regulation of IRF7 in the MDA5/RIG-I receptor signaling pathway and the inhibition of TLR3 signal transduction in the Toll-like receptor signaling path-way.Positive regulation of IL-27 mediated pathway and regulation of JAK-STAT signaling path-way were supplemented by activation of the expression of IRF7,TLR3,STAT1 and other related genes,and interaction with corresponding downstream proteins to promote the expression of IFN-α and regulatory cytokines,coupled with negative regulation of viral(defense)response and viral processes.Thus,baicalin interferes with IBV replication in CEK cells.

Objective:To analyze the prevalence and related factors of depression symptom among middle-aged and older adults belonging to Zhiguo ethnic minority groups,who experienced relative isolation prior to mod-emization and bypassed the transitional period associated with feudal monarchy in Yunnan Province.Methods:Using stratified cluster sampling,a total of 1 035 individuals from Zhiguo ethnic minority groups were investigated with the 9-item Patient Health Questionnaire(PHQ-9)to measure depression symptom scores(a total score≥5 was considered indicative of depression symptom).A self-administered questionnaire was utilized to investigate 24 cova-riates across five dimensions:sociodemographic,social-interpersonal network,mental health status,physical health status,and health behaviors.Results:Among the surveyed participants,231 individuals(22.32％)exhibited depres-sion symptoms.The logistic regression analysis showed that middle-aged and elderly people belonging to Zhiguo ethnic minority groups with occupations as laborers(OR=8.73),farmers(OR=7.34),and other professions(OR=7.13),those who reported feeling stressed or anxious in the last month(OR=5.43),those suffering from one(OR=2.81)or more chronic illnesses(OR=2.14),experiencing sleep problems(OR=3.74)/debilitating(OR=1.69)/mild-moderate pain(OR=2.23,4.37),and engaging in sedentary behavior(OR=2.27)were at higher risk for depressive symptoms.The risk of depressive symptoms was lower among middle-aged and elderly people be-longing to Zhiguo ethnic minority groups with higher social support scores(OR=0.96)and meaning in life scores(OR=0.96).Conclusion:The prevalence of depressive symptoms among middle-aged and elderly individuals of Zhiguo ethnic minorities is substantial,influenced by multiple factors.

Objective:To evaluate the efficacy and safety of unilateral adrenalectomy for treating primary bilateral macronodular adrenal hyperplasia (PBMAH) of different clinical types.Methods:The clinical and biochemical data of 54 patients with PBMAH who underwent unilateral adrenalectomy from May 2008 to March 2023 were retrospectively collected. Preoperative CT images of all patients showed enlarged bilateral adrenal glands with multiple nodules of " fused masses". Mean preoperative blood cortisol concentration at 8am was (21.5±7.7)μg/dl, urinary free cortisol concentration was (442.6±300.4)μg/24h, and mean 8am ACTH concentration was (6.4±2.3)pg/ml. Postoperative symptoms, BMI, blood pressure, mass diameter, cortisol and ACTH concentration were recorded and analyzed.Results:Compared with ordinary laparoscopic surgery, robot-assisted surgery showed shorter operation time [(115.4±22.1)min vs.(95.0±19.8)min, P=0.045]; less blood loss [(118.2±57.0)ml vs. (125.6±45.3)ml, P=0.441] and shorter hospitalization time [(5.2±0.9)day vs. (6.4±1.2)day, P=0.279]. Compared with laparoscopic surgery, open surgery showed longer operation time [(134 34.5) min vs. (104.3±20.1) min, P=0.035]; more blood loss [(305.5±85.2) ml vs. (122.5±44.3) ml, P=0.012] and longer hospitalization time[(10.4±3.2)day vs. (5.7±1.0) day, P=0.020]. The average follow-up time was (23.7±11.7) months. Sixteen cases biochemically relapsed, and the average relapse-free time was (25.4±13.4) month. Mean postoperative systolic blood pressure was (131.1±16.8)mmHg ( P=0.001) while diastolic blood pressure decreased to (82.2±11.1)mmHg ( P=0.002). Postsurgical average blood cortisol concentration decreased to (10.2±4.0)μg/dl ( P<0.01), while urine cortisol concentration decreased to (106.6±43.4)μg/24h( P<0.01). Average ACTH concentration increased to (12.6±4.1)pg/ml( P=0.005). Recurrent patients had higher preoperative blood and urine cortisol concentration(24.7±8.2)μg/dl( P=0.046), (522.8±234.2)μg/24h( P=0.028), and all of them underwent contralateral adrenalectomy. Conclusions:Unilateral adrenalectomy is safe and effective for treatment of PBMAH while part of patients biochemically relapsed. Subclinical patients were observed no recurrent cases after surgery. Recurrent patients have higher preoperative blood and urine cortisol levels and should undertake contralateral adrenalectomy and supplement corticosteroids for whole life.

