Irritable bowel syndrome （IBS） is a functional bowel disorder characterized primarily by abdominal pain and altered defecation habits. In recent years， traditional Chinese medicine （TCM） has made progress in multiple aspects of IBS research and treatment， including syndrome distribution， development of TCM formulas， clinical efficacy evaluation， external therapies， and psychosocial regulation. However， it still faces challenges such as over-reliance on symptomatic manifestations rather than biomarkers for diagnostic criteria， and the lack of high-quality evidence-based data supporting the efficacy of TCM formulas in treating IBS. This paper proposed that TCM diagnosis and treatment of IBS should adhere to the strategy of integrating the holistic concept with syndrome differentiation and treatment， combining TCM external therapies such as acupuncture， moxibustion and acupoint application）， and emphasizing individualized diagnosis and treatment for psychosomatic abnormalities. Future research should integrate multi-omics technologies， artificial intelligence and other methods to deepen the understanding of the pathogenesis of IBS and the mechanisms of TCM formulas， so as to promote the standardization and internationalization of TCM in the diagnosis and treatment of IBS.

Coronary artery bypass grafting(CABG) remains a cornerstone treatment for complex coronary artery disease, with long-term graft patency being essential for clinical success. In 2024, the European Society of Cardiology(ESC) and the European Association for Cardio-Thoracic Surgery(EACTS) jointly released an expert consensus document on the intraoperative and postoperative management of CABG grafts. This article provides a comprehensive Chinese translation and interpretation of the consensus, covering key topics including graft harvesting techniques(such as skeletonized vs. pedicled, endoscopic vs. open harvesting), optimal preservation solutions, mechanisms and prevention of graft spasm, and secondary prevention strategies involving antithrombotic and lipid-lowering therapies. Additionally, based on the current situation of clinical practice in China and the characteristics of the Chinese population, the article discussed some key issues in depth, put forward adaptive suggestions, and pointed out the future research direction. The translated consensus and accompanying commentary aim to facilitate the dissemination and application of ESC-endorsed recommendations in Chinese clinical settings, promoting more standardized and evidence-based graft management in CABG surgery.

BACKGROUND:Accurate early diagnosis and timely reperfusion therapy are important prerequisites for saving the lives and improving the prognosis of patients with acute myocardial infarction.Therefore,it is important to find ideal biomarkers for early diagnosis of acute myocardial infarction.OBJECTIVE:To analyze key genes associated with neutrophils by acute myocardial infarction through bioinformatics and machine learning to explore new biomarkers.METHODS:Differentially expressed genes were identified based on the Gene Expression Omnibus(GEO)database and Limma R package.Deconvolution algorithm was used to explore the immune cells infiltration level.Then,acute myocardial infarction and neutrophils-related biomarkers were screened by weighted gene co-expression network analysis(WGCNA),protein-protein interaction(PPI)networks,machine learning,and functional enrichment analysis.Receiver operating characteristic curve analysis was conducted to assess the diagnostic efficacy of biomarkers for acute myocardial infarction.Targeted drugs for biomarkers were screened through the STITCH and Herb database.Finally,the hospitalized patients who were first diagnosed with acute myocardial infarction in the Department of Cardiology of Affiliated Hospital of Guizhou Medical University from March to June 2023 were used as the experimental group,and the hospitalized patients who had no ischemic changes on electrocardiograms and no stenosis on coronary angiograms during the same period were used as the control group.Peripheral blood of the patients in the two groups was collected.The relative expressions of the genes were verified in the human peripheral blood samples by RT-qPCR.RESULTS AND CONCLUSION:(1)A total of 2 349 differentially expressed genes were obtained,and immune infiltration analysis revealed differences in immune cell scores such as B cells memory,NK cells resting,and Neutrophils between the disease and normal groups.(2)Using WGCNA,two gene modules,ME green and ME turquoise,were found to exhibit the highest correlation with neutrophil fine with acute myocardial infarction.(3)Twenty-four differential module genes were obtained after intersecting with differentially expressed genes.Functional enrichment analysis revealed that they were associated with a variety of processes such as innate immune response and defense response to bacteria.KEGG results showed that they were mainly associated with the tumor necrosis factor signaling pathway.(4)The genes mined by the machine learning algorithm took the intersection to obtain three genes,namely,S100A12,PTCH1,and LOC400499,all of which were greater than 0.7 by the area under the receiver operating characteristic curve in both the GSE48060 and GSE66360 datasets.They were considered as potential biomarkers.(5)Based on the STITCH and Herb databases,11 target drugs were found for S100A12 and a total of 6 target drugs were found for PTCH1.(6)RT-qPCR results showed that S100A12,PTCH1,and LOC400499 were significantly differentially expressed in acute myocardial infarction patients compared with controls(P＜0.05).(7)S100A12,PTCH1,and LOC400499 may be potential diagnostic biomarkers for acute myocardial infarction,but their specificity in relation to acute myocardial infarction needs to be further investigated,in which S100A12 may be a potential target for regulating acute myocardial infarction.

