Sangjuyin， as a pungent and cooling agent with precise therapeutic effect， is a classic pungent formula for cooling relief of the epidermis， which is highly respected by medical practitioners. This formula is from the Wenbing Tiaobian written by WU Jutong in the Qing dynasty， on the basis of which subsequent medical practitioners have made additions and subtractions to apply it. The authors used the bibliometric method to systematically organize the medical books from the Qing dynasty and the Republic of China and modern literature to analyze the composition， concoction， decoction， efficacy， and previous and modern application of Sangjuyin. After examination， the drug base of this formula is basically clear. Armeniacae Semen Amarum is the dried mature seeds of Armeniaca vulgaris， family Rosaceae. Forsythiae Fructus is the dried fruit of Forsythia suspensa， family Mulleinaceae. Menthae Haplocalycis Herba is the dried above-ground part of Mentha haplocalyx， family Labiatae. Mori Folium is the dried leaves of Morus alba， family Moraceae. Chrysanthemi Flos is the dried head of Chrysanthemum morifolium， family Asteraceae. Platycodonis Radix is the dried root of Eryngium grandiflorum， family Eryngium. Glycyrrhizae Radix et Rhizoma is the dried root and rhizome of Glycyrrhiza uralensis of the Leguminosae family， and Phragmitis Rhizoma is the fresh or dried rhizome of Phragmites communis of the Gramineae family. It is recommended that the eight drugs be used in raw form as medicine. The dosage and method of decoction were converted into a modern single dosage of 7.46 g Armeniacae Semen Amarum， 5.60 g Forsythiae Fructus， 2.98 g Menthae Haplocalycis Herba， 9.33 g Mori Folium， 3.73 g Chrysanthemi Flos， 7.46 g Platycodonis Radix， 2.98 g Glycyrrhizae Radix et Rhizoma， and 11.19 g Phragmitis Rhizoma， with 400 mL water added， and the solution was boiled to obtain 200 mL， taken twice a day. Sangjuyin has the efficacy of dispersing wind and clearing heat， promoting lung and relieving cough， and it is used for treating the initial onset of wind-warmth and the evidence of evil spirits in the lungs and collaterals. Modern research has shown that Sangjuyin is often used in the treatment of cough， pneumonia， rhinitis， and other respiratory diseases， and the results of this study provide a reference for the later development of Sangjuyin.

Functional dyspepsia （FD） is a prioritized disease category where traditional Chinese medicine （TCM） demonstrates distinct therapeutic advantages. The current western medicine treatment for FD is mainly based on proton pump inhibitors and prokinetic agents， with digestive enzymes， probiotics and antidepressants serving as adjuvant medication， yet such therapies still have certain limitations. TCM treatment for FD includes oral administration of Chinese herbal formulas and Chinese patent medicines， as well as external TCM therapies such as acupuncture and moxibustion， acupoint application， hot medicinal compress therapy， rubbing with ointment， medicinal iontophoresis， auricular acupoint therapy and tui na （Chinese medical massage）. The combined treatment of FD with integrated TCM and western medicine can significantly improve clinical effectiveness and reduce adverse reactions. The common mechanisms underlying the therapeutic effects of both TCM and western medicine revolve around the core pathological processes of FD， mainly focusing on restoring gastrointestinal motility， regulating the levels of brain-gut peptides， modulating intestinal microecology， and ameliorating inflammatory status. The differential mechanisms lie in the precise targeting feature of western medicine versus the holistic-regulating and multi-target characteristics of TCM， and the two approaches exert a synergistic effect to enhance efficacy. This paper proposes to leverage the advantages of TCM in holistic regulation and the strengths of western medicine in targeted treatment， so as to provide personalized and comprehensive treatment regimens for FD patients.

