This paper summarizes Professor LU Fang's clinical experience in treating systemic lupus erythematosus （SLE） based on the differentiation and treatment of heat-toxin and blood-stasis in the collaterals. SLE is generally characterized by deficiency in origin with excess in manifestation. The core pathogenesis is heat-toxin obstructing the collaterals. During the acute active stage， the predominant pattern is blazing heat-toxin causing blood stasis， while in the chronic remitting stage， the main pattern is toxic stasis blocking the collaterals with qi and yin deficiency. Clinical treatment follows the basic principle that treat with salty-cold herbs， when heat invades internally and that assist with acrid-dispersing herbs when stasis obstructs the collaterals. The self-formulated Yimian Decoction （抑免汤） serves as the base formula and is applied in stages. During the acute active stage， it is often combined with herbs for clearing heat and detoxifying， cooling blood and resolving stasis， and unblocking the collaterals. In the chronic remitting stage， it is often combined with herbs for activating blood circulation and unblocking the collaterals， as well as tonifying qi and nourishing yin.

This paper explores the therapeutic approach for glaucoma based on the concept of "jueyin （厥阴） as the closing phase" from the perspectives of time and space. In traditional Chinese medicine， jueyin governs inward， converging aspect of qi， representing the crucial turning point between the end of yin and the emergence of yang， as well as the transformation between yin and yang. When the closing and descending function of jueyin operates smoothly， it promotes the inward convergence and smooth descent of qi， enabling the internal retention of blood， spirit， and emotions， which nourishes the internal organs and moistens the meridian-sinews. Conversely， dysfunction of this "closing" mechanism results in a disturbance of yin and yang， a mixture of cold and heat， and disharmony of qi and blood. It is proposed that "failure of jueyin to properly close and descend" is a core pathomechanism of glaucoma. From the perspective of spatiotemporal theory， clinical treatment should focus on "regulating the closing function of jueyin and harmonizing yin and yang". The modified Wumei Pill （乌梅丸） is recommended to adjust the ascending-descending and entering-exiting dynamics of jueyin qi transformation， thereby restoring its free flow， achieving yin and yang balance， and ensuring nourishment to the ocular system.

Objective: To evaluate the impact of comprehensive nursing based on the behavioral goal attainment model on the clinical intervention effect among elderly female patients with stress urinary incontinence (SUI), so as to provide a basis for optimizing the nursing strategies for patients with SUI and improving their quality of life. Methods: A total of 190 elderly female patients with SUI who were treated in the Department of Gynecology of the First Hospital of Jilin University from January 2023 to August 2024 were selected and randomly divided into the intervention group and the control group. The control group received routine nursing care, while the intervention group received comprehensive nursing based on the behavioral goal attainment model. The 1-hour pad test was used to assess urinary incontinence symptoms. The bio-electrical stimulation feedback instrument was employed to detect the electromyogram (EMG) values in the pre-resting stage and slow-muscle stage for evaluating pelvic floor function. The bladder function scale was utilized to evaluate bladder function. The Chinese version of urinary incontinence ego-efficacy rating scales and incontinence quality of life assessment scale (IQOL) were used to assess self-efficacy and quality of life. The data on intervention compliance and nursing satisfaction were collected by a questionnaire survey. The differences between the two groups before and after the intervention were compared using the analysis of variance for repeated-measures data to evaluate the intervention effect. Results: There were 95 cases in the control group and 95 cases in the intervention group, with median ages were 64.00 (interquartile range, 23.50) and 64.50 (interquartile range, 19.50) years, respectively. The proportion of patients with cesarean section as the last delivery method was 21.05% in the control group and 12.63% in the intervention group. The proportion of patients with moderate disease severity was 67.36% in the control group and 58.95% in the intervention group. There were no statistically significant differences in age, body mass index, number of pregnancies, number of deliveries, marital status, educational level, mode of last delivery and severity of the disease between the two groups of patients (all P>0.05). The analysis of variance of repeated-measures data showed that there were significant interactions between time and group for the urine leakage volume in the 1-hour pad test, the EMG values in the pre-resting stage, the EMG values in the slow-muscle stage, the scores of the bladder function, the self-efficacy scores, and the IQOL scores (all P<0.05). After 12 weeks of intervention, the EMG values in the slow-muscle stage, the scores of the bladder function, the self-efficacy scores, the IQOL scores in the intervention group were higher than those in the control group, while the urine leakage volume in the 1-hour pad test and the EMG values in the pre-resting stage in the intervention group were lower than those in the control group (all P<0.05). The good compliance rate of intervention and the satisfaction rate of nursing in the intervention group were higher than those in the control group (83.16% vs. 60.00%, 90.53% vs. 75.79%, both P<0.05). Conclusion Comprehensive nursing based on the behavioral goal attainment model can improve urinary incontinence symptoms, pelvic floor function, bladder function, self-efficacy, quality of life, and intervention compliance of elderly female patients with SUI.

