Objective:This study was aimed to evaluate the clinical effectiveness of tympanoplasty using auricular cartilage combined with balloon eustachian tuboplasty for the treatment of adhesive otitis media（adhesive otitis media, AdOM） under endoscopic. Methods:A retrospective analysis was conducted on 60 patients with unilateral adhesive otitis media who visited Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xiamen University between January 2017 and February 2022. All patients were divided into three groups: ①conservative treatment group;②simple tympanoplasty group; ③tympanoplasty combined with balloon dilation group（BET group）. All patients were regularly assessed for the improvement of tympanic membrane morphology, hearing, and Eustachian tube function, as well as complications, after treatment. Results:There was no significant improvement in eardrum morphology, hearing, or eustachian tube function in the conservative treatment group（P>0.05）; both the simple tympanoplasty group and the BET group showed significant improvements in eardrum morphology and hearing after surgery（P<0.01）; In terms of Eustachian tube function improvement, the BET group showed significantly greater improvements in Eustachian tube manometry（TMM） and Eustachian Tube Dysfunction Questionnaire（ETDQ-7） scores compared to the tympanoplasty alone group（P<0.01）. Conclusion:Tympanoplasty using auricular cartilage combined with balloon eustachian tuboplasty shows good clinical outcomes in the treatment of adhesive otitis media, significantly ameliorating patients' subjective symptoms such as tinnitus and ear congestion after surgery, thereby improving the patient's quality of life.
Humans ; Eustachian Tube/surgery* ; Retrospective Studies ; Tympanoplasty/methods* ; Otitis Media/surgery* ; Ear Cartilage/surgery* ; Endoscopy ; Dilatation ; Treatment Outcome ; Male ; Female ; Adult ; Middle Aged

Traditional development of small protein scaffolds has relied on display technologies and mutation-based engineering, which limit sequence and functional diversity, thereby constraining their therapeutic and application potential. Protein design tools have significantly advanced the creation of novel protein sequences, structures, and functions. However, further improvements in design strategies are still needed to more efficiently optimize the functional performance of protein-based drugs and enhance their druggability. Here, we extended an evolution-based design protocol to create a novel minibinder, BindHer, against the human epidermal growth factor receptor 2 (HER2). It not only exhibits super stability and binding selectivity but also demonstrates remarkable properties in tissue specificity. Radiolabeling experiments with ^99mTc, ⁶⁸Ga, and ¹⁸F revealed that BindHer efficiently targets tumors in HER2-positive breast cancer mouse models, with minimal nonspecific liver absorption, outperforming scaffolds designed through traditional engineering. These findings highlight a new rational approach to automated protein design, offering significant potential for large-scale applications in therapeutic mini-protein development.

[Objective]To investigate the mechanism of Huanglian Zhimu Decoction in treating type 2 diabetes mellitus(T2DM)rats by 16S ribosomal RNA(16S rRNA)gut microbiota gene sequencing and non-targeted metabolomics.[Methods]Twenty-four GK rats were fed a high-fat diet to induce a T2DM model.After successful modeling,they were divided into T2DM model(MO)group,Huanglian Zhimu Decoction(HL)group and metformin(MET)group.Eight Wistar rats were designated as control(CTRL)group.After 12 weeks of drug intervention,the food intake,water intake,urine volume,body weight and fasting blood glucose of the rats were measured.Biochemical tests were conducted to assess the four lipid profile parameters.Pathological examinations of the liver and colon were observed through hematoxylin-eosin(HE)staining and periodic acid-Schiff(PAS)staining.16S rRNA sequencing technology was used for gene sequencing of the fecal microbiota in the rats,and non-targeted metabolomics was performed to detect fecal metabolites.[Results]Huanglian Zhimu Decoction can significantly reduce the fasting blood glucose(P<0.001)and serum levels of total cholesterol(TC),high-density lipoprotein(HDL)and low-density lipoprotein(LDL)in T2DM rats(P<0.05,P<0.01).It also alleviates hepatic steatosis and inflammatory cell infiltration in the liver tissue of T2DM rats induced by high-fat diet,and the synthesis of glycogen increased.Additionally,it repairs the intestinal barrier damage in the colonic tissue to a certain extent and reduce the infiltration of inflammatory cells.16S rRNA gene sequencing analysis revealed that Huanglian Zhimu Decoction can ameliorate intestinal microbiota disruption by reducing the ratio of Firmicutes to Bacteroidota(F/B)at the phylum level,down-regulating the abundance of harmful bacterial genera such as Allobaculum,Colidextribacter,Oscillibacter and Dorea,and up-regulating the abundance of beneficial bacterial genera including Prevotella_9 and Akkermansia muciniphila.Fecal metabolomics analysis indicated that Huanglian Zhimu Decoction improved abnormalities in primary bile acid metabolism and linoleic acid metabolism.[Conclusion]Huanglian Zhimu Decoction can reduce the fasting blood glucose and blood lipid levels in T2DM rats,and its mechanism of action may be related to regulating the structure of intestinal flora and influencing the metabolic pathways of primary bile acids and linoleic acid.These findings provide basis for further studying the mechanism of action of Huanglian Zhimu Decoction.

