1.Clinical Advantages of Traditional Chinese Medicine in Treatment of Childhood Simple Obesity: Insights from Expert Consensus
Qi ZHANG ; Yingke LIU ; Xiaoxiao ZHANG ; Guichen NI ; Heyin XIAO ; Junhong WANG ; Liqun WU ; Zhanfeng YAN ; Kundi WANG ; Jiajia CHEN ; Hong ZHENG ; Xinying GAO ; Liya WEI ; Qiang HE ; Qian ZHAO ; Huimin SU ; Zhaolan LIU ; Dafeng LONG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(6):238-245
Childhood simple obesity has become a significant public health issue in China. Modern medicine primarily relies on lifestyle interventions and often suffers from poor long-term compliance, while pharmacological options are limited and associated with potential adverse effects. Traditional Chinese Medicine (TCM) has a long history in the prevention and management of this condition, demonstrating eight distinct advantages, including systematic theoretical foundation, diversified therapeutic approaches, definite therapeutic efficacy, high safety profile, good patient compliance, comprehensive intervention strategies, emphasis on prevention, and stepwise treatment protocols. Additionally, TCM is characterized by six distinctive features: the use of natural medicinal substances, non-invasive external therapies, integration of medicinal dietetics, simple exercise regimens, precise syndrome differentiation, and diverse dosage forms. By combining internal and external treatments, TCM facilitates individualized regimen adjustment and holistic regulation, demonstrating remarkable effects in improving obesity-related metabolic indicators, regulating constitutional imbalance, and promoting healthy behaviors. However, challenges remain, such as inconsistent operational standards, insufficient high-quality clinical evidence, and a gap between basic research and clinical application. Future efforts should focus on accelerating the standardization of TCM diagnosis and treatment, conducting multicenter randomized controlled trials, and fostering interdisciplinary integration, so as to enhance the scientific validity and international recognition of TCM in the prevention and treatment of childhood obesity.
2.Lysosomes as Regulators of Cancer Stemness and Drug Resistance
Fa-Xiao ZHOU ; Di-Ping YU ; Si-Qi TAN ; Hong-Yu DUAN ; Xiao-Ming WU
Progress in Biochemistry and Biophysics 2026;53(4):951-967
Cancer stem cells (CSCs) represent a distinct subpopulation of cells characterized by self-renewal capacity, differentiation potential, and critical roles in driving tumor progression, therapeutic resistance, recurrence, and maintenance of the tumor microenvironment. Targeting CSCs has emerged as a pivotal direction in cancer research, offering novel strategies to overcome drug resistance and prevent metastasis and relapse. Lysosomes, traditionally recognized as central organelles for intracellular degradation and recycling, are indispensable for cellular homeostasis. Dysregulation of lysosomal function is intimately linked to various diseases, including cancer. In tumors, aberrant lysosomal activity can promote malignant progression through mechanisms such as altering metabolic pathways, enhancing lysosomal exocytosis, modulating drug resistance, and interfering with autophagy-lysosomal pathways. Recent studies have underscored the involvement of lysosomes in regulating CSC properties. This review synthesizes findings on lysosomal regulation of CSCs through the following aspects. (1) Lysosomes exert complex and critical bidirectional control over CSC stemness maintenance through three degradation pathways that are dependent on their degradative function. (i) The lysophagy pathway. This pathway exhibits dual roles. Activation can sustain CSC functions; for instance, in glioblastoma, hypoxia upregulates Gal-8 via the STAT3/HIF1α signaling axis to induce autophagy, supporting stem cell survival. In head and neck squamous cell carcinoma, degradation of GSK3β activates the Wnt pathway, enhancing stemness. Conversely, this pathway can suppress stemness by degrading stemness-related proteins such as BMI-1 and OCT4A, thereby impairing CSC self-renewal capacity. (ii) Mitophagy pathway. In non-small cell lung cancer stem cells, mitophagy-related mechanisms, such as the accumulation of mitochondrial DNA (mtDNA) activating the TLR9-Notch1-AMPK signaling axis, have been shown to promote CSC proliferation. (iii) Autophagosome-dependent