AIM: To investigate the diagnostic value of the axial length/corneal radius of curvature(AL/CR)for myopia in children and adolescents.METHODS: PubMed, Embase, The Cochrane Library, CNKI, CBM, WanFang Data and VIP databases were searched to collect clinical research on the value of AL/CR in diagnosing myopia in children and adolescents, and the retrieval time was from establishment to September 30, 2023. The QUADAS-2 tool was used to evaluate the quality of the extracted literature. A random-effects model was used to pool diagnostic test data, Meta-regression and subgroup analysis were performed to explore sources of heterogeneity.RESULTS: A total of 10 articles involving 19 872 study participants were included, and Meta-analysis showed that the pooled sensitivity of the AL/CR for the diagnosis of myopia in children and adolescents was 0.91[95%CI(0.90-0.91)], the pooled specificity was 0.84 [95%CI(0.84-0.85)], and area under the SROC curve of 0.95 [95%CI(0.93-0.96)].CONCLUSION: The AL/CR is a good indicator of myopia in children and adolescents.

Objective To investigate the effects of forsythinol(Fo)on the expression of matrix metalloproteinase-2(MMP2)in hepatoma cells through Janus kinase 2/signal transduction and transcriptional activator 3(JAK2/STAT3)signaling pathway.Methods SMMC-7721 cells were divided into experimental-L,-M,-H groups,control group,inhibitor group and activator group.The control group was added with equal volume dimethyl sulfoxide(DMSO);the experimental-L,-M,-H groups were treated with 50,200,500 μg·mL-1 Fo;and the inhibitor group was added with 50 μmol·L-1 JAK2/STAT3 inhibitor AG490 based on the experimental-M group.In the activator group,10 μmol·L-1 JAK2/STAT3 activator Broussonin E was added to the experimental-M group.Apoptosis was detected by deoxynucleotide terminal transferase-mediated dUTP notch end labeling(TUNEL);protein expression was detected by Western blot;real-time quantitative polymerase chain reaction(qRT-PCR)was used to detect mRNA levels.Results The apoptosis rates of control group,experimental-M group,inhibitor group and activator group were(19.94±4.88)％,(27.04±5.27)％,(15.36±3.40)％and(46.66±7.89)％,respectively;the relative expression levels of phosphorylated JAK2 protein were 1.00±0.13,0.73±0.11,1.33±0.17 and 0.26±0.07,respectively;the relative expression levels of phosphorylated STAT3 protein were 1.00±0.12,0.27±0.04,0.88±0.13 and 0.12±0.04,respectively;the mRNA relative expression levels of MMP2 were 1.00±0.14,0.68±0.08,1.17±0.17 and 0.51±0.09,respectively.Compared with experimental-M group and control group,inhibitor group and activator group,there were statistically significant differences(P＜0.05,P＜0.001).Conclusion Fo promotes apoptosis of hepatocellular carcinoma cells,and its mechanism may be related to the effect of Fo on the expression of MMP2 by regulating JAK2-STAT3 signaling pathway.

