The study focuses on the concept of multifunctional traditional Chinese medicine (TCM) formulas and aims to evaluate the efficacy of the classical formula Xiaoyao San (逍遥散). Study employs the integrated evidence chain (Eff-iEC) method to organize, integrate, and evaluate its therapeutic efficacy in treating different diseases with the same therapy, and to investigate the feasibility of using Eff-iEC to evaluate the multifunctionality of TCM formulas. The evaluation covered Xiaoyao San's therapeutic effects on depression, premenstrual syndrome, chronic hepatitis, irritable bowel syndrome, dyspepsia, and menopausal syndrome. Concurrently, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for evaluation, and authoritative medical documents were incorporated to corroborate the recognition of Xiaoyao San within the medical community. Depression and menopausal syndrome received higher ratings than other conditions in the Eff-iEC, GRADE, and Medical Community Recognition assessments. The Eff-iEC evidence grade for Xiaoyao San was rated as "High" or above for chronic hepatitis, irritable bowel syndrome, dyspepsia, and menopausal syndrome. Premenstrual syndrome received a "Moderate ⁺" rating. The GRADE evidence level was "Low-〇〇⨁⨁" for depression, premenstrual syndrome, and chronic hepatitis; "Moderate-〇⨁⨁⨁" for dyspepsia and menopausal syndrome; and "Very Low-〇〇〇⨁" for irritable bowel syndrome. Depression and menopausal syndrome had the highest inclusion frequency, appearing in all 4 categories. Premenstrual syndrome, chronic hepatitis, and dyspepsia are not recommended in Western medical guidelines, but they are included in TCM guidelines, the China National Basic Medical Insurance Drug List, and the China National Essential Drug List. Irritable bowel syndrome appears only in the China National Basic Medical Insurance Drug List and China National Essential Drug List. The evaluation results obtained using the Eff-iEC method align with Medical Community Recognition, providing an objective and comprehensive assessment of Xiaoyao San's efficacy. The findings suggest that Xiaoyao San has strong evidence for treating depression and menopausal syndrome. However, further experimental and clinical trials are needed to assess its efficacy in treating premenstrual syndrome, chronic hepatitis, irritable bowel syndrome, and dyspepsia. These results support the clinical efficacy and rational use of Xiaoyao San, expand the application scope of the Eff-iEC method, and offer valuable insights and methodological references for the comparative evaluation of multifunctional TCM formulas.

Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Objective:To summarize the clinical application and rules of Zhu Lian acupuncture and moxibustion therapy based on the relevant literature.Methods:Clinical research literature about Zhu Lian acupuncture and moxibustion therapy was retrieved from CNKI, Wanfang Data, Chongqing VIP, CBM and PubMed from the establishment of the databases to May 10, 2024. Excel 2019 was used to establish literature database. The TCM data mining system (TCM Minner) was used to analyze the clinical application of Zhu Lian acupuncture and moxibustion therapy, combination with other therapies, treatment methods, acupoint selection, needle retention time and other information.Results:A total of 95 articles were included. Zhu Lian acupuncture and moxibustion therapy was mainly used in internal medicine, surgery, gynecology, and dermatology, involving 40 diseases. Among them, the number of internal diseases was the most (19 times), followed by surgical diseases (14 times). The main diseases included stroke and its sequelae, facial paralysis, cervical spondylosis and lumbar disc herniation. There were 73 studies on the combination of other therapies, with mild moxibustion being the most widely used (21 times). In terms of manipulation, Zhu Lian inhibition of type Ⅱ acupuncture was the most widely used (26 times), followed by Zhu Lian excitation of type Ⅱ acupuncture (17 times). Acupoint selection mainly included Zusanli (45 times), Sanyinjiao (39 times), Hegu (34 times) and so on. Zhu Lian inhibition of type Ⅰ acupuncture needle retention time was mainly 30 min; Zhu Lian inhibition of type Ⅱ acupuncture was mainly 30 min, 20 min, and 15 min; Zhu Lian excitement of type Ⅰ acupuncture was mostly without needle retention; Zhu Lian excitement type Ⅱ acupuncture was mainly 10 min and 5 min; slow twisting acupuncture was mainly 30 min; Zhu Lian finger acupuncture therapy was mainly 20-25 min.Conclusion:Zhu Lian acupuncture and moxibustion therapy is mostly used to treat internal medicine and surgical diseases. Zhu Lian inhibition type Ⅱ and excitation type Ⅱ acupuncture methods are often used for treatment, and mild moxibustion therapy is often used to enhance the efficacy.