lysosomal degradation pathway. This pathway directly regulates stemness-related proteins in a bidirectional manner. Enhanced degradative function can promote CSC properties, exemplified by the degradation of NUMB to activate Notch signaling. Conversely, attenuated degradative function can also enhance stemness by stabilizing oncoproteins (e.g., protecting Frizzled-1 from degradation to sustain Wnt signaling) or preventing the degradation of tumor suppressors (e.g., inhibiting Notch degradation). (2) Constituent proteins of lysosomes, including membrane proteins and luminal acid hydrolases, participate in regulating CSC stemness. Regarding membrane proteins, LAMP2A facilitates chaperone-mediated autophagy to maintain stemness in glioblastoma and ovarian cancer. V-ATPase, by maintaining an acidic luminal environment, promotes proliferation and drug resistance in glioma stem cells. Among hydrolases, cathepsins B and L are highly expressed in pancreatic and ovarian cancers and correlate with poor prognosis. Furthermore, targeting lysosomes to induce lysosomal membrane permeabilization (LMP) triggers lysosome-mediated cell death, presenting a potential therapeutic strategy for eradicating CSCs.(3) The acidic luminal environment, single-membrane structure, and the presence of transmembrane transporters (e.g., ABCA3) enable lysosomes to passively trap or actively uptake and sequester chemotherapeutic drugs. Subsequent drug extrusion via exocytosis confers drug resistance. In CSCs, this lysosome-mediated drug sequestration, often cooperating with autophagy, establishes multimodal drug resistance. Therefore, targeting lysosomal function represents a potential strategy to overcome therapy resistance. The central role of lysosomes in regulating CSC stemness and resistance positions them as highly promising therapeutic targets. Strategies aimed at disrupting lysosomal function to selectively eliminate CSCs include: inhibiting the lysosome-autophagy system using agents like IITZ or lovastatin; inducing lysosomal membrane permeabilization (LMP) with compounds such as hexamethylene amiloride to compromise membrane stability; and disrupting the acidic luminal environment using drugs like siramesine or the K/H transport compound 2. In conclusion, lysosomes critically regulate CSC stemness maintenance and drug resistance through degradative pathways, membrane protein functions, luminal hydrolase activities, and drug sequestration mechanisms. This redefines the lysosome from a traditional “waste disposal unit” to a “signal integration center” in CSCs. The duality and context-dependency of lysosomal function in CSCs offer novel insights into the heterogeneity observed across different tumors. Targeting lysosomal vulnerabilities—such as inducing LMP, disrupting acidity, or blocking autophagic flux—provides a strategy to bypass canonical CSC resistance mechanisms and directly trigger cell death. This establishes the lysosome as a key target to overcome CSC-mediated therapy resistance, paving the way for developing diverse candidate drugs and innovative combination therapies in oncology.
3.Protective effects and mechanisms of luteolin on vascular injury induced by polystyrene microplastics
Deyu ZHU ; Qi HUANG ; Xiao LIANG ; Zhuangzhuang WEI ; Xinyu BAO ; Ping MA ; Yang WU ; Cuiyu BAO
Acta Universitatis Medicinalis Anhui 2026;61(3):432-438
ObjectiveTo explore the vascular endothelial injury in male mice caused by exposure to polystyrene microplastics (PS-MPs) and the intervention effect of luteolin on vascular remodeling. Additionally, to investigate the mechanism through the oxidative system and metabolomics. MethodsThirty-two C57BL/6 mice (6-8 weeks old) were randomly divided into the saline group (saline group), the 0.1 mg/kg PS-MPs exposure group (0.1PS-MPs group), the 1 mg/kg PS-MPs exposure group (1PS-MPs group), and the 1 mg/kg PS-MPs + luteolin treatment group (1PS-MPs + Lut group), with 8 mice in each group. After 8 weeks of intervention, the body weight, blood pressure, aortic organ coefficient, and aortic histopathological changes of mice in each group were detected; the total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) lipid metabolism-related indicators in the aorta of mice were detected; the reactive oxygen species (ROS), glutathione (GSH), and malondialdehyde (MDA) oxidative stress-related indicators were