ObjectiveTo study the mechanism of Huanglian Jiedutang （HLJDT） in treating mice with atherosclerosis （AS） by improving ferroptosis. MethodsA total of 10 SPF C57BL/6J mice were selected as a normal group， and 50 ApoE^-/- mice were randomly divided into five groups： model group， low-dose group of HLJDT， medium-dose group of HLJDT， high-dose group of HLJDT， and atorvastatin （ATV） group. ApoE^-/- mice were fed a high-fat diet for eight weeks to establish the AS model， and at the 9th week， they were given normal saline， low， medium， and high doses of HLJDT （3.9， 7.8， 15.6 g·kg^-1·d^-1）， and atorvastatin calcium tablets （0.01 g·kg^-1·d^-1）， respectively， for a total of eight weeks. The formation of aortic plaque in mice was observed by gross oil red O staining and Masson staining. The levels of total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， triglyceride （TG）， and high-density lipoprotein cholesterol （HDL-C） in blood fat were measured by the automatic biochemical analyzer， and the mitochondrial structure of the aorta was observed by transmission electron microscopy. The content of serum superoxide dismutase （SOD） in serum was detected by enzyme-linked immunosorbent assay （ELISA）. The content of reduced glutathione （GSH） in serum was detected by the microplate method， and that of malondialdehyde （MDA） in serum was detected by the TBA method. The protein expression of nuclear factor E₂-associated factor 2 （Nrf2）/glutathione peroxidase 4 （GPX4） signaling pathway was detected by Western blot. ResultsCompared with those of the normal group， the contents of TC， LDL-C， TG， HDL-C， and MDA in the serum and the aortic vascular plaque deposition of the model group were significantly increased （P<0.01）， while the expression levels of SOD and GSH in serum， as well as Nrf2， solute carrier family 7 member 11 （SLC7A11）， and GPX4 in aorta were significantly decreased （P<0.01）. Mice in the model group appeared mitochondrial fragmentation and vacuolation in the aorta， volume atrophy， mitochondrial crista reduction， or a loose and disorganized form. Compared with those in the model group， the aortic vascular plaque deposition was significantly decreased in the low-dose， medium-dose， and high-dose groups of HLJDT and ATV group， and the contents of serum TC， LDL-C， TG， and MDA in serum were significantly decreased （P<0.05， P<0.01）. The contents of serum SOD and GSH and the expression levels of Nrf2， SLC7A11， and GPX4 in the aorta were increased （P<0.05， P<0.01）， and the symptoms of aortic mitochondrial vacuolation were alleviated. The number of cristae was increased， and they were ordered neatly. ConclusionHLJDT can reduce aortic vascular plaque deposition， decrease blood lipid and MDA expression， increase SOD and GSH expression， and ameliorate the pathological changes of ferroptosis， the mechanism of which is related to the Nrf2/GPX4 signaling pathway.

Diabetes mellitus （DM） is a metabolic disease caused by absolute or relative insulin deficiency and reduced insulin sensitivity in peripheral cells， posing a serious threat to global health. Chronic complications arising in the later stages of DM can lead to the decline or even loss of function in multiple organs， including the eyes， heart， liver， kidneys， nerves， and feet， making them the primary cause of mortality in DM patients. Although modern medicine has made some progress in the treatment of these complications， challenges such as high costs and adverse drug reactions remain. Thus， identifying highly effective drugs with minimal adverse effects has become a top priority. Astragalus membranaceus is a shining gem in the treasure trove of Chinese medicine. Numerous studies have shown that its primary active component， astragaloside Ⅳ， possesses various biological activities， including anti-inflammatory， antioxidant， and antiviral effects， as well as benefits for cardiac and cerebral function， nerve conduction， and myocardial protection. Meanwhile， the phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） signaling pathway plays a crucial role in regulating oxidative stress， inflammatory responses， apoptosis， and autophagy. Extensive research has highlighted the significant role of this pathway in various DM complications， leading to widespread studies on its interaction with astragaloside Ⅳ. This review summarizes research findings on how astragaloside Ⅳ alleviates pancreatic cytotoxicity in DM patients by modulating the PI3K/Akt pathway. Additionally， it highlights its protective effects on basic cardiac function， inhibition of retinal cell damage， improvement of cerebral nerve dysfunction， reduction of chronic kidney and liver damage， and mitigation of neurovascular toxicity in the lower limbs. These insights provide a valuable reference for the clinical application of A. membranaceus and its active monomer， astragaloside Ⅳ， in the treatment of DM and its complications.

