Traditional Chinese medicine （TCM） diagnosis is a cognitive process where practitioners rely on their subjective clinical experience and clinical perception abilities to comprehensively integrate the four examinations and flexibly differentiate syndromes， embodying a simple humanistic concern for the state of life. The essential characteristics of the subjectivity and experience of TCM diagnosis determine that there is a threshold in the syndrome differentiation capability of the artificial intelligence （AI）-based TCM diagnostic systems， which refers to a critical point of capability in the process of simulating the syndrome differentiation thinking， due to its inability to replicate the subjective cognition， clinical perception， and humanistic care of the practitioners. Furthermore， this threshold encompasses both a technical threshold and a theoretical threshold. Based on the above analysis， four human-machine collaborative practice paths are proposed to balance the application of AI technology and the subjectivity of TCM syndrome differentiation， including clarifying the auxiliary diagnosis and treatment positioning of AI， optimizing algorithms to achieve technical adaptation， strengthening the cultivation of the practitioner's subjectivity， and promoting interdisciplinary cross-collaboration， aiming to provide theoretical references for the development of AI-based TCM diagnostic systems towards human-machine collaborative clinical applications.

Objective To summarize the whole process comprehensive management experience in transfemoral aortic valve replacement(TF-TAVR)using self-expanding valve in 79 patients with pure native aortic valve regurgitation(PNAR).Methods The nursing team adopted a multi-team collaboration approach.Preoperative nursing assessment and full preparation,enhanced psychological support,and sleep management were carefully carried out;during the operation,nurses well cooperated with doctor,implemented predictive care and intervention for possible complications;and after surgery the hemodynamics and respiratory functions were closely monitored to promptly detect and manage the complications,and to implement the infection prevention cluster management process and discharge preparation services.Besides,the comprehensive management measures throughout the entire process,the occurrence of complications and corresponding nursing responses,as well as the six-minute walk test before and after the operation were recorded.The Discharge Readiness Scale was used to evaluate the implementation of patient discharge readiness services so as to check the implementation effect of the comprehensive whole process management measures.Results Through the implementation of comprehensive whole process management measures,the surgery-related ventricular fibrillation and cardiac arrest obtained accurate and timely treatment,no newly-developed complications such as deep vein thrombosis of lower limbs occurred.Through the implementation of infection cluster nursing measures,the incidence of pulmonary infection in patients decreased from 52.00％in the early stage of carrying out the management measures to 9.26％.Through the implementation of discharge preparation services and continuous quality improvement,the left ventricular ejection fraction(LVEF)value in 64 patients receiving successful TAVR increased from(44.06±5.51)％to(54.67±5.20)％,and the difference was statistically significant(t=19.634,P＜0.001).On the day of discharge,the six-minute walk test distance increased from preoperative(131.39±39.36)meters to postoperative(180.77±29.72)meters,and the difference was statistically significant(t=10.898,P＜0.001).The average self-assessment score of discharge readiness of patients was(7.33±1.41)points.All patients were well recovered when discharged from hospital.Conclusion According to the different surgical key points and the difficult problems,full and effective implementation of comprehensive whole process management measures can ensure that the PNAR patients are able to smoothly pass through the perioperative period and obtain a satisfactory recovery after receiving TF-TAVR.

As the defining characteristic and essence of traditional Chinese medicine(TCM),the integration of disease and syndrome,along with the correlation between syndrome and prescription,forms the foundation for syndrome differentiation and treatment,and guides the clinical diagnosis and treatment practice of TCM.However,key scientific questions remain unresolved regarding the"disease-syndrome-prescription"framework,particularly the biological basis of diseases and syndromes,the active pharmacodynamic constituents of compound formulas,and their mechanism of action.Furthermore,a systematic paradigm for investigating"disease-syndrome-prescription"relationships has not been established,restricting the innovation and development of TCM theory and practice.Xiaoyao Powder,which was first described in a medical book named Taiping Huimin Heji Ju Fang written during the Song Dynasty of China,disperses stagnated liver qi for relieving qi stagnation,thus nourishing the blood and strengthening the spleen,making it a representative prescription for addressing depression due to liver qi stagnation and spleen deficiency under the guidance of correspondence between syndrome and prescription.Therefore,base on the combination of disease and syndrome,and correspondence between syndrome and prescription,investigating the formula-syndrome scientific connotation of Xiaoyao Powder and exploring the research paradigm for the"disease-syndrome-prescription"can provide insights into TCM theory from the perspective of modern science.