detected; the endothelin (ET-1), nitric oxide (NO), vascular endothelial growth factor A (VEGF-A), vascular cell adhesion molecule-1 (VCAM-1/CD106), and intercellular adhesion molecule-1 (ICAM-1/CD54) endothelial function-related indicators and serum metabolomics were detected. ResultsCompared to the saline group, exposure to PS-MPs resulted in pathological thickening of the mouse aorta, increased aortic organ coefficient, and elevated blood pressure. Lipid metabolism-related indicators, including TC and TG, were elevated, while HDL-C was reduced, indicating lipid metabolism disorder in mice. Oxidative stress markers such as ROS and MDA increased, whereas GSH decreased, demonstrating oxidative damage. Vascular endothelial inflammation and injury markers, including ET-1, VEGF-A, VCAM-1, and ICAM-1, were upregulated, while the vasodilatory substance NO was downregulated, confirming endothelial injury. Furthermore, serum metabolomics results revealed that PS-MPs exposure induced endothelial damage by disrupting metabolic pathways such as the citrate cycle. Compared to the PS-MPs group, luteolin significantly reversed these effects, attenuating oxidative stress and lipid metabolism disorders, and effectively repairing endothelial injury. ConclusionPS-MPs induce vascular toxicity through oxidative stress and lipid metabolism. Luteolin effectively alleviates endothelial damage and vascular remodeling.
4.Shaoyaotang Regulates miRNA-155-mediated SOCS1/JAK1/STAT1 Signaling Pathway to Affect Macrophage Polarization
Qi CHENG ; Bo ZOU ; Youwei XIAO ; Yiqian YU ; Ruoru HUANG ; Yan GONG ; Jiachun XIONG ; Jun XIONG ; Dichang LAI ; Dongsheng WU ; Hui CAO
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(13):43-52
ObjectiveTo investigate the mechanism by which Shaoyaotang regulates the miRNA-155-mediated suppressor of cytokine signaling 1 (SOCS1)/Janus kinase 1 (JAK1)/signal transducer and activator of transcription 1 (STAT1) signaling pathway and thereby affects macrophage polarization. MethodsThe cell-counting kit-8 (CCK-8) assay was used to detect the effect of drug-containing serum of Shaoyaotang at different concentrations on the viability of RAW 264.7 cells. A cell model of inflammation was established by stimulating RAW264.7 cells with lipopolysaccharide (LPS) at a concentration of 10 mg·L-1 The modeled cells were assigned by the random number table method into seven groups: LPS-induced M1 polarization (model), M1+miRNA-155 mimics, M1+miRNA-155 inhibitor, M1+Shaoyaotang-containing serum, M1+miRNA-155 mimics+Shaoyaotang-containing serum, M1+miRNA-155 inhibitor+Shaoyaotang-containing serum, and M1+blank serum. Enzyme-linked immunosorbent assay was employed to measure the levels of inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β)]. Immunofluorescence assay was used to detect the expression of macrophage polarization markers [inducible nitric oxide synthase (iNOS) and macrophage mannose receptor 1 (CD206)]. Real-time PCR was employed to measure the expression of miRNA-155 in cells. Western blot was performed to determine the protein levels of SOCS1, STAT1, and JAK1. ResultsCompared with the LPS-induced M1 polarization (model) group, the M1+miRNA-155 mimics group showed up-regulated expression of miRNA-155, JAK1, STAT1, TNF-α, IL-6, IL-1β, and iNOS (P<0.05) and down-regulated expression of CD206 (P<0.05). In both the M1+miRNA-155 inhibitor group and the M1+Shaoyaotang-containing serum group, the expression levels of miRNA-155, JAK1, STAT1, TNF-α, IL-6, IL-1β, and iNOS were down-regulated (P<0.05), while those of SOCS1 and CD206 were up-regulated (P<0.05). Compared with the M1+miRNA-155 mimics group, the M1+miRNA-155 mimics+Shaoyaotang-containing serum group showed down-regulated expression of miRNA-155, JAK1, STAT1, TNF-α, IL-6, IL-1β, and iNOS (P<0.05) and up-regulated expression of SOCS1 and CD206 (P<0.05). Compared with the M1+miRNA-155 inhibitor group, the M1+miRNA-155 inhibitor+Shaoyaotang-containing serum group showed down-regulated expression of miRNA-155, JAK1, STAT1, TNF-α, IL-6, IL-1β, and iNOS (P<0.05) and up-regulated expression of SOCS1 and CD206 (P<0.05). ConclusionShaoyaotang regulates macrophage polarization by modulating miRNA-155 expression and interfering with the SOCS1/JAK1/STAT1 signaling pathway. The findings provide new experimental evidence for the treatment of ulcerative colitis with Shaoyaotang.