Objective:To investigate the efficacy and safety of oral semaglutide in Chinese patients with type 2 diabetes mellitus(T2DM) inadequately controlled by diet and exercise only.Methods:In the randomized, double-blind, multicenter, multinational PIONEER-11 trial, Chinese patients were prospectively randomly assigned to receive oral semaglutide 3, 7, or 14 mg, or placebo. The primary endpoint was the change from baseline in glycated hemoglobin(HbA 1C) at week 26. This is a pre-defined subset analysis to assess the efficacy and safety in Chinese patients. Results:Totally 390 Chinese T2DM patients were enrolled(mean age 51 years), with a T2DM duration of 1.8 years, HbA 1C of 7.9%, and BMI of 26.5 kg/m 2 at baseline. Overall, changes at week 26 from baseline in HbA 1C were -1.1%, -1.6%, -1.6%, and 0.0%, and in bodyweight were -0.7, -1.9, -2.6, and -0.7 kg in oral semaglutide(3, 7, or 14 mg) and placebo groups, respectively. Compared to the placebo group, estimated treatment differences(ETDs) in HbA 1C for the 3, 7, and 14 mg groups were -1.2%(95% CI -1.4, -0.9), -1.7%(95% CI -1.9, -1.4), and -1.6%(95% CI -1.9, -1.4)(all P<0.001), respectively, and in weight loss for the 7 mg and 14 mg groups were -1.2 kg(95% CI -2.1, -0.4; P=0.006) and -1.9 kg(95% CI -2.8, -1.0; P<0.001), respectively. The most frequent gastrointestinal adverse events were diarrhea(oral semaglutide: 3.1%-12.5% vs placebo: 2.0%) and nausea(3.1%-6.3% vs 2.0%), mostly mild in severity and transient. Conclusion:In Chinese patients with T2DM who had insufficient glycemic control with diet and exercise only, oral semaglutide showed better glycemic control at doses of 3, 7, and 14 mg and more weight loss at doses of 7 and 14 mg compared to placebo, with a safety profile consistent with that observed in the global trial population.

Objective To explore the expression, correlation with clinicopathologic parameters, and clinical significance of MIS18 binding protein 1 (MIS18BP1) in bladder cancer. Methods TCGA and GEO databases were used to analyze the mRNA expression of MIS18BP1 in tumors and controls, and the results were verified via qRT-PCR. UALCAN online database was utilized in the analysis of the expression of MIS18BP1 and its correlation with clinicopathological parameters and the degree of immune cell infiltration. Immunohistochemistry was employed to analyze the expression of MIS18BP1 in bladder cancer and its relationship with clinicopathological features. The ROC curve was applied to evaluate the diagnostic value of MIS18BP1 mRNA in bladder cancer. Results Bioinformatics analysis and qRT-PCR results revealed the increased expression of MIS18BP1 mRNA in bladder cancer compared with that in the control group (P<0.05). Immunohistochemistry unveiled the significantly high positive rate of MIS18BP1 protein in bladder cancer (P<0.05) and its correlation with the clinical stage of tumors, depth of invasion, and lymph node metastasis (P<0.05). The immune infiltration analysis showed the association of MIS18BP1 with immune cell infiltration in bladder cancer. Conclusion The increased expression level of MIS18BP1 gene and protein in bladder cancer may regulate the development of bladder cancer by influencing immune cell infiltration.

BACKGROUND:In recent years,studies have shown that obesity is closely related to chronic inflammation.Due to excessive energy intake,inflammatory macrophage infiltration and inflammatory response occur in visceral adipose tissue,which is crucial for the regulation of adipose tissue fibrosis. OBJECTIVE:To summarize the molecular mechanism of inflammation-related signals involved in the regulation of adipose tissue fibrosis and to provide reference for the treatment of adipose tissue fibrosis and related metabolic diseases through anti-inflammatory pathways. METHODS:Relevant documents were retrieved from CNKI and PubMed,and the Chinese and English search words were"inflammation,inflammatory factors,inflammatory signals,lip fibrosis,adipose fibrosis,adipose tissue fibrosis"respectively.The search period was from January 2003 to December 2022.Finally,52 documents meeting the criteria were included for review. RESULTS AND CONCLUSION:During obesity,visceral adipose tissue expands through adipocyte proliferation and hypertrophy to store excess energy,and defects caused by remodeling or functional changes mainly include impaired angiogenesis,adipocyte apoptosis promoted by white adipose tissue hypoxia,macrophage infiltration,and adipocyte fibrosis.Adipose tissue fibrosis has adverse effects on the natural growth of adipose cells.The factors that trigger chronic inflammation of adipose tissue include a variety of signal stimuli,such as adipocyte death caused by hypoxia,mechanical signal transduction caused by extracellular matrix remodeling and lipogenic factor imbalance.Inflammatory factors such as interleukin-1β,tumor necrosis factor-α,C-type lectins and adiponectin secreted by adipocytes and other inflammatory signaling pathways such as nuclear factor-κB,transforming growth factor-β/Smad and MAPK jointly regulate the process of adipose tissue fibrosis.

