ObjectiveTo explore the potential mechanism of Xianglian Huazhuo prescription （XLHZ） in treating chronic atrophic gastritis （CAG） by regulating cell cycle and inhibiting proliferation， using bioinformatics technology and animal experiments. MethodsDifferential expressed genes （DEGs） related to CAG were screened using GEO database and GEO2R tool. Weighted gene co-expression network analysis （WGCNA） was employed to search for hub genes of CAG. These hub genes were intersected with cell cycle proliferation based on GeneCards database. Eenrichment analysis of the intersecting genes was performed to obtain signaling pathways and biological processes related to CAG. Protein protein interaction （PPI） analysis of genes was conducted using the Protein Interaction Platform （STRING） database to search the super hub gene （hub 2.0）， and animal experiments were conducted for further validation. Fourteen of 70 male Wistar rats were randomly selected as the normal group， and the remaining 56 rats were prepared by the combined modeling method of "starvation disorder+N-methyl-N-nitro-N-nitrosoguanidine （MNNG） + sodium salicylate". The successfully modeled rats were randomly divided into the model group， XLHZ-H， XLHZ-M， and XLHZ-L groups （36， 18， 9 g·kg^-1， respectively）， and Morodan group （1.4 g·kg^-1）. Each group was given corresponding intervention for 60 days. Hematoxylin-eosin （HE） staining was used to observe the histopathological changes of gastric mucosa in rats. The ultrastructure of gastric mucosal tissue cells was observed by transmission electron microscopy. The relative expression levels of TGF-β₁， Smad2 and Smad3 proteins， S/G₂/M phase marker geminin and proliferation marker MCM2 were detected by Western blot in gastric mucosal tissue， and Spearman correlation analysis was performed. ResultsA total of 15 hub 2.0 genes were identified， including TGF-β₁， suggesting the involvement of the TGF-β₁ signaling pathway in the CAG pathogenesis. Compared with the normal group， the expressions of TGF-β₁， Smad2， geminin and MCM2 proteins in the gastric mucosa tissue of the model group were increased （P<0.05）， and the expression of Smad3 protein was decreased （P<0.05）. Compared with the model group， the expressions of TGF-β₁ and geminin in the gastric mucosa were decreased in the drug groups （P<0.05）. The XLHZ-M group， XLHZ-H group and Morodan group had significantly decreased protein expression of Smad2 and MCM2 （P<0.05）. The protein expression of Smad3 was significantly increased in XLHZ-M， XLHZ-H， and Morodan groups （P<0.05）. Spearman correlation analysis showed that Smad3 was negatively correlated with other indicators， and positively correlated with other indicators （P<0.01）. ConclusionXLHZ may inhibit TGF-β₁/Smads signaling pathway， regulate cell cycle， and inhibit proliferation in the treatment of CAG.

AIM: To evaluate the safety and efficacy of low-dose transscleral cyclophotocoagulation(TSCP)in the management of persistent ocular hypertension after an acute attack of angle-closure glaucoma(AACG).METHODS:This retrospective study enrolled patients diagnosed with persistent ocular hypertension after an acute AACG attack at the No.988 Hospital of the Joint Logistics Support Force of the Chinese PLA between September 2023 and September 2024. All patients underwent low-dose TSCP using a semiconductor diode laser. Subsequent cataract surgery combined with goniosynechialysis was performed once intraocular pressure(IOP)was stabilized. Changes in anterior chamber depth(ACD), best-corrected visual acuity(VA), and IOP were compared before and after TSCP, as well as before and after phacoemulsification. Post-TSCP complications were also documented.RESULTS: A total of 21 patients(21 eyes)were enrolled, including 8 males and 13 females, with a mean age of 67.95±7.25 y. Compared with pre-cyclophotocoagulation values, ACD increased significantly at 3 d post-TSCP(1.49±0.18 vs 1.22±0.21 mm; P<0.001). BCVA and IOP decreased significantly at 1 d post-TSCP, pre-phacoemulsification, 1 wk post-phacoemulsification, and 1 mo post-phacoemulsification compared with pre-TSCP IOP(all P<0.01). Regarding postoperative complications, 2 eyes experienced pain on the day of the procedure, 5 eyes developed mild corneal endothelial folds, 2 eyes exhibited moderate anterior chamber inflammatory reaction, and 12 eyes showed shallow ciliary body detachment. No serious complications occurred during the 1-month follow-up period.CONCLUSION:Low-dose TSCP appears to be an effective bridging therapy for patients with persistent ocular hypertension following an AACG attack. It facilitates rapid IOP reduction, alleviates symptoms, and helps preserve visual function with a favorable safety profile, thereby reducing the risks associated with subsequent intraocular surgery.

