To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

Objective:To explore the efficacy and adverse reactions of nimotuzumab combined with induction chemotherapy (IC) based on albumin-bound paclitaxel plus cisplatin (TP regimen) for patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC).Methods:Clinical data were collected from 65 patients with LA-HNSCC (stages Ⅲ/Ⅳ A/Ⅳ B; excluding nasopharyngeal carcinoma) who received 2-3 cycles of IC followed by concurrent chemoradiotherapy (CRT) in the Second Hospital of Dalian Medical University from January 2018 to June 2022. Based on the IC regimen, these patients were categorized into a nimotuzumab combined with TP (Nimo-TP) group ( n = 34) and a TP group ( n = 31), and their short-term efficacy [i.e., the objective response rate (ORR)], survival outcomes [e.g., overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS)], and adverse reactions were compared. Additionally, factors affecting their survival outcomes were analyzed. Results:There were statistically significant differences in 1- and 2-year DMFS between both groups (90.4% vs. 69.5%, 90.4% vs. 66.0%, χ2=1.81, P < 0.05), so did the ORRs after IC and CRT of both groups (after IC: 67.6% vs. 41.9%, χ2=4.34, P = 0.037; after CRT: 88.2% vs. 67.7%, χ2=4.03, P = 0.045). However, there was no statistically significant difference in the 2-year OS, PFS, and LRFS between both groups ( P > 0.05). Multivariate analysis revealed that nimotuzumab combined with TP-based IC served as an independent prognostic factor for DMFS ( HR = 0.27, 95% CI: 0.07-0.97, P = 0.045), while complete/partial response after IC acted as an independent prognostic factor for both PFS and local relapse-free survival ( HR = 0.36, 95% CI: 0.17-0.76, P = 0.008; HR = 0.28, 95% CI: 0.11-0.69, P = 0.006). Notably, adding nimotuzumab did not aggravate the adverse reactions in the patients during IC and CRT( P > 0.05). Conclusions:Nimotuzumab combined with TP-based induction chemotherapy followed by CRT significantly improved the DMFS of LA-HNSCC patients, exhibiting high safety. However, such therapy failed to significantly improve their OS, PFS, and LRRFS, and, thus, further research is required.

BACKGROUND: The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts. METHODS: Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts. RESULTS: In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use. CONCLUSIONS Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.
Humans ; Arthritis, Psoriatic/drug therapy* ; East Asian People ; Enthesopathy/complications* ; Registries ; Severity of Illness Index ; Spondylarthritis/epidemiology*

Objective:To observe the effect of Naringin on neuronal apoptosis in mice with memory consolidation disorderinduced by sodium nitrite.Methods:Fifty mice were randomly divided into blank group, model group, standardized protocol group, high-dose Naringin group and low-dose Naringin group, with 10 mice in each group. The standardized protocol group was given Donepezil 1 mg/kg, the Naringin high and low dose groups were gavaged with Naringin solution 100 and 50 mg/(kg·d), blank group and model group were gavaged with equal volume of distilled water once a day for 21 days. The model was established on the 22nd day. The blank group was intraperitoneally injected with normal saline, and the other groups were intraperitoneally injected with 100 mg/(kg·d) sodium nitrite solution for 7 days. The cognitive ability of mice in each group was evaluated by platform jumping test, and the hippocampal synaptic structure was observed by electron microscope. The contents of acetylcholine (ACh), SOD, MDA and NO in hippocampus and the activity of choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) was detected by ELISA. The expression of N-methyl-D-aspartate receptor (NMDAR), glutamine receptor 2 (GluR), calcium/calmodulin dependent protease Ⅱ (CaMK Ⅱ), Caspase-3, Bcl-2 and Bad proteins in hippocampus of model mice were detected by Western blot.Results:The number and morphology of hippocampal neurons were normal, nucleus, mitochondria, rough endoplasmic reticulum and synaptic membrane of hippocampal neurons in high-dose Naringin group were clear. Compared with the model group, the latency of mice in the high-dose Naringin group was prolonged and the number of errors was reduced ( P<0.01). The levels of MDA and NO in hippocampus of mice in the high-dose Naringin group significantly decreased ( P<0.01), and the activity of SOD significantly increased ( P<0.01). The content of ACh (23.682 ± 2.835 μg/mg prot vs. 14.939 ± 2.901 μg/mg prot), ChAT (163.302 ± 21.278 U/g vs. 89.612 ± 11.497 U/g) increased, AChE (0.367 ± 0.015 U/mg prot vs. 0.471 ± 0.014 U/mg prot) activity decreased ( P<0.01); The expression of Bad (0.441 ± 0.010 vs. 0.633 ± 0.010), Caspase-3 (0.425 ± 0.036 vs. 0.537 ± 0.024) significantly decreased, and the expression of Bcl-2 (0.890 ± 0.014 vs. 0.727 ± 0.009) significantly increased ( P<0.01); The expression of CAMKⅡ (1.043 ± 0.037 vs. 1.475 ± 0.043) significantly decreased ( P<0.01), and the expression of NMDAR1 (0.407 ± 0.037 vs. 0.345 ± 0.012), GluR2 (1.125 ± 0.033 vs. 0.664 ± 0.023) significantly increased ( P<0.01). Conclusion:Naringin could play the role of protecing the neuron and improving the cognition of mice with memory consolidation disorder by regulating the balance of ACh and glutamate system and reducing neuronal apoptosis and antioxidant stress.

