Objective To observe the efficacy of modified endoscopic sinus surgery(ESS)in treatment of chronic rhinosinusitis with nasal polyps(CRSwNP)complicated by allergic rhinitis(AR).Methods Forty patients with CRSwNP and perennial AR who were scheduled for ESS were divided into study group and control group,with 20 cases in each group.The control group was treated with conventional ESS,while the study group underwent resection of a large part of the middle turbi-nate on the basis of ESS to enhance middle meatal drainage.The postoperative mucosal outcomes,complications,as well as the Visual Analog Scale(VAS),sino-nasal outcome test-20(SNOT-20),and nasal endoscopic Lund-Kennedy scores before surgery,at 3 months after surgery,and at 1 year af-ter surgery were compared between the two groups.Results In the control group,there were 3 cases of local adhesion between the displaced middle turbinate and the lateral nasal wall at 3 months after surgery,and 10 cases of middle turbinate edema at 1 year after surgery,including 4 cases with local polypoid changes in the middle turbinate and polypoid hyperplasia in the ethmoid sinus and frontal re-cess regions.No complications were observed in the study group,and the epithelialization of the surgical area was good.Moreover,the nasal congestion score,olfactory score,and Lund-Kennedy score at 1 year after surgery in the study group were lower than those in the control group,with statistically significant differences(P＜0.05).Conclusion Modified ESS can significantly improve nasal con-gestion and olfactory symptoms in patients with CRSwNP complicated by perennial AR and effective-ly enhance their quality of life.

OBJECTIVE To investigate the effects of Estradiol tablet/Estradiol and dydrogesterone tablet combined with Dan'e fukang decoction on postoperative recovery,sex hormone levels,uterine artery blood flow,and endometrium in patients with high risk of endometrial basal layer injury after induced abortion,and evaluate the safety of drug use.METHODS A retrospective analysis was conducted on the clinical data of 244 patients with high risk of endometrial basal layer injury who underwent artificial abortions in our hospital between January 2022 and December 2023.They were divided into control group(120 cases)and observation group(124 cases)according to postoperative medication plan.All patients received anti-infective treatment after induced abortion.Based on it,control group was given Estradiol tablet/Estradiol and dydrogesterone tablet,and observation group was given Estradiol tablet/Estradiol and dydrogesterone tablet+Dan'e fukang decoction,for consecutive 28 d.The time of vaginal bleeding,abdominal pain,return of menstruation,and vaginal bleeding volume were observed in 2 groups;serum sex hormone levels[serum follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol,and progesterone],uterine artery blood flow parameters[peak systolic blood flow velocity(PSV),pulsatility index(PI),and resistance index(RI)]and endometrial thickness were compared between the two groups before and after treatment.The occurrence of complications and adverse reactions in patients were recorded.RESULTS After treatment,the duration of vaginal bleeding,vaginal bleeding volume,duration of abdominal pain,and menstrual cycle recovery time in observation group were significantly shorter or less than the control group(P＜0.05).After treatment,both groups exhibited a significant increase in endometrial thickness,serum FSH and LH levels,and PSV,compared to before treatment,and the observation group was significantly thicker/higher than the control group(P＜0.05);the levels of estradiol and progesterone,as well as the values of PI and RI,were significantly lower than those before treatment,and the observation group was significantly lower than the control group(P＜0.05).The total incidence of postoperative complications in observation group was significantly lower than control group(P＜0.05),but there was no significant difference in the total incidence of adverse reactions between the 2 groups(P＞0.05).CONCLUSIONS Estradiol tablet/Estradiol and dydrogesterone tablet combined with Dan'e fukang decoction can accelerate the postoperative recovery of patients with high risk of endometrial basal layer injury after induced abortion,promote endometrial growth,regulate serum sex hormone levels,improve uterine artery blood flow,reduce postoperative complications,and have good safety.