Chronic gastritis is a chronic inflammation of the gastric mucosa caused by various etiologies and can be categorized into chronic non-atrophic gastritis and chronic atrophic gastritis.Chronic atrophic gastritis is a common disorder of the digestive system characterized by gastric mucosal gland atrophy,mucosal thinning,and basal layer thickening.The development of intestinal metaplasia and atypical hyperplasia on this basis is recognized as a precancerous lesion of gastric cancer and represents a key stage in the"inflammation-cancer transformation"of chronic gastritis.However,universally recognized and effective treatment strategies for this"inflammation-cancer transformation"process are lacking in clinical practice.This study integrates Correa′s cascade reaction with clinical practice,summarizing the pathogenesis of the"inflammation-cancer transformation"of chronic gastritis as weakness of the middle jiao and blood stasis.It suggests that the"inflammation-cancer transformation"process involves the pathological development of spleen and stomach deficiency,transportation and transformation dysfunction,turbid phlegm,blood stasis,and the gradual formation of cancerous toxins,with spleen and stomach weakness as the core mechanism and phlegm and blood stasis as the crucial pathological link.Based on an in-depth exploration of the deficiency of the middle jiao and blood stasis,supported by pharmacological research and clinical experience,this paper proposes the therapeutic approach of strengthening the spleen and replenishing qi,expelling phlegm and activating blood.It discusses the related prescriptions in preventing and treating the"inflammation-cancer transformation"of chronic gastritis.This study aims to provide new perspectives and insights for the prevention and treatment of chronic gastritis with traditional Chinese medicine,offering a novel framework for clinical treatment.

BACKGROUND:Accurate early diagnosis and timely reperfusion therapy are important prerequisites for saving the lives and improving the prognosis of patients with acute myocardial infarction.Therefore,it is important to find ideal biomarkers for early diagnosis of acute myocardial infarction.OBJECTIVE:To analyze key genes associated with neutrophils by acute myocardial infarction through bioinformatics and machine learning to explore new biomarkers.METHODS:Differentially expressed genes were identified based on the Gene Expression Omnibus(GEO)database and Limma R package.Deconvolution algorithm was used to explore the immune cells infiltration level.Then,acute myocardial infarction and neutrophils-related biomarkers were screened by weighted gene co-expression network analysis(WGCNA),protein-protein interaction(PPI)networks,machine learning,and functional enrichment analysis.Receiver operating characteristic curve analysis was conducted to assess the diagnostic efficacy of biomarkers for acute myocardial infarction.Targeted drugs for biomarkers were screened through the STITCH and Herb database.Finally,the hospitalized patients who were first diagnosed with acute myocardial infarction in the Department of Cardiology of Affiliated Hospital of Guizhou Medical University from March to June 2023 were used as the experimental group,and the hospitalized patients who had no ischemic changes on electrocardiograms and no stenosis on coronary angiograms during the same period were used as the control group.Peripheral blood of the patients in the two groups was collected.The relative expressions of the genes were verified in the human peripheral blood samples by RT-qPCR.RESULTS AND CONCLUSION:(1)A total of 2 349 differentially expressed genes were obtained,and immune infiltration analysis revealed differences in immune cell scores such as B cells memory,NK cells resting,and Neutrophils between the disease and normal groups.(2)Using WGCNA,two gene modules,ME green and ME turquoise,were found to exhibit the highest correlation with neutrophil fine with acute myocardial infarction.(3)Twenty-four differential module genes were obtained after intersecting with differentially expressed genes.Functional enrichment analysis revealed that they were associated with a variety of processes such as innate immune response and defense response to bacteria.KEGG results showed that they were mainly associated with the tumor necrosis factor signaling pathway.(4)The genes mined by the machine learning algorithm took the intersection to obtain three genes,namely,S100A12,PTCH1,and LOC400499,all of which were greater than 0.7 by the area under the receiver operating characteristic curve in both the GSE48060 and GSE66360 datasets.They were considered as potential biomarkers.(5)Based on the STITCH and Herb databases,11 target drugs were found for S100A12 and a total of 6 target drugs were found for PTCH1.(6)RT-qPCR results showed that S100A12,PTCH1,and LOC400499 were significantly differentially expressed in acute myocardial infarction patients compared with controls(P＜0.05).(7)S100A12,PTCH1,and LOC400499 may be potential diagnostic biomarkers for acute myocardial infarction,but their specificity in relation to acute myocardial infarction needs to be further investigated,in which S100A12 may be a potential target for regulating acute myocardial infarction.