Objective:To study clinical and genetic factors for early phase gastric mucosal injury due to long-term aspirin use in elderly people treated with angiotensin-converting enzyme inhibitors(AVCEI)/angiotensin II AT-1 receptor blockers(ARB)or statins.Methods:Four hundred and sixty-seven elderly persons taking 100 mg aspirin per day for a long time combined with ACEI/ARB or statins in our hospital were enrolled and retrospectively analyzed.According to endoscopy results, patients were divided into the normal gastric mucosa group(n=125), chronic gastritis group(n=199)and gastric mucosal erosion group(n=143). Clinical features and SLCO1B1 genetic polymorphisms affecting the absorption of ACEI/ARB and statins were statistically analyzed.Results:Compared with the normal gastric mucosa group, reduced glomerular filtration rate(GFR)was a risk factor for chronic gastritis and gastric mucosal erosion[(66.5±24.4) ml·min·1.73 m -2vs.(70.9±18.5) ml·min·1.73 m -2, OR=5.06, 95% CI: 2.14-11.51, P<0.01]. Advanced age[(78.5±10.1) years old vs.(71.5±9.6) years old, OR=1.33, 95% CI: 1.04-2.87, P<0.05], history of peptic ulcer[14.0% or 20/143 vs.5.6% or 7/125, OR=2.41, 95% CI: 1.08-5.01, P<0.05], no prescription of proton pump inhibitor[18.2% or 26/143 vs.50.4% or 63/125, OR=0.18, 95% CI: 0.11-0.31, P<0.01], lower GFR[(55.8±23.1) ml·min·1.73 m -2vs.(70.9±18.5) ml·min·1.73 m -2, OR=8.04, 95% CI: 3.02-22.6, P<0.01]and SLCO1B1*1b diplotype[42.0% or 60/143 vs.24.0% or 30/125, OR=2.64, 95% CI: 1.59-4.17, P<0.05]were risk factors for gastric mucosal erosion. Conclusions:The SLCO1B1*1b diplotype may increase the risk of gastric mucosal erosion induced by aspirin via weakening the protective effects of ACEI/ARB and statins on the gastric mucosa.Advanced age, a history of peptic ulcer, no prescription of proton pump inhibitors and renal function decline are risk factors for gastric mucosal injury.