OBJECTIVE To study the protective effect and potential mechanism of chikusetsu saponin Ⅳ a （chsⅣ） on renal function in diabetic nephropathy （DN） model rats. METHODS DN rat model was established by high-fat diet combined with streptozotocin injection. Thirty-six model rats were randomly divided into model group （i.g. administration of normal saline， high-fat diet）， chsⅣ low-dose and high-dose groups （i.g. administration of 90， 180 mg/kg chsⅣ， high-fat diet）， with 12 rats in each group. Additionally， 10 normal rats were set as the control group （i.g. administration of normal saline， regular diet）. From the 5th to the 12th week after streptozotocin injection， they were given intragastric administration of relevant drug or normal saline， once a day. After the last medication， the levels of fasting blood glucose， fasting insulin， blood urea nitrogen， serum creatinine and urine protein as well as the levels of reduced glutathione （GSH）， superoxide dismutase （SOD） and malondialdehyde （MDA） in renal tissues were measured. Additionally， the insulin resistance index was calculated. Hematoxylin-eosin， periodic acid-Schiff， and Masson staining techniques were employed to examine the histopathological alterations in the renal tissue. The expressions of Notch signaling pathway-related proteins in renal tissue were detected by immunohistochemical staining and Western blot methods. RESULTS Compared with model group， the histomorphological of renal tissues in the chsⅣ low- and high-dose groups were significantly improved， with significant decreases in renal histological scores， mesangial expansion index， and glomerulosclerosis scores （ P ＜0.05）； the levels of fasting blood glucose， fasting insulin， blood urea nitrogen， serum creatinine， urine protein and homeostasis model assessment for insulin resistance， as well as MDA content， the expression levels of Notch1， Notch intracellular domain， hairy and enhancer of Split 1 and Delta-like protein 1 in renal tissue were all significantly decreased （ P ＜0.05）. The levels of GSH and SOD in renal tissue were significantly elevated （ P ＜0.05）. Moreover， the improvement in these indicators was significantly more pronounced in the chsⅣ high-dose group compared to the chsⅣ low-dose group （ P ＜0.05）. CONCLUSIONS ChsⅣ can ameliorate renal pathological damage and functional impairment in DN rats. Its underlying mechanisms include restoration of glucose homeostasis and insulin sensitivity， attenuation of renal oxidative stress， and suppression of aberrant Notch signaling pathway activation.

This study aimed to investigate the effect of atractylenolide I (Atr-I) on myocardial mitochondrial function in mice with dilated cardiomyopathy (DCM) by regulating the cyclic GMP-AMP synthase (cGAS)/stimulator of interferon genes (STING) pathway. Sixty SPF-grade male cTnT R141W transgenic DCM mice were randomly divided into the DCM group, Atr-I low-dose group (60 mg/kg), Atr-I high-dose group (240 mg/kg), captopril group (0.01 g/kg), and Atr-I high-dose+cGAS/STING pathway activator 5,6-dimethylxanthenone-4-acetic acid (DMXAA) group, with 12 mice in each group. Additionally, 12 male C57BL/6J mice were used as the control group. All mice were administered via oral gavage once daily for 8 weeks. Cardiac function was assessed using the Vevo 770 ultrasound system; myocardial pathology was examined via HE staining; mitochondrial ultrastructure in cardiomyocytes was observed using transmission electron microscopy; the proportion of cardiomyocytes without reduced mitochondrial membrane potential was detected using JC-1 staining; reactive oxygen species (ROS) content in myocardial tissue was measured using 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) staining; adenosine triphosphate (ATP) content in myocardial tissue was determined using a commercial kit; and Western blot was performed to detect the protein expression levels of mitofusin-2 (MFN2), dynamin-related protein 1 (DRP1), cGAS, STING, interferon-β (IFN-β), CXC chemokine ligand 10 (CXCL10), and interleukin-6 (IL-6) in myocardial tissue. The aim was to observe the effect of Atr-I on myocardial mitochondrial function in DCM mice. The results showed that low- and high-dose Atr-I (60 mg/kg, 240 mg/kg) intervention improved cardiac function, alleviated cardiomyocyte hypertrophy and disordered muscle fiber arrangement, ameliorated mitochondrial ultrastructure in cardiomyocytes, reduced ROS content and the protein expression levels of DRP1, cGAS, STING, IFN-β, CXCL10, and IL-6 in myocardial tissue, and increased the proportion of cardiomyocytes without reduced mitochondrial membrane potential, as well as ATP content and MFN2 protein expression in myocardial tissue. However, DMXAA attenuated the beneficial effects of high-dose Atr-I on myocardial mitochondrial function in DCM mice. In conclusion, Atr-I may improve myocardial mitochondrial function in DCM mice by inhibiting the cGAS/STING pathway.

