ObjectiveTo decipher the mechanism by which Zuoguiwan （ZGW） treat hyperthyroidism in rats with kidney-Yin deficiency based on the dopamine receptor D4 （DRD4）/nicotinamide adenine dinucleotide phosphate （NADPH） oxidase 4 （NOX4） signaling pathway. MethodsThe rat model of kidney-Yin deficiency was induced by unilateral intramuscular injection of dexamethasone （0.35 mg·kg^-1）. After successful modeling， the rats were randomized into model， methimazole （positive control， 5 mg·kg^-1）， low-， medium-， and high-dose （1.85， 3.70， 7.40 g·kg^-1， respectively） ZGW， and normal control groups. After 21 days of continuous gavage， the behavioral indexes and body weight changes of rats were evaluated. The pathological changes of the renal tissue were observed by hematoxylin-eosin staining. The serum levels of thyroid hormones ［triiodothyronine （T₃）， thyroxine （T₄）， thyroid-stimulating hormone （TSH）］， renal function indexes ［serum creatine （Scr） and blood urea nitrogen （BUN）］， energy metabolism markers ［cyclic adenosine monophosphate （cAMP） and cyclic guanosine monophosphate （cGMP）］， and oxidative stress-related factors ［superoxide dismutase （SOD）， malondialdehyde （MDA）， and NADPH）］ were measured by enzyme-linked immunosorbent assay （ELISA）. Western blot was employed to analyze the expression of DRD4， NOX4， mitochondrial respiratory chain complex proteins ［NADH：ubiquinone oxidoreductase subunit S4 （NDUFS4） and cytochrome C oxidase subunit 4 （COX4）］， and inflammation-related protein ［tumor necrosis factor-alpha （TNF-α）， interleukin-6 （IL-6）， p38 mitogen-activated protein kinase （MAPK）］ pathway in the renal tissue. ResultsCompared with the normal group， the model group showed mental malaise， body weight decreases （P<0.01）， inflammatory cell infiltration in the renal tissue， a few residual parotid glands in the thyroid， elevations in serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA， and NADPH （P<0.01）， down-regulation in protein levels of TSH， SOD， and DRD4 （P<0.05， P<0.01）， and up-regulation in expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.01）. Compared with the model group， ZGW increased the body weight （P<0.05， P<0.01）， reduced the infiltration of renal interstitial inflammatory cells， restored the thyroid structure and follicle size， lowered the serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA and NADPH （P<0.05， P<0.01）， up-regulated the expression of TSH， SOD and DRD4 （P<0.05， P<0.01）， and down-regulated the expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.05， P<0.01）. Moreover， high-dose ZGW outperformed methimazole （P<0.05）. ConclusionBy activating DRD4， ZGW can inhibit the expression of NOX4 mediated by the p38 MAPK pathway， reduce oxidative stress and inflammatory response， thereby ameliorating the pathological state of hyperthyroidism due to kidney-Yin deficiency. This study provides new molecular mechanism support for the clinical application of ZGW.

AIM: To investigate the correlation of serum C-reactive protein(CRP)-to-albumin(ALB)ratio(CAR)and neutrophil-to-lymphocyte count ratio(NLR)with pathological staging and prognosis of retinopathy of prematurity(ROP), and the predictive value of its combined testing for the prognosis of infants.METHODS:Prospective study. A total of 147 children with ROP who were born in our hospital from March 2022 to September 2024 were served as the ROP group, and 100 premature infants without ROP were served as the control group in the same period. Fully automatic biochemical analyzer was used to detect serum CRP and ALB; the flow cytometry nucleic acid fluorescence staining was used to count neutrophils and lymphocytes, and the CAR and NLR were calculated. Spearman correlation was used to analyze the relationship of serum CAR and NLR with ROP staging. Logistic regression was used to analyze the factors affecting the prognosis of children with ROP. ROC curve was drew to analyze the predictive value of serum CAR and NLR for the prognosis of ROP.RESULTS: There was comparability between the ROP group and the control group. The ROP group had significantly higher serum CRP, CAR, neutrophil count, and NLR than the control group, and clearly lower ALB and lymphocyte count than the control group(all P<0.05). Children with stage IV ROP had clearly higher serum CAR and NLR than stages I, II, and III, and the differences among stages I, II, and III were significant(all P<0.05). Serum CAR and NLR were positively correlated with ROP staging(r=0.529, 0.587, all P<0.05), and there was a positive correlation between serum CAR and NLR(r=0.546, P<0.05). The poor prognosis group had clearly higher serum CAR and NLR than good prognosis group(all P<0.001). Elevated serum CAR and NLR were risk factors affecting the prognosis of children with ROP(all P<0.05). The AUC of serum CAR, NLR, and joint detection in predicting the prognosis of ROP children was 0.803, 0.825, and 0.938, respectively. The joint detection showed better predictive performance(Zcombinatoion-CAR=2.637, Zcombinatoion-NLR=2.528, all P<0.05).CONCLUSION:Serum CAR and NLR are elevated in children with ROP, and they are closely related to pathological staging and prognosis. The joint detection has a higher predictive value in evaluating the prognosis of ROP.