ObjectiveBased on the phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， the effects of Huanglian Zhimutang on glucose and lipid metabolism disorders and hepatic insulin resistance （IR） with type 2 diabetes mellitus （T2DM） were investigated. MethodsGoto-Kakizaki （GK） rats were fed a high-fat diet to induce a T2DM rat model and then randomly divided into four groups： normal control group， model control group， metformin group （0.10 g·kg^-1）， and Huanglian Zhimutang group （3.60 g·kg^-1）， with eight rats in each group. Drug intervention was administered continuously for 8 weeks. Serum and liver tissues were collected from each group. Fasting insulin （FINS） levels were measured using enzyme-linked immunosorbent assay （ELISA）， and the homeostasis model assessment of insulin resistance （HOMA-IR） index was calculated. Total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C） levels were measured using an automatic biochemical analyzer. Liver tissue pathology was observed via hematoxylin-eosin （HE） staining. Serum interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） levels were detected using ELISA. Network pharmacology and transcriptomics sequencing were combined to analyze differentially expressed genes （DEGs） in liver tissue from the normal control group， model control group， and Huanglian Zhimutang group. Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis was performed to identify pathways affected by Huanglian Zhimutang intervention in T2DM. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to assess the mRNA expression of insulin receptor substrate-1 （IRS-1）， PI3K， Akt， and peroxisome proliferator-activated receptor gamma （PPARγ） in liver tissue， while Western blot was used to evaluate corresponding protein expression levels. ResultsAfter 8 weeks of Huanglian Zhimutang intervention， typical symptoms of T2DM rats such as polydipsia， polyphagia， and polyuria were significantly alleviated， along with reductions in fasting blood glucose levels and insulin resistance（P<0.01）. Histopathological results revealed that Huanglian Zhimutang effectively improved hepatic steatosis and inflammatory edema and reduced lipid vacuole formation. Biochemical tests demonstrated that Huanglian Zhimutang significantly reduced serum levels of TC， TG， and LDL-C（P<0.01）. ELISA results showed that Huanglian Zhimutang effectively decreased serum concentrations of IL-6 and TNF-α（P<0.05，P<0.01）. Combined network pharmacology predictions with KEGG pathway analysis of transcriptomics showed that DEGs between the Huanglian Zhimutang and model control groups were significantly enriched in the PI3K/Akt signaling pathway. Real-time PCR and Western blot results confirmed that Huanglian Zhimutang upregulated the expression of PI3K/Akt signaling pathway-related mRNAs and proteins in liver tissue（P<0.05，P<0.01）， thereby reducing inflammation， alleviating hepatic lipid accumulation， and enhancing insulin sensitivity. ConclusionHuanglian Zhimutang effectively ameliorates glucose and lipid metabolism disorders in T2DM rats. Its mechanism may be related to the regulation of the PI3K/Akt pathway， which reduces inflammation and hepatic lipid deposition and relieves hepatic insulin resistance.

