AIM: To explore the therapeutic effect of oral Xuefu Zhuyu Pill combined with intravitreal injection of aflibercept in the treatment of retinal vein occlusion(RVO).METHODS: A total of 80 patients(80 eyes)with RVO admitted to our hospital from January 2021 to March 2024 were prospectively selected. According to the treatment method, they were divided into a control group of 40 patients treated with intravitreal injection of aflibercept, and an observation group of 40 patients treated with oral Xuefu Zhuyu Pill combined with intravitreal injection of aflibercept. The efficacy, TCM syndrome score, retinal microcirculation parameters, macular edema(ME), and adverse reactions were compared between the two groups of patients in the treatment of RVO.RESULTS: All patients have completed follow-up. The clinical effective rate of the observation group after treatment was 95%, obviously higher than that of the control group(80%; χ2=4.114, P=0.043). After treatment for 3 mo, the traditional Chinese medicine syndrome scores, foveal avascular area(FAZ)area, FAZ circumference, macular central retinal thickness, and neovascularization leakage area of both groups decreased, the overall blood flow density of the superficial capillary plexus(SCP)and deep capillary plexuses(DCP)increased, and the observation group showed better results than the control group(all P<0.05). There was no statistically significant difference in the occurrence of adverse reactions between the two groups during the treatment period(P>0.05).CONCLUSION: Oral administration of Xuefu Zhuyu Pill combined with intravitreal injection of aflibercept in the treatment of RVO can improve retinal microcirculation, enhance vision, restore ocular blood circulation, improve bleeding, promote ME absorption, and improve clinical efficacy.

ObjectiveTo investigate the mechanism of Baihuan Xiaoyao Decoction （Xiaoyaosan added with Lilii Bulbus and Albiziae Cortex） in alleviating depression-like behaviors of juvenile rats by regulating the polarization of microglia. MethodSixty juvenile SD rats were randomized into normal control， model， fluoxetine， and low-， medium-， and high-dose （5.36， 10.71， 21.42 g·kg^-1， respectively） Baihuan Xiaoyao decoction groups. The rat model of juvenile depression was established by chronic unpredictable mild stress （CUMS）. The sucrose preference test （SPT） was carried out to examine the sucrose preference of rats. Forced swimming test （FST） was carried out to measure the immobility time of rats. The open field test （OFT） was conducted to measure the total distance， the central distance， the number of horizontal crossings， and the frequency of rearing. Morris water maze （MWM） was used to measure the escape latency and the number of crossing the platform. The immunofluorescence assay was employed to detect the expression of inducible nitric oxide synthase （iNOS， the polarization marker of M1 microglia） and CD206 （the polarization marker of M2 microglia）. Real-time polymerase chain reaction was employed to determine the mRNA levels of iNOS， CD206， pro-inflammatory cytokines ［tumor necrosis factor （TNF）-α， interleukin （IL）-1β， and IL-6］ and anti-inflammatory cytokines （IL-4 and IL-10） in the hippocampus. Western blotting was employed to determine the protein levels of iNOS and CD206 in the hippocampus. The levels of IL-4 and IL-6 in the hippocampus were detected by enzyme-linked immunosorbent assay. ResultCompared with the normal control group， the model rats showed a reduction in sucrose preference （P<0.05）， an increase in immobility time （P<0.05）， decreased motor and exploratory behaviors （P<0.05）， and weakened learning and spatial memory （P<0.05）. In addition， the model rats showed up-regulated mRNA and protein levels of iNOS and mRNA levels of IL-1β， IL-6， and TNF-α （P<0.05）. Compared with the model group， Baihuan Xiaoyao decoction increased the sucrose preference value （P<0.05）， shortened the immobility time （P<0.01）， increased the motor and exploratory behaviors （P<0.05）， and improved the learning and spatial memory （P<0.01）. Furthermore， the decoction down-regulated the positive expression and protein level of iNOS， lowered the levels of TNF-α， IL-1β， and IL-6 （P<0.01）， promoted the positive expression of CD206， and elevated the levels of IL-4 and IL-10 （P<0.01） in the hippocampus of the high dose group. Moreover， the high-dose Baihuan Xiaoyao decoction group had higher sucrose preference value （P<0.01）， shorter immobility time （P<0.01）， longer central distance （P<0.01）， stronger learning and spatial memory （P<0.01）， higher positive expression and protein level of iNOS （P<0.01）， lower levels of TNF-α， IL-1β， and IL-6 （P<0.05， P<0.01）， lower positive expression and mRNA level of iNOS （P<0.05）， and higher levels of IL-4 and IL-10 （P<0.05， P<0.01） than the fluoxetine group. ConclusionBaihuan Xiaoyao decoction can improve the depression-like behavior of juvenile rats by inhibiting the M1 polarization and promoting the M2 polarization of microglia in the hippocampus.