Background Diarrhea disease is a common intestinal infectious disease, and its incidence is affected by meteorological conditions. A better understanding of its epidemiological patterns and influencing factors, together with the construction of reliable prediction models, is of great significance for precise public health prevention and control. Objective To clarify the epidemic characteristics of adult diarrhea disease in Shanghai, analyze the associations of meteorological factors and a web search index with adult diarrhea disease, and develop and compare forecasting models to support precise regional prevention and control. Methods Weekly surveillance data of adult diarrhea disease cases from the Shanghai Comprehensive Surveillance Information System for Diarrhea Diseases, together with concurrent meteorological observation data and web search index (Baidu index) data from 2014 to 2019, were collected. A distributed lag non-linear model (DLNM) was adopted to analyze the associations of multiple meteorological factors and the web search index with the number of diarrhea disease cases. By integrating meteorological factors and web search index data, three types of forecasting models were developed, including autoregressive integrated moving average (ARIMA), Random Forest, and extreme gradient boosting (Xgboost), and their predictive performances were evaluated. Results Adult diarrhea disease in Shanghai exhibited seasonal variation, with an major incidence peak in summer and winter peaks in some years. The number of cases declined annually after 2015. Mean temperature was significantly associated with the risk of diarrhea disease, and both low and high temperature exposures were associated with increased risks. The highest risk was observed at 32.8°C (RR=2.04, 95%CI: 1.62, 2.55), while the strongest effect of low temperature was observed at 0.9 °C (RR=1.53, 95%CI: 1.25, 1.88). When relative humidity exceeded 69%, the risk of diarrhea disease increased with relative humidity, reaching a peak at 81% (RR=1.20, 95%CI: 1.07, 1.35). When weekly cumulative precipitation exceeded 16 mm, the risk also increased with increasing precipitation, reaching a maximum at 105 mm (RR=1.23, 95%CI: 1.07, 1.42). The web search index was positively associated with the risk of diarrhea disease. Model prediction indicated that both the Random Forest model and the Xgboost model adequately captured the overall trend in diarrhea disease cases, with R² values generally exceeding 0.7. Notably, the Xgboost model demonstrated greater accuracy in capturing peak intensities. Conclusion Meteorological factors are associated with adult diarrhea disease in Shanghai. The web search index may serve as an auxiliary indicator for diarrhea forecasting. Machine learning models, with advantages in integrating multisource data, may provide effective predictive tools for the prevention and control of diarrhea disease.

ObjectiveTo analyze the clinical data of 126 patients with hepatic myelopathy （HM）， to summarize their clinical manifestations and prognostic features， and to provide a reference for clinical diagnosis and treatment. MethodsRelated clinical data were collected from 126 HM patients who attended The First Hospital of Lanzhou University from January 1， 2016 to June 30， 2025， and according to their muscle strength on admission， they were divided into grade<3 group， grade 3 group， and grade 4 group. The three groups were compared in terms of the clinical data including etiology， symptoms， clinical signs， past history， personal history， laboratory test results， imaging findings， treatment， and outcome. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups， and the Bonferroni correction method was used for further comparison between two groups； the chi-square test was used for comparison of categorical data between multiple groups. ResultsAll 126 patients with HM were comorbid with liver cirrhosis， with a male/female ratio of 2.7∶1， an age of 23 — 73 years， a mean age of 53.9±9.3 years， and a median age of 54 years. The top three etiologies of liver cirrhosis were hepatitis B in 78 patients （61.9%）， hepatitis C in 9 patients （7.1%）， and alcoholic hepatitis in 8 patients （6.3%）. During the course of the disease， all 126 patients with HM showed weakness in both lower limbs， among whom 9 patients （7.1%） also had the symptoms of lower limb pain and numbness. Among the 126 patients， 3 （2.4%） had grade 0 muscle strength， 4 （3.2%） had grade 1 muscle strength， 9 （7.1%） had grade 2 muscle strength， 39 （31.0%） had grade 3 muscle strength， and 71 （56.3%） had grade 4 muscle strength. Comparison of related data between the three groups of patients with varying grades of muscle strength showed that as for comorbidities， there were significant differences between the three groups in the constituent ratios of overt hepatic encephalopathy （OHE） （χ²=6.254， P=0.044）， ascites （χ²=6.248， P=0.044）， and liver failure （χ²=7.704， P=0.029）； as for laboratory markers， there were significant differences between the three groups in red blood cell count （RBC） （F=5.334， P=0.006）， hemoglobin （HGB） （F=4.627， P=0.012）， aspartate aminotransferase （AST） （H=6.866， P=0.032）， alanine aminotransferase （H=6.444， P=0.040）， albumin （Alb） （F=6.331， P=0.002）， cholinesterase （ChE） （H=11.064， P=0.004）， total cholesterol （TC） （F=4.843， P=0.009）， prothrombin activity （PTA） （F=3.937， P=0.022） and international normalized ratio （INR） （H=6.448， P=0.040）. Compared with the grade 4 group， the grade<3 group had significantly lower levels of RBC， HGB， and ChE （all P<0.05） and a significantly higher level of AST （P<0.05）； compared with the grade 3 group， the grade<3 group had significant reductions in Alb， TC， and PTA （all P<0.05） and a significant increase in INR （P<0.05）. At discharge， 27 patients （21.4%） achieved improvement， and 99 patients （78.6%） showed no response， among whom 2 patients died. ConclusionHM has the main clinical manifestation of symmetrical spastic paraplegia of both lower limbs， and it is more common in men. The main causes of HM include hepatitis B， hepatitis C， and alcoholic hepatitis. Muscle strength in HM patients is associated with the comorbidity of OHE， ascites， or liver failure， and patients with weak muscle strength tend to have low levels of RBC， HGB， Alb， ChE， TC， and PTA and high levels of AST and INR， suggesting that the changes in these indicators may be correlated with the degree of muscle strength impairment. HM often has a poor prognosis， and there are currently no effective treatment methods.

