Objective To study the correlation between traditional Chinese medicine(TCM)constitution and pathogenic factors in patients with ankylosing spondylitis(AS).Methods One hundred patients of AS and their family members who had medical consultation in the Fifth Hospital of Xi'an(i.e.,Shaanxi Hospital of Integrated Traditional Chinese and Western Medicine)in August 2019 and September 2020 were selected as the study subjects.The guidelines of Classification and Determination of Traditional Chinese Medicine Constitution issued by the China Association of Chinese Medicine were adopted to determine the traditional Chinese medicine(TCM)constitution types of the study subjects.The sociodemographic information,living habits,clinical symptoms,and TCM constitution types of the AS patients and their family members were collected by means of questionnaires and clinical investigations,and then the pathogenic factors of the patients with AS were investigated.The binomial Logistic regression model was used to analyze the correlation between TCM constitution types and pathogenic factors in patients with AS.Results(1)Among the 100 AS patients,the majority of them had the biased constitutions,and the biased constitutions with the occurrence frequency in descending order were yang deficiency constitution,qi deficiency constitution,and damp-heat constitution,which accounted for 33.00%,14.00%,and 18.00%,respectively.(2)The prevalence rates of AS in the first-,second-,and third-degree relatives of AS patients were 56.25%,40.00%and 25.00%,respectively.For the positive rates of human leukocyte antigen B27(HLA-B27)in AS patients and their family members,HLA-B27 in AS patients was all positive,while the positive rates of HLA-B27 in the first-,second-,and third-degree relatives of AS patients were 44.31%,30.67%and 15.63%,respectively.(3)The results of regression analysis showed that the disease duration of AS patients was significantly correlated with qi deficiency constitution,the grading of sacroiliac arthritis was correlated with qi stagnation constitution,and age was correlated with blood stasis constitution(P＜0.05 or P＜0.01).The results indicated that disease duration and age were the important factors affecting the constitution types of AS patients,and disease duration was closely related to qi deficiency while age was closely related to blood stasis.Conclusion AS is a highly hereditary autoimmune disease,and its onset is associated with HLA-B27.Yang deficiency is the basic constitution type of AS,and damp-heat constitution is the main constitution type in the progression of AS(especially in the active stage of the disease).The prolongation of the disease will exacerbate the illness condition of AS and then the manifestations of qi deficiency will be more obvious.

Objective To optimize the optimal extraction process for phthalein and phenolic acid components in Angelicae Sinensis Radix-Chuanxiaong Rhizoma decoction pieces.Methods On the basis of a single factor experiment,central combination design-response surface methodology was adopted,and the extraction time,ethanol concentration,and ethanol dosage were used as influencing factors,and the total normalized values of the content of Senkyunolide I,Senkyunolide A and ligustilide,and extract yield were used as evaluation indicators to optimize the extraction process of phthalein components in Angelicae Sinensis Radix-Chuanxiaong Rhizoma decoction pieces;the total normalized values of chlorogenic acid,caffeic acid,ferulic acid,and extract yield were used as evaluation indicators to optimize the extraction process of phenolic acids components in Angelicae Sinensis Radix-Chuanxiaong Rhizoma decoction pieces.Results The optimal extraction process was to add 7 times the amount of 90%ethanol to the phthalein components,extract for 130 minutes each time,and extract twice;phenolic acid components were extracted twice with 7.5 times the amount of 65%ethanol for 120 minutes each time.Conclusion The optimized extraction process for phthalein and phenolic acids in Angelicae Sinensis Radix-Chuanxiaong Rhizoma decoction pieces is stable and feasible,which can provide a basis for subsequent research.

