To introduce and analyze guideline terminology related to clinical question formulation, evidence retrieval and appraisal, and recommendation development.

Oxidative stress due to aberrant metabolism is considered as a crucial contributor to diabetes and its complications. Hyperglycemia and hyperlipemia boost excessive reactive oxygen species generation by elevated mitochondrial respiration, increased nicotinamide adenine dinucleotide phosphate oxidase activity, and enhanced pro-oxidative processes, including protein kinase C pathways, hexosamine, polyol, and advanced glycation endproducts, which exacerbate oxidative stress. Oxidative stress plays a significant role in the onset of diabetes and its associated complications by impairing insulin production, increasing insulin resistance, maintaining hyperglycemic memory, and inducing systemic inflammation. A more profound comprehension of the molecular processes that link oxidative stress to diabetes is crucial to new preventive and therapeutic strategies. Therefore, this review discusses the mechanisms underlying how oxidative stress contributes to diabetes mellitus and its complications. We also summarize the current approaches for prevention and treatment by targeting the oxidative stress pathways in diabetes.
Oxidative Stress/physiology* ; Humans ; Diabetes Mellitus/physiopathology* ; Diabetes Complications/metabolism* ; Reactive Oxygen Species/metabolism* ; Glycation End Products, Advanced/metabolism* ; Animals

OBJECTIVES: Hypertriglyceridemic acute pancreatitis (HTG-AP) has a rapid onset and is associated with a high risk of progression and recurrence. Early identification of patients at risk of severe disease can help reduce the likelihood of multiple organ failure and mortality. This study aims to investigate the changes in inflammatory composite markers and D-dimer (D-D) levels in young and middle-aged/elderly patients with HTG-AP and to evaluate their predictive value for disease progression. METHODS: A total of 230 patients with HTG-AP admitted to Chongqing University Jiangjin Hospital (Jiangjin Central Hospital) between 2017 and 2023 were retrospectively enrolled. Patients were first divided into a young group (≤45 years) and a middle-aged/elderly group (>45 years), and then stratified into mild and severe groups based on disease severity. Inflammatory composite markers, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), C-reactive protein-to-lymphocyte ratio (CLR), systemic inflammation response index (SIRI), systemic immune inflammation index (SII), as well as D-D levels, were compared among groups. Least absolute shrinkage and selection operator (LASSO) regression and Logistic regression were used to identify independent risk factors for disease progression in each age group. Receiver operating characteristic (ROC) curves and the DeLong test were used to assess and compare the predictive performance (area under the curve, AUC) of risk factors. Internal validation was performed using the bootstrap method (n=1 000). RESULTS: No significant differences in NLR, PLR, MLR, SIRI, SII, CLR, or D-D levels were observed between the young (n=127) and middle-aged/elderly (n=103) groups (all P>0.05). Among young patients, the severe group (n=59) had significantly higher NLR, SIRI, SII, CLR, and D-D levels compared to the mild group (n=68) (all P<0.05). Among middle-aged/elderly patients, CLR and D-D levels were significantly higher in the severe group (n=49) than in the mild group (n=54) (P<0.05). LASSO and Logistic regression analyses identified elevated D-D as an independent risk factor for disease progression in young patients (P=0.007, OR=1.458, 95% CI 1.107 to 1.920), while both D-D (P=0.001, OR=2.267, 95% CI 1.413 to 3.637) and CLR (P=0.003, OR=1.007, 95% CI 1.003 to 1.012) were independent risk factors in middle-aged/elderly patients. ROC analysis showed that D-D predicted disease progression in young and middle-aged/elderly patients with AUCs of 0.653 and 0.741, sensitivities of 67.8% and 57.1%, and specificities of 72.1% and 88.9%, respectively. CLR predicted progression in middle-aged/elderly patients with an AUC of 0.687, sensitivity of 63.3%, and specificity of 70.4%. DeLong test showed no significant difference in AUC between D-D and CLR for middle-aged/elderly patients (Z=0.993, P=0.321). Internal validation via bootstrap analysis yielded a D-D AUC of 0.732, with sensitivity and specificity of 68.1% and 91.0%, respectively. CONCLUSIONS Differences in inflammatory response and coagulation function exist across age groups and disease severities in HTG-AP patients. Elevated D-D is an independent predictor of disease progression in both young and middle-aged/elderly patients, while CLR also predicts progression in the latter group. D-D, in particular, demonstrates strong predictive value for severe disease in middle-aged/elderly patients with HTG-AP.
Humans ; Fibrin Fibrinogen Degradation Products/metabolism* ; Disease Progression ; Middle Aged ; Pancreatitis/etiology* ; Male ; Female ; Retrospective Studies ; Adult ; Biomarkers/blood* ; Hypertriglyceridemia/blood* ; Acute Disease ; Predictive Value of Tests ; Aged ; Inflammation ; C-Reactive Protein/analysis* ; Neutrophils ; Age Factors