Objective To explore the medication rules and mechanism of Xin'an physicians in the treatment of diabetes mellitus.Methods The prescriptions for the treatment of diabetes mellitus in Xin'an medical writings were collected.The core drug prescriptions were obtained by using IBM SPSS Modeler 18.0 for dispensing association rules as well as complex network analysis,and the cluster analysis of high-frequency traditional Chinese medicines was carried out by using IBM SPSS Statistics 25.0.The active ingredients and targets of the core drugs were extracted from the BATMAN-TCM database.The GeneCards database was used to search for diabetes gene targets,and after obtaining the intersecting targets,the STRING online platform was imported to construct the protein interactions network,and screened the core genes by using the Cytoscape 3.9.1 software,and imported into the DAVID database for GO function and KEGG pathway enrichment analysis.Results A total of 135 valid prescriptions were included,involving 184 flavors of traditional Chinese medicines,with cold and mild properties.Sweet,bitter and pungent flavors,and the main attributes of lung,spleen,kidney,stomach and heart meridians.The association rules mined 14 pairs of commonly used medicine pairs.Cluster analysis clustered the top 20 traditional Chinese medicines into five cluster groups.Complex network visualization analysis formed a core prescription consisting of honey-fried licorice root,ginseng,rhizoma anemarrhenae,ophiopogon japonicus,poria cocos.The core prescription drugs were screened for 164 effective active ingredients,1,498 action targets,1,995 diabetes gene targets,404 intersecting targets,10 core targets were extracted,and a total of 1,363 items covering BP were obtained from GO functional enrichment analysis,129 items involving CC,264 items containing MF,and 206 items of KEGG signaling pathway.Conclusion The prescriptions and medicines used by Xin'an doctors in the treatment of diabetes mellitus reflect the academic idea of"treating both the symptoms and the root cause"as well as the therapeutic thought of"using cold and warmth,supplementing with sweetness and warmth,opening up and lowering with bitterness,cultivating the earth and generating gold,and consolidating the root and cultivating the elements",which provide references for the treatment of diabetes mellitus in today's clinics.

Objective To explore the medication rules and mechanism of Xin'an physicians in the treatment of diabetes mellitus.Methods The prescriptions for the treatment of diabetes mellitus in Xin'an medical writings were collected.The core drug prescriptions were obtained by using IBM SPSS Modeler 18.0 for dispensing association rules as well as complex network analysis,and the cluster analysis of high-frequency traditional Chinese medicines was carried out by using IBM SPSS Statistics 25.0.The active ingredients and targets of the core drugs were extracted from the BATMAN-TCM database.The GeneCards database was used to search for diabetes gene targets,and after obtaining the intersecting targets,the STRING online platform was imported to construct the protein interactions network,and screened the core genes by using the Cytoscape 3.9.1 software,and imported into the DAVID database for GO function and KEGG pathway enrichment analysis.Results A total of 135 valid prescriptions were included,involving 184 flavors of traditional Chinese medicines,with cold and mild properties.Sweet,bitter and pungent flavors,and the main attributes of lung,spleen,kidney,stomach and heart meridians.The association rules mined 14 pairs of commonly used medicine pairs.Cluster analysis clustered the top 20 traditional Chinese medicines into five cluster groups.Complex network visualization analysis formed a core prescription consisting of honey-fried licorice root,ginseng,rhizoma anemarrhenae,ophiopogon japonicus,poria cocos.The core prescription drugs were screened for 164 effective active ingredients,1,498 action targets,1,995 diabetes gene targets,404 intersecting targets,10 core targets were extracted,and a total of 1,363 items covering BP were obtained from GO functional enrichment analysis,129 items involving CC,264 items containing MF,and 206 items of KEGG signaling pathway.Conclusion The prescriptions and medicines used by Xin'an doctors in the treatment of diabetes mellitus reflect the academic idea of"treating both the symptoms and the root cause"as well as the therapeutic thought of"using cold and warmth,supplementing with sweetness and warmth,opening up and lowering with bitterness,cultivating the earth and generating gold,and consolidating the root and cultivating the elements",which provide references for the treatment of diabetes mellitus in today's clinics.