ObjectiveTo observe the clinical efficacy of modified Shenqi Pill （肾气丸） plus Tongdu Tiaoshen Acupuncture （通督调神针刺） in the treatment of neurogenic bladder after spinal cord injury of kidney-yang deficiency syndrome. MethodsForty-six patients were randomly divided into 23 cases each in the control group and the treatment group. Both groups were given conventional treatment， i.e. oral methylcobalamin tablets （0.5 mg each time， 3 times a day） and paraplegic conventional acupuncture （once a day， 6 consecutive days a week）. The control group was given simple bladder function rehabilitation training on the basis of the conventional treatment； and the treatment group was given modified Shenqi Pill orally （1 dose a day， 150 ml each time， taken warmly in morning and evening） and Tongdu Tiaoshen Acupuncture （once a day， 6 consecutive days per week） in addition to what were given to the control group. The treatment course lasted for 4 weeks. The 24 h urination frequency， 24 h urine leakage frequency， 24 h single urine volume， bladder residual urine volume， international lower urinary tract symptom （LUTS） score， traditional Chinese medicine （TCM） syndrome score were compared between the two groups， and clinical effectiveness and TCM syndrome effectiveness were compared between the two groups after treatment. ResultsTwenty patients in each group were finally analyzed in this study. The number of 24 h urination， the number of 24 h urine leakage， bladder residual urine volume， LUTS score， and the TCM syndrome scores decreased after treatment in both groups， and the 24 h single urine volume increased （P＜0.01）； and much more improvement was found of each index in the treatment group than in the control group （P＜0.05 or P＜0.01）. The total clinical effectiveness and TCM syndrome effectiveness in the treatment group was 85.00% （17/20） respectively， which were statistically significantly higher than 45.00% （the total clinical effectiveness， 9/20） and 60.00% （TCM syndrome effectiveness， 12/20） in the control group （P＜0.01）. ConclusionModified Shenqi Pill plus Tongdu Tiaoshen Acupuncture can signi-ficantly improve the clinical symptoms of neurogenic bladder patients after spinal cord injury of kidney-yang deficiency syndrome， having better effectiveness than simple bladder function rehabilitation training， and its mechanism may be related to the improvement of the injured nerve function innervating the bladder.

Objective To explore the potential mechanism of proguanil on the proliferation and apoptosis of bladder cancer cells.Methods 253J cells were randomly divided into control group(normal treatment),proguanil group(42.06 μmol·L-1 proguanil),pcDNA group(transfected with pcDNA+42.06 μmol·L-1 proguanil),FADS2 group[transfected fatty acid desaturase gene 2(FADS2)+42.06 μmol·L-1 proguanil],si-NC(transfection si-NC),si-FADS2(transfection si-FADS2),Ferrostatin-1 group(transfected with si-FADS2+10 μmol·L-1 ferrostatin-1).Real-time fluorescence quantitative polymerase chain reaction(RT-qPCR)assay was used to detect mRNA expression of related genes;Western blot assay was used to detect the expression of each protein;apoptosis was detected by TdT mediated dUDP nick end labeling(Tunel)assay;5-ethynyl-2'-deoxyuridine(EdU)assay to detect cell proliferation;the Transwell assay measures the ability of cells to migrate;Fe2+levels were determined by kit method;DCFH-DA probe was used to detect ROS levels.Results The mRNA levels of FADS2 in control group,proguanil group,pcDNA group and FADS2 group were 1.00±0.11,0.47±0.09,0.49±0.06 and 2.09±0.21,respectively;cell proliferation rate were(100.00±3.50)％,(54.31±4.90)％,(56.46±5.17)％and(78.76±6.50)％,respectively;the apoptosis rate were(3.92±0.53)％,(28.79±3.30)％,(27.20±2.90)％and(7.34±0.68)％,respectively;the migration number were 132.70±9.81,70.10±5.05,68.70±537 and 101.80±11.25,respectively;Fe2+level were(100.00±8.14)％,(201.33±17.84)％,(192.38±21.34)％and(116.70±10.90)％,respectively;GPX4 protein relative expression level were 0.77±0.05,0.31±0.05,0.34±0.05 and 0.68±0.06,respectively.The above indexes in proguanil group were compared with those in control group,the above indexes in FADS2 group were compared with those in pcDNA group,all the differences were statistically significant(all P＜0.05).The ROS levels of si-NC,si-FADS2 and Ferrostatin-1 groups were 9.72±1.18,40.94±5.63 and 13.77±1.40,respectively.Compared the si-FADS2 group with the si-NC group,Ferrostatin-1 group compared with si-FADS2 group,ROS level were significantly different(all P＜0.05).Conclusion Proguanil can induce the apoptosis of bladder cancer cells by inhibiting FADS2 expression mediated by oxidation-reduction driven ferroptosis pathway.

