Objective:To investigate the effect of astragaloside IV (AS-IV) regulating the signal axis of stromal cell-derived factor-1α (SDF-1α)/CXC chemokine receptor 4 (CXCR4) on the mobilization of bone marrow endothelial progenitor cells (EPCs) to peripheral blood in diabetes skin ulcer (DSU) rats.Methods:Twenty four SPF grade male Sprague Dawley (SD) rats were selected to make the model of type 2 diabetes rats by intraperitoneal injection of 30 mg/kg 1% (plastid ratio) streptozotocin, and then round full-thickness skin with a diameter of 2 cm was cut on both sides of the waist and back to make the skin ulcer model of diabetes rats. After that, they were randomly divided into AS-IV group (50 mg/kg AS-IV), blocker group (50 mg/kg AS-IV+ 5 mg/kg AMD3100) and model group. At the same time, a blank group ( n=8) was set up, The drug was administered via intraperitoneal injection, and the model group and blank group were treated with 0.9% NaCl of equal volume. On the 10th day, peripheral blood, femoral bone marrow, and wound neovascularization tissues of rats were collected. The number of EPCs in peripheral blood of each group of rats was measured by flow cytometry, and the protein expression of SDF-1α and CXCR4 in peripheral blood, femoral bone marrow, and wound neovascularization tissues of rats was detected by enzyme-linked immunosorbent assay (ELISA); At the same time, the wound healing rates of each group were tested. Results:On the 10th and 21st day after modeling, the wound healing rate of each group of rats was compared. The blank group healed the fastest, while the model group healed the slowest. The AS-IV group had better healing than the model group and the blocker group, and the difference was statistically significant (all P<0.05). On the 10th day after modeling, the positive rates of peripheral blood EPCs in the white group, AS-IV group, and blocker group were significantly higher than those in the model group (all P<0.05), while the positive rates of peripheral blood EPCs in the blocker group were significantly lower than those in the AS-IV group (all P<0.05). On the 10th day after modeling, the protein expression of SDF-1α and CXCR4 in the wound, serum, and bone marrow of the model group was the lowest, while the protein expression in the blank group was the highest (all P<0.05). The protein expression of SDF-1α and CXCR4 in the wound, serum, bone marrow of the AS-IV group was significantly higher than that of the blocker group and model group, and the difference was statistically significant (all P<0.05). Conclusions:Astragaloside IV can promote the mobilization and migration of endothelial progenitor cells from bone marrow to peripheral blood in diabetes ulcer rats by regulating SDF-1α/CXCR4 signal axis, and can participate in angiogenesis of diabetes ulcer wounds as seed cells to promote the healing of diabetes skin ulcers.

Objective:To evaluate the efficacy and safety of discriminative application of Chinese patent medicines in female patients after percutaneous coronary intervention (PCI) due to acute coronary syndrome (ACS).Methods:The study population was from the Chinese Patent Medicine (CPM) trial. CPM trial was a multicenter prospective cohort study, which enrolled patients from 40 centers in mainland China between February 2012 and December 2015, with the discriminative use of Chinese patent medicines as the exposure factor. Female patients with ACS after PCI who completed 36-month follow-up were included in this analysis, and were divided into a conventional treatment group (using conventional western medicine recommended by the guidelines) and a group with the discriminative use of proprietary Chinese medicines (on the basis of conventional western medicine treatment, discriminative use of Qishen Yiqi dropping pills for Qi deficiency and blood stasis syndrome, Guanxin Danshen dropping pills for blood stasis syndrome, and Danlou tablets for phlegm and blood stasis syndrome combined with the conventional western medicine). The primary endpoint event was a composite endpoint event including cardiovascular death, nonfatal myocardial infarction, and emergency revascularization surgery. Secondary endpoint events were composite endpoint events including readmission for ACS, heart failure, stroke, and other thrombotic events. Adverse events were collected. Cox proportional risk model was used to assess the effect of discriminatory application of Chinese patent medicine on endpoint events, and sensitivity analysis was performed by comparing the results with propensity score matching analysis.Results:A total of 748 female ACS post-PCI patients were included in the analysis, aged (63.2±8.3) years. There were 370 patients in the group of discriminative application of Chinese patent medicines and 378 patients in the conventional treatment group. There were 37 cases (10.0%) and 58 cases (15.3%) of primary endpoint events in the discriminatory application of Chinese patent medicines group and the conventional treatment group, respectively. Cox analysis showed that the risk of primary endpoint in the discriminatory application of Chinese patent medicines group was lower than that in the conventional treatment group after adjusting for confounding factors (adjusted HR=0.62, 95% CI 0.40-0.96, P=0.031). There were 38 (10.3%) and 57 (15.1%) cases of secondary endpoint events in the two groups, respectively. Cox regression analysis showed that the risk of secondary endpoint events in the discriminatory application of Chinese patent medicine group was lower than that in the conventional treatment group after adjusting for confounders (adjusted HR=0.56, 95% CI 0.37-0.87, P=0.001). The results of propensity score matching analysis also showed that Chinese patent medicines based on discriminatory application could reduce the risk of primary endpoint ( HR=0.62,95% CI 0.40-0.97 ,P=0.033) and second endpoint ( HR=0.56, 95% CI 0.37-0.87, P=0.009) significantly. There was no significant difference in adverse events between the two groups (12.4% (46/370) vs. 10.3% (39/378), P=0.362). Conclusion:On the basis of conventional western medicine treatment, discriminatory application of Chinese patent medicines can reduce the risk of endpoints in female patients after PCI due to ACS without significant adverse effects.

