Psychological factors have become significant contributors to the onset and progression of insomnia. This article explored the treatment of insomnia from the perspective of “liver governs wei qi （defensive qi）”. The concept of “liver governs wei qi （defensive qi）” is summarized in three aspects， firstly， the liver assists the spleen and stomach in transformation and transportation， governing the generation of wei qi； secondly， the liver aids lung qi diffusion and dispersion， governing the distribution of wei qi； thirdly， the liver regulates circadian rhythms， governing the circulation of wei qi. It is proposed that the clinical treatment of insomnia should focus on the following methods： for regulating the liver to harmonize the five viscera， and facilitate the circulation of wei qi， medicinals entering the liver channel include Chaihu （Bupleuri radix）， Baishao （Paeoniae Radix Alba）， Zhizi （Gardeniae Fructus）， and Suanzaoren （Ziziphi Spinosae Semen） could be commonly used； for nourishing the liver， the treatment should align with the day-night rhythm， and herbs such as Baihe （Lilium）， Hehuan （Albizia julibrissin）， and Yejiaoteng （Polygoni multiflori caulis） are commonly used； for soothing the liver and address both mental and physical health to calm wei qi， treatment should advocate verbal counseling， psychological regulation， and health education. Ultimately， this treatment approach can free liver qi to flow， soothe qi movement， restore the motion of wei qi， regulate during day and night， balance yin and yang， and resolve insomnia effectively.

OBJECTIVES: To investigate the expression patterns and prognostic value of lipid metabolism-related genes in breast cancer. METHODS: RNA sequencing data and clinical information were obtained from The Cancer Genome Atlas breast cancer (TCGA-BRCA) dataset, including 1100 breast cancer tissue samples (18 paired with adjacent tissues) and 112 normal breast tissue samples. Differentially expressed lipid metabolism-related genes were screened from a predefined set of 2043 genes using Bioconductor in R, with a false discovery rate <0.05 and |log2(fold change)|>2. Eligible samples were randomly divided into a training cohort (n=651) and a validation cohort (n=431) at a 6∶4 ratio. Prognostic lipid metabolism-related genes were identified using univariate Cox regression (P<0.005) and further refined via LASSO regression. A risk score model was constructed using multivariate Cox regression, and patients were stratified into high- and low-risk groups based on the median risk score. The model's performance was evaluated using Kaplan-Meier survival analysis with the log-rank test and time-dependent receiver operating characteristic (ROC) curves. A nomogram integrating age, TNM stage, clinical grade, and risk score was developed and validated using calibration curves and the concordance index. Immune cell infiltration was quantified using an immune scoring algorithm, and weighted gene co-expression network analysis (WGCNA) was applied to identify key modules associated with immune cell infiltration. Finally, to validate the function of the key gene ALDH2, small interfering RNA targeting ALDH2 was transfected into breast cancer cells, and its effects on invasion and migration were assessed using Transwell invasion and wound healing assays. RESULTS: A total of 185 differentially expressed lipid metabolism-related genes were identified. Univariate Cox and LASSO regression analyses identified three genes-ALDH2, CYP21A2, and IL24-which were incorporated into the multivariate Cox model. The prognostic model based on these genes demonstrated good predictive performance in both cohorts: patients in the high-risk group had significantly shorter overall survival (P<0.01), and the area under the ROC curve for predicting 1-, 3-, and 5-year survival rates was above 0.64. Analysis of the tumor microenvironment revealed an immunosuppressive phenotype in the high-risk group, characterized by reduced infiltration of several anti-tumor immune cells and downregulation of key immune checkpoint molecules such as PDCD1 and CTLA4. WGCNA suggested an association between ALDH2 and immune cell infiltration. Functional experi-ments confirmed that ALDH2 knockdown significantly enhanced the migration and invasion abilities of breast cancer cells. CONCLUSIONS This study established and validated a pro-gnostic model for breast cancer based on lipid metabolism-related genes. It revealed that low ALDH2 expression is closely associated with poor prognosis and immunosuppression, suggesting its potential as a prognostic biomarker and therapeutic target in breast cancer.