ObjectiveTo investigate the different effects of Yunvjian with or without Achyranthis Bidentatae Radix on glucose and lipid metabolism and inflammatory response in diabetic rats with the syndrome of Yin deficiency and internal heat. MethodThe rat model of diabetes due to Yin deficiency and internal heat was established by feeding with a high-sugar and high-fat diet and injection of thyroxine and streptozotocin. The successfully modeled rats were randomized into model control， Yunvjian without Achyranthis Bidentatae Radix （11.8 g·kg^-1）， Yunvjian with Achyranthis Bidentatae Radix （12.8 g·kg^-1）， and Achyranthis Bidentatae Radix （1.0 g·kg^-1） groups （n=10）， and another 10 rats were taken as the normal control group. Each group was administrated with corresponding drugs or saline by gavage for 28 days. The fasting blood glucose （FBG）， fasting insulin （FINS）， total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C） in rats were measured. Enzyme-linked immunosorbent assay was employed to determine the levels of cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， triiodothyronine （T₃）， thyroxine （T₄）， interleukin （IL）-1β， IL-6， tumor necrosis factor （TNF）-α， and C-reactive protein （CRP） in the serum. The histopathological changes of the liver were observed. The expression of lipoxygenase-2 （COX-2） was detected by immunofluorescence. The mRNA levels of nuclear transcription factors-κB （NF-κB）， monocyte chemotactic protein-1 （MCP-1）， and intercellular adhesion molecule-1 （ICAM-1） were determined by real-time polymerase chain reaction （Real-time PCR）.Western blot was employed to determine the protein levels of NF-κB in hibitory protein（IκB） kinase β （IKKβ）， IκBα， and phosphorylated IκBα （p-IκBα） in the liver and the protein levels of NF-κB in the cytoplasm and nucleus. ResultCompared with the normal group， the model group showed elevated levels of FBG， FINS， insulin resistance index， TC， TG， LDL-C， cAMP， T₃， T₄， IL-1β， IL-6， TNF-α， and CRP， up-regulated mRNA levels of NF-κB， MCP-1， and ICAM-1， and up-regulated protein levels of COX-2， p-IκBα， and nuclear NF-κB （P<0.01）. Compared with the model group， Yunvjian without Achyranthis Bidentatae Radix lowered the levels of FBG， FINS， insulin resistance index， TC， TG， LDL-C， cAMP， T₃， T₄， IL-1β， IL-6， TNF-α， and CRP， down-regulated the mRNA levels of NF-κB， MCP-1， and ICAM-1， and down-regulated the protein levels of COX-2， p-IκBα and nuclear NF-κB （P<0.05， P<0.01）. Compared with the Yunvjian without Achyranthis Bidentatae Radix， Yunvjian with Achyranthis Bidentatae Radix showed lowered levels of FBG， FINS， insulin resistance index， and inflammatory cytokines， down-regulated mRNA levels of NF-κB， MCP-1， and ICAM-1， and down-regulated protein levels of p-IκBα and nuclear NF-κB （P<0.05， P<0.01）. ConclusionAchyranthis Bidentatae Radix can enhance the performance of Yunvjian in reducing blood glucose and inhibiting inflammation in diabetic rats with the syndrome of yin deficiency and internal heat by down-regulating the IKK/IκB/NF-κB signaling pathway.

Objective:To explore the effect of intervention model based on comprehensive nutrition management on glucose and lipid metabolism and pregnancy outcome in patients with gestational diabetes mellitus (GDM).Methods:104 GDM patients admitted to Shanxi Bethune Hospital from February 2022 to March 2023 were randomly divided into control group and experimental group, with 52 cases in each group. The control group implemented routine management measures and nutrition guidance, while the experimental group implemented an intervention model based on comprehensive nutrition management on the basis of routine management. The indexes of glucose and lipid metabolism (glycosylated hemoglobin, fasting blood glucose, 2 h postprandial blood glucose, total cholesterol, triglyceride and low density lipoprotein cholesterol), pregnancy outcome, self-management ability and self-efficacy were compared between the two groups before and after intervention.Results:Before the intervention, there was no significant difference in general situation, glucose and lipid metabolism index, self-management ability and self-efficacy between the two groups ( P>0.05). After the intervention, the level of glucose and lipid metabolism index in the experimental group was significantly lower than that in the control group, with statistical significance ( P<0.05). The incidence of adverse pregnancy outcome in the experimental group was significantly lower than that in the control group, with statistical significance ( P<0.05). The scores of self-management ability and self-efficacy in the experimental group were significantly higher than those in the control group, with statistical significance ( P<0.05). Conclusion:The intervention model based on comprehensive nutrition management can effectively improve the glucose and lipid metabolism index and pregnancy outcome of GDM patients, and significantly improve their self-management ability and self-efficacy related to nutrition management, which has high clinical application and promotion value.

Objective To compare the effects of intratracheal instillation by lumbar spinal needle and intratracheal atomization on bleomycin-induced pulmonary fibrosis modeling in mice,to determine the optimal modeling method.Methods Seventy-two C57BL/6J mice were divided randomly into control,lumbar spinal needle and aerosolization groups,according to body weight(n=24 mice per group).Mice in the control and lumbar spinal needle groups received intratracheal instillation of saline or bleomycin,respectively,and mice in the aerosolization group received aerosolized bleomycin intracheally by microsprayer aerosolizer.Micro-computed tomography(CT),histopathological changes,hydroxyproline(HYP)levels,Collagen Ⅰ(COL Ⅰ)and α-smooth muscle actin(α-SMA)protein expression were examined on days 14 and 21 to evaluate the degree of pulmonary fibrosis in each group.Results Mice in the two model groups showed listlessness,slow responses,and decreased body weights on days 14 and 21,compared with the control group(P＜0.001).Micro-CT showed white shadows surrounding the trachea in the lumbar spinal needle group,while the shadows were more diffuse in the aerosol group.The degrees of alveolitis and pulmonary fibrosis were highest in the aerosolization group,with a time-dependent trend.The hydroxyproline contents were significantly increased in the two model groups on days 14 and 21 after modeling(P＜0.05),with the increase on day 21 being more significant and stable(P＜0.001).COL Ⅰ expression was significantly increased in both the lumbar spinal needle group and aerosolization group on days 21 after modeling,especially in the aerosolization group(P＜0.001).Expression levels of α-SMA were significantly higher in the lumbar spinal needle group and aerosolization group compared with the control group on days 21(P＜0.001);however,there was no significant difference between the two model groups.Conclusions intratracheal atomization of bleomycin is the optimal method for establishing a mouse model of pulmonary fibrosis.

