OBJECTIVE To investigate the mechanism of pachymic acid on renal injury in pregnancy induced hypertension （PIH） rats by regulating the silent information regulator transcript 1/peroxisome proliferator-activated receptor γ coactivator-1α （Sirt1/PGC-1α） pathway. METHODS Pregnant SD rats were prepared by co-caging and PIH model was induced using N-nitro-L- arginine methyl ester （L-NAME） method. PIH rats were randomly divided into model group， L-pachymic acid （low-dose pachymic acid， 10 mg/kg） group， H-pachymic acid （high-dose pachymic acid， 20 mg/kg） group， and H-pachymic acid+EX527 （20 mg/kg pachymic acid+10 mg/kg EX527） group， with 6 rats in each group. Another 6 normal pregnant rats were selected as blank group. Each group was given relevant medicine or solvent intragastrically or intraperitoneally daily， once a day， for 28 consecutive days. After the last administration， 24 h urinary protein and tail artery systolic blood pressure （SBP） were measured in pregnant rats from each group， along with the levels of serum creatinine （Scr）， blood urea nitrogen （BUN），uric acid （UA）， and cystatin C （Cys-C）. The contents of superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）， and 8-hydroxy-2′-deoxyguanosine （8-OHdG） in renal tissue， as well as the mRNA and protein expression levels of Sirt1 and PGC-1α， were also determined. Meanwhile， renal histopathological changes in rats from each group were evaluated using hematoxylin-eosin （HE） staining and periodic acid-Schiff （PAS） staining. RESULTS Compared with model group， L-pachymic acid group and H-pachymic acid group exhibited significant decreases in 24 h urine protein quantification， tail artery SBP， Scr， BUN， UA， Cys-C levels， glomerulosclerosis index score of renal tissue， renal tubular injury score， the percentage of PAS positive area， MDA and 8-OHdG （P＜0.05）. Conversely， the contents of SOD and GSH-Px， along with the mRNA and protein expression levels of Sirt1 and PGC-1α， were significantly increased （P＜0.05）. Moreover， these improvements were more pronounced in H-pachymic acid group （P＜0.05）. Compared with H-pachymic acid group， the aforementioned indicators in pregnant rats from the H-pachymic acid+EX527 group showed significant reversal （P＜0.05）. CONCLUSIONS Pachymic acid significantly ameliorates renal injury induced by PIH in rats， potentially through activation of the Sirt1/PGC-1α pathway.

ObjectiveTo investigate the influencing factors and independent risk factors for lower extremity deep vein thrombosis （DVT） in patients with acute necrotizing pancreatitis （ANP）， to analyze the effectiveness of three commonly used risk assessment models for thrombosis （Caprini score， Padua score， and Wells score）， and to provide a reference for clinical identification of high-risk individuals and optimization of prevention and treatment strategies. MethodsA retrospective analysis was performed for the clinical data of 320 patients with ANP who were admitted to Luzhou People’s Hospital and The Affiliated Hospital of Southwest Medical University from April 2013 to April 2024， and according to the presence or absence of DVT during hospitalization， the patients were divided into thrombosis group with 25 patients and control group with 295 patients. After propensity score matching， the two groups were compared in terms of past history and various examination results during hospitalization. The risk factors for lower extremity DVT in ANP patients during hospitalization were analyzed through univariate and multivariate Logistic regression， and a DVT risk prediction model was established based on independent influencing factors. The receiver operating characteristic （ROC） curve was used to assess the performance of models， and the DeLong test was used for comparison of the area under the ROC curve （AUC）， sensitivity， and specificity. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups； the chi-square test was used for comparison of categorical data between groups. ResultsAfter matching， the patients were divided into thrombosis group with 24 patients and control group with 112 patients. The clinical characteristics analysis showed that compared with the control group， the thrombosis group had significantly higher degree of pancreatic necrosis， D-dimer level， Bedside Index for Severity in Acute Pancreatitis （BISAP） score， and proportion of patients undergoing dialysis （all P<0.05）. The multivariable Logistic regression analysis showed that BISAP score， degree of pancreatic necrosis， and D-dimer level were independent risk factors for lower extremity DVT in ANP patients during hospitalization （all P<0.05）. The BISAP-Caprini score model had an AUC of 0.832 （95% confidence interval： 0.722 — 0.942， P<0.001） in predicting the risk of lower extremity DVT， with a Youden index of 1.661， an optimal cut-off value of 0.26， a sensitivity of 75.0%， and a specificity of 91.1%. ConclusionD-dimer， BISAP score， and the degree of pancreatic necrosis are independent risk factors for lower extremity DVT in patients with ANP during hospitalization， and the BISAP-Caprini score model can effectively predict the risk of DVT in ANP patients.