Exosomes are a kind of extracellular vesicles,which directly stimulate target cells through receptor-mediated interaction,or exert their biological functions by transferring various bioactive molecules to target cells,playing a key role in intercellular communi-cation between cells and their microenvironment.From the perspective of tissue engineering,pulp regeneration refers to the combination of scaffolds,stem cells,and signaling factors implanted into a properly treated pulp cavity.Under the action of scaffolds and signaling factors,stem cells proliferate and differentiate to form pulp dentin-like complexes,restoring pulp function.In recent years,studies have found that p38MAPK,TGF-β/SMAD,Wnt/β-Catenin signaling pathway and some other signaling pathways are important for the se-cretion in regulating pulp regeneration,and play a key role in pulp regeneration.Therefore,this article reviews the mechanism and re-search progress of signaling pathways related to the regulation of pulp regeneration by exosomes.

Objective To evaluate the effect of different operation methods on the early swallowing function in the patients with laryngocarcinoma.Methods A total of 138 patients with the first time of open laryngectomy in this hospital from January 2021 to December 2022 were selected as the research subjects by convenience sampling method.The patients were divided into the vertical laryngeal resection group(vertical group,n=34),horizontal laryngeal partial resection(horizontal group,26 cases),suprachloroid laryngeal par-tial resection annular hyoid epiglottis fixation group(SCPL-CHEP group,n=26)and total laryngeal resection group(total laryngeal group,n=52)according to the operation methods.The Anderson Dysphagia Scale,Syd-ney Dysphagia Scale and modified swale drinking water test were used to evaluate the swallowing function on the first day of postoperative oral feeding in the patients.Results The total scores and scores of various di-mensions of the Chinese version of Anderson Dysphagia Scale,total scores and scores of various dimensions of Sydney Swallowing Scale and the results of the modified swale drinking water test had statistical differences a-mong the various groups(P＜0.01);the above indexes had statistical difference between the total laryngeal group and the other groups(P＜0.01),but the above indexes had no statistical difference between the two groups in the horizontal group,vertical group and SCPL-CHEP group(P＞0.05).Conclusion In the patients with laryngeal cancer undergoing open laryngectomy,the dysphagia is less severe during early eating after to-tal laryngectomy,which has little impact on life.

The pre-metabolic disease state is the body state of substance metabolism disorder that has not yet reached the physical and chemical indicators of the disease, and abnormal glucose metabolism is often the key link of metabolic disorder. In TCM, the healthy function of the spleen is the cornerstone of the production and distribution of fine substances. This article discussed the pre-metabolic disease state based on the theory of "overflow of Five Qi" in the Nei Jing, taking the loss of spleen preparedness as the starting point, in order to provide new ideas and directions for the prevention and treatment of clinical metabolic diseases.

ObjectiveTo examine the inhibitory effects of berberine compounds， including columbamine， on acetylcholinesterase from the perspectives of drug-target binding affinity and kinetics and explore the blood-brain barrier （BBB） permeability of these compounds in different multi-component backgrounds. MethodThe median inhibitory concentration （IC₅₀） of acetylcholinesterase by berberine compounds including columbamine was measured using the Ellman-modified spectrophotometric method. The binding kinetic parameters （K_off） of these compounds with acetylcholinesterase were determined using the enzyme activity recovery method. A qualitative analysis of the ability of these components to penetrate the BBB and arrive at the brain tissue in diverse multi-component backgrounds （including medicinal herbs and compound formulas） was conducted using ultra performance liquid chromatography-high resolution mass spectrometry （UPLC-HRMS）. ResultBerberine compounds， including columbamine， exhibited strong inhibition of acetylcholinesterase， with IC₅₀ values in the nanomolar range. Moreover， they displayed better drug-target binding kinetics characteristics （with smaller K_off values） than the positive control of donepezil hydrochloride （P<0.01）， indicating a longer inhibition duration of acetylcholinesterase. Berberine components such as columbamine could penetrate the BBB to arrive at brain tissue in the form of a monomer， as well as in the multi-component backgrounds of Coptis and Phellodendri Chinensis Cortex medicinal extracts and the compound formula Huanglian Jiedutang. ConclusionThese berberine compounds such as columbamine exhibit a strong inhibitory effect on acetylcholinesterase and can arrive at brain tissue in multi-component backgrounds. In the level of pharmacological substance， this supports the clinical efficacy of compound Huanglian Jiedutang in improving Alzheimer's disease， providing data support for elucidating the pharmacological basis of compound Huanglian Jiedutang.