Medicinal plants are a valuable source of essential medicines and herbal products for healthcare and disease therapy. Compared with chemical synthesis and extraction, the biosynthesis of natural products is a very promising alternative for the successful conservation of medicinal plants, and its rapid development will greatly facilitate the conservation and sustainable utilization of medicinal plants. Here, we summarize the advances in strategies and methods concerning the biosynthesis and production of natural products of medicinal plants. The strategies and methods mainly include genetic engineering, plant cell culture engineering, metabolic engineering, and synthetic biology based on multiple "OMICS" technologies, with paradigms for the biosynthesis of terpenoids and alkaloids. We also highlight the biosynthetic approaches and discuss progress in the production of some valuable natural products, exemplifying compounds such as vindoline (alkaloid), artemisinin and paclitaxel (terpenoids), to illustrate the power of biotechnology in medicinal plants.

ObjectiveTo investigate the therapeutic effect and mechanism of coptisine on chronic atrophic gastritis （CAG） in rats based on the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway. MethodA CAG rat model was induced by multiple factors， including sodium salicylate， N-methyl-N′-nitro-N-nitrosoguanidine （MNNG）， and irregular feeding. The successfully modeled rats were randomly divided into the model group， folic acid group， and high- and low-dose coptisine groups. The high- and low-dose coptisine groups were given coptisine （50， 10 mg·kg^-1， respectively）， and the folic acid group was given folic acid at 2 mg·kg^-1 for 60 days. The pathological changes were detected by hematoxylin-eosin （HE） staining. The ultrastructure of gastric mucosal cells was observed by electron microscopy. Serum pepsinogen Ⅰ （PGⅠ）， pepsinogen Ⅱ （PGⅡ）， and PGⅠ/PGⅡ ratio （PGR） were detected by immunoturbidimetry. Serum gastrin-17 （G-17） level was detected by radioimmunoassay. The content of interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） in serum of rats was detected by enzyme-linked immunosorbent assay （ELSIA）. Western blot analysis was used to detect the expression levels of TGF-β₁， PI3K， phosphorylated-Akt （p-Akt）， mTOR， and phosphatase and tensin homolog deleted on chromosome 10 （PTEN） in gastric mucosa. The mRNA levels of TGF-β₁， PI3K， Akt， mTOR， PTEN， microtubule-associated protein light chain 3Ⅱ （LC3Ⅱ）， and Beclin-1 were detected by real-time quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the normal group， the model group showed atrophy and reduced number of intrinsic glands in the gastric mucosal tissues， as well as inflammatory cell infiltration. The ultrastructure of gastric mucosal cells in the model group displayed nuclear condensation， reduced and swollen mitochondria， and abnormal structure. The serum levels of G-17， PGⅠ， PGR， and the protein and mRNA levels of PTEN in gastric tissues were significantly lower in the model group （P<0.01）， while serum levels of IL-6， IL-1β， TNF-α， and the protein and mRNA levels of TGF-β₁， PI3K， Akt， and mTOR in gastric tissues were significantly higher （P<0.01）. Compared with the model group， various drug intervention groups showed different degrees of improvement in pathological damage and gastric mucosal cell ultrastructure， significantly increased serum levels of G-17， PGⅠ， and PGR （P<0.05，P<0.01）， and significantly decreased levels of IL-6， IL-1β， and TNF-α （P<0.05，P<0.01）. The high-dose coptisine group significantly downregulated the protein and mRNA levels of TGF-β₁， PI3K， Akt， and mTOR （P<0.05，P<0.01）. ConclusionBerberine has a therapeutic effect on CAG in rats， possibly exerting a protective effect on gastric mucosa by inhibiting inflammation and blocking the PI3K/Akt/mTOR signaling pathway.