Objective:To evaluate the effect of online and offline blended teaching in microendodontics, attempting to promote the widespread application of blended teaching mode in Operative Dentistry and Endodontics.Methods:A questionnaire survey was carried out among 865 trainees who attended the blended teaching in microendodontics combined the online theory curriculum and offline practice training from April 6 to 28 in 2022, organized by Department of Operative Dentistry and Endodontics, Hospital of Stomatotogy, Sun Yat-sen University. The content of questionnaire included trainees′ basic information as well as their perspectives and expectations on the teaching mode. Data was analyzed by SPSS 24.0 and Chi-square test was used for enumeration data.Results:A total of 855 trainees participated in the valid survey with the effective recall rate of 98.8% (855/865), 50.3% (430/855) of which were young people in 18-30 years old. Their working period ranged from 0.5 to 40 years. Physicians and physician assistants occupied 40.9% (350/855) and 32.9% (281/855), respectively. And the intermediate and senior titles accounted for 26.2% (224/855). The proportion of trainees who had used and never used dental operative microscope (DOM) were 70.5% (603/855) and 29.5% (252/855), respectively. The blended teaching in microendodontics was universally approved by the trainees, which showed more superiority in the improvement of learning efficiency and interest, comprehension of knowledge as well as practical ability, etc., compared to the traditional offline teaching. For the current stomatology education, trainees were inclined to choose the blended teaching mode combining online theory curriculum and offline practice training, whereas 41.3% (353/855) and 39.6% (339/855) of trainees agreed that the teaching effectiveness was likely influenced by the condition and frequency of the offline training, respectively. Besides, significant differences were detected in the question about the factors affecting the blended teaching effectiveness of microendodontics between the trainees who had used and not used DOM (χ2=13.37, P=0.004). Conclusions:The application of online and offline blended teaching in microendodontics was affirmed to have some advantages, and it should be considered that the discrepancy in the level of expertise among trainees probably influenced the teaching effectiveness, which may promote the quality and effect of teaching, the spread and sharing of microendodontics, and provide experience and reference for the practice teaching of Operative Dentistry and Endodontics.