OBJECTIVE： To investigate the effects of total flavonoids from Psidium guajava leaves （GLTF） on the related factors for estrogen-associated receptor γ（ERRγ）/cyclic adenosine monophosphate responsive element binding protein H（CREBH）pathway in liver of type 2 diabetes mellitus（T2DM）model mice， and to investigate the specific mechanism of its hypoglycemic effect. METHODS： Healthy male ICR mice were collected. T2DM models were established by high-sugar and high-fat diet feeding combined with repeated intraperitoneal injection of low dose streptozotocin. According to the blood glucose value， model mice were randomly divided into model group， metformin group（positive control， 0.17 g/kg），Xiaoke jiangtang capsule group（positive control， 0.75 g/kg），GLTF low-dose and high-dose groups（0.047， 0.094 g/kg）， with 12 mice in each group. Another 12 normal mice were included in normal group. Except that normal group and model group were given constant volume of water intragastrically， other groups were given relevant solution 10 mL/kg intragastrically， qd， for consecutive 21 d. After administration， fasting blood glucose and serum insulin levels of mice were measured and insulin sensitivity index （ISI） was calculated. Histopathological changes of liver and pancreas were observed by HE staining. The protein expressions of ERRγ and CREBH in liver tissues were detected by immunoblotting. The mRNA expression of peroxisome proliferator-activated receptor-γ coactivator-1α（PGC1α）and CREB protein co-activator 2（TORC2）in liver tissue of mice were measured by RT-PCR. RESULTS： Compared with normal group， the levels of fasting blood glucose and serum insulin in T2DM mice were significantly increased in model group， while ISI was decreased significantly （P＜0.01）. The pathological changes of liver tissue were obvious and a large number of vacuoles could be seen. The number and volume of islets in pancreatic tissue decreased， and islet cells showed mild vacuolar lesions. The protein expression of ERRγ and CREBH， mRNA expression of PGC1α and TORC2 in liver tissue were increased significantly （P＜0.01）. Compared with model group， above blood glucose， insulin indexes and pathological changes were improved significantly in GLTF groups. Protein expression of ERRγ and CREBH， mRNA expression of PGC1α and TORC2 in liver tissue were decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS： GLTF showed obvious hypoglycemic effect on T2DM model mice； its mechanism might be related to inhibiting ERRγ/CREBH signaling pathway.

Objective To study the effect of Shenlingbaizhu Pills on hyperlipidemia and gut microbiota in guinea pigs, providing data support for the treatment of hyperlipidemia from the " spleen" . Methods Guinea pigs were randomly divided into control group, model group, ezetimibe group, Shenlingbaizhu Pills high and low dose groups, with 12 guinea pigs for each group. Guinea pig models of hyperlipidemia were established with high fat diet for 8 weeks. Oral administration of the drug began at the fifth week and continued for 4 weeks. The serum lipid levels of guinea pigs were determined after final administration. The pathological changes of liver tissue were observed by HE staining. The mRNA expression levels of ATP binding cassette ( ABC ) A1 in liver, Niemann Pick C1 like 1 ( NPC1L1) and ABCG5/8 in small intestine were detected by realtime PCR. 16S rDNA sequencing was used to detect changes of gut microbiotas in guinea pigs. Results Shenlingbaizhu Pills significantly reduced the serum triglyceride, total cholesterol, and low density lipoprotein-cholesterol levels in guinea pigs with hyperlipidemia ( P＜0. 01 or P＜0.05). The pathological degree of fatty liver was improved obviously by Shenlingbaizhu Pills. Shenlingbaizhu Pills could reduce the mRNA expression level of NPC1L1 of small intestine and increase the level of liver ABCA1 and small intestine ABCG5/8 (P＜0.01 or P＜0.05). At the phylum level, Shenlingbaizhu Pills could reduce the proportion of verrucomicrobia of guinea pigs in model group (P＜0.01); At the genus level, Shenlingbaizhu Pills could increase the proportions of erysipelotrichaceae＿unclassified, ruminococcus＿1, and ileibacterium of guinea pigs in model group (P＜0. 01 or P＜0. 05 ), reduce the proportion of akkermansia and eubacterium＿coprostanoligenes＿group ( P＜0.01). Conclusion Shenlingbaizhu Pills had significantly therapeutic effect on hyperlipidemia, and its specific mechanism was related to the regulation of cholesterol transport and intestinal flora.