Objective:To study the changes in skeletal muscle and serum nutritional indicators during concurrent chemoradiotherapy in cervical cancer patients,and to evaluate their correlation with short-term efficacy and long-term prognosis. Methods:A retrospective analysis was conducted on 114 patients with cervical cancer who underwent radical concurrent chemoradiotherapy in the Department of Oncology,Nanjing Drum Tower Hospital from February 2019 to February 2023. All patients underwent a treatment regimen comprising external beam radiation (EBRT),internal radiation,and concurrent chemotherapy. Serum nutritional data of the patients were collected before radiotherapy,one week,two weeks and five weeks after the onset of radiotherapy. CT images of the patients at the time of simulation and about five weeks after the onset of radiotherapy were imported into the Pinnacle 39.10 planning system,and the skeletal muscle index (SMI) of the third lumbar vertebra (L3) were calculated for each patients. The changes of the serum nutritional indicators of the patients prior to and post EBRT were analyzed statistically. The patients are categorized into two groups according to the baseline SMI:a sarcopenic group consisting of 35 cases and a non-sarcopenic group comprising 79 cases. The therapeutic outcomes between the two groups were compared,and logistic analysis of the relevant factors affecting the occurrence of sarcopenia during radiotherapy was conducted. The survival curves were drawn using Kaplan-Meier method and disease-free survival (DFS) between the two groups was compared using Log Rank test. We used Cox univariate and multivariate regression analysis to identify prognostic factors related to DFS. Results:The serum nutritional indicators of the patient at one week,two weeks,and five weeks after the beginning of EBRT were significantly lower than those before radiotherapy (P<0.05). The SMI from the CT images of simulation at five weeks after the onset of radiotherapy was significantly lower than that before radiotherapy (P<0.001). There was a significant correlation between hemoglobin levels prior to radiotherapy and incidence of sarcopenia during radiotherapy (P=0.046). There was no significant difference in efficacy between the two groups at the end of EBRT (P>0.05). At the end of radiotherapy,the complete response (CR) rate of the non-sarcopenia group was significantly higher than that of the sarcopenia group (P=0.040). However,the objective response rate (ORR) and disease control rate (DCR) of both groups at the end of radiotherapy were 100％. The 2-year DFS of the sarcopenia group and the non-sarcopenia group were 66.7％ and 85.5％,respectively,and the difference was statistically significant (P=0.016). Only four patients died during the 2-year follow-up,so OS was not reached. Baseline SMI,serum squamous cell antigen levels prior to radiotherapy,and degree of bone marrow suppression were three independent prognostic factors affecting DFS in the patients. Conclusion:Cervical cancer patients experience significant nutritional loss during chemoradiotherapy,and baseline SMI is significantly correlated with short-term efficacy and long-term prognosis and can serve as a predictive marker for patients with cervical cancer receiving chemoradiotherapy.