5.Effect and Mechanisms of Shaoyaotang on Murine Ulcerative Colitis via Modulating Macrophage Glycolytic Reprogramming and Polarization Through HIF-1α Pathway
Yiqian YU ; Hui CAO ; Dongsheng WU ; Bo ZOU ; Ruoru HUANG ; Qi CHENG ; Youwei XIAO ; Yan GONG ; Jiachun XIONG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(13):53-60
ObjectiveTo investigate the potential role and underlying mechanisms of Shaoyaotang in intervening macrophage glycolytic reprogramming in ulcerative colitis (UC). MethodsForty-eight C57BL/6 mice were randomly divided into six groups: Normal control group, model group, mesalazine group (0.39 g·kg-1), Shaoyaotang group (15.54 g·kg-1), 2-deoxy-D-glucose (2-DG) group (glycolysis inhibitor, 100 mg·kg-1), and 2-DG + Shaoyaotang combined group (100 mg·kg-1+15.54 g·kg-1). Except for the normal control group, mice in the other five groups were induced to establish UC models using dextran sulfate sodium (DSS). The normal control group was administered pure water via intragastric gavage, while the other groups received intragastric gavage of mesalazine solution, intragastric gavage of Shaoyaotang, and the 2-DG group was treated with 2-DG via intraperitoneal injection. After 7 consecutive days of treatment, colonic tissues were extracted. Hematoxylin and eosin (HE) staining was performed to evaluate histopathological changes and tissue injury in the colon. Enzyme-linked immunosorbent assay (ELISA) was used to detect the expression of interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) in colonic tissues. Western blot analysis was employed to determine the expression levels of hypoxia-inducible factor-1α (HIF-1α), glucose transporter (GLUT1), lactate dehydrogenase A (LDHA), pyruvate kinase M2 (PKM2), and 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3) in colonic tissues. Immunofluorescence was conducted to detect the expression of CD206 and inducible nitric oxide synthase (iNOS) in colonic tissues. Liquid chromatography-mass spectrometry (LC-MS) was utilized to measure lactate and citrate levels in colonic tissues. ResultsCompared with the normal control group, mice in the model group exhibited a significant increase in disease activity index (DAI) scores, accompanied by colonic mucosal congestion, edema, and inflammatory cell infiltration, significantly elevated expression of the inflammatory cytokine TNF-α (P<0.05), significantly decreased IL-10 expression (P<0.05), significantly increased levels of HIF-1α, GLUT1, LDHA, PKM2, and PFKFB3 in colonic tissues (P<0.05), markedly elevated iNOS expression (P<0.05), significantly decreased CD206 expression (P<0.05), and significantly elevated lactate and citrate levels in colonic tissues (P<0.05). In contrast to the model group, the Shaoyaotang group, inhibitor group, and Shaoyaotang combined with inhibitor group demonstrated amelioration of mucosal injury in colonic tissues, markely decreased expression levels of the inflammatory cytokine TNF-α (P<0.05), elevated IL-10 expression levels, significantly decreased expression of HIF-1α, GLUT1, LDHA, PKM2, and PFKFB3 (P<0.05), markedly reduced iNOS expression levels (P<0.05), significantly increased CD206 expression (P<0.05) and significantly decreased lactate and citrate levels (P<0.05). ConclusionShaoyaotang ameliorates symptoms of DSS-induced UC in mice, and its therapeutic mechanism may be associated with regulating macrophage glycolytic reprogramming via modulation of the HIF-1α signaling pathway.