In the European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma updated recently, there are 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points, including initial resuscitation and prevention of further bleeding, diagnosis and monitoring of bleeding, rapid control of bleeding, initial management of bleeding and coagulopathy, further goal-directed coagulation management, management of antithrombotic agents, thromboprophylaxis, guideline implementation and quality control, as welll as the management of tissue oxygenation, volume, fluids and temperature. In this paper, we introduce the recommendations and rationale of the guideline and add some newly published clinical study evidence. These information would be very helpful to the development and training of the guidelines or protocols for the management of the trauma patient with major haemorrhage and coagulopathy in China.

Objective To investigate the efficacy and safety of a single induction dose of cyclopofol in painless four-dimensional hysterosalpingography,this study aims to assess its academic significance and adherence to Nature journal's publication standards.Methods A total of 120 patients admitted to Guangdong Reproductive Hospital between February 2022 and December 2022,requiring painless vaginal four-dimensional ultrasound hysterosalpin-gography,were selected as the study population.Random selection was performed with 40 patients in each group.The dosage of cyclopofol administered was 0.3 mg/kg(C1 group),0.5 mg/kg(C2 group),and 0.7 mg/kg(C3 group).Heart rate(HR),mean arterial pressure measured non-invasively using a cuff,time to wake after surgery,and incidence of adverse reactions were observed at three time points:before examination(T1),during contrast agent injection(T2),and after examination(T3).Results There were no significant differences in heart rate(HR)and mean arterial pressure(MAP)between T1 and T3 among the three groups(P>0.05).However,at T2,group C1 exhibited significantly higher HR and MAP compared to group C2(P<0.05),while there was no statistically significant difference in HR and MAP between group C2 and C3 at T2(P>0.05).The duration of wakefulness was shorter in group C2 than in group C3(P<0.05),but there was no statistical significance in wakefulness duration between group C1 and C2(P>0.05).The incidence of adverse reactions was lower in group C2(10.0%)compared to both group C1(32.5%)and group C3(37.5%)with statistical significance(P<0.05).Conclusion The admin-istration of cyclopofol at a dosage of 0.5 mg/kg exhibits notable advantages in painless four-dimensional hysterotubal ultrasonography,including effective sedation,prompt wakefulness,and a low occurrence rate of adverse reactions.

Objective:To observe and analyze the effect of airflow obstruction on the inspiratory flow index and patient-ventilator synchronization in non-invasive pressure support ventilation (NI-PSV). Methods:The ASL 5000 machine simulation lung system was used to simulate health adult on semi-recumbent position and patients with chronic obstructive pulmonary disease (COPD),whose body weights were 70 kg. The models of health adult,mild obstruction,moderate obstruction and severe obstruction were set. The static compliance (Cst) of the simulated lung system was 60 mL/cmH2O,and the airway resistance (Raw) values of health adult,COPD patients with mild obstruction,moderate obstruction and severe obstruction model were respectively 5.0,10.0,15.0 and 20.0 cmH2O/(L*s),and the effort of spontaneous inhalation (Pmus) was 5.0 cmH2O,and the inspiratory time was 1.6s,and the respiratory rate was 15 times/min. Using the mode of spontaneous to time control (S/T) of Respironics V60 ventilator to operate,and the positive end-expiratory pressure (PEEP) was 5.0 cmH2O. The output tidal volume (VT) of ventilator was controlled at 7.0-8.0 mL/kg through adjusted the inspiratory pressure. The output various ventilation parameters and the change of breathing work of the simulated lung were collected,and the flow index was calculated. Results:Peak inspiratory flow (PIF) and peak expiratory flow (PEF) were decreased gradually with the severity of airflow obstruction of models of COPD patients,which inspiratory triggering flow (Flow-trig) was always remained at approximate 6.0 L/min. The value of flow index of the model with severe obstruction reached to 0.65,and the delay time (Td) of inspiratory triggering was more than 400 ms. The switching between inhalation and exhalation was from premature cycling (-469.50±16.35) ms of health adult model to mildly delayed cycling (207.25±14.86) ms,and the difference of that was significant (t=69.28,P<0.05). The inspiratory work of breathing (WOBpat) and ventilator work (WOBtot) of severe obstruction model of COPD patient were higher than those of health adults,and mild obstruction and moderate obstruction model of COPD patients,but the inspiratory work ratio (WOBpat/tot) of severe obstruction model of COPD patient was lower than that of other 3 kinds of models,and the differences were significant (F=2477.70,46960.87,51222.97,P<0.01),respectively. Conclusion:During NI-PSV support,airflow obstruction not only can decrease the value of peak airflow,change airflow shape and lead to increase the value of inspiratory flow index,but also can increase breathing work,thus affect patient-ventilator synchronization.