Objective:To discuss the effect of erythritol on glucose and lipid metabolism in the body,and to clarify the mechanism of erythritol affecting liver metabolism based on metabonomics.Methods:The male ICR mice were randomly divided into normal group,sucrose group(2％sucrose),low dose of erythritol(1％erythritol)group,medium dose of erythritol(2％erythritol)group,and high dose of erythritol(4％erythritol)group,with 10 mice in each group.The corresponding concentrations of sucrose and erythritol solutions were prepared and placed in water bottles,and the mice were allowed to drink and eat freely for 12 consecutive weeks;the body mass,food intakes,and water intakes of the mice in various groups were measured.Commercial kits were used to detect the serum triglyceride(TG),total cholesterol(TC),and blood glucose levels of the mice in various groups;the liver indexes of the mice were calculated.Ultra performance liquid chromatography-orbitrap exactive mass spectrometry(UPLC-OE-MS)non-targeted metabonomics was used to detect the liver metabolites of the mice normal group and high dose of erythritol group;bioinformatics analysis was used to screen the differential liver metabolites between the two groups with variable importance in projection(VIP)＞1 and adjusted P＜0.05;Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathway enrichment analysis were performed to investigate the functional roles of the differential liver metabolites.Results:Compared with normal group,there were no significant differences in the body mass,food intake,liver index,and blood lipid levels of the mice in various groups(P＞0.05);compared with normal group,the blood glucose level of the mice in high dose of erythritol group was significantly increased(P＜0.01).The metabonomics analysis of the liver tissues of the mice in two groups identified 1 144 metabolites,mainly including lipids and lipid-like molecules(17.39％),organic acids and derivatives(10.87％),organic heterocyclic compounds(5.80％),and organic oxygen compounds(5.07％).Compared with normal group,there were 138 differential liver metabolites in the mice in high dose of erythritol group,among which 112 metabolites were up-regulated and 26 metabolites were down-regulated.The KEGG signal pathway enrichment analysis results showed that the differential metabolites were mainly enriched in metabolism,steroid hormone biosynthesis,cortisol synthesis and metabolism,and Cushing's syndrome pathways;the further topological analysis of the metabolic pathways results showed that the differential metabolites were mainly involved in sphingolipid metabolism,tricarboxylic acid cycle,riboflavin metabolism,steroid hormone biosynthesis,and purine metabolism signal pathways.Conclusion:Long-term intake of high dose of erythritol can increase the blood glucose level in the mice,and the mechanism may be that it affects the tricarboxylic acid cycle by interfering with riboflavin metabolism and interferes with sphingolipid metabolism,leading to impairment of the blood glucose control system.

Clopidogrel effectively inhibits platelet aggregation in response to ADP by irreversibly binding to the platelet P2Y₁₂ receptor through its active metabolite. However, the observed discrepancies between the pharmacokinetics (PK) and pharmacodynamics (PD) of clopidogrel present substantial challenges in individualizing of antiplatelet therapy. To address these challenges, a robust liquid chromatography-tandem mass spectrometry method has been developed to facilitate the real-time assessment of platelet P2Y₁₂ receptor occupancy. This method has been validated in animal models, providing a reliable link between individual PK profiles and PD effects. Target receptor occupancy offers a comprehensive overview of interindividual variations in clopidogrel metabolism, regulation of P2Y₁₂ receptor expression, and platelet turnover. Moreover, it directly correlates with the inhibitory effect on platelet aggregation. The levels of platelet P2Y₁₂ occupancy accurately reflect the extent of clinical factors influencing the PD of clopidogrel, including dosage, drug-drug interactions (DDI), and type 2 diabetes mellitus (T2DM). As a normalized metric, platelet P2Y₁₂ occupancy not only serves potential as a diagnostic tool for personalized clopidogrel therapy but also aids in elucidating the role of the P2Y₁₂ signaling pathway in cases of abnormal on-treatment platelet reactivity.

Solanum nigrum is a traditional Chinese herb widely distributed in China. It is rich in active ingredients such as alkaloids and saponins， and has shown remarkable hepatoprotective effects and various mechanisms in the treatment of various liver diseases. It can prevent and treat chemical liver injury through anti-inflammatory， antioxidant， gut microbiota-regulating， and anti- fibrotic pathways. In the prevention and treatment of fatty liver disease， it can regulate lipid metabolism， inhibit lipogenesis， and promote fat degradation. It has potential antiviral activity against viral hepatitis. By inducing tumor cell apoptosis， arresting the cell cycle， and inhibiting tumor cell proliferation and metastasis and so on， it plays a role in the prevention and treatment of liver cancer. Clinically， S. nigrum has been used in the treatment of liver cancer and liver fibrosis after chronic hepatitis B， showing good efficacy and high safety. Future research should focus on further elucidating its mechanisms of action and promoting the development and application of new drugs， in order to benefit more patients with liver diseases.