This article reports a rare case of autoinflammatory disease presenting initially with skin induration and swelling after trauma as the initial manifestation, followed by progressive limb weakness. The patient was a middle-aged female who developed skin induration and swelling after trauma, which gradually progressed to limb weakness, dysarthria and bilateral facial paralysis, accompanied by livedo reticularis of the lower extremities, diffuse skin induration of the limbs, and beaded subcutaneous nodules in the right upper limb. The patient had a susceptibility to infection since childhood and a history of chronic livedo reticularis. Skin pathological examination revealed panniculitis. A comprehensive etiological screening for special infections and autoimmune diseases was completed with an unremarkable results, and whole-exome sequencing showed no abnormal findings. Following a multidisciplinary discussion combined with RNA sequencing results, the patient was diagnosed with an autoinflammatory disease, with a suspected type Ⅰ interferonopathy. Treatment with tofacitinib resulted in gradual improvement of clinical symptoms. This case highlights the importance of detailed medical history collection, systematic physical examination and multidisciplinary collaborative diagnosis and treatment, and underscores the pivotal role of molecular diagnosis in the confirmation of rare diseases. It can provide a reference for the clinical diagnosis and management of similar rare cases.

ObjectiveTo observe the effects of Xiere Xingpi Yin （XRXPY） on the body mass and body fat distribution in patients with simple obesity， and to preliminarily explore whether the mechanism involves the regulation of specific obesity-related microRNAs （miRNAs）. MethodsA randomized controlled trial design was employed to recruit patients with simple obesity diagnosed with the traditional Chinese medicine （TCM） syndrome of dampness-heat accumulating in the spleen. Using a randomized controlled trial design， 95 patients with simple obesity of dampness-heat encumbering the Spleen syndrome were recruited， after 3 were excluded， 92 were randomly assigned in a 1∶1 ratio by means of a random number table. On the basis of lifestyle intervention， the observation group received XRXPY granules， while the control group received a placebo. Serum samples and TCM symptom scores were collected before and after the 12-week observation period. Differences in body mass loss， body composition， lipid metabolism， and TCM symptom scores were compared between the groups. An obesity-related miRNA dataset was constructed by searching the Human MicroRNA Disease Database. Library construction， sequencing， and quality control were performed on 6 selected patients from each group to screen the differentially expressed miRNAs. The intersection of these miRNAs with the obesity-related miRNAs was verified by bioinformatics and correlation analysis. ResultsBaseline characteristics were comparable between the two groups before treatment. A total of 86 patients completed the study （42 cases in the observation group and 44 cases in the control group）. The proportion of patients achieving ≥5% body weight reduction was significantly higher in the observation group than in the control group 81.0% （34/42） vs. 43.2% （19/44） （χ²=12.963， P<0.01）. Compared with baseline within the observation group， body weight， waist circumference， and TCM syndrome score were significantly decreased （P<0.01）， as were body fat percentage （P<0.01） and serum triglyceride level （P<0.05）. Compared with the control group after treatment， waist circumference and TCM syndrome score were significantly lower in the observation group （P<0.01）， and body weight showed a trend toward reduction. When changes from baseline were compared between the two groups， the magnitudes of decrease in body weight， waist circumference， and TCM syndrome score were all significantly greater in the observation group than in the control group （P<0.01）. With respect to safety， no serious adverse events occurred in either group and no participant discontinued the study because of adverse events. Compared with baseline， alanine aminotransferase levels decreased significantly in both the control and observation groups （P<0.01）， and urea decreased significantly in the observation group （P<0.01）， indicating a favorable safety profile. Sequencing identified nine differentially expressed miRNAs. After intersecting with the obesity-related miRNA dataset （187 miRNAs）， 3 miRNAs were identified： miR-221 （log₂FC=-6.62， P=0.009）， miR-29a （log₂FC=6.33， P=0.016）， and miR-10b （log₂FC=-5.91， P=0.029）. A total of 262 target genes of the 3 miRNAs were identified， which were significantly enriched in 67 pathways， including the lysine degradation pathway （P=0.001）. Correlation analysis revealed a positive correlation between miR-221 and triglycerides （r=0.46， P=0.027）， a negative correlation between miR-29a and waist-to-hip ratio （r=-0.41， P=0.047）， and positive correlations of miR-10b with body fat percentage （r=0.49， P=0.014） and waist circumference （r=0.44， P=0.032）. ConclusionXRXPY combined with lifestyle intervention can effectively reduce the body mass and improve body composition. The underlying mechanism may involve the regulation of the lysine degradation pathway via miR-221， miR-29a， and miR-10b， though further verification is required.