ObjectiveTo explore the potential mechanism of Xianglian Huazhuo prescription （XLHZ） in treating chronic atrophic gastritis （CAG） by regulating cell cycle and inhibiting proliferation， using bioinformatics technology and animal experiments. MethodsDifferential expressed genes （DEGs） related to CAG were screened using GEO database and GEO2R tool. Weighted gene co-expression network analysis （WGCNA） was employed to search for hub genes of CAG. These hub genes were intersected with cell cycle proliferation based on GeneCards database. Eenrichment analysis of the intersecting genes was performed to obtain signaling pathways and biological processes related to CAG. Protein protein interaction （PPI） analysis of genes was conducted using the Protein Interaction Platform （STRING） database to search the super hub gene （hub 2.0）， and animal experiments were conducted for further validation. Fourteen of 70 male Wistar rats were randomly selected as the normal group， and the remaining 56 rats were prepared by the combined modeling method of "starvation disorder+N-methyl-N-nitro-N-nitrosoguanidine （MNNG） + sodium salicylate". The successfully modeled rats were randomly divided into the model group， XLHZ-H， XLHZ-M， and XLHZ-L groups （36， 18， 9 g·kg^-1， respectively）， and Morodan group （1.4 g·kg^-1）. Each group was given corresponding intervention for 60 days. Hematoxylin-eosin （HE） staining was used to observe the histopathological changes of gastric mucosa in rats. The ultrastructure of gastric mucosal tissue cells was observed by transmission electron microscopy. The relative expression levels of TGF-β₁， Smad2 and Smad3 proteins， S/G₂/M phase marker geminin and proliferation marker MCM2 were detected by Western blot in gastric mucosal tissue， and Spearman correlation analysis was performed. ResultsA total of 15 hub 2.0 genes were identified， including TGF-β₁， suggesting the involvement of the TGF-β₁ signaling pathway in the CAG pathogenesis. Compared with the normal group， the expressions of TGF-β₁， Smad2， geminin and MCM2 proteins in the gastric mucosa tissue of the model group were increased （P<0.05）， and the expression of Smad3 protein was decreased （P<0.05）. Compared with the model group， the expressions of TGF-β₁ and geminin in the gastric mucosa were decreased in the drug groups （P<0.05）. The XLHZ-M group， XLHZ-H group and Morodan group had significantly decreased protein expression of Smad2 and MCM2 （P<0.05）. The protein expression of Smad3 was significantly increased in XLHZ-M， XLHZ-H， and Morodan groups （P<0.05）. Spearman correlation analysis showed that Smad3 was negatively correlated with other indicators， and positively correlated with other indicators （P<0.01）. ConclusionXLHZ may inhibit TGF-β₁/Smads signaling pathway， regulate cell cycle， and inhibit proliferation in the treatment of CAG.