As a major global public health concern,the incidence of depression disorder is increasing annually.The pathological mechanism of depression involves bidirectional dysregulation between the hypothalamic-pituitary-adrenal(HPA)and gut-brain axes.According to traditional Chinese medicine(TCM),the liver controls conveyance and dispersion,the spleen governs transportation and transformation,and both jointly maintain the balance between ascending and descending qi movement and zang fu viscera function in the body.Liver qi stagnation and spleen deficiency result in qi movement disorder and a lack of source qi and blood,leading to depression induced by malnutrition of heart spirit.As a classic prescription for soothing the liver,invigorating the spleen,and replenishing blood,Xiaoyao Powder is used to reinforce healthy qi and eliminate pathogenic factors.Xiaoyao Powder not only regulates the"yin in property of liver"but also strengthens the"ascending and descending"of the spleen.As commonly used by ancient and modern physicians,also indirectly inhibits HPA axis upregulation and improves depression-related gastrointestinal dysfunction.This paper systematically expounds the multi-dimensional mechanism of Xiaoyao Powder in treating depression through the two-way regulation of the HPA-gut-brain axis.It reveals the therapeutic characteristics of"multi-component and multi-target"in TCM to provide a novel theoretical basis for the modernization of TCM and the treatment of depression by combining TCM and Western medicine.

Depression is closely associated with a neuro-endocrine-immune(NEI)system imbalance.The"excessive vitality leading to restraint and counter-regulation(Kang Hai Cheng Zhi)"theory elucidates the self-regulating mechanism for maintaining dynamic equilibrium in the body,and serves as an importance principle guiding treatment formulation and medication selection.Based on the correlation between NEI system imbalance and the traditional Chinese medicine pathogenesis of depression,and integrating the"Kang Hai Cheng Zhi"theory,the author posits that the pathogenesis of depression lies in overactive liver invading spleen,earth dampness impeding wood′s ascendancy,and disharmony between body and mind,as well as imbalance in storage and discharge functions of liver and kidney,disharmony between Yin and Yang,and disrupted counter-regulation.This dosely aligns with two key pathological methanisms at the micro level:microglial-limbic system homeostatic imbalance and hypothalamic-pituitary-adrenal axis-inflammatory circuit dysregulation.Clinically,the treatment principle for depression adheres to supporting the counter-regulation to restrain excess,with herbal interventions using strategies such as restraining wood to support earth,dredging earth to unblock wood,and harmonizing pivotal functions,as well as nourishing water to nurture wood,warming kidney to tonify liver,and relieving depression to calm the spirit.These approaches aim to regulate the liver,spleen,and kidney,embodying the core therapeutic tenet of"striving for equilibrium,"thereby restoring the body′s self-regulating capability.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