OBJECTIVE To observe the clinical efficacy of Shuihuo Zhongyu Decoction combined with estrogen and progesterone sequential treatment for patients with intrauterine adhesion(IUA)of kidney deficiency and blood stasis syndrome,and to explore its possible mechanism of action by transcriptomics.METHODS A total of 70 hospitalized patients with IUA of kidney deficiency and blood stasis syndrome who met the inclusion criteria were retrospectively selected,with 35 cases in the observation group and 35 cases in the control group.The control group underwent hysteroscopic transcervical resection of adhesion(TCRA)and then received estrogen and progesterone sequential treatment.The observation group was treated with Shuihuo Zhongyu Decoction on the basis of the treatment of the control group.The treatment course of both groups was 3 months.The TCM syndrome scores,therapeutic efficacy,AFS scores,endometrial thickness(ED),endometrial receptivity[endometrial volume(EV),endometrial flow index(FI),vascularization index(VI),vascularization flow index(VFI)],pregnancy outcomes and intrauterine re-adhesion were evaluated in the 2 groups before and after treatment.10 cases of endometrial tissues in each group were selected for transcriptomic sequencing,and differentially expressed genes were verified by qPCR.RESULTS After treatment,the TCM syndrome scores,AFS scores and CD138 positive rate in the 2 groups were significantly decreased(P<0.05),and the observation group was better than the control group(P<0.05);after treatment,ED,EV,FI,VI and VFI in the observation group were significantly increased(P<0.01),which were better than those in the control group(P<0.05,P<0.01);the therapeutic efficacy,pregnancy rate and incidence of intrauterine re-adhesion in the observation group were better than those in the control group(P<0.05,P<0.01).Transcriptomics results showed that a total of 365 differentially ex-pressed genes(DEGs)were found in the observation group compared with the control group,of which 132 were upregulated,including sulfotransferase family 2B member 1(SULT2B1),apolipoprotein A1(APOA1),etc.;233 were downregulated,including lactoferrin(LTF),C-X-C chemokine ligand 1(CXCL1),etc.;GO function and KEGG pathway enrichment analysis showed that SHT may in-teract with metal ions,glycosaminoglycans,protein serine/threonine kinases,endopeptidases,etc.in the membrane components,plasma membrane,extracellular part,extracellular matrix,etc.,and play a role by regulating biological processes such as cell adhe-sion,extracellular tissue structure,and antigen receptor regulation.The signaling pathways involved include chemokine signaling path-way,chemokine and cytokine receptor interactions,IL-17 signaling pathway,nuclear factor-κ-light chain enhanced of activated B cells(NF-κB),etc.CONCLUSION Shuihuo Zhongyu Decoction can effectively improve the clinical symptoms of IUA patients with kidney deficiency and blood stasis syndrome,reduce AFS scores,increase endometrial thickness,improve endometrial receptivity,im-prove pregnancy outcomes,and decrease the incidence of intrauterine re-adhesion.Its mechanism may be related to upregulating SULT2B1 and APOA1,downregulating the expression of genes such as LTF and CXCL1,and regulating signal pathways such as che-mokines,IL-17,and NF-κB.

Apelin is an adipokine family which includes Apelin-13,Apelin-36 and other isoforms and regulates phys-iological functions by immunomodulation,oxidative stress,glycolipid metabolism,and apoptosis and so on.Apelin is closely related to polycystic ovary syndrome,ovarian cancer and other diseases of the female reproductive system so it is expected to be new target molecules and may orient the development of research and clinical treatment.