Against the backdrop of digital transformation in higher education， the traditional teaching model has become inadequate to meet the demands for cultivating new-quality nursing talents. Nursing ethics teaching confronts several dilemmas， such as unbalanced regional development， disconnection between theory and practice， scattered teaching resources， and fragmented knowledge points. With the iterative update of modern digital technologies， the knowledge graph， due to its structured， semantic， scalable， and multi-source integrative characteristics， offers a technological pathway to address these issues. Based on the construction foundation of the Ministry of Education’s first batch of virtual teaching and research platforms for humanistic nursing courses， the nursing ethics artificial intelligence（Al）course was developed around the“thinking-research-teaching-learning”framework. By strengthening ideological and political guidance， constructing a curriculum knowledge graph， and promoting the deep integration of humanistic care and professional knowledge，the course realized intelligent support for research，learning，and teaching. This innovative education model provides a replicable paradigm for cultivating outstanding nursing talents equipped with humanistic literacy， digital competence， and advanced ethical thinking， while also offering references for the digital transformation of higher nursing education.

ObjectiveTo observe the effects of Xiere Xingpi Yin （XRXPY） on the body mass and body fat distribution in patients with simple obesity， and to preliminarily explore whether the mechanism involves the regulation of specific obesity-related microRNAs （miRNAs）. MethodsA randomized controlled trial design was employed to recruit patients with simple obesity diagnosed with the traditional Chinese medicine （TCM） syndrome of dampness-heat accumulating in the spleen. Using a randomized controlled trial design， 95 patients with simple obesity of dampness-heat encumbering the Spleen syndrome were recruited， after 3 were excluded， 92 were randomly assigned in a 1∶1 ratio by means of a random number table. On the basis of lifestyle intervention， the observation group received XRXPY granules， while the control group received a placebo. Serum samples and TCM symptom scores were collected before and after the 12-week observation period. Differences in body mass loss， body composition， lipid metabolism， and TCM symptom scores were compared between the groups. An obesity-related miRNA dataset was constructed by searching the Human MicroRNA Disease Database. Library construction， sequencing， and quality control were performed on 6 selected patients from each group to screen the differentially expressed miRNAs. The intersection of these miRNAs with the obesity-related miRNAs was verified by bioinformatics and correlation analysis. ResultsBaseline characteristics were comparable between the two groups before treatment. A total of 86 patients completed the study （42 cases in the observation group and 44 cases in the control group）. The proportion of patients achieving ≥5% body weight reduction was significantly higher in the observation group than in the control group 81.0% （34/42） vs. 43.2% （19/44） （χ²=12.963， P<0.01）. Compared with baseline within the observation group， body weight， waist circumference， and TCM syndrome score were significantly decreased （P<0.01）， as were body fat percentage （P<0.01） and serum triglyceride level （P<0.05）. Compared with the control group after treatment， waist circumference and TCM syndrome score were significantly lower in the observation group （P<0.01）， and body weight showed a trend toward reduction. When changes from baseline were compared between the two groups， the magnitudes of decrease in body weight， waist circumference， and TCM syndrome score were all significantly greater in the observation group than in the control group （P<0.01）. With respect to safety， no serious adverse events occurred in either group and no participant discontinued the study because of adverse events. Compared with baseline， alanine aminotransferase levels decreased significantly in both the control and observation groups （P<0.01）， and urea decreased significantly in the observation group （P<0.01）， indicating a favorable safety profile. Sequencing identified nine differentially expressed miRNAs. After intersecting with the obesity-related miRNA dataset （187 miRNAs）， 3 miRNAs were identified： miR-221 （log₂FC=-6.62， P=0.009）， miR-29a （log₂FC=6.33， P=0.016）， and miR-10b （log₂FC=-5.91， P=0.029）. A total of 262 target genes of the 3 miRNAs were identified， which were significantly enriched in 67 pathways， including the lysine degradation pathway （P=0.001）. Correlation analysis revealed a positive correlation between miR-221 and triglycerides （r=0.46， P=0.027）， a negative correlation between miR-29a and waist-to-hip ratio （r=-0.41， P=0.047）， and positive correlations of miR-10b with body fat percentage （r=0.49， P=0.014） and waist circumference （r=0.44， P=0.032）. ConclusionXRXPY combined with lifestyle intervention can effectively reduce the body mass and improve body composition. The underlying mechanism may involve the regulation of the lysine degradation pathway via miR-221， miR-29a， and miR-10b， though further verification is required.