This study was aimed atanalyzing the epidemic characteristics of dengue fever in Ruili City atthe China-Myanmar bor-der in late 2023,to provide evidence for local dengue fever prevention and control measures.Adult Aedes mosquitoes were collected from Ruili City with a backpack type mosquito sucking machine in October of 2023.Serum samples frompatients with suspected den-gue were collected in acutephase,in November of 2023.Detection ofdengue virus(DENV)nucleic acids in Aedesmosquitoes and acute phase serum samples from suspected dengue fever patients using reverse transcription-polymerase chain reaction,and nucleic acid positive samples were inoculated into Vero cells for viral culture.After three consecutive blind passage,samples with cytopathic effect(CPE)were collected for be sequencingand analysisof genetic and evolutionary information.Dengue case characteristics were analyzed through descriptive epidemiological methods.Among the 109 cases of dengue fever,the ratio of males to females was 1.27∶1.The youngest patient was 1 year old,the oldest patient was 84 years old,the age group of 20～59 years accounted for 73.39%,and the major-ity of occupations were freelancer(40.37%).A total of 827 female Aedes albopictus and 312 Aedes aegypti were collected,all of which tested negative for DENV nucleic acid.109 serum samples tested positive for DENV nucleic acid,including 49 DENV-1 and 60 DENV-2.Moreover,five DENV-1 and nine DENV-2 samples were obtainedthrough third-generation blind passaging with CPE.The E gene sequences of these five DENV-1 strains were detected,all were found to belong to DENV-1 genotype I,and had same evolu-tionary branch as the 2023 Guangzhou,China(PP563911),the 2019 Myanmar(MW793710),and 2019 Attapeu,Laos(MW559046).The nucleotide and amino acid sequence similarityamong the five DENV-1 genotype was 99.4%-99.9%and 99.8%-100.0%.Compared with the aforementioned epidemic strains,their nucleotide similarities were 99.5%-100.0%,99.4%-99.6%and 99.3%-99.5%,respec-tively,and amino acid similarity was 99.8%-100.0%.Nine DENV-2 E gene sequences were of Asian genotype I and belonged to the same evolutionary branch as the 2018 Myanmar(MW788982),2019 Hangzhou(OP684212)and 2019 Ruili(OQ928150).The nucleotide and amino acid similarities of the nine samples were 99.5%-100.0%and 99.8%-100.0%,respectively.Compared with the aforementioned epidemic strains,their nucleotide similarities were 99.7%-100.0%,99.3%-99.7%and 99.3%-99.7%,respectively,and the amino acid similarity was 99.8%-100%,99.8%-100.0%and 99.4%-99.6%,respectively.Two dengue vectors,Aedes albopictus and Aedes aegypti,were present in Ruili city,and the dengue outbreak was caused primarily by DENV-1 genotype I and DENV-2 Asian genotype I in later 2023.The sources of DENV-1 were probably the same as those of DENV-1 with Guangzhou(2023),and the sources of DENV-2 were probably from Myanmar.Dengue cases were found primarilyin the 20-59 year age group and freelancers,thus suggesting that relevant local departments should strengthen surveillance of dengue imported case and vector.

Donors with a serum sodium concentration of >155 mmol/L are extended criteria donors for liver transplantation (LT). Elevated serum sodium of donors leads to an increased incidence of hepatic dysfunction in the early postoperative period of LT; however, the exact mechanism has not been reported. We constructed a Lewis rat model of 70% hepatic parenchymal area subjected to ischemia-reperfusion (I/R) with hypernatremia and a BRL-3A cell model of hypoxia-reoxygenation (H/R) with high-sodium (HS) culture medium precondition. To determine the degree of injury, biochemical analysis, histological analysis, and oxidative stress and apoptosis detection were performed. We applied specific inhibitors of the epithelial sodium channel (ENaC) and Na⁺/Ca²⁺ exchanger (NCX) in vivo and in vitro to verify their roles in injury. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels and the area of hepatic necrosis were significantly elevated in the HS+I/R group. Increased reactive oxygen species (ROS) production, myeloperoxidase (MPO)‍-positive cells, and aggravated cellular apoptosis were detected in the HS+I/R group. The HS+H/R group of BRL-3A cells showed significantly increased cellular apoptosis and ROS production compared to the H/R group. The application of amiloride (Amil), a specific inhibitor of ENaC, reduced ischemia-reperfusion injury (IRI) aggravated by HS both in vivo and in vitro, as evidenced by decreased serum transaminases, inflammatory cytokines, apoptosis, and oxidative stress. SN-6, a specific inhibitor of NCX, had a similar effect to Amil. In summary, hypernatremia aggravates hepatic IRI, which can be attenuated by pharmacological inhibition of ENaC or NCX.
Animals ; Reperfusion Injury/drug therapy* ; Hypernatremia/complications* ; Rats ; Liver/metabolism* ; Rats, Inbred Lew ; Male ; Apoptosis ; Sodium-Calcium Exchanger/antagonists & inhibitors* ; Reactive Oxygen Species/metabolism* ; Oxidative Stress ; Epithelial Sodium Channel Blockers/pharmacology* ; Epithelial Sodium Channels ; Cell Line ; Liver Transplantation