The theory of “rhythmic equilibrium” is developed based on the idea of sharing the same laws between nature and human， and by integrating with the medical concept of homeostasis of calm yin and sound yang. "Rhythmic instability" runs through the entire process of the occurrence and development of myopia， covering four aspects including imbalance of rhythm （high-risk period of myopia）， imbalance of qi and blood （premyopia）， imbalance of sinew-membranes （low myopia）， and imbalance of essence and blood （high myopia）. The treatment should focus on adjusting the rhythm and harmonizing situation， which can help balance yin and yang， and nourish the eye system. For high-risk period of myopia， adjusting sleeping time and increasing outdoor activities are stressed to adjust the rhythm in a timely manner. In the stage of premyopia， appropriate techniques of traditional Chinese medicine （TCM） such as pressing needles can be added to harmonize qi and blood. In the period of low myopia， appropriate TCM techniques such as pressing needles and ear acupuncture are mainly used， supplemented by modified Danggui Buxue Decoction （当归补血汤） to soften tendons and unblock collaterals. During the period of high myopia， it is recommended to control the development of existing disease and put focus on nourishing essence and blood， usually with Zhujing Pill （驻景丸） or modified Siwu Wuzi Decoction （四物五子汤） to restore the stability of the eyes and the whole body.

Objective:To examine the correlation between serum Klotho levels and frailty in elderly people.Methods:In this cross-sectional study, 150 community-dwelling elderly people aged 65 years and over were enrolled.Subjects were divided into a frail(n=50, 33.3%), a pre-frail(n=47, 31.3%)and a non-frail(n=53, 35.3%)group based on the Fried phenotype.General participant data, routine laboratory test results, short physical performance battery(SPPB)results and human body composition data were collected.Serum Klotho protein levels were measured by an enzyme-linked immunosorbent assay.The relationship between serum Klotho protein levels and frailty was analyzed by using Spearmen's correlation analysis and Logistic regression analysis.Results:Klotho protein levels were lower in the frail group than in the non-frail group( P=0.001), whereas differences between the frail group and the pre-frail group and between the pre-frail group and the non-frail group were not statistically significant(all P>0.05).When Klotho protein levels were classified into four quartiles, i.e., Q 1, Q 2, Q 3, and Q 4, using three cut-off vales(2.28, 3.52, and 5.09 mg/L), the prevalences of frailty were 51.4%(19/37), 39.5%(15/38), 24.3%(9/37)and 18.4%(7/38), respectively.The prevalence of frailty decreased with increasing Klotho protein levels( χ2=11.204, P=0.011).Spearman correlation analysis showed that the Klotho protein level was negatively correlated with frailty( r=-0.310, P<0.001).Multivariate Logistic regression analysis results showed that age( OR=1.109, 95% CI: 1.011-1.217, P=0.028)and sarcopenia( OR=6.511, 95% CI: 1.279-33.147, P=0.024)were risk factors for frailty, while walking( OR=0.104, 95% CI: 0.033-0.326, P<0.001), a high SPPB score( OR=0.780, 95% CI: 0.627-0.970, P=0.026), and a high Klotho protein level( OR=0.752, 95% CI: 0.581-0.974, P=0.031)were protective factors against frailty. Conclusions:The serum Klotho protein level may be used as a parameter for the assessment of frailty.It is negatively correlated with frailty, suggesting that elderly people with low serum Klotho protein levels are at high risk of developing frailty.