OBJECTIVE To investigate the effects of galangin(GLA)on autophagy and apoptosis of chondrocytes in knee osteoarthritis(KOA)rats by regulating the adenosine monophosphate-activated protein kinase(AMPK)/mammalian target of rapamycin(mTOR)/UNC-51-like kinase 1(ULK1)signaling pathway.METHODS KOA rat model was constructed and separated into model group,L-GLA,M-GLA,H-GLA groups[subcutaneous injection of 100,200,400 μg/kg GLA],GLA+Compound C group[subcutaneous injection of 400 μg/kg GLA+0.2 mg/kg AMPK inhibitor Compound C],with 10 rats in each group.Additionally,10 normally fed rats were selected as the sham operation group.After the last medication,the degree of knee joint swelling of rats in each group was detected;the pathology of knee joints in KOA rats was observed.The serum expressions of matrix metalloproteinase 13(MMP-13)and interleukin-1 β(IL-1 β)in KOA rats were detected;the autophagy of chondrocytes in KOA rats was observed;the chondrocyte apoptosis in KOA rats was detected;the phosphorylation of AMPK/mTOR/ULK1 pathway-related proteins in cartilage tissue of knee joint were detected in rats.RESULTS Compared with the sham operation group,the arrangement of articular chondrocytes in the model group was disordered,with nuclear pyknosis and severe fibrosis of the articular cartilage layer,accompanied by a large amount of inflammatory cell infiltration;the degree of joint swelling,the number of autophagic vacuoles and apoptosis rate of chondrocytes,serum levels of MMP-13 and IL-1β,and the phosphorylation of mTOR protein in cartilage tissue of knee joint were all increased significantly(P＜0.05),while the phosphorylation of AMPK and ULK1 protein were all decreased significantly in cartilage tissue of knee joint(P＜0.05).Compared with the model group,L-GLA,M-GLA,H-GLA groups showed significant improvement in joint cartilage injury and reduced infiltration of inflammatory cells in rats.The above quantitative indicators were significantly reversed in a dose-dependent manner,except the number of autophagic vacuoles increased significantly(P＜0.05).Compared with the H-GLA group,the GLA+Compound C group showed aggravated cartilage tissue of joint cartilage injury and inflammatory cell infiltration in rats,and the above quantitative indicators were reversed significantly(P＜0.05).CONCLUSIONS GLA can promote autophagy and inhibit apoptosis of chondrocytes in KOA rats,the mechanism of which may be associated with activating AMPK/mTOR/ULK1 signaling pathway.