Objective:To explore the risk factors for malnutrition after a tracheotomy and to construct a predictive model useful for its prevention through early intervention.Methods:Clinical data describing 440 tracheotomy patients were subjected to a retrospective analysis. The variables examined were age, sex, etiology, Glasgow Coma Score (GCS), activities of daily living (ADL) score, age-corrected Charlson comorbidity index (aCCI), food intake, swallowing function, incidence of infections, as well as any history of diabetes mellitus, hypertension, smoking or alcohol consumption. Patients identified as being at risk of malnutrition (NRS-2002≥3) were screened using the Nutritional Risk Screening tool (NRS-2002) and the European Society of Clinical Nutrition and Metabolism′s ESPEN2015 criteria. The subjects were thus categorized into a malnutrition group of 343 and a control group of 97. Unifactorial and multifactorial logistic regression analyses were performed, and stepwise regression was applied to include the factors found significant in the unifactorial analysis into the multifactorial logistic regression analysis, and to construct a column-line graph prediction model. The clinical utility of the model was assessed by applying the receiver operator characteristics (ROC) curves, calibration plots and decision curve analysis (DCA).Results:Of the 440 persons studied, 343 (78%) were malnourished. The multivariate logistic regression analysis showed that pulmonary infection, dysphagia, low GCS score and high aCCI score were significant risk factors for malnutrition after a tracheotomy. A prediction nomograph was constructed. After fitting and correcting, the area under the curve (AUC) of the prediction model′s ROC curve was 0.911, the specificity was 80.4%, and the sensitivity was 91.3%. That was significantly higher than the AUCs for pulmonary infection (0.809), dysphagia (0.697), aCCI (0.721) and GCS (0.802). Bootstrap self-sampling was used to verify the model internally. After 1000 samples the average absolute error between the predicted risk and the actual risk was 0.013, indicating good prediction ability. The DCA results demonstrated that the model has substantial clinical applicability across a range of nutritional interventions, particularly for threshold probability values ranging from 0 to 0.96.Conclusion:Pulmonary infection, dysphagia, low GCS score, and high aCCI score are risk factors for malnutrition among tracheotomy patients. The nomogram model constructed in this study has good predictive value for the occurrence of malnutrition among such patients.

Objective To investigate the effects of clearing meibomian gland ducts prior to cataract surgery on the gland dysfunction and dry eye induced by surgery.Methods A prospective,randomized controlled trial was conducted on 110 patients(110 eyes)undergoing elective cataract surgery for senile cataract in our department from June 1,to December 31,2021.The participants were randomly allocated into treatment(n=56)and control(n=54)groups.The patients from the treatment group were given eyelid compresses and cleaning to remove an obstructed meibum in 1 week prior to cataract surgery,while those from the control group received no such treatment.Ocular surface disease index(OSDI),indicators related to meibomian gland function,including tear film lipid layer thickness(LLT),meibomian glands yielding liquid secretion(MGYLS),meibomian glands yielding secretion score(MGYSS),and tear film break-up time(TBUT)before,and 1 and 3 months after surgery were employed to evaluate the efficacy of clearing meibomian gland ducts.Results The control group exhibited significantly decreased MGYLS(P＜0.05),increased MGYSS(P＜0.01),thinner LLT(P＜0.01),shorter TBUT,worsened dry eye symptoms,and elevated OSDI score(P＜0.05)in 1 month after surgery.Conversely,the treatment group showed significantly improved MGYLS(P＜0.01),decreased MGYSS(P＜0.01),thicker LLT,extended TBUT,and improved subjective outcomes reported on OSDI.Conclusion Our preoperative meibomian gland treatment prior to cataract surgery may be a safe and effective intervention for relieving dry eye and meibomian gland dysfunction induced by surgery.

Objective:To compare the effects of leukocyte-poor platelet-rich plasma (Lp-PRP) and leukocyte-rich platelet-rich plasma (Lr-PRP) on dorsal wound healing in rats.Methods:Thirty-six male Sprague-Dawley rats were randomly divided into Lp-PRP group, Lr-PRP group and control group, each containing twelve rats. Venous blood was drawn and the Lp-PRP and Lr-PRP were prepared separately using a centrifugal method. Circular full-thickness skin defect wounds (15 mm in diameter) were created on the backs of the rats in the three groups. The wounds were then treated with 100 μl Lp-PRP, Lr-PRP and saline, respectively. At 7 and 14 days post-operation, the wounds were photographed, and Image J software was used to calculate the wound area rate (postoperative wound area/wound area at modeling time × 100%). At 14 days post-operation, the total neo-epithelium length and collagen deposition rate of the wounds were evaluated using HE and Masson staining, respectively. At 7 days post-operation, the relative expression of vascular endothelial growth factor (VEGF) in the wounds was detected by Western blotting, and the number of CD31 positive microvessels in the wounds was examined by immunohistochemistry. Statistical analysis was performed using SPSS 28.0. One-way analysis of variance (ANOVA) was used to compare the three groups, and Tukey’s test was used for pairwise comparisons. A significance level of P<0.05 was considered statistically significant. Results:Blood analysis revealed that the platelet concentrations in the prepared Lp-PRP and Lr-PRP were 4.1 times and 4.5 times that of whole blood, respectively ( P<0.01), with no significant difference between the two PRPs ( P>0.05). The leukocyte concentration in Lp-PRP was undetectable, while in Lr-PRP, it was 3.5 times that of whole blood ( P<0.01). The wound area rate at 7 and 14 days post-operation, the total neo-epithelium length and collagen deposition rate at 14 days post-operation, as well as the relative expression of VEGF and the number of CD31-positive microvessels at 7 days post-operation in the Lp-PRP and Lr-PRP groups were superior to those in the control group (all P<0.01). However, there was no significant difference between the two PRP groups (all P>0.05). Conclusion:Both Lp-PRP and Lr-PRP promote dorsal wound healing in rats by enhancing re-epithelialization, collagen deposition, and angiogenesis. The impacts of Lp-PRP and Lr-PRP on promoting wound healing are comparable and not influenced by the presence of leukocytes in PRPs.