Objective:To investigate the effects of dexmedetomidine(DEX)on the malignant biological behavior of gastric cancer(GC)cells through the immune regulation mechanism mediated by cyclic GMP-AMP synthase-stimulator of interferon gene(cGAS-STING)pathway.Methods:GC cell line MGC-803 was randomly divided into Control group(blank medium treatment),DEX low concentration group(DEX-L group,1 ng/ml),DEX medium concentration group(DEX-M group,10 ng/ml),DEX high concentra-tion group(DEX-H group,100 ng/ml)and DEX high concentration+cGAS inhibitor RU.521 group(DEX-H+RU.521 group,100 ng/ml DEX+1.0 μmol/L RU.521).Cell proliferation was detected by CCK-8 method.Cell scratch test was used to detect the migration ability of cells in each group.Transwell test was used to detect the invasive ability of cells in each group.The apoptosis rate was detected by flow cytometry.The levels of IL-2,interferon gamma(IFN-γ)and tumor necrosis factor alpha(TNF-α)in cells were detected by ELISA.Real time-fluorescent quantitative PCR(RT-qPCR)was applied to detect the expression levels of cGAS,STING and interferon typeⅠ(IFN-Ⅰ)mRNA.Western blot was used to detect the expressions of cGAS,STING,Bax,CyclinD1,matrix metalloproteinase 9(MMP9),N-cadherin,Vimentin,E-cadherin,Caspase3,Caspase8 and their shear type and phosphorylation level of TANK-binding kinase 1(TBK1)and interferon regulatory factor 3(IRF3).Results:Compared with Control group,the cell migration rate,number of cell invasions,TNF-α level,CyclinD1,MMP9,N-cadherin,Vimentin protein expressions in MGC-803 cells in DEX-M and DEX-H groups were decreased obviously(P<0.05),the growth inhibition rate(48 h,72 h),apoptosis rate,IL-2,IFN-γ,Bax,E-cadherin,Cleaved Caspase3,Cleaved Caspase8 protein expression levels,cGAS,STING,IFN-Ⅰ mRNA levels and protein expression levels and phosphorylation levels of TBK1 and IRF3 were increased obviously(P<0.05).RU.521 weakened the inhibitory effects of DEX on the proliferation,migration and invasion of GC cells and the ability to induce apoptosis,and alleviated the improvement on immune function.Conclusion:DEX may inhibit the proliferation,migration and invasion of GC cells and induce apoptosis of GC cells by acti-vating cGAS-STING pathway mediated immune regulation.

