ObjectiveTo evaluate the clinical efficacy of Shenqi Yangxin decoction in the treatment of ischemic cardiomyopathy （ICM） with Qi and Yin deficiency and blood stasis syndrome and its effect on serum hydrogen sulfide （H₂S） and calcium ion （Ca²⁺）. MethodsA total of 64 ICM patients with Qi and Yin deficiency and blood stasis syndrome who met the inclusion criteria were randomly divided into a control group （n=32） and a treatment group （n=32）. All patients received conventional Western medicine treatment. The treatment group was additionally given Shenqi Yangxin decoction. The TCM syndrome score， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， left ventricular ejection fraction （LVEF）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， 6-minute walk test （6MWT）， New York Heart Association （NYHA） cardiac function classification， and serum H₂S and Ca²⁺ levels were compared between the two groups pre- and post-treatment. ResultsTwo cases dropped out from each group during the study. Finally， 30 patients in each group were included in the analysis. There were no significant differences in age， gender， course of coronary heart disease， underlying diseases， and laboratory tests between the two groups. Compared with baseline， the TCM syndrome score， MLHFQ score， and NT-proBNP in both treatment group and control group decreased significantly （P<0.01）， LVEF， 6MWT， and H₂S increased significantly （P<0.01）， and serum Ca²⁺ increased （P<0.05）. Compared with the control group after treatment， the MLHFQ score and NT-proBNP in the treatment group decreased （P<0.05）， the TCM syndrome score decreased significantly （P<0.01）， LVEF， 6MWT， and serum Ca²⁺ increased （P<0.05）， and H₂S increased significantly （P<0.01）. The improvement degree of the NYHA cardiac function classification in the treatment group was higher than that in the control group， but there was no significant difference. ConclusionShenqi Yangxin decoction is effective in treating ICM patients with Qi and Yin deficiency and blood stasis， which could significantly improve cardiac function and quality of life， and its therapeutic effect may be related to the regulation of serum H₂S and Ca²⁺ levels.

Objective To explore the prognostic factors for patients with descending duodenum gastrointestinal stromal tumors (GIST), analyze the impact of different surgical approaches on prognosis, and develop a predictive model for surgical approach selection. Methods This single-center retrospective cohort study included patients with primary descending duodenum GIST treated in Zhongshan Hospital, Fudan University from January 2010 to January 2015, with follow-up until August 2025. The primary outcomes were incidence of postoperative complications, disease-free survival (DFS) rate, and overall survival (OS) rate. Cox regression and logistic regression were used to identify factors influencing prognosis and surgical approach selection, respectively. A nomogram model for selecting the surgical approach was constructed. Results A total of 78 patients with descending duodenum GIST were included, with age of (56.14±11.76) years. The 1-, 5-, and 10-year OS rates were 100%, 98.7%, and 85.7%, respectively, and the corresponding DFS rates were 100%, 90.9%, and 82.3%. Intraoperative blood loss, postoperative gastroparesis, mucosal ulceration, maximum tumor diameter, and Ki-67-positive cell ratio were independent risk factors for DFS, while maximum tumor diameter and mitotic figure were independent risk factors for OS (P＜0.05). The 10-year DFS rate was higher in the local resection group than in the pancreaticoduodenectomy group (89.45% vs 74.24%; HR＝0.300, P＝0.013), but there was no statistical difference in OS between the two groups. The incidence of postoperative complications in the pancreaticoduodenectomy group was higher than that in the local resection group (P＜0.001). Maximum tumor diameter and distance from tumor to the duodenal papilla were independent factors influencing surgical approach selection. The nomogram model based on these two indices demonstrated good discrimination and accuracy upon internal validation. Conclusions The long-term prognosis of patients with descending duodenal GIST is favorable, and surgical treatment achieves satisfactory outcomes. The nomogram model developed in this study can effectively guide individualized surgical approach selection and provide a reference for clinical decision-making.