Allergic rhinitis （AR） is one of the most common chronic non-infectious inflammatory diseases in children. Traditional Chinese medicine （TCM） employs a comprehensive therapeutic system integrating treatment by stages and syndrome differentiation and treatment， demonstrating significant advantages in the management of pediatric AR. This article systematically reviews the clinical treatment methods and underlying mechanisms of TCM for pediatric AR in recent years. It is found that internal therapies （such as herbal formulas or Chinese patent medicines like Xiaoqinglong decoction， Yiqi tuomin decoction）， external therapies （including intradermal needles， acupoint application， tuina， and herbal nasal therapy）， as well as combined internal and external approaches （oral herbs combined with acupoint application）， have demonstrated significant effects in alleviating clinical symptoms， improving immune indicators， and reducing recurrence rates in children with AR. The underlying mechanisms are primarily associated with the regulation of signaling pathways such as Toll-like receptor/nuclear factor-kappa B and mitogen-activated protein kinase， thereby modulating immune balance， suppressing inflammatory responses， inhibiting pyroptosis， reducing mucus secretion， and promoting nasal mucosal repair.

Traditional Chinese medicine(TCM) processing is a unique and highly distinctive pharmaceutical technology in China. Utilizing modern scientific methods to elucidate the connotations of traditional processing theory and its effects is expected to facilitate the inheritance, development, innovation, and enhancement of TCM processing, and lead to more original research outcomes in the field of TCM. The breakthrough in TCM processing lies in the study of its underlying principles, and analyzing these principles involves researching the transformation mechanisms of chemical components and the biological effect mechanisms of the transformed components. This paper proposed the concept of "TCM processing chemical biology"(TCMPCB) for the first time. Under the guidance of TCM theory, the active components transformed during TCM processing were used as chemical tools to study their targets and molecular regulatory mechanisms, aiming to clarify the scientific principles by which TCM processing affected biological effects in the organism. The research findings also provided new directions for discovering novel active components, new lead compounds, creating new decoction pieces, and developing new TCM drugs. This paper provided a detailed introduction to the background, definition, research content, research ideas, research methods, and prospects of TCMPCB, with the aim of offering new research perspectives for analyzing the principles of TCM processing and providing new pathways for achieving the "four new and eight transformations" in TCM processing.
Drugs, Chinese Herbal/chemistry* ; Medicine, Chinese Traditional/methods* ; Humans ; Animals

OBJECTIVE: To explore the timing of weaning extracorporeal membrane oxygenation (ECMO) and analyze the risk factors that affect survival outcomes before weaning. METHODS: A retrospective case-control study was conducted. Patients who received ECMO treatment and were weaned according to physicians' orders at the Second Xiangya Hospital of Central South University from January 2020 to June 2024 were enrolled as the study subjects. The general information, underlying diseases, indications and processes of ECMO, vital signs and arterial blood gas analysis 1 hour before weaning test, and biochemical indicators 24 hours before weaning test were collected through the hospital electronic medical record system. The primary outcome measure was the hospital mortality. The variables with P < 0.1 in univariate analysis and correlation analysis were included into binary Logistic regression analysis to identify risk factors. A nomogram model was constructed to predict the risk of weaning death in patients with ECMO, and receiver operator characteristic curve (ROC curve) and calibration curve were drawn to evaluate the model. Decision curve analysis (DCA) was used to evaluate the clinical net benefit rate of the model. RESULTS: A total of 32 ECMO patients were included, among whom 10 received veno-arterial ECMO (VA-ECMO) and 22 received veno-venous ECMO (VV-ECMO). During the hospitalization period, 23 patients survived, while 9 died. The time from mechanical ventilation to ECMO activation in the death group was significantly longer than that in the survival group, and the time from ECMO cessation to discharge was significantly shorter than that in the survival group. The levels of diastolic blood pressure (DBP) and albumin (Alb) before weaning were significantly lower than those in the survival group, and the level of procalcitonin (PCT) was significantly higher than that in the survival group (all P < 0.05). Spearman correlation analysis showed that DBP, PCT, Alb, and thrombin time (TT) were correlated with the weaning outcomes of ECMO patients (r values were -0.450, 0.373, -0.376, -0.346, all P < 0.1). Binary Logistic regression analysis showed that the final indicators entering the regression equation included DBP [odds ratio (OR) = 0.864, 95% confidence interval (95%CI) was 0.756-0.982], PCT (OR = 1.157, 95%CI was 0.679-1.973), and TT (OR = 0.852, 95%CI was 0.693-1.049), and a nomogram model was constructed to predict the weaning outcomes of ECMO patients. ROC curve analysis showed that the area under the curve (AUC) of the nomogram model for predicting the weaning outcome of ECMO patients was 0.831, with a sensitivity of 77.8% and a specificity of 65.2%. Its predictive value was better than that of single indicators DBP, PCT, and TT (AUC of 0.787, 0.739, and 0.722, respectively). The calibration curve showed that the prediction probability of the model was in good consistency with the actual observed results, the Hosmer-Lemeshow goodness of fit test showed that, χ ² = 8.3521, P = 0.400, indicating that the model fits well. DCA showed that across risk threshold of 0-0.8, the net benefit rate was greater than 0, which was significantly better than that of single indicator. CONCLUSIONS The nomogram model constructed with DBP, PCT, and TT has certain predictive value for the weaning outcomes of ECMO patients and can be used as a screening indicator for ECMO weaning timing.
Humans ; Extracorporeal Membrane Oxygenation ; Retrospective Studies ; Risk Factors ; Case-Control Studies ; Hospital Mortality ; Male ; Female ; Nomograms ; Logistic Models ; ROC Curve ; Middle Aged ; Adult ; Ventilator Weaning ; Time Factors