Objective:To observe and analyze the effect of airflow obstruction on the inspiratory flow index and patient-ventilator synchronization in non-invasive pressure support ventilation (NI-PSV). Methods:The ASL 5000 machine simulation lung system was used to simulate health adult on semi-recumbent position and patients with chronic obstructive pulmonary disease (COPD),whose body weights were 70 kg. The models of health adult,mild obstruction,moderate obstruction and severe obstruction were set. The static compliance (Cst) of the simulated lung system was 60 mL/cmH2O,and the airway resistance (Raw) values of health adult,COPD patients with mild obstruction,moderate obstruction and severe obstruction model were respectively 5.0,10.0,15.0 and 20.0 cmH2O/(L*s),and the effort of spontaneous inhalation (Pmus) was 5.0 cmH2O,and the inspiratory time was 1.6s,and the respiratory rate was 15 times/min. Using the mode of spontaneous to time control (S/T) of Respironics V60 ventilator to operate,and the positive end-expiratory pressure (PEEP) was 5.0 cmH2O. The output tidal volume (VT) of ventilator was controlled at 7.0-8.0 mL/kg through adjusted the inspiratory pressure. The output various ventilation parameters and the change of breathing work of the simulated lung were collected,and the flow index was calculated. Results:Peak inspiratory flow (PIF) and peak expiratory flow (PEF) were decreased gradually with the severity of airflow obstruction of models of COPD patients,which inspiratory triggering flow (Flow-trig) was always remained at approximate 6.0 L/min. The value of flow index of the model with severe obstruction reached to 0.65,and the delay time (Td) of inspiratory triggering was more than 400 ms. The switching between inhalation and exhalation was from premature cycling (-469.50±16.35) ms of health adult model to mildly delayed cycling (207.25±14.86) ms,and the difference of that was significant (t=69.28,P<0.05). The inspiratory work of breathing (WOBpat) and ventilator work (WOBtot) of severe obstruction model of COPD patient were higher than those of health adults,and mild obstruction and moderate obstruction model of COPD patients,but the inspiratory work ratio (WOBpat/tot) of severe obstruction model of COPD patient was lower than that of other 3 kinds of models,and the differences were significant (F=2477.70,46960.87,51222.97,P<0.01),respectively. Conclusion:During NI-PSV support,airflow obstruction not only can decrease the value of peak airflow,change airflow shape and lead to increase the value of inspiratory flow index,but also can increase breathing work,thus affect patient-ventilator synchronization.

ObjectiveTo explore the clinical efficacy and safety of the combination of Erchentang and Bixie Fenqingyin in the treatment of patients with acute cerebral infarction accompanied by hyperuricemia of phlegm and blood stasis blocking collaterals syndrome to provide a new method and evidence for the treatment of acute cerebral infarction with hyperuricemia. MethodA total of 132 eligible patients with acute cerebral infarction accompanied by hyperuricemia of phlegm and blood stasis blocking collaterals syndrome admitted to the Putuo Hospital of Shanghai University of Traditional Chinese Medicine（TCM） from May 2021 to May 2022 were randomly divided into a Chinese medicine group， a western medicine group， and a control group， with 44 cases in each group. All three groups received routine western medical treatment for acute cerebral infarction. Additionally， the Chinese medicine group received Erchentang combined with Bixie Fenqingyin， the western medicine group received Benzbromarone tablets， and the control group did not receive any uric acid-lowering treatment. The treatment duration was four weeks. The modified Rankin Scale （mRS） score after three months of onset， as well as the National Institutes of Health Stroke Scale （NIHSS） scores， TCM syndrome scores， serum uric acid （SUA） levels， serum C-reactive protein （CRP） and interleukin-6 （IL-6） levels， serum superoxide dismutase （SOD） and malondialdehyde （MDA） levels， and other safety indicators were observed before and after treatment. ResultA total of 129 cases completed the trial observation， with 43 cases in the Chinese medicine group， 42 cases in the western medicine group， and 44 cases in the control group. The rate of good prognosis in the Chinese medicine group （83.7%，36/43） was higher than that in the western medicine group （64.3%，27/42） and the control group （40.9%，18/44） （χ²=4.184，16.930，P<0.05）， and the western medicine group was superior to the control group （χ²=4.707，P<0.05）. After treatment， the NIHSS scores， TCM syndrome scores， SUA， CRP， IL-6， and MDA levels of the patients in all three groups decreased， while the SOD levels increased compared with those before treatment （P<0.05）. Among them， the improvement in NIHSS score was better in the Chinese medicine group and the western medicine group than in the control group （P<0.05）. The Chinese medicine group showed the greatest improvement in TCM syndrome （P<0.05）， while the western medicine group showed the greatest reduction in uric acid levels （P<0.05）. No significant abnormalities in safety indicators were observed before and after treatment in the three groups， and no serious adverse reactions were reported. ConclusionThe combination of Erchentang and Bixie Fenqingyin can significantly improve the prognosis， early neurological deficits， and TCM syndromes of patients acute cerebral infarction accompanied by hyperuricemia of phlegm and blood stasis blocking collaterals syndrome. It can also lower uric acid levels and inhibit inflammatory and oxidative stress reactions.