Ischemic stroke （IS） is characterized by a high incidence， a high disability rate， and a high mortality rate. Its pathological mechanism is complex， involving oxidative stress， neuroinflammation， glutamate excitotoxicity， blood-brain barrier （BBB） disruption， abnormal autophagy and apoptosis， energy metabolism disorder， ferroptosis， and cuproptosis. Long-term use of conventional clinical drugs is associated with certain adverse reactions. As a classic Chinese herbal medicine for replenishing Qi， Astragali Radix is widely used in the prevention and treatment of IS. Modern research has confirmed that it contains various active components， including total astragalosides， total polysaccharides， and total flavonoids， which exert cerebroprotective effects by regulating signaling pathways such as nuclear factor erythroid 2-related factor 2/heme oxygenase-1 （Nrf2/HO-1）， nuclear factor-κB （NF-κB）， phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， adenosine monophosphate-activated protein kinase/mammalian target of rapamycin （AMPK/mTOR）. These effects include anti-oxidation， anti-inflammation， inhibition of excitotoxicity， protection of BBB， regulation of autophagy and apoptosis， suppression of ferroptosis， and improvement of energy metabolism. This article systematically reviews the core pathological links of IS， summarizes the cerebroprotective effects of the main active components， classic herb pairs， and representative compound formulas of Astragali Radix， and analyzes their synergistic intervention patterns against the above pathological mechanisms. Furthermore， this paper discusses the current research limitations in clinical translation， material basis， and emerging cell death modalities， along with future perspectives， aiming to provide a theoretical reference for the clinical application of Astragali Radix and its combinations in treating IS and for the development of new drugs.

Objective The objective of this research was to examine the cardioprotective properties of a SIRT1 agonist in mice afflicted with coronary artery disease(CAD).Methods Using the random number table method,60 male C57BL/6J mice were randomly divided into a control group,a model group,an SRT1 agonist group(Group SRT 1460,30 mg/kg),an Nrf2 inhibitor group(ML385 group,10 mg/kg),and a combined treatment group of SRT 1460+ML385,with 12 mice in each group.The control group mice were fed with normal feed,and the other groups of mice were fed with high-fat feed to create atherosclerosis mouse model.The modeling period was 12 weeks.After the successful construction of the model,ultrasonic parameters were used to detect the myocardial function of mice;two-dimensional ultrasound spot tracking technology was used to detect the strain of each layer of left ventricular myocardium.Pathological alterations in myocardial tissue were detected via HE staining,and the levels of cTnI,LDH and CK were measured using ELISA.Cardiomyocyte apoptosis was evaluated using TUNEL analysis,and levels of ROS in myocardial tissue were measured via DHE fluorescence assay.Additionally,SOD activity and MDA,GSH and Fe2+contents in myocardial tissue were determined using colorimetry.Finally,gene and protein expressions of Nrf2,GPX4,FTH1,and ACSL4 were assessed through qRT-PCR and Western blot analysis.Results A significant decrease in LVEDd and LVPWd levels was observed in the SRT 1460 group(P<0.05),whereas increases in GLSendo,GLSmid,and GCSendo levels were identified.A decrease in collagen fiber deposition was observed in the SRT 1460 group,in which the myocardium space narrowed.In comparison to the control group,the SRT 1460 group showed reductions in serum cTnI,CK,and LDH levels,cardiomyocyte apoptosis rate,ROS,MDA,and Fe2+contents,as well as ACSL4 mRNA and protein levels(P<0.05).An increase in SOD activity and GSH content as well as in Nrf2,GPX4,and FTH1 mRNA and protein levels was observed(P<0.05).By inhibiting the nuclear translocation of Nrf2,ML385 could significantly block the regulatory effect of SRT 1460(P<0.05).Conclusion It has been shown that SRT 1460 enhances GLSendo,GLSmid,and GCSmid,and improves left ventricular remodeling and systolic function in mice with CAD,in part because it regulates the Nrf2-GPX4 ferroptosis pathway.

