Traditional Chinese medicine （TCM） offers a rich theoretical foundation and clinical experience for the prevention and treatment of cardiovascular-kidney-metabolic syndrome（CKM）， demonstrating unique advantage. Building on previous work in managing diabetes， its complications， and chronic kidney disease， our team has proposed a five-phase evolution theory of "constraint， heat， deficiency， stasis， and toxin" as the core pathogenesis. These phases correspond to the pathological progression of constraint of phlegm-dampness， constraint transforming into heat， heat damaging qi and yin， stasis accumulated in the collateral vessels， and toxin induced by deficiency and stasis. In the prevention and treatment of CKM by TCM， it is emphasized to integrate the concept of "treating disease before it arises" with constitution theory， and incorporate the "2-5-8" prevention and treatment strategy， which combines prevention with treatment， tailors interventions to different phases， and employs comprehensive treatment modalities. Our goal is to leverage TCM's holistic advantages in preventing and treating CKM.

Case-based reasoning is a method of reasoning from experience to solve current problems in the field of cognitive science， which has the advantages of easy acquisition of knowledge， simple operation steps， and the ability to improve the efficiency of reasoning with the growth of experience. Formula-syndrome differentiation is a method of differentiation and treatment based on the scope of the adapted disease， disease mechanism， therapeutic methods， and contraindications of the formula. Analysed from the perspectives of concept， applicable field， and implementation steps， it is believed that the concept of formula-syndrome differentiation belongs to the scope of case-based reasoning， the clinical diagnosis and treatment of traditional Chinese medicine belongs to the applicable field of case-based reasoning， and the steps of formula-syndrome differentiation are consistent with the process of case-based reasoning. Based on the characteristics of case-based reasoning， we analyse the advantages， limitations and problems to be noted in the process of formula-syndrome differentiation， and put forward four strategies to improve the ability of formula-syndrome differentiation， including accumulating experience on formulas and syndromes， cultivating the ability to grasp the main symptoms， accumulating a rule base to improve the ability to modify formulas according to the symptoms， and improving the ability to assess the effect of treatment plans and obtain corresponding feedback， with a view to promoting the clinical application of formula-syndrome differentiation.

Stomach exuberance and spleen deficiency are common pathogenesis of many metabolic diseases. Through analyzing the pathogenesis of stomach exuberance and spleen deficiency， it is believed that its essence is stomach heat and spleen deficiency. Stomach heat includes gastrointestinal heat， spleen and stomach damp-heat， and spleen deficiency is divided into deficiency of spleen yin， deficiency of spleen qi ， and deficiency of spleen yang. It is suggested that the metabolic diseases of stomach-exuberance and spleen-deficiency syndrome can be divided into three categories，i.e. stomach-heat and spleen yin-deficiency， stomach-heat and spleen qi-deficiency， and stomach-heat and spleen yang-deficiency， and the main treatment methods are clearing and draining heat， nourishing yin and moistening intestine， clearing dampness and heat， strengthening spleen and qi， clearing dampness and heat， strengthening spleen and warming yang， respectively， with prescriptions as Maziren Pills （麻子仁丸）， Qinlian Pingwei Powder （芩连平胃散）， and Jiawei Lianli Decoction （加味连理汤） accordingly.

Background: and Purpose Non-high-density lipoprotein cholesterol (non-HDL-C), which represents the total cholesterol content of all pro-atherogenic lipoproteins, has recently been included as a new target for lipid-lowering therapy in high-risk atherosclerotic patients in multiple guidelines. Herein, we aimed to explore the relationship between non-HDL-C level and the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in preventing stroke recurrence. Methods: This study comprised a post hoc analysis of the CHANCE-2 (Ticagrelor or Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II) trial, from which 5,901 patients with complete data on non-HDL-C were included and categorized by median non-HDL-C levels, using a cutoff of 3.5 mmol/L. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days. Results: Ticagrelor-aspirin significantly reduced the risk of recurrent stroke in patients with low non-HDL-C (71 [4.8%] vs. 119 [7.7%]; adjusted hazard ratio [HR] 0.54; 95% confidence interval [CI], 0.40–0.74), but not in those with high non-HDL-C (107 [7.3%] vs. 108 [7.6%]; adjusted HR, 0.88; 95% CI, 0.67–1.16), compared with clopidogrel-aspirin (P for interaction=0.010). When analyzed as a continuous variable, the benefit of ticagrelor-aspirin for recurrent stroke decreased as non-HDL-C levels increased. No significant differences in the treatment assignments across the non-HDL-C groups were observed in terms of the rate of severe or moderate bleeding (5 [0.3%] vs. 8 [0.5%] in the low non-HDL-C group; 4 [0.3%] vs. 2 [0.1%] in the high non-HDL-C group; P for interaction=0.425). Conclusion CHANCE-2 participants with low non-HDL-C levels received more clinical benefit from ticagrelor-aspirin versus clopidogrel-aspirin compared to those with high non-HDL-C, following minor ischemic stroke or transient ischemic attack.