Objective To explore the clinical application value of emergency bedside echocardiography(EB-Echo)in the diagnosis and treatment of reverse-Takotsubo syndrome(r-TTS).Methods A retrospective study method was conducted,the EB-Echo imaging and clinical data of 10 patients already diagnosed with r-TTS and admitted to the department of critical care medicine of Zhengzhou People's Hospital from January 2014 to December 2021 were selected.The r-TTS group,while data from 33 concurrently admitted patients with classic Takotsubo syndrome(TTS)were selected as the classic TTS group.Comparisons were made in terms of EB-Echo detection rates,diagnosis times,cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular stroke volume(LVSV)],blood volume indicators[inferior vena cava diameter(IVCD),collapse degree of inferior vena cava(cIVC)],complications[acute left ventricular outflow tract obstruction(ALVOTO),acute mitral regurgitation(AMR),and pulmonary hypertension(PH)],and prognosis between the two groups.Results The detection rate of EB-Echo in the r-TTS group was significantly higher than that in the classic TTS group[100.0%(10/10)vs.66.7%(22/33),P<0.05],and the diagnosis time was significantly shorter(minutes:26.80±3.77 vs.41.18±6.61,P<0.05).In terms of cardiac function indicators,both LVEF and LVSV were significantly lower in the r-TTS group compared to the classic TTS group[LVEF:0.36±0.05 vs.0.41±0.04,LVSV(mL):36.43±4.30 vs.40.65±5.09,both P<0.05].However,there were no significant differences in blood volume indicators(IVCD and cIVC)between the r-TTS group and the classic TTS group[IVCD(mm):15.02±1.88 vs.14.94±1.75,cIVC:(0.43±0.06)%vs.(0.44±0.07)%,both P>0.05].Concerning complications,the incidence of ALVOTO was slightly lower in the r-TTS group compared to the classic TTS group[0%(0/10)vs.21.2%(7/33),P>0.05],while the incidences of AMR and PH were similar between the two groups[AMR incidence:40.0%(4/10)vs.24.2%(8/33),PH incidence:30.0%(3/10)vs.18.2%(6/33),both P>0.05].After a follow-up ranging from 6 months to 3 years,no deaths were reported in the r-TTS group,whereas there was one fatality in the classic TTS group.Nevertheless,the mortality difference between the groups was not statistically significant.Conclusion EB-Echo demonstrates significant clinical value in the early diagnosis,guiding therapy,and enhancing prognosis of r-TTS.

Objective To explore the correlation between hs-cTnT and long-term cognitive function in elderly patients with mild to moderate cerebral infarction.Methods A total of 207 inpatients with cerebral infarction admitted in our hospital from February to November 2020 were prospec-tively recruited,and according to the serum level of hs-cTnT at admission,they were divided into in a high-level group(hs-cTnT＞12 ng/L,102 cases)and a low-level group(hs-cTnT ≤12 ng/L,105 cases).Among them,190 patients completed a 3-year follow-up,including 94 from the high-level group and 96 from the low-level group.The general information and Mini-Mental Status Ex-amination(MMSE)score were compared and analyzed in the two groups.Logistic regression analy-sis was used to identify the factors affecting cognitive function of the patients at discharge and in 3 years after discharge.ROC curve was plotted to analyze the value of the serum level of hs-cTnT at admission for cognitive impairment in 3 years after discharge.Results In 3 years after dis-charge,both groups had a higher MMSE score and lower proportion of cognitive impairment when compared with the conditions at discharge(P＜0.01).The MMSE scores at discharge and 3 years after discharge were significantly lower,and the proportions of cognitive impairment at the two time points were obviously higher in the high-level group than the low-level group(P＜0.01).Logistic regression analysis showed that female,high baseline hs-cTnT level,and delirium dura-tion＞1 d were risk factors(P＜0.05,P＜0.01),while education level of college or above was a protective factor for cognitive impairment in patients with cerebral infarction at discharge(P＜0.05).Age,female,presence of cognitive impairment at discharge,and high baseline hs-cTnT level were risk factors for cognitive impairment in 3 years after discharge(P＜0.05,P＜0.01).ROC curve analysis indicated that the AUC value of baseline hs-cTnT in predicting cognitive impair-ment in 3 years after discharge was 0.732(95％CI:0.531-0.927).Conclusion High serum hs-cTnT level at admission is a risk factor for cognitive impairment in elderly patients with mild to moderate cerebral infarction at discharge and 3 years after discharge,and it can help predict long-term cognitive function in these patients.