Objective To investigate the perioperative use of antimicrobial agents in class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City,and provide a basis for the rational use of antimicrobial agents in such surgeries.Methods Perioperative antimicrobial prophylaxis(PAP)in patients undergoing class Ⅰ incisional ophthalmic surgery reported by secondary first-class and above hospitals in Shanghai City from 2017 to 2022 was collected retrospectively.The prophylactic use rate,types,rationality of selection,and timing of use of antimicrobial agents were analyzed comprehensively.Results From 2017 to 2022,a total of 54 868 cases of class Ⅰ incisional ophthalmic surgeries were reported from secondary first-class and above hospitals in Shanghai City.The PAP rates in tertiary comprehensive hospitals,tertiary specialty hospitals,tertiary traditional Chinese medicine hospitals,and secondary comprehensive hospitals were 4.72％,1.79％,3.22％,and 6.63％,re-spectively.The overall PAP rate showed a yearly decreasing trend,from 6.39％in 2017 to 2.31％in 2021.Among different types of hospitals,the PAP rate in secondary comprehensive hospitals decreased most significantly,from 12.72％in 2017 to 0.53％in 2022.The main types of prophylactic antimicrobial use were first-,second-and third-generation cephalosporins,and quinolones.The rational selection rates of antimicrobial agents were highest in ter-tiary comprehensive hospitals(17.13％)and lowest in tertiary specialty hospitals(1.08％).The PAP rates in sys-temic veins 0.5-1 hour before surgery were highest in tertiary specialty hospitals(88.17％)and lowest in tertiary comprehensive hospitals(71.53％).The withdrawal rates of antimicrobial agents within 24 hours after surgery were highest in tertiary traditional Chinese medicine hospitals(80.87％)and lowest in tertiary specialty hospitals(13.26％).Conclusion The PAP for class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City still presents certain irrational phenomena in terms of antimicrobial types and administration routes.The administration rate 0.5-1 hour before surgery and withdrawal rate of antimicrobial agents within 24 hours after surgery need to be further improved.Enhanced management is necessary to promote more rational use of antimicrobial agents.

Objective To investigate the clinical effect of percutaneous transhepatic papillary balloon dilation(PTPBD)in the treatment of common bile duct stone(CBDS).Methods The relevant data of patients treated with PTPBD for CBDS under digital subtraction angiography(DSA)were analyzed retrospectively,and its safety and effectiveness were analyzed.Results Among the 50 patients,there were 3 cases of abdominal pain,2 cases of bleeding,2 cases of fever,and no serious complications related to bile duct or intesti-nal perforation or pancreatitis.45 cases(90.00%)were successfully treated with PTPBD,while other 5 cases experienced technical failure due to excessive stone size(>20 mm).Conclusion PTPBD is a safe,effective,and minimally invasive treatment for CBDS with a high success rate,which is especially suitable for the patients with older age,multiple underlying diseases,inability to toler-ate surgical procedure,and without suitable endoscopic pathways,and the method is worthy of clinical promotion.

Objective To analyze the effect of percutaneous transhepatic cholangial drainage(PTCD)combined with percutaneous transhepatic papillary balloon dilation(PTPBD)in the treatment of common bile duct stone in elderly patients.Methods The clinical data of elderly patients treated with PTCD combined with PTPBD under digital subtraction angiography(DSA)for common bile duct stone were retrospectively collected,the changes in liver function,postoperative complications,and prognosis were analyzed.Results All 70 patients were successfully treated with PTCD,and other 3 patients died after PTCD operation,mainly due to severe infection combined with a variety of underlying diseases.Among the remaining 67 patients,65 cases(97.00%)were successfully treated with PTPBD,while other 2 cases(3.00%)experienced technical failure due to excessive stone size(>20 mm).Among the 70 cases after the pro-cedure,there were 5 cases with abdominal pain,2 cases with bleeding,4 cases with fever,and no serious complications occurred,such as bile duct perforation,intestinal perforation,or pancreatitis.The symptoms of 67 patients were improved from 3 to 7 days after PTCD,and the changes in leukocyte,total bilirubin,alanine aminotransferase and C-reactive protein before and after surgery were sta-tistically significant(P<0.05).Conclusion PTCD combined with PTPBD is a minimally invasive treatment method for common bile duct stone with a high success rate,safety,and effectiveness,which is especially suitable for elderly patients with multiple under-lying diseases,an inability to tolerate surgical and endoscopic treatments.It is worthy of clinical promotion and application.