Objective:To analyze the survival time, prognostic factors and the value of postoperative thoracic radiotherapy in resected small cell lung cancer (SCLC) patients.Methods:Clinic opathological data of SCLC patients who received surgical treatment in Cancer Hospital & General Hospital of Ningxia Medical University from April 2014 to September 2021 were enrolled in this retrospective study. All patients were subject to follow-up. The survival time of SCLC patients was evaluated by Kaplan-Meier method. Univariate and multivariate analyses of prognostic factors were performed by Cox proportional hazard model.Results:A total of 64 patients with SCLC were enrolled in the study. The 5-year overall survival (OS) rate was 43.5%. Univariate analysis showed that TNM staging ( P=0.027), postoperative neutrophil-lymphocyte ratio (NLR) ( P=0.039) and adjuvant thoracic radiotherapy ( P=0.041) were the prognostic factors. Multivariate analysis showed that TNM staging ( P=0.038) and adjuvant thoracic radiotherapy ( P=0.022) were the prognostic factors in patients with SCLC. The 5-year OS rates of patients with and without adjuvant thoracic radiotherapy were 71.6% and 35.4% ( P=0.028), respectively. There was a statistically significant difference in the 5-year OS rates between pathological stage N 2 SCLC patients with or without adjuvant thoracic radiotherapy (75.0% vs. 0%, P=0.030). Conclusions:TNM staging and postoperative adjuvant thoracic radiotherapy are prognostic factors in patients with SCLC undergoing surgical treatment. Pathological stage N 2 SCLC patients can benefit from adjuvant thoracic radiotherapy.

Objective:To explore the effect of long-chain fat emulsion in parenteral nutrition therapy on the perioperative nutritional status of patients with low rectal cancer.Methods:A total of 204 patients who underwent rectal cancer surgery in the Third Hospital of Shanxi Medical University from January 2017 to June 2020 were retrospectively analyzed. The patients were divided into two groups according to the specific nutritional treatment methods, 100 cases in the study group used long-chain fat emulsion for parenteral nutrition support, and 104 cases in the control group used medium- and long-chain fat emulsion injection. After admission, the nutritional status of patients were evaluated according to the results of Scored Patient-Generated Subjective Global Assessment (PG-SGA) and related laboratory tests. At 7th day before the operation, the patients were treated with nutrition and electrolyte support. Parenteral nutrition and enteral nutrition combined treatment and early enteral nutrition were given after the operation. The albumin, prealbumin, retinol-binding protein, total cholesterol and body mass index (BMI) at 7th day before the operation, 1st day after the operation and 7th day after the operation and the patient's first exhaust time after surgery, occurrence of postoperative complications, postoperative fever and total hospital stay were recorded and compared between the two groups.Results:Postoperative first exhaust time [(42±11) h vs. (54±10) h], fever time [(48±8) h vs. (57±7) h], total hospital stay [(16.0±0.7) d vs. (18.0±0.9) d)], resting energy expenditure at the 7th day after surgery [(5 326±589) kJ/d vs. (5 840±599) kJ/d] and total cholesterol at the 7th day after surgery [(4.8±0.3) mmol/L vs. (5.0± 0.4) mmol/L] in the study group were lower than those in the control group, and albumin [(33±3) g/L vs. (28± 3) g/L], prealbumin [(0.189±0.041) g/L vs. (0.164±0.037) g/L] and retinol-binding protein [(0.039±0.016) g/L vs. (0.032±0.013) g/L] at the 7th day after surgery in the study group were higher than those in the control group, and the differences between the two groups were statistically significant (all P < 0.05). There was no statistical difference in other detection indexes between the two groups (all P > 0.05). Conclusion:The use of long-chain fat emulsion in low rectal cancer patients with malnutrition during the perioperative period may be more conducive to the recovery of the body.