Objective:To investigate the iodine nutrition levels of children aged 8 - 10 and pregnant women in iodine deficient areas and iodine adequate areas of Inner Mongolia Autonomous Region (Inner Mongolia for short), and to provide scientific basis for prevention and treatment of iodine deficiency disorders.Methods:From March to July 2022, iodine nutrition analysis was conducted in iodine deficient areas and iodine adequate areas of 104 banners (counties, cities and districts) in 12 league cities in Inner Mongolia. Each monitoring banner (county, city and district) was divided into five sampling areas by east, west, south, north, and center, with one Sumu (township, street) selected from each area. One primary school was selected from each Sumu (township, street), and 40 non-boarding students aged 8 - 10 were selected from each primary school. One third of the students underwent thyroid ultrasound examination. Twenty pregnant women were selected from each of the 5 Sumus (townships, streets) in each monitoring banner (county, city and district). Household salt samples and random urine samples of children and pregnant women were collected to detect salt iodine and urinary iodine levels.Results:In 2022, the median thyroid volume of children aged 8 - 10 in iodine deficient areas and iodine adequate areas of Inner Mongolia was 2.44 ml, and the goiter rate was 1.89% (123/6 496). There were statistically significant differences in thyroid volume and goiter rate between different league cities ( H = 1 229.05, χ 2 = 34.13, P < 0.001). The coverage rate of iodized salt in 12 league cities was 98.51% (30 628/31 090), the consumption rate of qualified iodized salt was 94.42% (29 355/31 090), and the median salt iodine was 22.80 mg/kg. The median urinary iodine of children ( n = 20 968) was 195.00 μg/L, among which the median urinary iodine in 7 league cities was at the appropriate level of iodine nutrition (100 - 199 μg/L), and the median urinary iodine in 5 league cities was at the level of iodine nutrition exceeding the appropriate level (200 - 299 μg/L). The median urinary iodine of pregnant women ( n = 10 122) was 168.00 μg/L, among which, except for Bayannur (149.18 μg/L), the median urinary iodine in other 11 league cities was at the appropriate level of iodine nutrition (150 - 249 μg/L). Conclusions:The overall iodine nutrition of children and pregnant women in Inner Mongolia is at an appropriate level, but some pregnant women still face the risk of iodine deficiency. In the future, the focus of iodine deficiency disorders prevention and control should be on iodine nutrition monitoring for special needs populations.

Objective:To investigate the difference of the attention bias of the resilience level of professional technicians in hospital to negative information.Methods:A total of 383 professional technicians of logistics admin-istrative posts in a third-level military hospital were selected and divided into high and low groups according to their scores on the resilience scale(the top 27％of the participants were in the high resilience group,and the bottom 27％were in the low resilience group).There were 22 participants in each of the high and low resilience groups that met the requirements.The attention bias test was conducted on the professional technicians in the high and low resil-ience groups using the Dot-probe Paradigm.A mixed experimental design of 2(group:low resilience group,high re-silience group)x 2(stimulus clues:negative stimulus,neutral stimulus)was adopted.The dependent variables were correct rate and reaction time.Results:The interaction between the response group and the stimulus cue was statisti-cally significant(P＜0.05),the response time of negative stimulus in low resilience group was lower than that of neutral stimulus.The main effect of the cue condition was statistically significant in both groups(P＜0.05),the correct rate of negative stimulus was lower than that of neutral stimulus.Conclusion:This study shows that the pro-fessional technicians in the high resilience group do not have obvious attention bias to negative information,while the professional technicians in the low resilience group have obvious attention bias to negative emotional informa-tion.