Objective:To investigate the feasibility and therapeutic efficacy of robot-assisted radical resection for hilar cholangiocarcinoma.Methods:This is a retrospective case series study. The clinical data of 29 patients who underwent robot-assisted radical resection for hilar cholangiocarcinoma at the Department of Minimally Invasive Hepatic Surgery,the First Affiliated Hospital of Harbin Medical University from July 2021 to February 2025 were retrospectively collected. There were 16 males and 13 females, aged ( M(IQR)) 68.0 (10.0) years (range:36 to 78 years), and body mass index (24.0±2.9) kg/m 2 (range:17.5 to 29.1 kg/m 2). Bismuth-Corlette classification: 12 cases type Ⅰ, 4 cases type Ⅱ, 6 cases type Ⅲb, and 7 cases type Ⅳ. Preoperative CA19-9 was 161.7(320.9) U/ml (range:7.1 to 1 000.0 U/ml), and carcinoembryonic antigen was 2.8(2.1)μg/L (range:0.3 to 203.1 μg/L). Preoperative total bilirubin was 134.2 (348.9) μmol/L (range:10.4 to 557.9 μmol/L), direct bilirubin was 90.8 (264.1) μmol/L (range:2.5 to 418.7 μmol/L), ALT was 136.4 (134.8) U/L (range:13.0 to 569.9 U/L), AST was 122.2 (119.9) U/L (range:16.0 to 384.0 U/L), and albumin was (34.5±6.3) g/L (range:21.7 to 41.3 g/L). Comparison of quantitative data at different time points using paired t-test or Mann-Whitney U test. Cox univariate analysis was performed for the relevant variables, and Cox multivariate regression analysis was used to screen the independent prognostic factors of patients after robot-assisted radical resection for hilar cholangiocarcinoma. Results:All the 29 patients successfully underwent robot-assisted radical resection of hilar cholangiocarcinoma, and the R0 resection rate was 93.1% (27/29) without conversion to laparotomy. The operation time was 295.0 (87.5) minutes (range:195 to 590 minutes), the intraoperative blood loss was 100.0 (150.0) ml (range:20 to 1 000 ml), the intraoperative blood transfusion rate was 20.1% (6/29), the number of lymph nodes dissected was 10.0 (7.0) pieces (range: 6 to 18 pieces), the first postoperative deflatus time was 3.0 (1.0) days (range:2 to 4 days), The oral feeding time was 5.0 (1.0) days (range: 4 to 7 days), the drainage tube removal time was 8.0 (2.0) days (range: 6 to 26 days), and the postoperative hospital stay time was 10.0 (6.0) days (range:7 to 27 days). The incidence of complications above grade Ⅱ of the Clavien-Dindo complication grading system was 24.1% (7/29), including 3 cases of gastrointestinal bleeding with recurrent high fever, 1 case of delayed gastric emptying, 1 case of bile leakage, and 5 cases of hypoalbuminemia. The total bilirubin was 42.8 (66.8) μmol/L (range:6.8 to 195.9 μmol/L), direct bilirubin was 28.1 (38.5) μmol/L (range:4.3 to 88.6 μmol/L), ALT was 55.8 (56.0) U/L (range:9.9 to 207.1 U/L), AST was 33.9 (17.9) U/L (range:10.6 to 122.7 U/L), and albumin was (32.1±3.8) g/L (range:22.8 to 37.7 g/L), the levels of transaminase and bilirubin in the postoperative liver function indexes were significantly improved compared with those before operation, and the differences were statistically significant (all P<0.05). The mortality rate of patients without perioperative death was 3.4% (1/29) at 90 days after surgery. The results of Cox multivariate regression analysis showed that R0 resection was an independent prognostic factor for survival at 1 year after surgery ( P<0.05). The follow-up time was 15.0 (12.0) months (range:6 to 30 months), 1 of the 29 patients died of intra-abdominal infection 1 week after discharge, and the remaining 28 patients were completely followed up, of which 20 patients had no recurrence and metastasis during the follow-up period, and the tumor-free survival was 15.0 (12.0) months (range:6 to 30 months), the tumor-free survival rate was 65.5% (19/29), the overall survival rate was 68.9% (20/29), and 8 patients with postoperative recurrence and metastasis. One patient with liver metastasis survived after reoperation, and one patient underwent postoperative chemoradiotherapy and died due to recurrence. There were 8 deaths during the follow-up, of which 7 died due to tumor recurrence and metastasis, and 1 died due to previous underlying diseases. Conclusion:Robot-assisted radical resection for hilar cholangiocarcinoma is feasible and effective.