Objective This study investigated the impact of occupational mercury(Hg)exposure on human gene transcription and expression,and its potential biological mechanisms. Methods Differentially expressed genes related to Hg exposure were identified and validated using gene expression microarray analysis and extended validation.Hg-exposed cell models and PTEN low-expression models were established in vitro using 293T cells.PTEN gene expression was assessed using qRT-PCR,and Western blotting was used to measure PTEN,AKT,and PI3K protein levels.IL-6 expression was determined by ELISA. Results Combined findings from gene expression microarray analysis,bioinformatics,and population expansion validation indicated significant downregulation of the PTEN gene in the high-concentration Hg exposure group.In the Hg-exposed cell model(25 and 10 μmol/L),a significant decrease in PTEN expression was observed,accompanied by a significant increase in PI3K,AKT,and IL-6 expression.Similarly,a low-expression cell model demonstrated that PTEN gene knockdown led to a significant decrease in PTEN protein expression and a substantial increase in PI3K,AKT,and IL-6 levels. Conclusion This is the first study to report that Hg exposure downregulates the PTEN gene,activates the PI3K/AKT regulatory pathway,and increases the expression of inflammatory factors,ultimately resulting in kidney inflammation.

Objective To construct the machine learning models based on the radiomic features of non-contrast and enhanced CT and to evaluate the predictive value in the risk stratification of gastrointestinal stromal tumor(GIST).Methods A total of 182 patients with pathologically confirmed GIST were randomly divided into a training set and a validation set at a ratio of 7∶3.The volume of interest(VOI)was outlined in the non-contrast phase,arterial phase and venous phase,and its radiomic features were extracted.The most valuable radiomic features were selected using the least absolute shrinkage and selection operator(LASSO)algorithm.The logistic regression(LR)classifier was used to construct the prediction models based on single-phase or multi-phase images.The predictive efficacy of the different models was compared by using receiver operating characteristic(ROC)curves.Results Four,three,and four radiomic features were selected in the non-contrast phase,arterial phase and venous phase,and 4 models were constructed in total.Among the single-phase models,the venous phase had better predictive efficacy,with the area under the curve(AUC)of 0.932[95％confidence interval(CI)0.873-0.969]and 0.924(95％CI 0.819-0.979)in the training and validation sets.The predictive efficacy of the combined model was improved,with the AUC of 0.946(95％CI 0.891-0.978)and 0.938(95％CI 0.838-0.986).Conclusion The venous phase model can predict the risk stratification of GIST accurately,and the prediction efficacy can be improved by combining the non-contrast and arterial phases.

Objective To discuss the optimized pain control with standard analgesia plus duloxetine hydrochloride for patients undergoing lumbar fusion surgery,and to analyze its effect on prognostic quality of life.Methods A prospective study was conducted on 106 patients who underwent lumbar fusion surgery in our hospital from May 2019 to December 2020.Patients were randomly assigned into two groups according to analgesic methods.Control group(n=52)was given standard analgesia,while observation group(n=54)received standard analgesia plus duloxetine hydrochloride.Then the degree of postoperative pain,the use of analgesics(the time of the first additional analgesic drugs,effective pressing times within 48 hours after operation),the improvement of psychological emotions,quality of life,and the occurrence of adverse reactions were compared between two groups.Results Observation group scored(4.19±0.78),(2.84±0.61)and(1.73±0.42)on visual analogue scale(VAS)at postoperative 1 d,3 d and 7 d,which were lower than(5.24±0.80),(3.51±0.57)and(2.49±0.56)in control group(P＜0.05).Compared with control group,observation group had delayed time of the first additional analgesic drugs[(12.33±2.34)h vs(7.61±0.85)h]and less effective pressing times within 48 hours after operation[(3.78±0.92)vs(10.44±3.27)]than those of control group(P＜0.05).Observation group scored lower on Self-rating Anxiety Scale(SAS)at postoperative 7 d[(52.44±6.71)vs(57.39±6.43)]and 14 d[(37.85±6.49)vs(42.66±5.25)],lower on Self-rating Depression Scale(SDS)at postoperative 7 d[(51.16±5.43)vs(55.37±5.25)]and 14 d[(35.64±5.36)vs(40.18±5.22)],and higher on 36-item Short-Form Health Survey(SF-36)at postoperative 4w[(83.44±6.72)vs(78.63±5.11)]than those of control group,with statistical difference(all P＜0.05).The adverse reaction rate was 7.41％in observation group,which was lower than 21.15％in control group(P＜0.05).Conclusion The optimized pain control with standard analgesia plus duloxetine hydrochloride for patients undergoing lumbar fusion surgery can effectively can effectively improve the analgesic effect,reduce the use of opioids,alleviate negative emotions and improve quality of life with less adverse reactions,which is worth promoting.