ObjectiveBased on the phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， the effects of Huanglian Zhimutang on glucose and lipid metabolism disorders and hepatic insulin resistance （IR） with type 2 diabetes mellitus （T2DM） were investigated. MethodsGoto-Kakizaki （GK） rats were fed a high-fat diet to induce a T2DM rat model and then randomly divided into four groups： normal control group， model control group， metformin group （0.10 g·kg^-1）， and Huanglian Zhimutang group （3.60 g·kg^-1）， with eight rats in each group. Drug intervention was administered continuously for 8 weeks. Serum and liver tissues were collected from each group. Fasting insulin （FINS） levels were measured using enzyme-linked immunosorbent assay （ELISA）， and the homeostasis model assessment of insulin resistance （HOMA-IR） index was calculated. Total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C） levels were measured using an automatic biochemical analyzer. Liver tissue pathology was observed via hematoxylin-eosin （HE） staining. Serum interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） levels were detected using ELISA. Network pharmacology and transcriptomics sequencing were combined to analyze differentially expressed genes （DEGs） in liver tissue from the normal control group， model control group， and Huanglian Zhimutang group. Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis was performed to identify pathways affected by Huanglian Zhimutang intervention in T2DM. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to assess the mRNA expression of insulin receptor substrate-1 （IRS-1）， PI3K， Akt， and peroxisome proliferator-activated receptor gamma （PPARγ） in liver tissue， while Western blot was used to evaluate corresponding protein expression levels. ResultsAfter 8 weeks of Huanglian Zhimutang intervention， typical symptoms of T2DM rats such as polydipsia， polyphagia， and polyuria were significantly alleviated， along with reductions in fasting blood glucose levels and insulin resistance（P<0.01）. Histopathological results revealed that Huanglian Zhimutang effectively improved hepatic steatosis and inflammatory edema and reduced lipid vacuole formation. Biochemical tests demonstrated that Huanglian Zhimutang significantly reduced serum levels of TC， TG， and LDL-C（P<0.01）. ELISA results showed that Huanglian Zhimutang effectively decreased serum concentrations of IL-6 and TNF-α（P<0.05，P<0.01）. Combined network pharmacology predictions with KEGG pathway analysis of transcriptomics showed that DEGs between the Huanglian Zhimutang and model control groups were significantly enriched in the PI3K/Akt signaling pathway. Real-time PCR and Western blot results confirmed that Huanglian Zhimutang upregulated the expression of PI3K/Akt signaling pathway-related mRNAs and proteins in liver tissue（P<0.05，P<0.01）， thereby reducing inflammation， alleviating hepatic lipid accumulation， and enhancing insulin sensitivity. ConclusionHuanglian Zhimutang effectively ameliorates glucose and lipid metabolism disorders in T2DM rats. Its mechanism may be related to the regulation of the PI3K/Akt pathway， which reduces inflammation and hepatic lipid deposition and relieves hepatic insulin resistance.

ObjectiveTo investigate the dynamic trajectories of prognostic scores and key clinical indicators in hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF） patients without liver cirrhosis， to clarify their association with outcomes， and to provide new evidence for individualized prognostic assessment. MethodsA prospective study was conducted for the data of 154 non-cirrhotic HBV-ACLF patients who attended Beijing YouAn Hospital of Capital Medical University from January 2016 to December 2023， including prognostic scores and key biochemical indicators on Days 3， 7， 14， 21， and 28 of the disease course. According to the outcome of patients at 1 year， they were divided into death/liver transplantation group with 43 patients， liver cirrhosis group with 23 patients， and non-liver cirrhosis group with 88 patients， and the trajectory heterogeneity of different outcome subgroups was analyzed. A one-way analysis of variance was used for comparison of normally distributed continuous data among the three groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data among the three groups； the Wilcoxon test was used between two groups. the chi-square test was used for comparison of categorical data between groups. The mean and its 95% confidence interval （CI） were calculated for each indicator at difference time points； the linear interpolation method was used to connect the means at adjacent time points and construct the group-specific longitudinal trend curve； the 95%CI was visualized using the semi-transparent ribbon area， with the transparency parameter （α=0.2） optimized to enhance the visual discrimination of overlapping intervals across multiple groups. A linear mixed-effects model was used to compare the longitudinal changing trend of each indicator between the patients with different outcomes； likelihood ratio was used to evaluate the significance of the interaction effect between time and group， and in case of the significant interaction effect， the slope based on the estimated marginal mean was used for comparison between two groups. ResultsThere were significant differences between the three groups in the incidence rates of ascites and grade