To explore the correlation between the transluminal attenuation gradient with corrected contrast opacification(TAG-CCO)and the severity of atherosclerotic stenosis in the anterior segment of myocrardial bridge(MB). The imaging data of 200 patients diagnosed with left anterior descending branch(LAD)single MB and coronary atherosclerosis in the anterior segment of MB were retrospectively analyzed.According to MB types,the patients were divided into two groups:incomplete and complete.There were some significant differences in TAG-CCO between patients with the same degree of coronary atherosclerosis(mild,moderate,and severe stenosis)in two groups.The relationships among groups with different degrees(mild,moderate,and severe stenosis)of the same type of MB were further compared. Among 84 patients with complete MB,36,30,and 18 patients had mild,moderate,or severe coronary atherosclerosis in the anterior segment of MB;among 116 patients with incomplete MB,45,42,and 29 patients had mild,moderate,or severe coronary atherosclerosis in the anterior segment of MB.In the complete MB group,the TAG-CCO in the anterior segment of MB subgroups were(-0.0086±0.0014)/10 mm,(-0.0170±0.0180)/10 mm,and(-0.0230±0.0026)/10 mm,respectively,in mild,moderate,and severe subgroups( = 404.728, <0.001).In the incomplete MB group,the TAG-CCO of patients with mild,moderate and severe coronary stenosis in the anterior segment of MB were(-0.0039±0.0011)/10 mm,(-0.0100±0.0140)/10 mm,and(-0.0160±0.0020)/10 mm,respectively,and the difference among the different stenosis groups was statistically significant( = 17.756, < 0.001);the TAG-CCO of patients with mild( = 16.519, < 0.001),moderate( = 2.570, = 0.012)and severe anterior segment coronary stenosis( = 10.714, < 0.001)were significantly lower in the complete MB group than in the incomplete MB group. TAG-CCO is correlated with the MB type and the degree of anterior coronary artery stenosis.Thus,TAG-CCO can be used as a predictive indicator for the degree of atheroscleratic stenosis in the anterior segment of MB.
Atherosclerosis ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Humans ; Retrospective Studies

Objective: To observe the pharmacodynamic effect of Xiaobanxia Decoction (XBXD) and categorized formula on cisplatin-induced delayed chemotherapeutic vomiting in rats, and to explore its prevention and treatment mechanism. Methods: Sixty Wistar rats were randomly divided into blank group, model group, ondansetron group, XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder group, with 10 rats in each group. The ondansetron group was given 2.6 mg/(kg•d) ondansetron, the XBXD group was given XBXD 22 g/(kg•d), the Ginger Pinellia Decoction group was given 31.5 ml/(kg•d) Ginger Pinellia Decoction, and Pinellia and Dried Ginger Powder group was given 0.63 g/(kg•d) Dried Ginger Powder. The blank group and the model group were intragastrically administered with normal saline. All the treattmens were last for three days and twice per day. After the first administration, except the blank group, the rats in all groups were intraperitoneally injected with 6 mg/kg cisplatin to establish chemotherapy-induced vomiting model. The kaolin intake of the chemotherapical rats were weighed every 24 h, and the ileum and medulla 5-HT, 5-HIAA, TPH and MAOA levels were detected by ELISA. Results: Compared with the model group, the kaolin intake of the chemotherapy rats in each treatment group significantly decreased (P<0.05). The levels of ileum 5-HT (308.04 ± 29.90 ng/L, 355.97 ± 19.16 ng/L, 389.97 ± 24.86 ng/L vs. 498.95 ± 13.92 ng/L) and medulla 5-HT (375.32 ± 19.33 ng/L, 395.18 ± 16.12 ng/L, 406.68 ± 12.09 ng/L vs. 478.52 ± 13.88 ng/L) in the XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased (P<0.05). The levels of ileum TPH (35.14 ± 2.68 ng/L vs. 47.31 ± 0.83 ng/L) in the XBXD group significantly decreased (P<0.05). The levels of medulla TPH (33.68 ± 2.79 ng/L, 38.19 ± 1.74 ng/L vs. 43.68 ± 1.53 ng/L) in the Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased (P<0.05). The levels of MAOA, 5-HIAA in the ileum and medulla of the XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased (P<0.05). Conclusions XBXD and categorized formula can effectively prevent and treat delayed chemotherapy-induced vomiting in rats, and its mechanism may be related to decrease the TPH level and inhibiting 5-HT synthesis.