The multimorbidity of rheumatoid arthritis （RA） and periodontitis （PD） has drawn increasing attention， as both conditions are characterized by chronic inflammation， immune dysregulation， and progressive bone destruction. Modern research confirms that PD is a significant risk factor for RA development， and their coexistence mutually exacerbates disease progression. However， traditional Chinese medicine （TCM） currently lacks a systematic theoretical explanation for this complex multimorbid relationship. This study， based on the TCM theory of abnormal collateral， thoroughly examines the intrinsic connection between RA and PD multimorbidity， proposing "abnormal collateral as the pivot， with accumulated toxins eroding bone" as the core TCM pathogenesis. The research elucidates PD as the "origin of abnormal collateral"， where its pathogens act as toxic factors that invade the joints through collaterals， triggering RA via mechanisms such as molecular mimicry. The dynamic pathological progression of RA-PD multimorbidity can be described as follows： the displacement of Ying and Wei at the microscopic level manifests as immune hyperactivation， leading to collateral malnutrition； heat-toxins traversing collaterals induce collateral hyperactivity， resulting in pathological angiogenesis； ultimately， toxin accumulation at the pivotal abnormal collateral site erodes bone， activating the receptor activator of nuclear factor kappa-B ligand （RANKL）-receptor activator of nuclear factor kappa-B （RANK） signaling pathway-driven osteoclast differentiation. This theoretical framework innovatively integrates modern findings in oral microbiology， immune-inflammation， and bone metabolism， offering a holistic and dynamic perspective to understand the complexity of multimorbidity. Given the limited efficacy of current periodontal treatments for RA and the scarcity of reported TCM compound interventions for multimorbidity， the abnormal collateral theory proposes a systematic intervention strategy centered on "governing diseases through collaterals and regulating collaterals with herbs"， along with TCM therapeutic principles such as "unblocking， clearing， and nourishing collaterals". Potential herbal treatments for multimorbidity are also highlighted. Future research should focus on refining TCM syndrome patterns in multimorbid patients and leveraging omics technologies for deeper exploration， thereby providing a theoretical foundation and research direction for TCM in addressing complex multimorbid conditions.

The multimorbidity of rheumatoid arthritis （RA） and periodontitis （PD） has drawn increasing attention， as both conditions are characterized by chronic inflammation， immune dysregulation， and progressive bone destruction. Modern research confirms that PD is a significant risk factor for RA development， and their coexistence mutually exacerbates disease progression. However， traditional Chinese medicine （TCM） currently lacks a systematic theoretical explanation for this complex multimorbid relationship. This study， based on the TCM theory of abnormal collateral， thoroughly examines the intrinsic connection between RA and PD multimorbidity， proposing "abnormal collateral as the pivot， with accumulated toxins eroding bone" as the core TCM pathogenesis. The research elucidates PD as the "origin of abnormal collateral"， where its pathogens act as toxic factors that invade the joints through collaterals， triggering RA via mechanisms such as molecular mimicry. The dynamic pathological progression of RA-PD multimorbidity can be described as follows： the displacement of Ying and Wei at the microscopic level manifests as immune hyperactivation， leading to collateral malnutrition； heat-toxins traversing collaterals induce collateral hyperactivity， resulting in pathological angiogenesis； ultimately， toxin accumulation at the pivotal abnormal collateral site erodes bone， activating the receptor activator of nuclear factor kappa-B ligand （RANKL）-receptor activator of nuclear factor kappa-B （RANK） signaling pathway-driven osteoclast differentiation. This theoretical framework innovatively integrates modern findings in oral microbiology， immune-inflammation， and bone metabolism， offering a holistic and dynamic perspective to understand the complexity of multimorbidity. Given the limited efficacy of current periodontal treatments for RA and the scarcity of reported TCM compound interventions for multimorbidity， the abnormal collateral theory proposes a systematic intervention strategy centered on "governing diseases through collaterals and regulating collaterals with herbs"， along with TCM therapeutic principles such as "unblocking， clearing， and nourishing collaterals". Potential herbal treatments for multimorbidity are also highlighted. Future research should focus on refining TCM syndrome patterns in multimorbid patients and leveraging omics technologies for deeper exploration， thereby providing a theoretical foundation and research direction for TCM in addressing complex multimorbid conditions.