Objective To explore the effects of image registration using various regions of interest(ROI)on the setup error for nasopharyngeal carcinoma(NPC)patients who were immobilized individually.Methods Forty-three NPC patients who required radiotherapy were enrolled.The patients were immobilized with customized plastic foam and thermoplastic mask,and CBCT verification was performed once a week.In CBCT images,ROI was divided into the whole ROI(ROIPTV)and 7 local ROI containing different cervical structures(ROIsphenoid sinus,ROIatlantoaxial,ROIneck3,ROIneck4,ROIneck5,ROIneck6,and ROIneck7),which were then used for registrations with localized CT image.The setup errors in superior-inferior(SI),left-right(LR),anterior-posterior(AP),Pitch,Roll,and Yaw directions were recorded.Results In SI direction,the setup errors within 0.3 cm accounted for 89.74%for ROIneck7,and more than 90%for the other ROI.The proportion of setup errors within 0.3 cm gradually increased with the neck upward in LR direction,and they were 76.78%,81.70%,85.26%,and above 90%for ROIneck7,ROIneck6,ROIneck5,and the other ROI,respectively.In AP direction,the proportions of setup errors within 0.3 cm were less than 90%,except for ROIatlantoaxial and ROIneck3.The setup errors of ROIsphenoid sinus,ROIatlantoaxial,ROIneck3,and ROIneck4 were significantly positively correlated with ROIPTV in SI direction,and the correlation coefficients(R)were 0.94,0.95,0.90,and 0.83,respectively.In LR direction,there were positive correlations between the setup errors of ROIatlantoaxial and ROIsphenoid sinus(R=0.95),ROIneck3 and ROIsphenoid sinus(R=0.91),ROIPTV and ROIneck3(R=0.91).The setup errors of ROIPTV in AP direction were positively correlated with ROIatlantoaxial vertebrae and ROIneck3(R=0.88,0.90).The margins of all ROIs ranged from 0.38 cm to 1.01 cm.The extension of ROIneck6 and ROIneck7 in AP direction exceeded 0.9 cm,and the extension of ROIneck7 reached 0.95 cm in SI direction.Conclusion ROIPTV and ROIsphenoid sinus,ROIatlantoaxial,ROIneck3 are significantly correlated in SI,LR,and AP directions.The setup error of nasopharyngeal carcinoma patients gradually increases with the neck down.The nasopharyngeal and cervical regions need to be expanded in segments when patients are immobilized individually.

Objective To analyze the current status and trends of TCM regulation of microRNA(miRNA)using visualization methods.Methods The literature related to the TCM regulation of miRNA was retrieved from CNKI,VIP and Wanfang Data from the establishment of the databases to May 31,2022.Excel 2019,VOSviewer 1.6.18,and CiteSpace 5.8.R3 software were applied to visualize and analyze the year of publication,journal source,author and keywords of the included literature.Results A total of 787 articles were included,and the number of publications continued to rise.Source journals with more publications includes Chinese Journal of Experimental Traditional Medical Formulas,China Journal of Traditional Chinese Medicine and Pharmacy,Chinese Archives of Traditional Chinese Medicine,etc.Research teams were formed with Wang Jie,Liu Xide,Diao Limei,etc.as the representatives,and the cooperation among the teams was not very close.Analysis on the keywords in the literature showed that the studies mainly focused on apoptosis,miRNA-21,electroacupuncture,atherosclerosis,proliferation and other related fields;TCM intervention that accounted for the most research were extracts of Chinese materia medica,with 42%of the studies;there were 24 miRNAs studied≥3 times,and the most studied miRNA was miRNA-21.Conclusion The research hotspots of TCM regulation of miRNA are mainly the molecular mechanism of various TCM therapeutic tools to improve cell autophagy,apoptosis,inflammatory response and other pathways through regulation of miRNAs.The trend of research is to study the mechanism of empirical prescriptions of famous TCM practitioners based on precise therapeutic strategies.

To explore the value of portable oto-endoscopy system in clinical teaching of otolaryngology residents.