Objective:To explore the perinatal characteristics and early postnatal circulatory function of the larger fetus in monochorionic diamniotic twin pregnancy complicated with selective intrauterine growth restriction (sIUGR).Methods:From February 2018 to August 2022, a total of 91 larger fetuses of the sIUGR pregnancies who were hospitalized in the neonatal intensive care unit of Peking University Third Hospital were retrospectively included. The perinatal factors, clinical monitoring indicators, and echocardiographic data of the larger twins in pregnancies with three types of sIUGR were compared using one-way analysis of variance and LSD test, Kruskal-Wallis H test, Chi-square test, and Bonferroni correction. Results:The gestational age, birth weight, and placental weight were (30.6±1.5) weeks, (1 503.9±286.4) g, and (548±120) g in the type Ⅱ sIUGR larger twins and were (30.5±2.3) weeks, (1 523.5±424.4) g, and (560±109) g in type Ⅲ, which were all smaller, lower, and lighter than those in the type Ⅰ[(33.0±1.7) weeks, (2 022.1±372.3) g, and (630±131) g, respectively] (LSD test, all P<0.05). Compared with type Ⅰ sIUGR larger twins, type Ⅱ and Ⅲ sIUGR larger twins had longer hospital stay [36.0 d (27.0-43.0 d) and 32.0 d (15.0-47.0 d) vs. 17.0 d (9.5-22.0 d)], higher proportion of preterm births due to fetal distress [63.6% (21/33) and 75.0% (15/20) vs. 31.6% (12/38), χ2=7.30 and 9.93] (Bonferroni correction, all P<0.017); Compared with type Ⅰ sIUGR larger twins, type Ⅱ sIUGR larger twins had higher proportion of postnatal use of vasoactive drugs [45.5% (15/33) vs. 18.4% (7/38), χ2=6.04, P=0.014]. The interventricular septum thickness was larger in the type Ⅲ sIUGR larger twins than those in the type Ⅰ and Ⅱ twins [(4.4±1.4) vs. (3.8±0.9) and (3.3±0.9) mm]; the thickness of left ventricular free wall was the largest in the type Ⅲ larger twins, followed by those in the type Ⅰ and type Ⅱ [(4.6±1.3) vs. (3.1±0.7) vs. (2.7±0.6) mm]; the left ventricular end-diastolic diameter, right ventricular outflow tract diameter, right ventricular anteroposterior diameter, and pulmonary artery diameter in type Ⅰ larger twins were increased comparing with those in type Ⅱ and Ⅲ [left ventricular end-diastolic diameter: (15.0±2.1) vs. (13.4±2.3) and (12.3±3.2) mm; right ventricular outflow tract diameter: (8.7±1.4) vs. (7.3±1.4) and (7.1±0.8) mm; right ventricular anteroposterior diameter: (7.1±1.5) vs. (6.5±0.9) and (6.4±1.0) mm; pulmonary artery diameter: (6.8±1.1) vs. (6.3±0.9) and (6.3±0.8) mm] (LSD test, all P<0.05). Conclusion:The larger fetuses of type Ⅱ and Ⅲ sIUGR pregnancies had smaller gestational age and lighter birth weight who are more prone to have fetal distress, so it is necessary to strengthen dynamic monitoring and circulatory support for such neonates during the perinatal period and early postnatal period. The thickening of the left ventricular wall and interventricular septum in the early postnatal period of type Ⅲ larger fetuses may lead to the decrease of ventricular diastolic function reserve, thereby the evaluation and monitoring of the myocardial diastolic function of these neonates in the early postnatal period are critical.