Childhood adversity is a risk factor for developing depressive symptoms or suffering from depressive disorders across the life course. However， existing evidence has focused on the analysis of the association between childhood adversity and depression from a single theoretical perspective， and there is a lack of comprehensive understanding of its multiple action pathways. By systematically summarizing the cumulative risk model， sensitive-period model， recency model， risk chain model， and the stress sensitization， stress amplification， and stress inoculation hypotheses， as well as the emerging pubertal stress recalibration hypothesis， this article attempts to construct an integrated theoretical framework to elucidate the internal logical synergy among these models. Furthermore， by reviewing relevant empirical evidence， this article analyzes the applicability and limitations of different theoretical models in illustrating the underlying psychopathological mechanisms of depression. The current evidence suggests that the impact of childhood adversity on the risk of psychopathology may be driven by a complex dynamic process involving the interaction of exposure timing， cumulative load， response boundaries of biological systems， and modification by later environments. Future research should utilize longitudinal cohorts and multimodal data within a unified analytical framework to comprehensively examine the multiple pathways through which childhood adversity affects the risk of depression. This will provide a reference for precisely identifying high-risk populations， targeting "recalibration windows" represented by adolescence， developing focused intervention strategies， and ultimately blocking the cascading effects of early life adversity as early as possible. ［Funded by the "Pioneer" and "Leading Goose" R&D program of Zhejiang Province （number， 2024C03006）］

Da Chaihutang， first recorded in Shanghanlun by Zhang Zhongjing of the Eastern Han dynasty， is composed of eight medicinal herbs， namely Bupleuri Radix， Scutellariae Radix， Rhei Radix et Rhizoma， Aurantii Fructus Immaturus， Paeoniae Radix Alba， Pinelliae Rhizoma， Zingiberis Rhizoma Recens， and Jujubae Fructus. It features a well-defined hierarchy of sovereign， minister， assistant， and courier ingredients. The prescription is characterized by its balanced compatibility， mutually restrained cold and warm properties， and combined use of harmonizing and purging therapeutic strategies. As a renowned classical formula indicated for harmonizing Shaoyang and purging internal heat accumulation， it is the core prescription for the treatment of Shaoyang-Yangming combined disease. A comprehensive review of modern research literature on Da Chaihutang reveals that its chemical composition is notably diverse. The core pharmacologically active material bases of its constituent single herbs have been clearly identified， including saikosaponins from Bupleuri Radix， flavonoids from Scutellariae Radix， anthraquinones from Rhei Radix et Rhizoma， flavonoids and alkaloids from Aurantii Fructus Immaturus， monoterpene glycosides from Paeoniae Radix Alba， alkaloids and organic acids from Pinelliae Rhizoma， gingerols from Zingiberis Rhizoma Recens， and polysaccharides and triterpenoid acids from Jujubae Fructus. In the compound formula， a total of 163 chemical constituents have been comprehensively identified， among which flavonoids and their glycosides constitute the most abundant component category. Flavonoids and their glycosides， monoterpene glycosides， and pentacyclic triterpenoid saponins are regarded as the core pharmacologically active substances of the whole formula. In addition， 9 potential quality markers that can comprehensively characterize the overall quality and core therapeutic efficacy of the whole formula have been screened out. Modern pharmacological studies have shown that the pharmacological effects of Da Chaihutang exhibit synergistic characteristics involving multiple components， multiple targets， and multiple pathways. Its core pharmacological activities encompass the regulation of digestive system disorders， including pancreatic protection， intervention in biliary tract diseases， and protection of gastrointestinal mucosa； intervention in hepatobiliary diseases such as non-alcoholic fatty liver disease and cholestatic liver injury； and regulation of metabolic disorders such as hypoglycemic effect， improvement of insulin resistance， and regulation of lipid metabolism. Furthermore， it also possesses multiple pharmacological activities， including intervention in atherosclerosis， regulation of immune and inflammatory responses， multi-organ protection， and anti-hepatocellular carcinoma effect. In modern clinical practice， Da Chaihutang and its modified formulas are mostly used in combination with conventional Western medical regimens. They have demonstrated notable therapeutic advantages in the treatment of digestive system diseases such as cholecystitis， acute pancreatitis， cholelithiasis， and non-alcoholic fatty liver disease， but also have shown definite curative efficacy in the management of diseases affecting multiple other systems， including cardiovascular， endocrine， dermatological， reproductive， respiratory， neurological， urinary， pediatric， and immune systems. These combined applications can effectively improve the overall clinical response rate， shorten the time to symptom relief， and reduce both the disease recurrence rate and the incidence of adverse reactions. This review systematically summarized the formula compatibility， chemical constituents， pharmacological mechanisms， and modern clinical applications of Da Chaihutang and its modified formulas， to provide a theoretical basis and practical reference for the secondary development of classic formulas， the research and development of new drugs， and the precise and safe clinical application of this classical prescription.