Objective To investigate the effect of prunella vulgaris extract on inflammation,macrophage phenotype,and phagocytic ability in septic mice,and analyze whether Toll like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway involved in its mechanism.Methods C57BL/6 mice were divided into the control group,the model group and the prunella vulgaris extract low(25 mg/kg),medium(50 mg/kg)and high(100 mg/kg)dose groups.Except for the control group,all other groups of mice were injected intraperitoneally with lipopolysaccharide(LPS)to prepare sepsis model.Each group was given corresponding medication by gavage.After 24 hours of administration,serum tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,high mobility group protein B1(HMGB1),IL-10 levels,the proportion of M1 type(CD11b+F4/80+)and M2 type(CD206+F4/80+)macrophages in peritoneal macrophages,the phagocytotic capacity of macrophages,the expression of inducible nitric oxide synthase(iNOS)messenger RNA(mRNA)and arginase 1(Arg1)mRNA in peritoneal macrophages and expression levels of TLR4,NF-κB p65 and their phosphorylated proteins in macrophages were detected.Results Compared with the control group,serum TNF-α,IL-1β,HMGB1,proportion of M1 type macrophages in abdominal cavity,mean fluorescence intensity and phagocytotic capacity of macrophages,iNOS mRNA,TLR4,phosphorylated NF-κB p65(p-NF-κB p65)/NF-κB p65 protein expression were increased in the model group(P＜0.05).IL-10,proportion of M2 type macrophages and Arg1 mRNA expression were decreased(P＜0.05).Compared with the model group,serum TNF-α,IL-1β,HMGB1,proportion of M1 type macrophages in abdominal cavity,iNOS mRNA,TLR4,p-NF-κB p65/NF-κB p65 protein expression were decreased successively in the prunella vulgaris extract low,medium and high dose groups(P＜0.05).IL-10,proportion of M2 macrophages,mean fluorescence intensity and phagocytotic capacity of macrophages and Arg1 mRNA expression were increased successively(P＜0.05).Conclusion By inhibiting TLR4/NF-κB pathway,prunella vulgaris extract may inhibit the polarization of peritoneal macrophages into M1 type and promote their polarization to M2 type,enhance macrophage phagocytic ability and alleviate LPS induced inflammatory response in septic mice.

Objective To investigate the neurodevelopmental characteristics of children with autism spectrum disorder(ASD),analyze the correlation between neurodevelopmental indicators and cerebral blood flow(CBF),and explore the potential mechanisms of neurodevelopment in ASD children.Methods A retrospective study was conducted on 145 children aged 2-6 years with newly-diagnosed ASD.Scores from the Gesell Developmental Diagnosis Scale and the Autism Behavior Checklist(ABC)and CBF results were collected to compare gender differences in the development of children with ASD and analyze the correlation between CBF and neurodevelopmental indicators.Results Fine motor and personal-social development quotient in boys with ASD were lower than those in girls with ASD(P<0.05).Gross motor development quotient in ASD children was negatively correlated with CBF in the left frontal lobe(r=-0.200,P=0.016),right frontal lobe(r=-0.279,P=0.001),left parietal lobe(r=-0.208,P=0.012),and right parietal lobe(r=-0.187,P=0.025).The total ABC score was positively correlated with CBF in the left amygdala(r=0.295,P<0.001).Conclusions Early intervention training should pay attention to gender and developmental structural characteristics for precise intervention in ASD children.CBF has the potential to become a biological marker for assessing the severity of ASD.