Objective:To identify the trajectories of dietary choline intake in middle-aged and older population, and to analyze its longitudinal association with cognitive function.Methods:Subjects aged 55 to 79 years with at least two rounds of completed population economics, lifestyle, disease history, cognitive function, dietary assessments and physical measurements in 1997-2018 and those with at least three rounds of dietary measures in 1991-2015 were selected from the China Health and Nutrition Survey. Dietary survey was conducted using three consecutive 24-hour dietary recalls combined with a weighing inventory at the household level. Cognitive assessment was performed using part of the Telephone Interview for Cognitive Status Scale. Group-based univariate trajectory modeling was used to identify trajectory of choline intake, and three-level linear mixed-effects models or three-level logistic mixed-effects models was employed to analyze the relationship between trajectory groups and cognitive function. Subgroup analyses were conducted by gender and age at baseline.Results:Four trajectories of dietary choline intake were identified in the whole population, named as low-intake-stable group (61.0%), medium-intake-stable group (23.9%), medium-intake-slowly-declined group (11.2%), and high-intake-stable group (3.9%). Three trajectories were identified for each subgroup. Low-intake-stable group accounted for more than 60% in total population as well as each subgroup, especially in women and 55-59 years group. After adjusting for covariates, global cognitive scores were 0.54 (95% CI: 0.26-0.82), 0.77 (95% CI: 0.36-1.18), and 0.85 (95% CI: 0.21-1.48) points higher in medium-intake-stable, medium-intake- slowly-declined and high-intake-stable groups in the whole population, respectively, compared with the low-intake-stable group. The likelihoods of cognitive decline were 18.4% ( OR=0.816,95% CI: 0.709-0.939), 17.6% ( OR=0.824, 95% CI: 0.680-0.998), 24.4% ( OR=0.756, 95% CI: 0.589-0.970) and 22.4% ( OR=0.776,95% CI: 0.623-0.968) lower in medium-intake-stable group of dietary choline in the whole population, medium-intake-stable group in males, medium-intake-slightly-increased group in females and medium-intake-slowly-increased group in 55-59 years at baseline than in low-intake-stable group, respectively. Conclusions:Dietary choline intake is generally lower in the Chinese population aged 55-79 years. Long-term lower choline intake has a negative impact on cognitive function in middle-aged and older adults and may increase the risk of cognitive decline. The increment in the consumption of choline-enriched foods should be recommended.

Objective To investigate the impact of different application methods of tissue compensators(bolus)on the skin dose delivered to the chest wall following radical mastectomy for breast cancer.Methods A retrospective analysis was conducted on 60 female patients who underwent radical mastectomy and required chest wall radiotherapy at the hospital between January 2023 and March 2025.The Pinnacle3 9.10 radiotherapy planning system(TPS)was utilized to design two VMAT dual semi-arc radiotherapy plans for each patient,with a prescribed target dose of 50 Gy delivered in 2 Gy fractions over 25 sessions.In Plan 1,a Bolus was applied and optimized during the first 15 fractions,and subsequently removed for the remaining 10 fractions without re-optimization.The sub-field configuration and dose weighting from the initial optimization were retained,and only dose recalculations were performed.The final treatment plan combined both the Bolus-included and Bolus-excluded phases.In contrast,Plan 2 involved the application and optimization of Bolus during the first 15 fractions,followed by its removal and re-optimization of the plan for the last 10 fractions.The two optimized plans were then combined for the overall treatment delivery.Data from the two plan groups were analyzed using a paired sample t-test with SPSS 29.0 software.Results There was a statistically significant difference(P＜0.05)in skin Dmean,V52.5,and V55;heart Dmean,V5,V30,and V40;affected lung Dmean,V5,and V20;PRVcord Dmean and Dmax;healthy breast Dmean,V5,and V10;affected humeral head Dmean and V30;as well as PTV Dmean,V50,V55,D2％,D98％,CI,and MU.Moreover,the dose distribution on the target layer and the DVH curves showed marked differences.However,no statistically significant difference was observed in PTV HI(P=0.125).Conclusion The combination of the two optimized plans,consisting of 15 fractions with bolus and 10 fractions without bolus,more accurately reflects the dose distri-bution within the planned target area and organs at risk,thereby providing enhanced protection for the patient's chest wall skin.