Objective To compare the effects of intratracheal instillation by lumbar spinal needle and intratracheal atomization on bleomycin-induced pulmonary fibrosis modeling in mice,to determine the optimal modeling method.Methods Seventy-two C57BL/6J mice were divided randomly into control,lumbar spinal needle and aerosolization groups,according to body weight(n=24 mice per group).Mice in the control and lumbar spinal needle groups received intratracheal instillation of saline or bleomycin,respectively,and mice in the aerosolization group received aerosolized bleomycin intracheally by microsprayer aerosolizer.Micro-computed tomography(CT),histopathological changes,hydroxyproline(HYP)levels,Collagen Ⅰ(COL Ⅰ)and α-smooth muscle actin(α-SMA)protein expression were examined on days 14 and 21 to evaluate the degree of pulmonary fibrosis in each group.Results Mice in the two model groups showed listlessness,slow responses,and decreased body weights on days 14 and 21,compared with the control group(P＜0.001).Micro-CT showed white shadows surrounding the trachea in the lumbar spinal needle group,while the shadows were more diffuse in the aerosol group.The degrees of alveolitis and pulmonary fibrosis were highest in the aerosolization group,with a time-dependent trend.The hydroxyproline contents were significantly increased in the two model groups on days 14 and 21 after modeling(P＜0.05),with the increase on day 21 being more significant and stable(P＜0.001).COL Ⅰ expression was significantly increased in both the lumbar spinal needle group and aerosolization group on days 21 after modeling,especially in the aerosolization group(P＜0.001).Expression levels of α-SMA were significantly higher in the lumbar spinal needle group and aerosolization group compared with the control group on days 21(P＜0.001);however,there was no significant difference between the two model groups.Conclusions intratracheal atomization of bleomycin is the optimal method for establishing a mouse model of pulmonary fibrosis.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

DNA barcoding has been widely used for herb identification in recent decades,enabling safety and innovation in the field of herbal medicine.In this article,we summarize recent progress in DNA bar-coding for herbal medicine to provide ideas for the further development and application of this tech-nology.Most importantly,the standard DNA barcode has been extended in two ways.First,while conventional DNA barcodes have been widely promoted for their versatility in the identification of fresh or well-preserved samples,super-barcodes based on plastid genomes have rapidly developed and have shown advantages in species identification at low taxonomic levels.Second,mini-barcodes are attractive because they perform better in cases of degraded DNA from herbal materials.In addition,some mo-lecular techniques,such as high-throughput sequencing and isothermal amplification,are combined with DNA barcodes for species identification,which has expanded the applications of herb identification based on DNA barcoding and brought about the post-DNA-barcoding era.Furthermore,standard and high-species coverage DNA barcode reference libraries have been constructed to provide reference se-quences for species identification,which increases the accuracy and credibility of species discrimination based on DNA barcodes.In summary,DNA barcoding should play a key role in the quality control of traditional herbal medicine and in the international herb trade.

Objective To investigate the status of medication adherence and various types of risky behaviors of schizophrenia patients in a certain area of western China and to explore accordingly the correlation between the two.Methods A total of 292 667 patients with schizophrenia were enrolled in a follow-up survey between 2006 and 2018.In addition,based on the outcome-wide analysis strategy,a multivariate Cox proportional risk regression model was used to estimate and compare the impact of medication adherence on different types of risky behaviors in schizophrenia patients.Results In this 13-year prospective cohort,65 175 patients(31.4％)showed good medication adherence,while 142 394 patients(68.6％)showed poor medication adherence.The incidence rates of various risky behaviors during the follow-up period were as follows,minor nuisances,12.25％,violation of the Law of the People's Republic of China on Penalties for Administration of Public Security(APS law),3.82％,violation of criminal law,0.94％,suicide completed,0.28％,self-harm,1.42％,and attempted suicide,0.82％.Schizophrenia patients who had poor medication adherence had higher risks of committing violence against others and self-inflicted injury compared to patients with good medication adherence did,with the associated effects being minor nuisances(hazard ratio[HR]=1.31,95％confidence interval[CI]:1.27-1.35),violation of APS law(HR=1.47,95％CI:1.38-1.56),violation of criminal law(HR=1.17,95％CI:1.05-1.31),and self-harm(HR=1.43,95％CI:1.32-1.56),respectively,while the risk of suicide completed is lower in schizophrenia patients with poor medication adherence than that in patients with good medication adherence(HR=0.56,95％CI:0.47-0.66).There was no statistically significant association between attempted suicide and medication adherence.Conclusion There are variations in the direction and strength of the association between medication adherence and different types of risky behaviors and further research is needed to elucidate the mechanisms of the association.