Ⅲ — Ⅳ hepatic encephalopathy， MELD score， MELD-Na score， CLIF-C ACLF score， COSSH-ACLF Ⅱ score， total bilirubin （TBil）， international normalized ratio （INR）， alpha-fetoprotein， blood sodium， alanine aminotransferase， and procalcitonin at the baseline（all P0.05）. The analysis of dynamic trajectories showed that the death/liver transplantation group had high levels of prognostic scores and the biochemical parameters of TBil and INR （TBil400 μmol/L， INR2.5）， as well as a low level of platelet count （PLT） （100×10⁹/L）. The non-liver cirrhosis group had rapid improvements in indicators， with TBil200 μmol/L， INR1.5， and PLT100×10⁹/L by day 28， while the liver cirrhosis group showed a trend of recovery， with TBil200 μmol/L， INR2.0， and PLT 100×10⁹/L on day 28， with significant global heterogeneity in the temporal trends of the above indicators across the three groups （all P0.01）. ConclusionDynamic monitoring of prognostic scores and key clinical indicators can effectively stratify the 1-year outcomes of non-cirrhotic patients with HBV-ACLF. Patients with poor prognosis were typically characterized by INR 2.5 and TBil 400 μmol/L. Among those who survived beyond 1 year， individuals who subsequently progressed to cirrhosis were frequently identified by the presence of INR 1.5， TBil 200 μmol/L， and PLT 100×10⁹/L at day 28.

Objective:To explore the clinical efficacy and safety of a multimodal treatment regimen integrating radiotherapy, chemotherapy, and immunotherapy in patients with human epidermal growth factor receptor 2 (HER2) -negative locally advanced or advanced gastric cancer.Methods:A total of 34 patients with unresectable, HER2-negative, locally advanced or metastatic gastric/gastroesophageal junction (G/GEJ) adenocarcinoma admitted to the Affiliated Cancer Hospital of Guizhou Medical University from September 2021 to March 2024 were selected as study objects. Participants received one cycle of either XELOX regimen (capecitabine + oxaliplatin) or SOX regimen (S-1 + oxaliplatin) with immunotherapy (sintilimab or nivolumab) . The process was succeeded by radiotherapy targeted at the primary G/GEJ tumor and regional lymph nodes. In selected cases, sequential radiotherapy was also administered for distant metastases. The primary endpoint was objective response rate (ORR) , and secondary endpoints were disease control rate (DCR) , clinical symptom response, changes in Karnofsky performance status (KPS) score, progression-free survival (PFS) , and adverse reactions. Clinical efficacy was assessed in accordance with Response Evaluation Criteria in Solid Tumors version 1.1. Adverse reactions were assessed and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 and the Chinese Society of Clinical Oncology guidelines for management of immune checkpoint inhibitor-related toxicity. With a median follow-up of 7 months (range: 2.3 to 30 months) , the final evaluation considered the best response documented throughout follow-up. Survival curves were constructed utilizing Kaplan-Meier analysis.Results:By the end of follow-up, an overall ORR of 58.8% (20/34) and DCR of 70.6% (24/34) were observed. The ORR of lesions by radiotherapy reached 73.8% (48/65) and the DCR reached 92.3% (60/65) . Univariate analysis showed that the ORR of female patients (84.6%, 11/13) was higher than that of male patients (42.9%, 9/21) , and the ORR of patients with distant lymph node metastasis alone (83.3%, 15/18) was higher than that of patients with distant lymph node metastasis combined with organ metastasis or organ metastasis alone (18.2%, 2/11) , with statistically significant differences ( P=0.030; P=0.010) . There were no statistically significant differences in ORR among patients with different age ( P=0.487) , KPS score ( P=0.198) , primary tumor location ( P=0.280) , histological differentiation ( P=0.668) , chemotherapy regimen ( P=0.728) , or immunotherapy regimen ( P>0.999) . Twenty-two of 23 (95.7%) patients with upper abdominal pain were relieved, 10 of 21 (47.6%) patients with appetite loss were relieved, 15 of 17 patients with upper abdominal distension were relieved, 13 of 14 patients with melena were relieved, 6 of 7 patients with eating obstruction were relieved, 3 of 4 patients with metastatic site pain were relieved, and 2 patients with hematemesis were relieved. KPS score enhanced in 82.4% (28/34) of patients, remained stable in 11.8% (4/34) , and declined in 5.8% (2/34) . The median PFS of the 34 patients was 7.9 months. The most common adverse reactions during radiotherapy combined with chemotherapy and immunotherapy were hematological adverse reactions, in which neutropenia accounted for the highest proportion (91.2%, 31/34) , followed by anemia (50.0%, 17/34) . Fatigue was the most common non-hematological adverse reaction (50.0%, 17/34) , followed by nausea and vomiting (26.5%, 9/34) . The adverse reactions of 6 patients receiving immune monotherapy maintenance were anemia, hypothyroidism, transaminase elevation, proteinuria, fatigue, and rash, all of which were grade 1-2. Conclusions:Radiotherapy combined with chemotherapy and immunotherapy shows good short-term clinical efficacy in patients with HER2-negative locally advanced or advanced gastric cancer, and the overall adverse reactions are tolerable. Female or patients with distant lymph node metastasis alone may be the preferred population for this study protocol.