Objective To evaluate the clinical efficacy of a sphincter-preserving technique combining cutting seton and loose seton drainage for the treatment of ischiorectal abscess.Methods A prospective ran-domized controlled trial was conducted involving 184 patients with ischiorectal abscess,who were randomly di-vided into an experimental group(n=92)and a control group(n=92).The experimental group underwent sphincter-preserving surgery combining cutting seton and loose seton drainage,while the control group re-ceived single-stage incision and seton drainage.Clinical outcomes,anal function,operative time,postoperative pain intensity,wound healing time,and pruritus ani were compared between the two groups.Results The sur-gical time of the experimental group was longer than that of the control group[31.50(25.00,40.00)min vs.20.00(20.00,30.00)min],and the difference was statistically significant(P<0.05).On postoperative days 1,3,and 7,the NRS scores for pain were lower than those in the control group,and the wound healing time was shorter than that in the control group[24.00(20.00,25.75)days vs.29.00(26.00,32.00)days],with statistically significant differences(P<0.05).The recent cure rate of the experimental group was lower than that of the control group(88.04%vs.94.57%),and the difference was not statistically significant(P>0.05).After follow-up,the long-term cure rate of the experimental group was lower than that of the control group(84.78%vs.93.48%),and the Wexner score for anal incontinence was lower than that of the control group[1.00(0.00,1.00)vs.1.00(0.00,2.00)],with statistically significant differences(P<0.05).Conclu-sion The sphincter-preserving technique combining cutting seton and loose seton drainage for ischiorectal ab-scess reduces postoperative pain,shortens wound healing time,and effectively protects anal function with reli-able short-term efficacy.However,further improvements are needed to enhance long-term clinical outcomes.

Objective To analyze the mutation status of Kirsten rat sarcoma viral oncogene homolog(KRAS),phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha(PIK3CA),v-raf murine sarcoma viral oncogene homolog B1(BRAF)genes,and the expression of mismatch repair(MMR)and human epidermal growth factor receptor 2(HER-2)proteins in tumor tissues of patients with colorectal cancer(CRC)harboring neuroblastoma rat sarcoma viral oncogene homolog(NRAS)gene mutations,and explore their relationships with the clinicopathological characteristics of CRC patients.Methods The clinicopathological data of 546 patients with NRAS mutation CRC were retrospectively analyzed.The mutation status of NRAS,KRAS,PIK3CA,and BRAF genes was detected by AmoyDx amplification refractory mutation system(ARMS)-polymerase chain reaction(PCR)kit(fluorescent PCR method),the expression levels of MMR and HER-2 proteins were detected by immunohistochemical staining EnVision method,and the relationship between them and the clinicopathological characteristics of patients were analyzed.Results The mutation rate of single-point mutations in the NRAS gene was 98.35%(537/546),double-point mutations in the NRAS gene were 1.65%(9/546),and double mutations in the NRAS and KRAS genes were 1.47%(8/546).No patients were found to harbor mutations in the PIK3CA or BRAF genes.The types of NRAS mutations included Q61R(or Q61K,Q61L,Q61H)mutations(266/546,48.72%),G12D(or G12S)mutations(154/546,28.21%),G13R(or G12C,G12V,G12A,G13V)mutations(134/546,24.54%),and A146T mutation(1/546,0.18%).G13R(or G12C,G12V,G12A,G13V)mutations in the NRAS gene were more likely to occur in the rectum cancer patients(P=0.035);although the tumors had a larger diameter(P=0.029),the patients had a longer progression-free survival after surgery(P=0.028).Among patients with NRAS gene mutations,HER-2 positive expression was associated with perineural invasion(P=0.003),and the patients with deficient MMR were younger on average(P=0.041)and were associated with double-point mutations in the NRAS gene(P=0.018).Conclusion CRC harboring NRAS mutations may have unique clinicopathological characteristics and molecular phenotypes,providing possibilities for individualized treatment and prognosis evaluation of CRC.