OBJECTIVE: To identify the risk factors related to the timing of patients receiving extracorporeal membrane oxygenation (ECMO) initiation and construct a risk prediction model for ECMO initiation timing. METHODS: Patients who received ECMO admitted to the Second Xiangya Hospital of Central South University from January 2020 to January 2024 were retrospectively collected. The case data mainly included physiological and biochemical indicators 1 hour before ECMO initiation. According to the outcome of the patients, they were divided into survival group and death group. Univariate and multivariate Logistic regression analysis were used to analyze the predictors of mortality risk in patients with ECMO, and a nomogram prediction model was constructed. The discrimination, calibration accuracy, and goodness of the model were evaluated by the receiver operator characteristic curve (ROC curve), calibration curve, and the Hosmer-Lemeshow test, respectively. Decision curve analysis (DCA) evaluated the clinical net benefit rate of the model. RESULTS: A total of 81 ECMO patients were included, including 59 males and 22 females; age range from 16 to 61 years old, with a median age of 56.0 (39.5, 61.5) years old; 20 patients received veno-arterial (V-A) ECMO, and 61 patients received veno-venous (V-V) ECMO; 23 patients ultimately survived and 58 patients died. Univariate analysis showed that age, blood urea nitrogen, serum creatinine, D-dimer, arterial blood carbon dioxide partial pressure, and prothrombin time of the death group were all higher than those of the survival group, while albumin was slightly lower than that of the survival group. There was a statistically significant difference in the direct cause of ECMO initiation between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.069, 95% confidence interval (95%CI) was 1.015-1.125, P = 0.012], direct cause of ECMO initiation [with heart failure as the reference, return of spontaneous circulation (ROSC) after cardiopulmonary support (OR = 30.672, 95%CI was 1.265-743.638, P = 0.035), novel coronavirus infection (OR = 8.666, 95%CI was 0.818-91.761, P = 0.073), other severe pneumonia (OR = 4.997, 95%CI was 0.558-44.765, P = 0.150)], pre-ECMO serum creatinine (OR = 1.008, 95%CI was 1.000-1.016, P = 0.044), prothrombin time (OR = 1.078, 95%CI was 0.948-1.226, P = 0.252), and D-dimer (OR = 1.135, 95%CI was 1.047-1.231, P = 0.002) were entered into the final regression equation. A nomogram prediction model was developed based on these five factors. The area under the ROC curve (AUC) of the model was 0.889 (95%CI was 0.819-0.959), higher than the AUC of the sequential organ failure assessment (SOFA; AUC = 0.604, 95%CI was 0.467-0.742). The calibration curve showed good consistency between the model predictions and the observed results. The Hosmer-Lemeshow goodness-of-fit test showed that χ ² = 4.668, P = 0.792. DCA analysis showed that when the risk threshold was 0-0.8, the net benefit rate was greater than 0, which was significantly better than that of SOFA score. CONCLUSIONS The risk prediction model for the timing of ECMO initiation, constructed using five factors (age, direct cause of ECMO initiation, thrombin time, serum creatinine, and D-dimer), demonstrated good discrimination and calibration. It can serve as a pre-initiation assessment tool to identify and predict post-initiation mortality risk in ECMO patients.
Humans ; Extracorporeal Membrane Oxygenation ; Middle Aged ; Male ; Female ; Retrospective Studies ; Adult ; Risk Factors ; Adolescent ; Young Adult ; Logistic Models ; Nomograms ; ROC Curve ; Time Factors ; Risk Assessment