Objective To explore the inhibitory effect of captopril on acute radiation-induced lung injury in rats and the possible mechanism. Methods Sixty-four female Wistar rats were randomly divided into control group, irradiation group, irradiation+low-dose captopril group, and irradiation+high-dose captopril group. A single dose of 20 Gy was given to the right lung of all rats except those in the control group to establish a rat model of acute radiation-induced lung injury. These rats were sacrificed at 1, 2, 4, and 8 weeks. HE staining was used to observe the pathological changes in lung tissue;RT-PCR and Western blot were used to measure the mRNA and protein expression of CCL-2 in lung tissue;immunohistochemical assay was used to determine the number of monocytes ( CD68 ) in lung tissue. A one-way analysis of variance was performed. Results Captopril significantly reduced lung inflammation in rats with acute radiation-induced lung injury (P<005), inhibited the accumulation of monocytes (CD68) in lung tissue (P<005), and decreased the content of CCL-2 in lung tissue ( P<005 ) . Conclusions For rats with acute radiation-induced lung injury, captopril can reduce the expression of CCL-2 to inhibit the accumulation of monocytes in lung tissue and thus attenuate lung inflammation.

Objective To explore the feasibility of establishing a swine model of liver cirrhosis with portal hypertension by portal infusion of 80％ alcohol.Methods A total of 13 Guizhou miniature pigs were randomly divided into three groups,experiment group 1 (n=5),experiment group 2 (n=5) and control group (n=3).Experiment groups of pigs received portal infusion of 80％ alcohol in volumes of 5 ml in group 1,and 10 ml in group 2,and the pigs in control group received portal perfusion of saline in volumes of 10 ml.All animals were performed direct portal angiography,the portal vein pressures and diameter were also detected before,immediately and 6 weeks after the infusion.All animals underwent liver biopsies before and 6 hours,1-6 weeks after operation.And contrast-enhanced abdominal CT was performed before and 6 weeks after operation.All animals were dissected 6 weeks after operation,aud each leaf of liver specimens were performed histological examination.Results There was no statistically significant difference of the portal venous pressure and diameter before infusion and 6 weeks after infusion in the experiment group 1 and control group (all P＞0.05).In the experiment group 2,compared with pre infusion,the portal vein pressure and diameter were higher than those of immediately and 6 weeks after infusion (all P＜0.05).In both experiment group 1 and group 2,all pigs had developed into liver fibrosis,the METAVIR score of 2 pigs in group 1 and 5 pigs in group 2 respectively were up to grade 4.Conclusion Portal infusion of 80％ alcohol is more suitable for establishing a swine model of liver cirrhosis with portal hypertension.

Objective To evaluate the interventional of bare-handed core muscle strength training and the sling exercise therapy (SET) on low back pain.Methods The soldiers of an Air Force Station who suffered from low back pain participated in the study.One hundred and forty-four patients were equally divided into three groups: the core muscle strength group (using core muscle strength training and the general physical therapy), the SET group (using SET and general physical therapy), and the control group (using the general physical therapy).All the groups were tested for 6 weeks.Questionnaires were distributed to the three groups before intervention, two weeks, four weeks and six weeks after intervention in order to find out about the degree of LBP, lumbar function and activity of these cases.Changes in the lumbar muscle strength were observed.Results The number of the patients who completed the test included 43 cases in the bare-handed core muscle strength group, 43 cases in the SET group and 44 cases in the control group, respectively, the VAS scores were 3.25, the Roland scores were 5.83,the FFD scores were 8.58 of the bare-handed core muscle strength group;the VAS scores were 3.30, the Roland scores were 5.93,the FFD scores were 8.10 of the SET group;the VAS scores were 2.41, the Roland scores were 3.03,the FFD scores were 7.40 of the control group.The LBP intervention efficiency of the three groups was 90.90%, 85.13% and 46.82%, respectively.There was no significant difference in indexes between the test groups(P>0.05).But compared with the control group,there was significant difference(P<0.05).Conclusion The bare-handed core muscle strength training and SET have obvious effects on LBP cases.According to their own infrastructure and facilities, military health care organizations in different environments can intervene in LBP cases with the bare-handed core muscle strength training or SET to alleviate the pain effectively.