Objective To investigate the therapeutic mechanism of Pterocarya hupehensis Skan total flavonoids(PHSTF)for rheumatoid arthritis(RA).Methods Twenty-five male SD rats were randomly divided into normal control group,RA model group,PHSTF treatment(45 and 90 mg/kg)groups,and Tripterygium glycosides(TPG)tablet(10 mg/kg)group(n=5).Except for those in the normal control group,all the rats were subjected to collagen-induced arthritis(CIA)modeling using a secondary immunization method,after which PHSTF and TPG were administered via gavage once daily for 4 weeks.After the treatments,serum levels of TNF-α and IL-1β were measured using ELISA,and ankle joint pathologies were assessed with HE staining;the expression of citrullinated histone H3(Cit-H3),a neutrophil extracellular trap(NET)marker,in the ankle joints was evaluated with immunohistochemistry.In primary cultures of rat peripheral blood neutrophils stimulated with phorbol ester(PMA),the effects of PHSTF(100 and 200 μg/mL)on the expressions of Cit-H3,peptidylarginine deiminase 4(PADI4),neutrophil elastase(NE),and myeloperoxidase(MPO)were examined with Western blotting;immunofluorescence assay was used to observe Cit-H3 expression and NET formation in the cells.Results In the CIA rat models,PHSTF significantly alleviated ankle swelling,decreased serum levels of TNF-α and IL-1β,improved histopathological changes in the ankle joints,and reduced Cit-H3 expression in both the serum and ankle joint cartilage.In the isolated rat neutrophils,PHSTF showed no significant effect on cell viability but strongly inhibited PMA-induced NET release.Conclusion PHSTF can alleviate RA by inhibiting the formation of NETs.

Objective To explore clinical effect of Jiawei Sangju decoction combined with oseltamivir in the treatment of influenza B complicated with benign acute childhood myositis(BACM).Methods Sixty children with influenza B complicated with BACM hospitalized in the Department of Pediatrics,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2021 to January 2024 were selected and divided into control group and study group according to random number table method,with 30 cases in each group.The control group was treated with oseltamivir,and the study group was treated with Jiawei Sangju decoction combined with oseltamivir.The clinical efficacy,symptom improvement time and aspartate transaminase(AST),alanine transaminase(ALT),creatine kinase(CK),creatine kinase isozyme(CK-MB),lactate dehydrogenase(LDH)and myoglobin(Mb)before and after treatment were compared between two groups.Results After treatment,the total effective rate of study group was significantly higher than that of control group(χ2=5.455,P=0.020).The duration of fever and leg pain relief in study group were significantly shorter than those in control group(P<0.05).After 5 days of treatment,the levels of AST,CK,CK-MB,LDH and Mb in two groups were significantly lower than before treatment(P<0.05),and the levels of AST,CK,CK-MB,LDH and Mb in study group were significantly lower than those in control group(P<0.05).Conclusion Jiawei Sangju decoction combined with oseltamivir can improve the symptoms of influenza B with BACM,reduce the levels of muscle enzyme and Mb,and have a positive effect on the prognosis of children.