Objectives:Present study aimed to use quantitative flow ratio based on Murray's law to analyze the risk factors of impaired side branches perfusion without naked eye visible slowing of blood flow in branches after interventional treatment of true bifurcation lesions of the coronary arteries. Methods:A total of 211 patients with non-left main coronary artery true bifurcation coronary artery disease who underwent percutaneous coronary intervention(PCI)in Hunan Provincial People's Hospital from June 2022 to September 2023 were continuously enrolled,with a total of 234 bifurcation lesions.The general clinical indicators,anatomical characteristics of coronary artery bifurcation lesions,branch protection methods,postoperative branch TIMI blood flow and other data were collected,and quantitative flow ratio(μQFR)was measured for postoperative branch blood vessels.Post-PCI μQFR<0.8 was considered as impaired branch perfusion and was included in the postoperative impaired branch perfusion group(n=51,53 branch lesions).Patients with μQFR≥0.8 were included in the postoperative normal branch perfusion group(n=160,181 branch lesions).Multivariate Logistic regression analysis was used to evaluate the effects of various clinical and anatomical factors on branch perfusion after PCI. Results:The post-PCI branch flow grading of all patients was TIMI grade Ⅲ.The postoperative branch μQFR of 53 vessels(22.6％)in the group with impaired postoperative branch perfusion was 0.70±0.10,and 0.93±0.05 in the group with normal postoperative branch perfusion,and the difference between the two groups was statistically significant(P<0.001).Compared with the postoperative group with normal branch perfusion,the postoperative group with impaired branch perfusion was featured with an elevated branch lesion length,branch reference diameter,postoperative branch opening diameter stenosis rate,postoperative branch narrowest lumen diameter stenosis rate,and a lower main branch-to-branch diameter ratio,preoperative branch narrowest lumen diameter stenosis rate,and preoperative main branch μQFR,all of which were statistically significant(all P<0.05).The postoperative branch opening diameter stenosis rate(r=-0.490,P<0.001),postoperative branch narrowest lumen diameter stenosis rate(r=-0.788,P<0.001),preoperative branch narrowest lumen diameter stenosis rate(r=-0.280,P<0.001),branch narrowest lumen diameter(r=-0.469,P<0.001),branch lesion length(r=-0.157,P=0.016)were negatively correlated with postoperative branch μQFR,and branch reference diameter(r=0.173,P=0.008),main branch/side branch diameter ratio(r=0.194,P=0.003),and branch opening diameter(r=0.328,P<0.001)were positively correlated with postoperative branch μQFR,and none of them were significantly correlated with clinical baseline data(all P>0.05).Multifactorial logistic regression analysis showed that following four factors were independent risk factors for impaired branch perfusion:postoperative stenosis of the narrowest branch lumen diameter(OR=1.228,95％CI:1.144-1.318,P<0.001),postoperative stenosis of the branch opening diameter(OR=1.110,95％CI:1.055-1.168,P<0.001),postoperative stenosis of the narrowest lumen diameter of the main branch(OR=1.115,95％CI:1.042-1.192,P=0.001),and length of the branch lesion(OR=1.121,95％CI:1.021-1.231,P=0016). Conclusions:Some of the patients whose branch flow reached TIMI grade Ⅲ after PCI are still faced the risk of hemodynamical impairment and should be functionally evaluated after PCI.The postoperative stenosis rate of the narrowest branch lumen diameter,postoperative stenosis rate of the branch opening diameter,postoperative stenosis rate of the narrowest lumen diameter of the main branch,and branch lesion length are the risk factors of branch perfusion impairment after PCI for coronary bifurcation lesions.

Objective To analyze the effect of fisetin against venous thrombosis in rats.Methods Seventy SD rats were randomly divided into the following groups:sham-operation group,model group,fisetin 45 mg/kg,15 mg/kg,5 mg/kg groups,and aspirin group(47 mg/kg).The corresponding medication was administered by gavage once a day consecutively(the sham-operation group and the model group were given 0.5％carboxymethyl cellulose sodium solution with 10 mL/kg,respectively)for 7 consecutive days.One hour after the last administration,the rats were anesthetized,the lower part of the intersection of inferior vena cava and left renal vein was ligated with silk thread(no ligation in the sham-operation group),and the abdominal wall was sutured.Two hours later,the abdominal cavity was reopened,the other venous branches 1.5 cm away from the ligation site were closed with the artery clamp,and blood was collected from the abdominal aorta.The anticoagulant ratio of 3.8％sodium citrate∶whole blood was 1∶9.The venous thrombus 1 cm down from the ligation point of the intersection of inferior vena cava and left renal vein was cut and the thrombus was separated.The residual blood was dried with filter paper,weighed and recorded.Plasma was taken after anticoagulant blood centrifugation.The levels of plasma antithrombin-Ⅲ(AT-Ⅲ),protease C(PC),plasminogen(PLG),and plasminogen activator inhibitor(PAI-1)were detected by ELISA kits.Results Compared with the model group,the weight of thrombus in fisetin 45 mg/kg group and aspirin 47 mg/kg group decreased(P＜0.01).The content of AT-Ⅲ in three fisetin groups increased(all P＜0.05).The content of PC in fisetin 45 mg/kg increased(P＜0.05).The content of PLG and PAI-1 in fisetin 45 mg/kg group decreased(both P＜0.05).Conclusion Fisetin has the effect against venous thrombosis in vivo,and the effect is related to the upregulation of AT-Ⅲ and PC and the downregulation of PLG and PAI-1.

Bone organoids can simulate the complex structure and function of the bone tissues, which makes them a frontier technology in organoid researches. Bone organoids show a tremendous potential of applications in bone disease modeling, bone injury repair, and medicine screening. Although advancements have been made so far in constructing bone organoids with functional structures like mineralization, bone marrow, trabecular bone, callus, woven bone, etc, the researches in this field are confronted with numerous challenges such as lack of standardized construction strategies and unified evaluation criteria, which limits their further promotion and application. To standardize researches in bone organoids, the Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, the Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, the Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and the Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine organized related experts to formulate Expert consensus on the construction, evaluation, and application of bone organoids ( version 2024) based on an evidence-based approach. A total of 17 recommendations were put forth, aiming to standardize researches and clinical applications of bone organoids and enhance their value in scientific research and clinical practice.