OBJECTIVES: To evaluate the inhibitory effect of oridonin against proliferation of pancreatic cancer cells and the mechanism underlying the synergistic effect of low-intensity pulsed ultrasound (LIPUS). METHODS: PANC-1 cells treated with different concentrations of oridonin were examined for changes in cell proliferation using CCK-8 assay and in MDA, GSH and ATP levels using flow cytometry. The protein expressions of GPX4, Nrf2 and HO-1 in the treated cells were detected with Western blotting. The effect of Fer-1, a ferroptosis inhibitor, on proliferation of oridonin-treated cells were assessed, and the effects of oridonin combined with LIPUS on PIEZO1 protein expression was evalauted using Western blotting. A C57BL/6J mouse model bearing pancreatic cancer cell xenograft was established and treated with oridonin, LIPUS, or both, and the histological changes in the tumor tissues and tumor cell proliferation were examined with HE staining and immunohistochemistry for Ki67; the changes in GPX4 expression in the tumor tissues were detected using Western blotting and immunofluorescence staining. RESULTS: In PANC-1 cells, oridonin treatment significantly inhibited cell proliferation, increased intracellular Fe²⁺, ROS, and MDA levels, and decreased GSH and ATP levels. Oridonin also resulted in lowered GPX4 and increased HO-1 and Nrf2 protein expression levels in the cells. The combined treatment with LIPUS signficiantly enhanced the inhibitory effect of oridonin on PANC-1 cell viability in vitro and on xenograft growth in the mouse models, resulting also in more obvious reduction of the intensity of Ki67 staining and GPX4 protein expression and more pronounced increase of PIEZO1 protein expression in the tumor tissues in the mouse models. CONCLUSIONS LIPUS enhances the effect of oridonin to promote ferroptosis of pancreatic cancer cells by activating PIEZO1 through the Nrf2/HO-1/GPX4 pathway.
Ferroptosis/drug effects* ; Animals ; Pancreatic Neoplasms/metabolism* ; NF-E2-Related Factor 2/metabolism* ; Humans ; Cell Line, Tumor ; Mice ; Heme Oxygenase-1/metabolism* ; Diterpenes, Kaurane/pharmacology* ; Cell Proliferation/drug effects* ; Mice, Inbred C57BL ; Phospholipid Hydroperoxide Glutathione Peroxidase ; Ion Channels/metabolism* ; Ultrasonic Waves ; Signal Transduction

Adolescent idiopathic scoliosis(AIS)is a complex three-dimensional deformity involving coronal,sagittal,and axial planes,with a prevalence that should not be overlooked.With advancements in technology and in-depth research,an increasing number of hospitals and physicians are exploring standardized diagnostic and treatment approaches for AIS.Comprehensive and in-depth understanding is required for AIS,including its etiology,screening and diagnosis,classification,assessment and examination,treatment options,exploration of current focus,and evaluation of quality of life.Such understanding ensures that the diagnostic and treatment are scientific,standardized,and timely.Based on the principles of evidence-based medicine,a consensus on the diagnosis and treatment of AIS is reached after multiple discussions among spinal surgery experts,aiming to provide reference and guidance for clinical practice.