6.Shaoyaotang Ameliorates Ulcerative Colitis by Regulating miR-155-5p
Ruoru HUANG ; Bo ZOU ; Yu ZHANG ; Yiqian YU ; Qi CHENG ; Youwei XIAO ; Jiachun XIONG ; Yan GONG ; Dongshen WU ; Hui CAO
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(13):61-68
ObjectiveTo investigate the role of microRNA-155-5p (miR-155-5p) in ulcerative colitis (UC) and study the molecular mechanism of Shaoyaotang in the treatment of UC by regulating miR-155-5p. MethodsForty-eight SPF-grade male C57BL/6 mice were selected and assigned via the random number table method into 6 groups (n=8): A blank control group, a model group, a mesalazine (0.39 g·kg-1) group, a Shaoyaotang (31.08 g·kg-1) group, a Janus kinase 1 (JAK1) inhibitor (baricitinib, 10 mg·kg-1) group, and a Shaoyaotang combined with inhibitor (baricitinib 10 mg·kg-1 + Shaoyaotang 31.08 g·kg-1) group. After successful modeling of UC by gavage of 3% dextran sulphate sodium solution, each group received corresponding drug intervention for 7 days. Shaoyaotang and mesalazine were administered by gavage, and baricitinib by intraperitoneal injection. Twenty-four hours after the last administration, mice were anesthetized by intraperitoneal injection of pentobarbital sodium, and blood was collected for determination of white blood cell count and erythrocyte sedimentation rate (ESR). Mice were then sacrificed for measurement of colon length. Hematoxylin-eosin staining was used to observe colonic pathological changes and perform pathological scoring. Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR) was employed to determine the relative expression of miR-155-5p in the colonic tissue, and Western blot was used to determine the protein levels of JAK1, phosphorylated JAK1 (p-JAK1), suppressor of cytokine signaling 1 (SOCS1), signal transducer and activator of transcription 1 (STAT1), and phosphorylated STAT1 (p-STAT1). ResultsCompared with the blank control group, the model group showed increased disease activity index (DAI) score and pathological score, shortened colon, upregulated relative expression of miR-155-5p and protein levels of p-JAK1 and p-STAT1, downregulated protein level of SOCS1 in the colonic tissue, prolonged time of erythrocyte sedimentation, and increased white blood cell count (P<0.01). Compared with the model group, all drug-treated groups exhibited improvements in the above indicators (P<0.01). Moreover, the Shaoyaotang group showed better therapeutic effects than the mesalazine group in regulating miR-155-5p expression, related protein levels, DAI score, and colonic pathological score (P<0.01). ConclusionShaoyaotang may downregulate miR-155-5p to relieve its inhibition on SOCS1, thereby suppressing the excessive activation of the JAK1/STAT1 signaling pathway and ultimately alleviating intestinal inflammatory damage.
7.A practice guideline for therapeutic drug monitoring of mycophenolic acid for solid organ transplants.