Objective:To analyse the clinical effect of percutaneous transhepatic papillary balloon dilatation (PTPBD) combined with lithotriptic basket in the treatment of large-diameter common bile duct stone (CBDS) after percutaneous transhepatic cholangia drainage (PTCD).Methods:The clinical data of 50 patients treated with PTPBD combined with lithotriptic basket after PTCD under digital subtraction angiography (DSA) for large-diameter CBDS in the Department of Interventional Radiology, the Second Affiliated Hospital of Nantong University from October 2021 to September 2024 were retrospectively analyzed, including 38 males and 12 females, aged (57.6±3.6) years. Clinical data, including gender, age, long diameter of the stone, and surgery-related complications, were recorded. Changes in leukocyte count, total bilirubin, alanine transaminase and C-reactive protein were compared before PTCD and on the 5th postoperative day.Results:All 50 cases were successfully treated with PTCD. Significant improvements were observed in white blood cell count [(7.35±2.36)×10 9/L vs. (11.34±2.81)×10 9/L], total bilirubin [(27.58±6.24) μmol/L vs. (74.35±12.26) μmol/L], alanine transaminase [(41.25±8.65) U/L vs. (141.41±29.16) U/L] and C-reactive protein [(39.34±13.45) mg/L vs. (81.43±31.35) mg/L] before and after PTCD (all P<0.001). The time interval between PTCD and PTPBD was (14.46±1.01) d. Among the 50 patients, 48 cases (96.0%) were successfully treated with PTPBD combined with a lithotriptic basket, while 2 cases (4.0%) failed due to the basket's inability to retrieve the stones. Among the 50 patients after PTCD, 2 cases (4.0%) of abdominal pain, 2 cases (4.0%) of bleeding, and 2 cases (4.0%) of fever. Following PTPBD with lithotriptic basket stone removal, abdominal pain occurred in 3 patients (6.0%) and fever in 2 (4.0%). Conclusion:PTPBD combined with lithotriptic basket in the second stage after PTCD under DSA is a minimally invasive treatment for large-diameter CBDS with safety and effectiveness.

Objective To investigate the clinical effect of digital subtraction angiography(DSA)-guided percutaneous transhepatic cholangial drainage(PTCD)in treatment of acute obstructive suppurative cholangitis(AOSC).Methods The relevant data of DSA-guided PTCD in treatment of AOSC patients were collected to analyze its safety and effectiveness.Results Among the 70 patients,there were 2 cases of bleeding,1 case of drainage tube blockage,and 1 case of drainage tube detachment,and no other serious surgical related complications occurred.The symptoms of 66 patients were improved from 3 to 7 d after PTCD compared with those before PTCD,and 4 patients died during hospitalization.The average daily bile drainage volume of patients was(650±130)m L,and the changes of leukocyte,total bilirubin,alanine aminotransferase and alkaline phosphatase indexes before and after surgery were statisti-cally significant(P<0.05).Conclusion DSA-guided PTCD in treatment of AOSC is a safe and effective minimally invasive method with high technical success rate,which can timely relieve obstruction,improve symptoms,reduce mortality,and create opportunities and conditions for secondary surgery or interventional therapy.

G protein-coupled receptors(GPCRs)are the largest family of membrane proteins in eukaryotes,with nearly 800 genes coding for these proteins.They are involved in many physiological processes,such as light perception,taste and smell,neurotransmitter,metabolism,endocrine and exocrine,cell growth and migration.Importantly,GPCRs and their ligands are the targets of approximately one third of all mar-keted drugs.GPCRs are traditionally known for their role in transmitting signals from the extracellular environment to the cell's interior via the plasma membrane.However,emerging evidence suggests that GPCRs are also localized on mitochondria,where they play critical roles in modulating mitochondrial functions.These mitochondrial GPCRs(mGPCRs)can influence processes such as mitochondrial respi-ration,apoptosis,and reactive oxygen species(ROS)production.By interacting with mitochondrial signaling pathways,mGPCRs contribute to the regulation of energy metabolism and cell survival.Their presence on mitochondria adds a new layer of complexity to the understanding of cellular signaling,highlighting the organelle's role as not just an energy powerhouse but also a crucial hub for signal transduction.This expanding understanding of mGPCR function on mitochondria opens new avenues for research,particularly in the context of diseases where mitochondrial dysfunction plays a key role.Ab-normalities in the phase conductance pathway of GPCRs located on mitochondria are closely associated with the development of systemic diseases such as cardiovascular disease,diabetes,obesity and Alz-heimer's disease.In this review,we examined the various types of GPCRs identified on mitochondrial membranes and analyzed the complex relationships between mGPCRs and the pathogenesis of various diseases.We aim to provide a clearer understanding of the emerging significance of mGPCRs in health and disease,and to underscore their potential as therapeutic targets in the treatment of these conditions.