Objective To analyze the diversity and composition of gut microbiota in individuals with circadian rhythm disruption and their correlation with cognition.Methods Night shift workers and regular shift workers were subjected from our hospital during August 2022 and October 2024.The participants with circadian rhythm disorders were assigned into an experimental group(n=24),and those with normal circadian rhythms were into a control group(n=24).Their height,weight,age,gender,body mass index(BMI)and fresh fecal samples were collected,and Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)were used to evaluate their mental status.Metagenomics,Alpha and Beta diversity analyses,Linear Discriminant Analysis Effect Size(LEfSe),and Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis were employed to investigate the diversity and function characteristics of gut microbiota in the participants.Results There were no statistical differences between the 2 groups in baseline data,such as height,weight,gender,age,and BMI(P>0.05).Alpha diversity analysis indicated that no statistical differences were observed in the ACE,Chao1,Shannon,or Simpson indices between the 2 groups,while beta diversity analysis revealed significant differences(P<0.01),suggesting different structure of gut microbiota between them.In the experimental group,the abundance of Faecalibacterium prausnitzii and Agathobacter rectalis was decreased,while that of Escherichia coli and Phocaeicola vulgaratus was increased,with significant differences when compared with the control group(P<0.05).Additionally,KEGG functional analysis showed that the experimental group had obviously higher expression levels in Th17 cell differentiation and the IL-17 signaling pathway than the control group(P<0.05).Agathobacter rectalis and Faecalibacterium prausnitzii were positively correlated with MoCA score and MMSE score(P<0.05,P<0.01).Agathobacter rectalis was negatively correlated with the IL-17 signaling pathway and Th17 cell differentiation.Conclusion Individuals with circadian rhythm disorders have significant changes in the structure and function of gut microbiota when compared to those with normal circadian rhythms.Agathobacter rectalis may be involved in the regulation of the IL-17 signaling pathway and differentiation of Th17 cells,thereby possibly impacting the increases of cognitive score related to circadian rhythm disorders.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA

Objective : To analyze the epidemiological characteristics and spatial clustering of brucellosis in Shanxi Province from 2019 to 2023, so as to provide a reference for formulating prevention and control measures of brucellosis. Methods: The case data of brucellosis in Shanxi Province from 2019 to 2023 were collected through the Infectious Disease Surveillance System of the Chinese Disease Prevention and Control Information System. The seasonal distribution, population distribution, and region distribution of brucellosis cases were described. Spatial autocorrelation analysis was applied to explore the spatial clustering characteristics of brucellosis. Results: A total of 21 241 human brucellosis cases were reported in Shanxi Province from 2019 to 2023, with an average annual reported incidence of 11.87/100 000, showing an upward trend (P<0.05). The peak incidence period was from March to August, with 14 163 cases reported cumulatively, accounting for 66.68% of the total. There were 16 336 male cases and 4 905 female cases, with a male-to-female ratio of 3.33:1. The high-incidence age group was 40-<70 years, with 15 675 cases accounting for 73.80%. The majority of patients were farmers, with 17 926 cases accounting for 84.39%. Spatial autocorrelation analysis showed that there was spatial clustering in the incidence of brucellosis from 2019 to 2023 (all Moran's I>0, P<0.05). The high-high clustering areas were mainly Datong City, and Shuozhou City in northern Shanxi, and Linfen City in the southern Shanxi. The low-low clustering areas were mainly Taiyuan City and Yangquan City in central Shanxi, and Changzhi City and Jincheng City in southeastern Shanxi. Conclusions From 2019 to 2023, the reported incidence of brucellosis in Shanxi Province showed an upward trend. The incidence peaked from March to August, and males, middle-aged and elderly people and farmers were the high-risk groups. There was spatial clustering and the high-high clustering areas gradually expanded from northern Shanxi to southern Shanxi.