Objective We aimed to study the distribution of traditional Chinese medicine(TCM)constitution and related influencing factors in patients with impaired glucose tolerance(IGT).Methods A cross-sectional study method was used to enroll IGT patients who attended one of eight collaborating units across China between January and August 2021.Basic information was recorded,physical and laboratory examinations were completed,and the data on TCM constitution were collected according to the"classification and determination table of TCM constitution."Finally,patient information was entered into an Excel table,and the data were analyzed using SPSS 26.0.Results Among the 450 patients,a balanced constitution accounted for 37.3%,yang-deficiency constitution for 15.6%,phlegm-dampness constitution for 14.4%,and dampness-heat constitution for 10.9%.Among the biased constitutions,the proportion of men with dampness-heat constitution was higher than that of women,and the proportion of women with yang-deficiency constitution and blood stasis constitution was significantly higher than that of men(P<0.05).The triglyceride level of patients with phlegm-dampness constitution was higher than that of patients with yang-deficiency constitution(P<0.05);the HDL-cholestrol level of patients with yang-deficiency constitution was higher than that of patients with phlegm-dampness constitution(P<0.05);and the uric acid level of patients with phlegm-dampness constitution,dampness-heat constitution,or yin-deficiency constitution was higher than that of patients with yang-deficiency constitution,and the UA level was the highest in patients with dampness-heat constitution(P<0.05).Conclusion The distribution of TCM constitution in IGT patients was dominated by balanced constitution,followed by yang-deficiency constitution,phlegm-dampness constitution,and dampness-heat constitution.Gender,blood lipid levels,and UA levels were the main factors affecting the constitution status of IGT patients.

Objective:To develop and evaluate a medical experience assessment scale for debridement and dressing change in chronic wound patients in China, and to provide a reference for improving hospital service quality.Methods:Based on the framework of hospital consumer assessment of healthcare providers and systems survey (HCAHPS) in the United States, a preliminary draft of the scale was formed through a literature review and qualitative interviews with 12 chronic wound patients (7 males and 5 females aged 58.1±12.3 years). Five experts were invited for content validity testing, and 191 chronic wound patients (111 males and 80 females aged 53.5±19.1 years) were selected to evaluate the internal consistency reliability, half reliability, retest reliability, and structural validity of the scale.Results:The Chronic Wound Patient Debridement and Dressing Experience Scale covered 5 dimensions with 30 sub-items and 2 comprehensive evaluation items, including demand response, good and friendly communication, professional trust, optimization of the medical treatment process, and encouragement of patient participation. The scale Cronbach′s α coefficient was 0.967 and ranged from 0.890 to 0.962 for each dimension. The overall retest reliability of the scale was 0.940 and ranged from 0.895 to 0.940 for each dimension. The overall half reliability of the scale was 0.923 and ranged from 0.834 to 0.935 for each dimension. 5 factors were extracted, with a cumulative variance contribution rate of 82.061%.Conclusions:Based on the HCAHPS framework in the United States, the Chronic Wound Debridement and Dressing Experience Scale developed has high reliability and validity, and can be used to evaluate the dressing change experience of patients with chronic wounds. It has clinical practice significance for dressing change in chronic wounds.