Objective To investigate the clinical significance of serum B cell activating factor(BAFF)and complement lytic factor Bb in patients with idiopathic membranous nephropathy(IMN),as well as their correlation with the urinary albumin-to-creatinine ratio(UACR).Methods A total of 204 IMN patients were enrolled as the study group,and 100 healthy individuals undergoing physical examinations during the same period served as the control group.Serum levels of BAFF,Bb,and UACR were measured and compared between the two groups.Pearson correlation analysis was performed to assess the associations among serum BAFF,Bb,and UACR.The patients in the study group were followed up for 12 months and stratified into a favorable prognosis group and a poor prognosis group(defined as no remission)based on disease remission status.Demographic and clinical characteristics,as well as serum BAFF and Bb levels,were compared between the two outcome groups.Multivariate logistic regression analysis was conducted to identify independent predictors of poor prognosis in IMN patients.Receiver operating char-acteristic(ROC)curve analysis was employed to evaluate the predictive value of these indicators for poor prognosis.Results The levels of BAFF,Bb,and UACR in the research group were significantly higher than those in the con-trol group(P<0.05).Pearson correlation analysis revealed that both BAFF and Bb were positively correlated with UACR(r=0.716 and 0.543,respectively;P<0.05).After one year of follow-up,a total of 200 patients completed the study,among whom 46 experienced poor prognosis.Based on the follow-up outcomes,patients were categorized into a poor prognosis group(n=46)and a good prognosis group(n=154).The poor prognosis group exhibited significantly higher levels of serum creatinine,24-hour urinary protein,BAFF,and Bb,as well as lower eGFR values,compared to the good prognosis group(P<0.05).Multivariate regression analysis identified 24-hour urinary protein,BAFF,and Bb as independent risk factors for poor prognosis in patients with IMN,whereas eGFR was identified as a protective factor(P<0.05).ROC curve analysis demonstrated that the combined assessment of 24-hour urinary protein,eGFR,BAFF,and Bb yielded a higher AUC value for predicting poor prognosis in IMN patients than any single indicator alone(Z=4.145,3.908,4.308,3.864;P<0.05).Conclusions The serum levels of BAFF and Bb in patients with IMN are significantly elevated and positively correlated with the UACR.The combi-nation of 24-hour urinary protein excretion and eGFR demonstrates high predictive value for poor prognosis in these patients.These findings suggest that BAFF and Bb may serve as potential biomarkers for prognostic assessment in IMN,and the integrated measurement of multiple parameters could provide a more comprehensive clinical basis for disease management.