Objective:To investigate the effect of abdominal circumference on intestinal radiation dose volume and acute intestinal toxicity in pelvic intensity modulated radiation therapy for rectal cancer.Methods:A total of 150 patients with locally advanced rectal cancer (LARC) who received adjuvant and neoadjuvant concurrent chemoradiotherapy at the Affiliated Cancer Hospital of Guizhou Medical University from March 2023 to January 2025 were enrolled, including 82 cases of adjuvant radiotherapy and 68 cases of neoadjuvant radiotherapy. All patients underwent radiotherapy CT simulation positioning in the standard mode of prone position with abdominal board padding and bladder filling. Intestinal toxicity was categorized as a binary variable based on the occurrence of ≥2 grade acute intestinal toxicity. Linear and logistic regression models were used to analyze the factors influencing intestinal radiation dose volumes (V 10, V 20, V 30, V 40) and acute intestinal toxicity in LARC patients. Generalized additive models and piecewise linear and logistic regression analyses were employed to examine the threshold effects of abdominal circumference on intestinal radiation dose volumes and acute intestinal toxicity. The threshold value for abdominal circumference was determined based on the upper limit of the 95% CI for the threshold. A difference test was used to validate the differences in intestinal radiation dose volume and acute intestinal toxicity between small and medium-to-large abdominal circumferences. Results:Univariate analysis showed that, gender, body mass, abdominal circumference, planning target volume (PTV), intestinal volume were all influencing factors for the radiation dose volumes (V 10, V 20, V 30, V 40) of each intestinal segment of patients with LARC undergoing adjuvant radiotherapy (all P<0.05). Body mass, abdominal circumference, intestinal volume were all influencing factors for the radiation dose volumes (V 10, V 20, V 30, V 40) of each intestinal segment of patients with LARC undergoing neoadjuvant radiotherapy (all P<0.05). Body mass index (BMI), abdominal circumference, intestinal volume and individual intestinal radiation volumes (V 10, V 20, V 30, V 40) were all influencing factors for the acute intestinal toxicity of patients with LARC undergoing adjuvant radiotherapy (all P<0.05). Body mass, BMI, abdominal circumference, multiple intestinal radiation dose volumes (V 20, V 30, V 40) were all influencing factors for the acute intestinal toxicity of patients with LARC undergoing neoadjuvant radiotherapy (all P<0.05). Multivariate analysis showed that, abdominal circumference (V 10: β=-1.01, 95% CI: -1.68--0.33, P=0.004; V 20: β=-0.94, 95% CI: -1.28--0.60, P<0.001; V 30: β=-0.58, 95% CI: -0.82--0.34, P<0.001; V 40: β=-0.41, 95% CI: -0.60--0.23, P<0.001) was an independent influencing factor for the radiation dose volume of each intestinal segment of patients with LARC undergoing adjuvant radiotherapy. Abdominal circumference (V 10: β=-0.92, 95% CI: -1.62--0.22, P=0.010; V 20: β=-0.84, 95% CI: -1.11--0.57, P<0.001; V 30: β=-0.42, 95% CI: -0.57--0.28, P<0.001; V 40: β=-0.30, 95% CI: -0.41--0.19, P<0.001) was an independent influencing factor for the radiation dose volume of each intestinal segment of patients with LARC undergoing neoadjuvant radiotherapy. Abdominal circumference ( OR=0.86, 95% CI: 0.78-0.95, P=0.002) was an independent influencing factor for the acute intestinal toxicity of patients with LARC