Shuang LIU ; Hongsheng CHEN ; Zaiwei SONG ; Qi GUO ; Xianglin ZHANG ; Bingyi SHI ; Suodi ZHAI ; Lingli ZHANG ; Liyan MIAO ; Liyan CUI ; Xiao CHEN ; Yalin DONG ; Weihong GE ; Xiaofei HOU ; Ling JIANG ; Long LIU ; Lihong LIU ; Maobai LIU ; Tao LIN ; Xiaoyang LU ; Lulin MA ; Changxi WANG ; Jianyong WU ; Wei WANG ; Zhuo WANG ; Ting XU ; Wujun XUE ; Bikui ZHANG ; Guanren ZHAO ; Jun ZHANG ; Limei ZHAO ; Qingchun ZHAO ; Xiaojian ZHANG ; Yi ZHANG ; Yu ZHANG ; Rongsheng ZHAO
Journal of Zhejiang University. Science. B 2025;26(9):897-914
Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C0), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug-drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage*
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Drug Monitoring/methods*
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Humans
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Organ Transplantation
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Immunosuppressive Agents/administration & dosage*
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Delphi Technique
8.Expert consensus on the positioning of the "Three-in-One" Registration and Evaluation Evidence System and the value of orientation of the "personal experience"
Qi WANG ; Yongyan WANG ; Wei XIAO ; Jinzhou TIAN ; Shilin CHEN ; Liguo ZHU ; Guangrong SUN ; Daning ZHANG ; Daihan ZHOU ; Guoqiang MEI ; Baofan SHEN ; Qingguo WANG ; Xixing WANG ; Zheng NAN ; Mingxiang HAN ; Yue GAO ; Xiaohe XIAO ; Xiaobo SUN ; Kaiwen HU ; Liqun JIA ; Li FENG ; Chengyu WU ; Xia DING
Journal of Beijing University of Traditional Chinese Medicine 2025;48(4):445-450
Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, plays a significant role in maintaining public health. In 2019, the Central Committee of the Communist Party of China and the State Council proposed for the first time the establishment of a TCM registration and evaluation evidence system that integrates TCM theory, "personal experience" and clinical trials (referred to as the "Three-in-One" System) to promote the inheritance and innovation of TCM. Subsequently, the National Medical Products Administration issued several guiding principles to advance the improvement and implementation of this system. Owing to the complexity of its implementation, there are still differing understandings within the TCM industry regarding the positioning of the "Three-in-One" Registration and Evaluation Evidence System, as well as the connotation and value orientation of the "personal experience." To address this, Academician WANG Qi, President of the TCM Association, China International Exchange and Promotion Association for Medical and Healthcare and TCM master, led a group of academicians, TCM masters, TCM pharmacology experts and clinical TCM experts to convene a "Seminar on Promoting the Implementation of the ′Three-in-One′ Registration and Evaluation Evidence System for Chinese Medicinals." Through extensive discussions, an expert consensus was formed, clarifying the different roles of the TCM theory, "personal experience" and clinical trials within the system. It was further emphasized that the "personal experience" is the core of this system, and its data should be derived from clinical practice scenarios. In the future, the improvement of this system will require collaborative efforts across multiple fields to promote the high-quality development of the Chinese medicinal industry.
9.Effect of Endoplasmic Reticulum Stress on Intestinal Mucosal Injury in Ulcerative Colitis and TCM Intervention Based on Theory of Sores Depending on Spleen-earth
Youwei XIAO ; Dongsheng WU ; Hui CAO ; Bo ZOU ; Yiqian YU ; Ruoru HUANG ; Qi CHENG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(24):238-247
In recent years, as the incidence of ulcerative colitis (UC) is growing, intestinal mucosal injury has garnered increasing attention, and it is characterized by high recurrence, risk of inflammation-cancer transformation, and difficulty in repair. Intestinal mucosal injury in UC is centered on persistent inflammation and barrier dysfunction, with its pathological mechanisms involving endoplasmic reticulum stress (ERS)-mediated changes such as abnormal apoptosis, abnormal autophagy, and inflammatory responses. ERS induces apoptosis of intestinal epithelial cells, disrupts tight junction proteins, and exacerbates inflammatory responses through pathways such as protein kinase R-like endoplasmic reticulum kinase (PERK), inositol-requiring enzyme 1 alpha (IRE1α), and activating transcription factor 6 (ATF6), ultimately causing intestinal mucosal injury. Traditional Chinese medicine (TCM) has a long history of research on UC. The theory of sores depending on spleen-earth holds that spleen deficiency is the fundamental cause of UC, while pathological products such as dampness-turbidity and blood stasis are the secondary manifestations. Dysfunction of the spleen-earth leads to insufficient production and transformation of Qi and blood, malnutrition