Tropane alkaloids (TAs) are a class of anticholinergic drugs widely used in clinical practice and mainly extracted from plant, among which Atopa belladonna is the main commercial drug source. It is of great industrial value to obtain TAs in large quantities by plant metabolic engineering. In TAs pathway, cytochrome oxidase CYP82M3 catalyze the synthesis of tropinone and then tropinone reductase I (TRI) compete with TRII for tropinone to form tropine leading to the TAs synthesis (drainage). In this study, based on the "increasing flow and drainage" metabolic engineering strategy, two genes, namely HnCYP82M3 and DsTRI from Hyoscyamus niger and Datura stramonium, respectively, were overexpressed in the hair roots of A. belladonna, with a view to promote the TAs accumulation. The HnCYP82M3 gene was cloned from the root of H. niger, and it encoded amino acid with 91.7% sequence identity with AbCYP82M3 from A. belladonna. Overexpression of HnCYP82M3 alone did not affect the content of TAs in hair roots of A. belladonna, indicating that CYP82M3 was not a key enzyme in TAs biosynthesis. Simultaneous overexpression of HnCYP82M3 and DsTRI greatly promoted the accumulation of the three TAs, and the contents of hyoscyamine, anisodamine and scopolamine were 4.97 times, 2.83 times and 2.19 times that of the control, respectively, and the increase amplitude was greater than that of single overexpression of DsTRI. This study showed that the "increasing flow and drainage" strategy of enzyme genes co-expression at branch points was a promising metabolic engineering method to effectively improve the biosynthesis of TAs in A. belladonna, and laid a theoretical and technical foundation for the large-scale industrial acquisition of TAs.

ObjectiveTo investigate the intervention effect of Jiedu Tongluo Tiaogan prescription （JTTP） in protecting pancreatic β cells by targeting the bile acid Takeda G protein-coupled receptor 5 （TGR5）/cyclic adenosine monophosphate （cAMP） signaling pathway against NOD-like receptor protein 3 （NLRP3） inflammasome. MethodThirty-two male SPF-grade db/db mice were randomly divided into the model group， low-dose JTTP group （3.6 g·kg^-1）， high-dose JTTP group （7.2 g·kg^-1）， and metformin group （0.2 g·kg^-1）. Eight db/m mice were assigned to the blank control group. The mice were treated with drugs for 8 weeks， and fasting blood glucose （FBG） was measured every 2 weeks. Oral glucose tolerance tests （OGTT） were conducted after the last administration. Enzyme-linked immunosorbent assay （ELISA） was performed to detect fasting insulin （FINS）， and the homeostasis model assessment of β-cell function （HOMA-β）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， and IL-1β levels were calculated. Hematoxylin-eosin （HE） staining was used to observe pathological changes in mouse pancreatic tissue. Immunofluorescence was performed to detect insulin expression in mouse pancreatic tissue. Western blot and real-time quantitative polymerase chain reaction （Real-time PCR） were used to detect the expression of proteins and mRNAs of key targets in the TGR5/cAMP signaling pathway and NLRP3 inflammasome. ResultCompared with blank group， FBG， OGTT， FINS， IL-6， TNF-α and IL-1β in model group were significantly increased （P<0.01）. Compared with model group， after 6 weeks of drug treatment， FBG level in JTTP group and metformin group decreased significantly （P<0.01）. The results of OGTT experiment showed that compared with model group， the blood glucose levels of mice in each administration group were decreased at all time points （P<0.05， P<0.01）， and the levels of FINS， TNF-α and IL-6 in JTTP dose groups and metformin group were significantly decreased. The level of IL-1β in JTTP high-dose group and metformin group was significantly decreased （P<0.01）. Pancreatic pathology showed that the islets in the model group were irregular in shape， uneven in distribution， and showed signs of atrophy. The prognosis of JTTP was that the cell count increased and the boundary was clearer. Immunofluorescence results showed that the islet cells in the blank group were arranged in an orderly and full shape with appropriate insulin secretion， while the islet cells in model group were distorted in shape， atrophy in structure and less insulin secretion. The insulin content of mice in JTTP and metformin group was significantly increased. Compared with blank group， mRNA expressions of NLRP3， apoptosis-related spot-like protein （ASC） and Caspase-1 in pancreatic tissues of model group were significantly increased （P<0.01）. Compared with model group， JTTP high-dose group and metformin group promoted the up-regulation of TGR5 and cAMP mRNA， and down-regulated the mRNA expressions of NLRP3， ASC and Caspase-1 （P<0.05， P<0.01）. Compared with blank group， the expression of TGR5 protein in model group was significantly decreased （P<0.01）. Compared with model group， TGR5 protein in JTTP high-dose group and metformin group was significantly increased （P<0.01）.