Objective To explore the effect of lncRNA of growth arrest-specific 5 (lncRNA GAS5) on the radiosensitivity of colon cancer cells by targeting miR-223.Methods The expressions of lncRNA GAS5 in a few of colon cancer cell lines were detected by real-time quantitative PCR (qPCR).The cell lines with low expression level of lncRNA GAS5 were selected for subsequent study.The effect of overexpression of lncRNA GAS5 on the radiosensitivity of colon cancer SW480 cells was detected by cell cloning experiments.The target gene miR-223 of lncRNA GAS5 was predicted and validated by the bioinformatics database starBase and dual luciferase reporter assays.qPCR was used to detect the expression of miR-223 in various colon cancer cell lines and the influence of lncRNA GAS5 overexpression on the expression of miR-223 in SW480 cells.Results Compared with normal human colonic epithelial cells (NCM460),the expressions of lncRNA GAS5 in the colon cancer SW480,LOVO,HT-29 and SW620 cell lines were significantly lower(t =15.25,8.69,14.42,11.62,P ＜ 0.05),with the lowest level in SW480 cells.Both overexpression of lncRNA GAS5 and down-regulation of miR-223 significantly increased the radiosensitivity of colon cancer cells by decreasing cell survival fraction (at 8 Gy,lncRNA GAS5,t =13.51,P ＜ 0.05;anti-miR-223,t =14.93,P ＜ 0.05)and promoting apoptosis (lncRNA GAS5,t =8.30,P ＜ 0.05;anti-miR-223,t =7.32,P ＜ 0.05).Bioinformatics analysis showed that the 3'sequence of lncRNA GAS5 contained the binding sites with miR-223.After overexpression or downregulation of lncRNA GAS5,the expression of miR-223 was enhanced or reduced.Conclusions The lncRNA GAS5 promotes the apoptosis of colon cancer cells and inhibits its survival by targeting miR-223 expression,thereby increases the radiosensitivity of colon cancer cells.

Objective To evaluate the effect of immune enhanced enteral nutrition on immune function in postoperative patients with gastric cancer by using meta-analysis. Methods The databases of PubMed, the Cochrane Library, CNKI, CBM, VIP and Wanfang Data were used to search randomized controlled trials (RCT) about the effect of immune enhanced enteral nutrition and conventional enteral nutrition on immune function in postoperative patients with gastric cancer. The retrieval time span was from inception to Sept 1, 2016. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Besides, the meta-analysis was conducted by using RevMan 5.3 software. Results Meta-analysis included 5 RCT, 216 cases in total. The results showed that the immune parameters of immune enhanced enteral nutrition such as IgA (MD=0.18, 95 % CI 0.09-0.27, P< 0.001), IgG (MD= 0.76, 95 % CI 0.43-1.09, P< 0.001), IgM (MD= 0.13, 95%CI 0.07-0.20, P<0.001), CD3 (MD=4.74, 95%CI 2.99-6.48, P<0.001), CD4 (MD=3.6, 95%CI 2.14-5.06, P< 0.001), CD4/CD8 (MD= 0.58, 95 %CI 0.20-0.97, P< 0.003) were significantly higher than those of conventional enteral nutrition after 9 or 10 days of gastric surgery. The CD8 level of conventional enteral nutrition were higher than immune enhanced enteral nutrition after 9 or 10 days of gastric surgery (MD = -1.26, 95 %CI-2.21 - -0.30, P= 0.01). The difference between two groups had no statistical significance in immune parameters such as IgA, IgG, IgM, CD3, CD4, CD8, CD4/CD8 after 1 day of gastric surgery (P>0.05). Regarding to cellular factor, the IL-6 level of immune enhanced enteral nutrition was lower than conventional enteral nutrition after 9 days of gastric surgery (MD=-77.40, 95 %CI-112.25 - -42.55, P< 0.001). The difference between two groups enteral nutrition had no statistical significance about IL-6, TNF-αafter 1 day of gastric surgery, TNF-α, IL-2 after 9 days of gastric surgery (P> 0.05). Conclusion Immune enhanced enteral nutrition for postoperative patients with gastric cancer can improve and enhance the immune function under stress, and reduce the excessive inflammatory reaction, which is more conducive to the safety of patients with gastric cancer.