undergoing adjuvant radiotherapy. Abdominal circumference ( OR=0.87, 95% CI: 0.79-0.96, P=0.004) was an independent influencing factor for the acute intestinal toxicity of patients with LARC undergoing neoadjuvant radiotherapy. The generalized additive model revealed a nonlinear relationship between abdominal circumference and intestinal radiation dose volume and acute intestinal toxicity of adjuvant radiotherapy patients. Further segmented regression analysis results showed that there was a threshold effect between abdominal circumference and intestinal radiation dose volume (V 10, V 20, V 30, V 40) and acute intestinal toxicity. The inflection point values between abdominal circumference and intestinal radiation dose volume V 10, V 20, V 30, V 40 in LARC patients undergoing adjuvant radiotherapy were all 71.9 cm; the inflection point values between abdominal circumference and the intestinal radiation dose volume V 10, V 20, V 30, V 40 in LARC patients undergoing neoadjuvant radiotherapy were 69.0, 69.0, 69.0, 68.6 cm, respectively; The inflection point values between abdominal circumference and acute intestinal toxicity in LARC patients undergoing adjuvant radiotherapy and neoadjuvant radiotherapy were 71.9, 69.0 cm, respectively. Based on the upper limit of the 95% CI threshold, the cutoff values for small and medium-to-large abdominal circumferences for patients undergoing adjuvant and neoadjuvant radiotherapy were set at 76.1, 71.9 cm, respectively. In patients undergoing adjuvant radiotherapy, the levels of intestinal radiation dose volume V 10 [ (7.65±2.29) cm 3vs. (5.88±2.68) cm 3, t=2.76, P=0.007], V 20 [ (4.28±1.27) cm 3vs. (2.72±1.31) cm 3, t=4.81, P<0.001], V 30 [ (2.42±1.07) cm 3vs. (1.37±0.76) cm 3, t=4.95, P<0.001], V 40 [ (1.69±0.74) cm 3vs. (0.92±0.58) cm 3, t=4.93, P<0.001] in the small abdominal circumference group ( n=22) were significantly higher than those in patients with medium-to-large abdominal circumferences ( n=60) ; In patients undergoing neoadjuvant radiotherapy, patients with small abdominal circumferences ( n=11) had significantly higher V 20 [ (3.09±0.84) cm 3vs. (2.28±1.17) cm 3, t=2.17, P=0.033], V 30 [1.44 (1.22, 1.53) cm 3vs. 0.91 (0.56, 1.22) cm 3, Z=-3.04, P=0.002], V 40 [0.93 (0.84, 1.09) cm 3vs. 0.44 (0.30, 0.81) cm 3, Z=-3.19, P=0.001] than patients with medium-to-large abdominal circumferences ( n=57). In patients receiving adjuvant radiotherapy and neoadjuvant radiotherapy, there were statistically significant differences in acute intestinal toxicity between patients with small abdominal circumferences and with medium-to-large abdominal circumferences ( χ2=10.46, P=0.001; χ2=8.13, P=0.004) . Conclusions:In the standard mode (prone position with abdominal board padding and bladder filling), abdominal circumference is an independent factor influencing the intestinal radiation dose volume and acute intestinal toxicity in rectal cancer radiotherapy patients. There is a significant non-linear threshold effect between abdominal circumference and different levels of intestinal radiation dose volume and acute intestinal toxicity. The impact of abdominal circumference on intestinal radiation dose volume and toxicity differs significantly before and after the inflection point value. Patients with smaller abdominal circumferences not only fail to achieve the expected benefits under the current standard radiotherapy regimen but also face higher risks of intestinal radiation dose volume and toxicity.