To sum up integrative nursing experience of a case with chronic refractory wound formation caused by drug extravasation.The essentials of integrative nursing are:structured nursing intervention of"assessment-management-treatment"based on the Triangle of Wound Assessment;determination of the timing for integrative nursing according to the theory of TCM sores and ulcers;implementation of copper board scraping method to promote circulation of qi and blood;use of Huo-long Comprehensive Moxibustion Therapy to promote muscle regeneration.With the help of the cooperation of the multidisciplinary specialist nursing team,the wound was completely healed after 59 days of integrated traditional Chinese and Western medicine nursing interventions.

Objective:To investigate the anti-inflammatory and analgesic effects of Zhonghua Dieda Pills; To preliminarily explore its mechanism on adjuvant arthritis model rats.Methods:Three inflammatory models and two pain models were used to investigate the anti-inflammatory and analgesic effects of Zhonghua Dieda Pills. After establishing the adjuvant arthritis rat model, the rats were divided into normal group, model group, dexamethasone group (0.8 mg/kg), and Zhonghua Dieda Pills (2.0, 1.0, 0.5 g/kg) groups according to random number table method. Each group was given corresponding drugs once a day for 5 weeks. The toe volume was measured at 1, 3 and 5 weeks after administration, and the swelling degree was calculated; the organ indices of rats were calculated and the histopathological changes of articular cartilage were observed by HE staining; the expressions of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β) in joint tissues were detected by immunohistochemistry.Results:Zhonghua Dieda Pills (2.0 g/kg) group significantly reduced the swelling of foot and plantar of rats, reduced the swelling of ear of mice, and reduced the dry weight of granuloma of rats ( P<0.05); Zhonghua Dieda Pills (1.4 g/kg) group significantly reduced the number of twisting of rats, and the pain threshold after 3 h of administration was significantly higher than that of the control group ( P<0.05); Zhonghua Dieda Pills (2.0 g/kg) group significantly reduced the swelling of the foot and metatarsal of arthritic rats after 3-5 weeks of administration ( P<0.05), decreased the thymus index ( P<0.05), and reduced the expression levels of IL-1β, TNF-α and TGF-β in joint tissues ( P<0.05). Conclusion:Zhonghua Dieda Pills have confirmed anti-inflammatory and analgesic effects, which may play a therapeutic role in adjuvant arthritis model rats by reducing the levels of inflammatory factors such as IL-1β, TNF-α and TGF-β.

ObjectiveTo review the ancient and modern literature of Huanglian Ejiaotang and learn about the historical evolution and clinical application， thereby providing a theoretical basis for the modern application of the classical prescription. MethodLiterature in the Chinese Medical Classics Database was retrieved with "Huanglian Ejiaotang" as the keyword. In China National Knowledge Infrastructure （CNKI） and PubMed， "Huanglian Ejiaotang" in Chinese and English was used as the keyword to retrieve literature. The items and modern clinical application studies related to the prescription， medicine， dosage， syndrome， and treatment of Huanglian Ejiaotang were selected and recorded. The inclusion and exclusion criteria were used to screen out literature. The information about the dynasty， book title， function， and indication was integrated to understand the history， evolution， and clinical application of Huanglian Ejiaotang. ResultFinally， 89 ancient books were included with 111 items. Huanglian Ejiaotang was initially recorded in ZHANG Zhongjing's Treatise on Cold Damage and Miscellaneous Diseases in the Han dynasty. It was composed of five herbs， namely Coptidis Rhizoma， Scutellariae Radix， Paeoniae Radix Alba， Asini Corii Colla， and egg yolk. With the change of historical dynasties， the composition， origin basis， dosage， and preparation method of Huanglian Ejiaotang all changed， but the changes in the processing were not obvious， which was basically consistent with Treatise on Cold Damage and Miscellaneous Diseases. In addition， 48 studies were included to analyze the clinical application of Huanglian Ejiaotang， which was mainly used for insomnia， anxiety， depression， diabetes， and so on. ConclusionAccording to the ancient and modern literature， the origin basis， dosage， processing， decoction， administration， and other content of Huanglian Ejiaotang are consistent with Treatise on Cold Damage and Miscellaneous Diseases. The present clinical application has expanded the usage scale of the ancient record， which promotes the innovation and development of the classic prescription and provides references for later research， development， and accurate application.