Objective To evaluate postoperative recovery and health-related quality of life in patients undergoing robotic,laparoscopic,or open total hysterectomy.Methods A total of 152 patients who underwent total hysterectomy at the Department of Obstetrics and Gynecology of The Second Affiliated Hospital of Naval Medical University from May 2022 to May 2024 were enrolled and assigned to robot-assisted laparoscopic surgery group(robotic surgery group,44 cases),traditional laparoscopic surgery group(laparoscopic surgery group,62 cases),or open surgery group(46 cases)based on the surgical approach.General information,perioperative indexes,and discomfort symptoms 1 month after discharge were collected.Health-related quality of life was evaluated using 36-item short-form health survey(SF-36)at 1-month postoperative follow-up.Results There were no significant differences in age,body mass index,education level,work status,or diagnosis of benign or malignant diseases(all P＞0.05).The postoperative hospital stay,time of first ambulation,time of first oral intake,and 24-h pain score in the robotic surgery group were significantly lower than those in the laparoscopic and open surgery groups(all P＜0.01).The incidence of urinary system and digestive system discomfort within 1 month after discharge was significantly lower in the robotic surgery group than in the laparoscopic and open surgery groups,and the incidence of lower abdominal pain was significantly lower in the robotic surgery group than in the open surgery group(all P＜0.01).The scores of SF-36 in each dimension were significantly higher in the robotic surgery group than those in the laparoscopic and open surgery groups 1 month after discharge(all P＜0.01).Conclusion Compared with those undergoing traditional laparoscopic or open total hysterectomy,patients who underwent robot-assisted laparoscopic total hysterectomy demonstrate faster postoperative recovery and better health-related quality of life.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

OBJECTIVE: To summarize the advances in MRI-based bone quality scoring systems and their clinical applications. METHODS: A comprehensive literature review was conducted on recent studies related to the MRI-based bone quality scoring system, focusing on measurement methods, influencing factors, and clinical significance. RESULTS: Osteoporosis has a high incidence in China, significantly impacting patients' quality of life and the postoperative outcomes of related orthopedic surgeries. Early identification of osteoporosis holds important clinical significance. In recent years, both domestic and international research has enriched the MRI-based bone quality scoring systems, which includes vertebral bone quality scoring, endplate bone quality scoring, and pedicle bone quality scoring. Compared to the "gold standard" of bone density measurement, dual-energy X-ray absorptiometry, the bone quality scoring systems demonstrate good efficacy in identifying abnormal bone mass and predicting postoperative complications, while being less influenced by degenerative changes in the lumbar spine, indicating its important clinical application value. CONCLUSION The MRI-based bone quality scoring systems have good value in clinical applications. However, current studies are mostly retrospective cohort and case-control studies, which carry a risk of bias. The clinical application value needs further clarification through meta-analysis and large-scale prospective studies.
Humans ; Magnetic Resonance Imaging/methods* ; Bone Density ; Osteoporosis/diagnosis* ; Absorptiometry, Photon ; Bone and Bones/diagnostic imaging* ; Lumbar Vertebrae/diagnostic imaging* ; Quality of Life ; Postoperative Complications

BACKGROUND:Studies have shown that the vulnerability and elasticity of carotid plaques are related to the presence and degree of neovascularization within the plaque. Ultrasound,as the preferred measure to screen and evaluate vulnerable carotid plaques,is non-invasive,easy to perform,highly reproducible and radiation-free.OBJECTIVE:To investigate the influencing factors of vulnerable carotid plaque in the high-risk stroke population based on clinical baseline characteristics and carotid ultrasound parameters,and to develop a Nomogram prediction model based on independent risk factors.METHODS:A total of 180 patients who were identified to be at high risk of stroke by stroke screening at Fuzhou First People's Hospital from November 2021 to November 2023 were retrospectively selected as the study objects,and the patients were divided into a modeling set (n=126) and a validation set (n=54)at a ratio of 7∶3. According to the results of carotid artery ultrasound,the subjects in the modeling set were divided into a vulnerable plaque group (n=54) and a non-vulnerable plaque group (n=72). Independent risk factors were obtained by multi-factor Logistic regression,and a Nomogram model was constructed. Decision curves were drawn using R language to evaluate the clinical benefit of the model. The predictive efficacy of the model was tested by receiver operating characteristic curve and calibration curve,and the case data of the validation set were analyzed for external validation.RESULTS AND CONCLUSION:Multivariate Logistic regression results showed that age,family history of stroke,maximum carotid plaque thickness,carotid plaque quantity,urine microalbumin,urine microalbumin/creatinine ratio were associated with vulnerable carotid plaques in patients at high risk of stroke (P<0.05). The area under curve of the established Nomogram model was 0.917,and the sensitivity and specificity were 79.6％ and 91.7％,respectively. The results of decision curve showed that the potential clinical benefit of this model was considerable and its usability was high. The calibration curve results showed that the model had good prediction accuracy. The verification set results showed that the external prediction performance of the model was good. To conclude,age,family history of stroke,and maximum carotid plaque thickness in the high-risk population are all factors that influence this prediction model. This Nomogram based on these independent risk factors can provide a powerful reference for the clinical treatment of this high-risk population.