Objective To observe the therapeutic effect and mechanism of Guhuaisi Kangfu Pills on rats with steroid-induced osteonecrosis of the femoral head(SONFH).Methods Sixty rats were randomly divided into blank group,model group,Xianling Gubao Capsules group and Guhuaisi Kangfu Pills low-,medium-and high-dose groups,10 rats in each group.Except for the blank group,the SONFH model was established by lipopolysaccharide combined with Glucocorticoid induction method in all other groups of rats.At the end of the intervention,for the femoral head,blood vessel radiography was performed to observe the microvascular changes in the bone marrow,and hematoxylin-eosin(HE)staining and calculation of the empty bone trap rate,Micro-CT scanning analysis,and compression experiments were carried out,and the real-time quantitative polymerase chain reaction(RT-qPCR)was used to detect the gene expressions of phosphatidylinositol 3-kinase(PI3K),protein kinase B(Akt)1,vascular endothelial growth factor(VEGF)and platelet endothelial cell adhesion molecule 1(CD31)in whole blood.Results Compared with the blank group,the blood supply in the femoral head medullary cavity of the model group was poor,the empty bone lacuna rate was increased(P＜0.05),the bone mineral density and bone volume fraction were significantly decreased(P＜0.05),the maximum load and elastic modulus of the femoral head were decreased(P＜0.05),and the mRNA expression levels of Akt1,PI3K,VEGF and CD31 in whole blood were decreased(P＜0.05).Compared with the model group,the blood supply in the femoral head medullary cavity was relatively good,the empty bone lacuna rate was decreased(P＜0.05),the bone mineral density,bone volume fraction,trabecular number and trabecular thickness were significantly increased(P＜0.05),the trabecular separation was significantly decreased(P＜0.05),the maximum load and elastic modulus of the femoral head were increased(P＜0.05),and the mRNA expression levels of Akt1,PI3K,VEGF and CD31 in the whole blood were increased(P＜0.05)in the high-dose group of Guhuaisi Kangfu Pills and Xianling Gubao Capsules group.There was no significant difference in the above indexes between the high-dose group of Guhuaisi Kangfu Pills and the Xianling Gubao Capsules group(P＞0.05).Conclusion Guhuaisi Kangfu Pills improves SONFH in rats,and its mechanism is related to the promotion of VEGF/PI3K/Akt pathway gene expression,thereby promoting angiogenesis.

Objective To investigate the medication rules of tradition Chinese medicine for the treatment of ulcerative colitis(UC)at remission stage by data mining method,thus to provide reference for clinical prescription and medication.Methods The clinical research or medical case report of UC remission treated by Chinese medicine issued in CNKI,Wanfang Data and VIP from July 2000 to December 2022 were retrieved.Excel 2019 was used to analyze the frequency statistics,and the distribution of the nature,flavor and meridian tropism of the prescribed drugs in the included literature.Modeler 18.0 and SPSS Statistics 26.0 were used for association rules and cluster analysis,and Cytoscape 3.9.1 was used to construct the network diagram of the associated drugs.Results A total of 121 articles were included in the analysis,involving 167 drugs,of which 24 drugs were frequently used,mainly including Atractylodis Macrocephalae Rhizoma,Poria,Aucklandiae Radix,Coptidis Rhizoma,Codonopsis Radix,Paeoniae Radix Alba,Coicis Semen,Astragali Radix,Glycyrrhizae Radix et Rhizoma Praeparata cum Melle,Angelicae Sinensis Radix,Citri Reticulatae Pericarpium,and Dioscoreae Rhizoma.According to the therapeutic actions,the drugs were mainly classified into deficiency-supplementing drugs,heat-clearing drugs,qi-regulating drugs,urination-promoting and dampness-percolating drugs,blood-stanching drugs,exterior-relieving drugs,interior-warming drugs,astringent drugs,dampness-resolving drugs,and blood-activating and stasis-resolving drugs.The medicinals were mainly warm,mild and cold in nature,and were sweet,bitter and pungent in flavor.Most of the drugs had the meridian tropism of the spleen,stomach,lung and liver.A total of 25 drug association rules were mined out,and five prescriptions were obtained after cluster analysis.Conclusion The Chinese medicine prescriptions for the treatment of UC remission usually deprive from the classical formulas such as Shenling Baizhu San,Sishen Pills,and Tongxie Yaofang.The compatibility of drugs reflects the thoughts of treating UC remission from the perspective of spleen,and embodies the therapies of strengthening the spleen and removing dampness,promoting qi and regulating blood,and focusing on tonifying ministerial fire and supporting yang in the later stage,which has the characteristics of treating both symptoms and root causes simultaneously by using multiple drugs through multiple methods.