Objective To evaluate the impact of lens capsule diameter and capsular tension ring(CTR)fit on the ro-tational stability and visual function of Toric intraocular lenses(IOLs)in patients with high myopia cataract after surgery,and to explore the main influencing factors.Methods A prospective study included 100 eyes of patients with high myopia(axial length≥26 mm)who underwent phacoemulsification cataract extraction combined with Toric IOL implantation at the Cataract Department of Hebei Eye Hospital from September 2023 to March 2024.Based on the ratio of the capsule equivalent diameter measured by anterior segment OCT(CASIA2)to the standard diameter of CTR,the eyes were divided into the matched group(ratio of 0.8-1.2)and the unmatched group.Follow-up was conducted at 1 week,1 month,3 months,6 months,and 12 months postoperatively to observe the rotation angle of Toric IOL,residual astigmatism,uncor-rected visual acuity,and other indicators.Safety was assessed based on intraoperative and postoperative complications.Correlation analysis and multiple linear regression were used to explore the impact of capsule-CTR fit,corneal astigmatism,axial length,and other factors on Toric IOL rotation and postoperative refractive status.Results The mean IOL rotation angle at each postoperative time point in the matched group was significantly smaller than that in the unmatched group,with statistically significant differences between groups at different time points(all P＜0.05).The matched group showed better stability in IOL decentration distance and tilt angle.At 12 months postoperatively,the residual astigmatism in the matched group was(0.53±0.29)D,which was better than that in the unmatched group(0.71±0.34)D(P=0.08).The matched group also had more significant improvement in uncorrected visual acuity and higher subjective visual quality scores.Multiple linear regression analysis showed that capsule-CTR fit and preoperative corneal astigmatism were the main independent factors affecting the rotation angle of Toric IOL(R2=0.52)and residual astigmatism(R2=0.46).Conclu-sion For patients with high myopia cataract,precise capsule-CTR matching based on CASIA2 measurement helps improve the rotational stability of Toric IOLs,reduce residual astigmatism,and enhance postoperative visual quality.Personalized CTR model selection is worth promoting and applying.

Objective:To explore the effects of mechanical ventilation（MV）at birth transition on lung pathophysiology and pathobiology in a very preterm animal model.Methods:Based on the model of respiratory distress syndrome（RDS）in very preterm rabbits at gestational age 26（term 31）days well established by the research group using perinatal medication and lung-protective ventilation strategies（very low tidal volume 1-3 mL/kg），we conducted a secondary data analysis. The studied rabbits were re-grouped according to the MV length（≤3 h，3-6 h，6-9 h，9-12 h，and >12 h）. The changes in lung mechanics，histopathology，phospholipid biochemistry，and mRNA relative expression of inflammatory/growth factor in lung tissue were evaluated over the time course of MV. The trend of each variable was tested by ANOVA trend test（ F trend）and Jonckheere-Terpstra trend test（ J-T value）with corresponding P value. Results:With the prolonged MV length，there was improved mean dynamic compliance of respiratory system（ F trend=16.722， P trend<0.001），along with decreased mean peak inspiratory pressure（ F trend =42.226， P trend<0.001）. The content of total phospholipids，disaturated phosphatidylcholine（ J-T=1 222，1 197， P trend=0.018，0.034，respectively）and total protein（ J-T=1 247 ，P trend= 0.009）in bronchoalveolar lavage fluid gradually increased. The wet lung weight in the ≤3 h group was significantly higher than in the other groups（ F=6.819， P<0.001）. The lung injury score（total，or hemorrhage，or inflammation）had progressive exacerbation in the ≤3 h，3-6 h and 6-9 h groups. The lung tissue mRNA expression of major proinflammatory cytokines increased modestly over the time groups in contrast to decreased expression of growth factors，of which the change of keratinocyte growth factor reached statistical significance（ J-T=531， P trend =0.034）. Conclusion:In the 26-day very preterm rabbits，with prolonged MV time，the content of surfactant phospholipid in the alveolar increased gradually，the lung compliance and lung fluid clearance gradually improved. Nevertheless，ventilator-induced lung injury remained evolving. The study warrants further study on the pathogenesis and protective strategies of early postnatal acute lung injury and chronic lung disease.