Objective To report the diagnosis and treatment processes of a fungal keratitis case caused by Lasio-diplodia theobromae(L.theobromae),and enhance the diagnosis and treatment experience on fungal keratitis caused by this rare pathogen.Methods Corneal scraping specimen from a patient with fungal keratitis was collec-ted.Gram-staining and fluorescence staining were conducted on specimen,followed with direct microscopic observa-tion and isolation culture.The strain was identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOF MS)technology and targeted DNA sequencing.Antimicrobial susceptibility testing was conducted.Literatures were summarized and clinical data on fungal keratitis caused by this pathogen were sorted out.Results Septal fungal hyphae could be seen on the corneal scraping specimen microscopically.The strain was identified as L.theobromae by both MALDI-TOF MS and targeted DNA sequencing after culture.Antimicrobial susceptibility testing(microdilution method)showed that the minimal inhibitory concentrations(MICs)of ampho-tericin B,vorionazole,itraconazole,posaconazole,fluconazole,5-fluorocytosine,micafungin,caspofungin,and anidulafungin against this strain were 1,0.25,＞8,0.25,＞256,8,16,2,and 0.25 μg/mL,respectively.Pa-tient recovered well after antifungal treatment plan was adjusted according to antimicrobial susceptibility testing re-sults.Conclusion L.theobromae is a rare pathogen that causes fungal keratitis.Laboratory tests provide rapid mi-croscopic examination results,and take MALDI-TOF MS and targeted DNA sequencing identification techniques as effective means to detect rare pathogen.In vitro antimicrobial susceptibility testing result can provide reference for clinicians to correctly use antifungal agents for treatment of infection due to this pathogen.

Objective To report a case of fungal keratitis caused by plant pathogens,evidenced by laboratory testing.Methods Specimens were collected by corneal scraping from a 52-year-old male patient for pathogen culture.The patient was treated at Qionghai People's Hospital for fungal keratitis.The isolates were identified and tested for antimicrobial susceptibility.PubMed,CNKI,Wanfang,and VIP database were searched using keywords Diaporthe or Diaporthe phaseolorum in English and Chinese from the establishment of the database to December 10,2024.A retrospective literature review was conducted on the cases of human infection caused by Diaporthe.Results The specimens from corneal scraping were directly examined under a microscope.Septate fungal hyphae were observed.The isolate was identified as Diaporthe phaseolorum by targeted DNA sequencing.Antimicrobial susceptibility testing by microdilution method showed that the minimum inhibitory concentrations(MIC)of fluorocytosine,fluconazole,amphotericin B,voriconazole,itraconazole,posaconazole,micafungin,caspofungin,and anidulafungin against this strain were＞64,64,0.5,0.12,2,0.06,0.03,＜0.03,and 0.12 mg/L,respectively.Clinicians adjusted the antifungal treatment plan timely based on the antimicrobial susceptibility testing results.The patient's vision was restored.Literature review found that of the 12 reported cases of infection worldwide,6 were localized skin or soft tissue infections,3 were peritonitis,and the remaining 3 cases were keratitis.Overall,9 patients were immunocompromised and 3 had normal immune function.Human infections caused by Diaporthe often occur in immunocompromised individuals.Invasive infections often lead to patient mortality.There are no established breakpoints for common antifungal agents against Diaporthe.The MICs against the strain were higher for flucytosine and fluconazole,but lower for azoles,echinocandins,and polyenes.Conclusions Fungal keratitis caused by D.phaseolorum is an emerging infection.The information in this case,including clinical symptoms,the morphology of D.phaseolorum under microscope after corneal scraping,the growth characteristics and antifungal susceptibility testing,targeted DNA sequencing,can inform the microbiology laboratory staff and clinicians of D.phaseolorum infections in the future.