Coronary artery bypass grafting(CABG) remains a cornerstone treatment for complex coronary artery disease, with long-term graft patency being essential for clinical success. In 2024, the European Society of Cardiology(ESC) and the European Association for Cardio-Thoracic Surgery(EACTS) jointly released an expert consensus document on the intraoperative and postoperative management of CABG grafts. This article provides a comprehensive Chinese translation and interpretation of the consensus, covering key topics including graft harvesting techniques(such as skeletonized vs. pedicled, endoscopic vs. open harvesting), optimal preservation solutions, mechanisms and prevention of graft spasm, and secondary prevention strategies involving antithrombotic and lipid-lowering therapies. Additionally, based on the current situation of clinical practice in China and the characteristics of the Chinese population, the article discussed some key issues in depth, put forward adaptive suggestions, and pointed out the future research direction. The translated consensus and accompanying commentary aim to facilitate the dissemination and application of ESC-endorsed recommendations in Chinese clinical settings, promoting more standardized and evidence-based graft management in CABG surgery.

Objective To investigate the value of measuring optic nerve sheath diameter(ONSD)at different times after the return of spontaneous circulation(ROSC)in evaluating the neurological function prognosis of patients with cardiac arrest(CA).Methods A total of 48 patients who successfully resuscitated from CA and transferred to the ICU in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from March 2021 to June 2024 were selected as subjects.ONSD was measured initially,12 to 24h,day 2 and day 3 after ROSC.According to the brain function score of 3 months after treatment cerebral performance categories(CPC),the patients were divided into poor neurological group(CPC 3-5 points,n=24)and neurological good group(CPC 1-2 points,n=24).The predictive value of ONSD measurements at each time for neurological outcome in CA patients was analyzed using receiver operating characteristic curves.Results There were significant difference in ONSD from 12 to 24 h,days 2 and 3 between two groups(P＜0.001),and the area under the curve were 0.785,0.837 and 0.841,respectively.Conclusion Measuring the ONSD by ultrasonography at 12-24 hours,day 2,and day 3 after ROSC in post-CA patients have good value in predicting neurologic prognosis.Measurement of ONSD on day 2 may be the optimal time to evaluate the neurological prognosis of patients after CA.

Objective:To analyze the effect of joint management of type 2 diabetes mellitus (T2DM) between specialty and community under the model of National Diabetes Prevention and Control Center (DPCC).Methods:A total of 2 527 T2DM patients managed by DPCC Pingshan Center of Shenzhen from January 1, 2022 to December 31, 2024 were retrospectively included. After management, the rate of downturn, reexamination rate, blood pressure compliance rate, metabolic indicators (waist circumference, body mass index, fasting blood glucose, glycosylated hemoglobin, blood lipids) and screening rate of chronic complications of diabetes (atherosclerotic cardiovascular disease, microvascular disease, diabetic peripheral neuropathy) were analyzed. Those included 2022 ( n=564), 2023 ( n=1 477), and 2024 ( n=2 527). Results:The downturn rate in 2022, 2023 and 2024 increased year by year (22.8% vs 67.2% vs 89.9%, P<0.01), and the review rate (41.1% vs 62.2% vs 52.7%, P<0.01), complication screening rate (51.6% vs 85.3% vs 62.2%, P<0.01), blood pressure compliance rate (53.1% vs 78.0% vs 67.2%, P<0.01), body mass index compliance rate (13.2% vs 17.3% vs 28.6%, P<0.01), fasting blood glucose meeting rate (46.4% vs 60.2% vs 68.5%, P<0.01), glycated hemoglobin meeting rate (58.4% vs 63.2% vs 45.6%, P<0.01) were relatively improved. Waist circumference compliance rate (30.6% vs 27.7% vs 21.6%) and blood lipid compliance rate (33.6% vs 35.5% vs 31.9%) were not significantly improved, and the review rate, blood pressure compliance rate and complication screening rate in 2024 were lower than those in 2023 and higher than those in 2022. Conclusions:The combined management of type 2 diabetes under the DPCC model has significant effects on improving the down-conversion rate, rediagnosis rate, blood pressure compliance rate, metabolic index compliance rate and the screening rate of diabetes-related chronic complications in patients with diabetes. At the same time, it was also found that with the progress of hierarchical diagnosis and treatment, the review rate, complication screening rate, blood pressure, waist circumference, blood lipid and glycosylated hemoglobin reached the standard of patients decreased compared with the previous situation, which needs to be further analyzed and improved.