Objectives:To construct a nomogram prediction model using common preoperative indicators for early weight loss (EWL) 1 year after laparoscopic sleeve gastrectomy (LSG).Methods:Relevant data of obese patients who had undergone LSG from January 2015 to May 2022 in Fujian Medical University Union Hospital and Quanzhou First Hospital Affiliated Fujian Medical University were analyzed. Patients with a history of major abdominal surgery, severe gastroesophageal reflux disease, pregnancy within 1 year after surgery, or who were lost to follow-up were excluded, resulting in a total of 200 patients in the study (190 from Fujian Medical University Union Hospital and 10 from Quanzhou First Hospital Affiliated Fujian Medical University). The participants were 51 men and 149 women of a mean age 29.9±8.2 years and a body mass index (BMI) 38.7±6.5 kg/m 2. All patients in this group underwent standardized LSG procedure. Achieving ideal weight (BMI≤25 kg/m 2) 1 year after LSG was defined as goal of EWL. Logistic regression analyses were performed to identify factors that independently influenced EWL. These factors were incorporated into the nomogram model. Receiver operating characteristic (ROC) curves (the larger the area under the curve [AUC], the better the predictive ability and accuracy of the model), likelihood ratio test (higher likelihood ratio indicates greater model homogeneity), decision curve analysis (higher net benefit indicates a better model), Akaike information criterion (AIC; smaller AIC indicates a better model), and Bayesian information criterion (BIC; smaller BIC indicates a better model) were used to validate the predictive ability of the column line diagram model. Results:In this study of 200 obese patients who underwent LSG surgery, 136 achieved EWL goal, whereas the remaining 64 did not. The rate of EWL goal achievement of the entire group was 68.0%. Compared with patients who did not achieve EWL goal, those who did had lower BMI, alanine transaminase, aspartate transaminase, triglycerides, and higher cholesterol. Additionally, the proportion of female was higher and the proportions of patients with fatty liver and hypertension lower in those who achieved EWL goal (all P<0.05). Univariate and multivariate logistic regression analysis revealed that preoperative BMI (OR=0.852, 95%CI: 0.796-0.912, P<0.001), alanine transaminase (OR=0.992, 95%CI: 0.985-0.999, P=0.024), presence of fatty liver (OR=0.185, 95%CI: 0.038-0.887, P=0.035) and hypertension (OR=0.374, 95%CI: 0.144-0.969, P=0.043) were independently associated with failure to achieve EWL goal. Cholesterol (OR=1.428, 95%CI: 1.052-1.939, P=0.022) was independently associated with achieving EWL goal. We used the above variables to establish an EWL nomogram model. ROC analysis, the likelihood ratio test, decision curve analysis, and AIC all revealed that the predictive value of the model was better than that of BMI alone (nomogram model vs. BMI: area under the curve 0.840 vs. 0.798, P=0.047; likelihood ratio: 58.785 vs. 36.565, AIC: 193.066 vs. 207.063, BIC: 212.856 vs. 213.660). Conclusion:Our predictive model is more accurate in predicting EWL after LSG compared with using BMI.