Acute high altitude disease (AHAD) is a general term for a series of clinical reactions that occur when the body fails to adapt to the low-pressure hypoxic environment of high altitudes. Mild cases can cause symptoms such as headache, nausea and vomiting, while more severe cases can lead to life-threatening conditions such as pulmonary edema, cerebral edema and other critical conditions that can be fatal. With the increasing demand for high altitudes deployment, understanding the common preventive measures of AHAD can reduce its morbidity or mortality to a certain extent, which is of great benefit to those who reside temporarily at high altitudes. In recent years, as people's health awareness has improved, there has been a growing attention towards non-pharmacological methods of disease prevention. At the same time, non-pharmacological therapy has significant therapeutic effects in preventing and treating high-altitude diseases, which has attracted the attention of researchers in this field. This review summarizes the major non-pharmacological preventive components of modern medicine and outlines the current non-pharmacological approaches to AHAD from the perspective of traditional Chinese medicine, intending to serve clinical purposes and improve the onset and prognosis of AHAD.

Objective:To study the neural mechanism between abnormal brain functional activity and alertness function in temporal lobe epilepsy (TLE) patients with or without hippocampal sclerosis.Methods:A total of 21 TLE patients with hippocampal sclerosis (TLE-HS), and 18 TLE patients without hippocampal sclerosis (TLE-N) diagnosed in the Department of Neurology of the First Affiliated Hospital of Guangxi Medical University from May 2016 to November 2022 and 28 healthy controls (HC) matched with demographic data were recruited.All the 67 participants completed the attention network test (ANT) and resting-state fMRI (rs-fMRI) scans. The REST software was used to analyze fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) based on one-way ANOVA in order to obtain differential brain regions in abnormal spontaneous neuronal activity and functional connectivity among the three groups. The SPSS 26.0 software was used to analyze the correlation between fALFF/FC values in differential brain regions and alertness network efficiency by Pearson correlation analysis.Results:There was a significant difference in the alerting network effect among the three groups ( F=4.621, P=0.013), and the post-hoc analysis showed that the alerting network effect in the TLE-HS group((59.40±22.85)ms)was significantly higher than that in the HC group((38.85±21.08)ms)(Bonferroni correction, P=0.017). The fALFF analysis showed that the fALFF values of the right superior frontal gyrus in the TLE-HS group (0.16±0.52) and the TLE-N group (0.49±0.51) were significantly lower than that in the HC group (1.01±0.46), while the fALFF values of the left precentral gyrus in the TLE-HS group (0.60±0.55) was significantly higher than that in the TLE-N group (-0.19±0.51) and the HC group (-0.15±0.36) (Bonferroni correction, all P<0.05). The functional connectivity analysis revealed that the FC values between the left inferior frontal gyrus and the right superior frontal gyrus in the TLE-HS group (0.11±0.16) and TLE-N group (0.02±0.19) were significantly higher than those in the HC group (-0.18±0.18). The FC values between the right supramarginal gyrus and the right superior frontal gyrus in the TLE-HS group (0.10±0.21) were significantly higher than those in the HC group (-0.18±0.16). The FC values between the left supplementary motor area and the right superior frontal gyrus in the TLE-HS group (0.20±0.21) were significantly higher than those in the TLE-N group (-0.03±0.31) and the HC group (-0.10±0.15) (Bonferroni correction, all P<0.05). The correlation analysis showed that the FC values between the left supplementary motor area and the right superior frontal gyrus in the TLE-HS group were significantly positively correlated with alertness network efficiency ( r=0.436, P=0.048). Conclusions:There are abnormal spontaneous neuronal activity and brain functional connectivity in TLE patients with or without hippocampal sclerosis, and the abnormality is more pronounced in the TLE-HS group. The abnormal brain functional connectivity may play an essential role in alertness dysfunction.