of the intestinal mucosa, and invasion of external pathogens. In the active phase of UC, spleen deficiency is often accompanied by excessive pathogenic factors such as dampness-heat and heat-toxin, leading to acute intestinal mucosal damage. In the remission phase, however, it is mainly characterized by spleen deficiency and healthy Qi deficiency, accompanied by residual pathogens, resulting in weak intestinal mucosal repair. Studies have shown that the endoplasmic reticulum, as a key site for protein synthesis and folding, has functions highly similar to the TCM concept of the spleen governing transportation and transformation. From a TCM perspective, the endoplasmic reticulum can be regarded as the carrier of spleen transportation, and ERS is a microcosmic manifestation of spleen dysfunction, leading to intestinal mucosal injury. ERS impairs the structure and function of the endoplasmic reticulum, induces the generation of abnormal Qi, and triggers pathological changes, making inflammation difficult to be reduced and causing the aggravation of ERS, forming a vicious cycle of spleen deficiency-pathological products-intestinal injury. TCM has unique advantages in regulating ERS to prevent and treat intestinal mucosal injury. According to the theory of sores depending on spleen-earth and the modern medical understanding of ERS, this paper delves into the TCM and Western medicine pathogenesis of intestinal mucosal injury in UC. Furthermore, this paper discusses the roles of TCM active components and compound formulas in reducing intestinal mucosal injury in UC by regulating ERS under the guidance of the treatment principles of invigorating the spleen and replenishing Qi as the key and dispelling dampness and removing blood stasis as the supplementation, aiming to provide new ideas and methods for the prevention and treatment of UC.
10.Risk factors for changes of eggshell vertebral body after fixation of thoracolumbar fracture with posterior pedicle screws
Xiao SUN ; Qi YAN ; Tianyi WU ; Leyu ZHAO ; Jinning WANG ; Huilin YANG ; Jun ZOU
Chinese Journal of Orthopaedic Trauma 2025;27(7):612-619
Objective:To investigate the risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures. Methods:A retrospective study was conducted to analyze the 118 patients with thoracolumbar single-segment fracture who had been treated at Department of Orthopaedic Surgery, The First Hospital Affiliated to Soochow University between January 2020 and January 2023. The patients were divided into a case group (47 cases) and a control group (71 cases) according to whether an eggshell vertebral body developed in the injured vertebra after internal fixation with posterior screw-rod system. The 2 groups were compared in terms of gender, age, follow-up time, body mass index, history of primary hypertension, history of diabetes mellitus, vertebral bone quality (VBQ) score, local Cobb angle correction, presence or absence of screwing at the injured vertebra, fracture site, fracture type, presence or absence of injury to the posterior ligamentous complex, presence or absence of injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rates of the anterior, middle, and posterior heights of the injured vertebra, and preoperative and postoperative visual analog scale (VAS) for pain. After positive indicators were screened by univariate analysis ( P<0.05), they were included in a multivariate logistic regression model and receiver operating characteristic curve (ROC) to analyze the risk factors for the formation of eggshell vertebral body after posterior screw-rod internal fixation of thoracolumbar spine fractures. Results:Of the 118 patients, 47 developed an eggshell vertebral body after surgery. Univariate analysis showed that VBQ score, presence or absence of screwing at the injured vertebra, burst fracture type, injury to the posterior ligamentous complex, injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rate of the anterior height of the injured vertebra, recovery rate of the middle height of the injured vertebra were statistically significant ( P<0.05). The multivariate logistic regression analysis and ROC curve analysis showed that a VBQ score ≥ 2.95 points( OR=6.216, 95% CI: 1.890 to 20.441, P=0.003), a recovery rate of the anterior height of the injured vertebra ≥ 25.26% ( OR=1.097, 95% CI: 1.046 to 1.149, P<0.001), a burst fracture type ( OR=6.397, 95% CI: 1.733 to 23.617, P=0.005), and injury to the upper and lower discs/endplate complex in the injured vertebrae ( OR=7.581, 95% CI: 1.827 to 31.461, P=0.005) were significantly associated with the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures ( P<0.05). Conclusion:A VBQ score ≥ 2.95 points, a recovery rate of the anterior height of the injured vertebra ≥ 25.26%, a burst fracture type, and injury to the disc/endplate complex in the injured vertebrae are the independent risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures.


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