Objective To observe the clinical efficacy of therapy of tonifying heart and spleen for the treatment of patients with postpartum depression of heart and spleen deficiency syndrome based on the theory of intestinal flora-neurotransmitter-brain axis(shortened as brain-intestine axis),and to explore its effect on the improvement of patients'depression and anxiety.Methods A total of 136 patients with postpartum depression of heart and spleen deficiency syndrome who admitted to The 908th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China from June 2021 to July 2023 were randomly divided into the conventional treatment group(control group)and the tonifying heart-spleen group(observation group)according to the random number table method,with 68 cases in each group.The control group was treated with conventional antidepressant drugs,and the observation group was treated with therapy of tonifying heart and spleen by utilization of Shen Qi Jieyu Prescription Granules)on the basis of treatment for the control group.Both groups were treated for six continuous weeks.Before and after the treatment,the two groups were observed in the changes of main symptom scores of traditional Chinese medicine(TCM)syndrome,Hamilton Depression Scale(HAMD)scores,7-Item Generalized Anxiety Disorder Scale(GAD-7)scores,and the levels of serum neurotransmitters of 5-hydroxytryptamine(5-HT),dopamine(DA),norepinephrine(NE),as well as microflora metabolites such as short-chain fatty acids(SCFAs),glutamic acid(GLU),gamma-aminobutyric acid(GABA).Moreover,the clinical efficacy and safety of the two groups of patients were evaluated.Results(1)After six weeks of treatment,the total effective rate of the observation group was 89.71%(61/68)and that of the control group was 73.53%(50/68),and the intergroup comparison(tested by chi-square test)showed that the efficacy of the observation group was significantly superior to that of the control group(P<0.05).(2)After treatment,the scores of TCM syndrome main symptoms such as emotional upset,slow thinking,poor appetite,abdominal distension and loose stools in the two groups were decreased compared with those before treatment(P<0.05),and the decrease in the observation group was significantly superior to that in the control group(P<0.01).(3)After treatment,the HAMD scores and GAD-7 scores in the two groups of patients were all decreased compared with those before treatment(P<0.05),and the decrease in the observation group was significantly superior to that in the control group(P<0.01).(4)After treatment,the serum levels of neurotransmitters 5-HT,DA,and NE in the two groups of patients were all increased compared with those before treatment(P<0.05),and the increase in the observation group was significantly superior to that in the control group(P<0.01).(5)After treatment,the serum levels of microflora metabolites SCFAs,GLU and GABA in the two groups of patients were all increased compared with those before treatment(P<0.05),and the increase in the observation group was significantly superior to that in the control group(P<0.01).(6)The incidence of adverse reactions in the observation group was 8.82%(6/68)and that in the control group was 5.88%(4/68),and the intergroup comparison showed that the difference was not statistically significant(P>0.05).Conclusion The application of therapy of tonifying heart and spleen for the treatment of patients with postpartum depression of heart and spleen deficiency syndrome based on brain-intestine axis exerts certain efficacy and safety through correcting the imbalance of neurotransmitters and regulating the microflora metabolites of the patients,thus to alleviate depression and anxiety.

Objective:To understand the burden of chronic kidney disease (CKD) and its risk factors in Fujian Province during 1990-2019.Methods:Based on the Global Burden of Disease Study 2019, the incidence rate, mortality rate and disability-adjusted life years (DALYs) of CKD in Fujian from 1990 to 2019 were calculated. An age-period-cohort model was used to estimate the effects of age, period, and cohort on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of CKD. Comparative risk assessment theory was used to calculate the potential attributable DALYs due to risk factors.Results:In 2019, the ASIR of CKD in Fujian exceeded the national average. The ASIR of CKD showed an increasing trend from 1990 to 2019, but the ASMR and ASDR of CKD exhibited decreasing trends during the same period. In 2019, the ASIR of CKD was higher in women than in men, while the ASMR and ASDR were higher in men than in women. Age-period-cohort analysis indicated that ASIR, ASMR, and ASDR of CKD increased with age. The period effect for ASIR decreased first before increase, while the period effect for ASMR and ASDR displayed fluctuating trends. The cohort effect showed an upward trajectory for ASIR, but a stable status before downward trajectories for ASMR and ASDR. Compared with 1990, except the increase in the ASDR of CKD attributed to high BMI and high temperatures, the ASDR of CKD attributed to other risk factors all showed decreases in 2019. However, the ASDR attributed to high sodium intake remained higher compared with the global average.Conclusion:The burden of CKD remains heavy in Fujian, and it is necessary to reduce the attributable risk factors, such as high sodium intake and high BMI, to address this problem.