Objective This study aimed to elucidate the protective effects of Da Cheng Qi Decoction (DCQD) on severe acute pancreatitis (SAP) by targeting ferroptosis in pancreatic acinar cells and to establish a predictive signature and nomogram for acute pancreatitis (AP) risk assessment. Methods We utilized microarray analysis to delineate gene expression patterns among 32 healthy controls and 87 AP patients stratified by severity. Employing SAP models and NOX2-deficient cells, we investigated the molecular underpinnings of ferroptosis. The impact of DCQD and the ferroptosis inhibitor Fer-1 on gene expression, oxidative stress, and inflammation was assessed. Machine learning algorithms identified differentially expressed genes (DEGs) sensitive to DCQD, SAP, and ferroptosis (DSNFGs), which were validated across multiple datasets. A predictive nomogram integrating DSNFGs was developed, and single-cell analysis provided a comprehensive view of the cellular dynamics. Results The microarray analysis revealed upregulation of NOX2 and downregulation of GPX4 in AP, with expression patterns correlating with disease severity. DCQD ameliorated SAP-induced pancreatic acinar cell damage and ferroptosis by reducing inflammatory markers and enhancing GPX4 expression. NOX2 knockout mitigated ferroptosis in SAP models, suggesting a key role in the disease process. DCQD and Fer-1 differentially regulated the expression of ferroptosis-related genes, reduced reactive oxygen species (ROS) and high-mobility group box 1 (HMGB1) levels, and suppressed the inflammatory response in a SAP mouse model. The HPLC analysis of DCQD constituents indicated eight components (aloe-emodin, rhein, emodin, chrysophanol, naringin, hesperidin, magnolol, and honokiol) with the capacity to modulate ferroptosis. Venn analysis identified 48 DSNFGs, with a subset of five genes demonstrating significant predictive value. The developed nomogram, based on LASSO regression, showed high accuracy in validation cohorts. Single-cell RNA sequencing (scRNA-seq) and CellChat analysis uncovered heterogeneity and cell-cell communication networks in the pancreas during recovery from pancreatitis, implicating several signaling pathways. Conclusion DCQD and its eight ingredients exert its protective effect in SAP by inhibiting ferroptosis through the NOX2/GPX4 pathway. The DCQD-SAP-ferroptosis-related signature and nomogram offer a novel tool for AP risk assessment, prognosis prediction, and personalized therapeutic strategies in SAP management.

Sarcopenic obesity (SO), characterized by concurrent muscle loss and excess adiposity, is an emerging public health challenge, yet prospective evidence linking SO to mild cognitive impairment (MCI) remains limited. Baseline data were collected from the China Health and Retirement Longitudinal Study (CHARLS) in 2015. The incidences of MCI during follow-ups by 2018 and 2020 were calculated. Participants were divided into healthy, obesity only, sarcopenia only, and SO groups. Aging-associated MCI was defined as a total cognitive score at least one standard deviation below the age-specific norm for participants aged 45 and above, adjusted for age in five-year increments. In the 11,674 individuals with an average age of 59.31 ± 9.21 years, SO was detected in 160 (1.37

BackgroundHelicobacter pylori (H. pylori) is a globally prevalent gastric bacterium implicated in gastrointestinal disease. Emerging evidence suggests it may also contribute to extra-gastric manifestations; however, its relationship with concurrent gastrointestinal, psychological, and sleep disturbances remains underexplored. This study investigated whether H. pylori infection is associated with a triad of gastrointestinal discomfort, sleep disturbance, and affective disorders.MethodsThis single-center cross-sectional study enrolled 969 adults at a H. pylori detection clinic (First Affiliated Hospital of Xiamen University) between June 2023 and June 2024. H. pylori infection status and severity were assessed using a 13C-urea breath test. Gastrointestinal symptoms, sleep disturbances, and affective disorders were evaluated with the Gastrointestinal Symptom Rating Scale (GSRS), Athens Insomnia Scale (AIS), and 4-item Patient Health Questionnaire (PHQ-4). Latent class analysis (LCA) was performed to identify distinct symptom phenotypes. Associations between infection severity and symptom clusters were examined using logistic regression adjusted for age, sex, and body mass index (BMI).ResultsIn terms of associated symptoms, 35.40% of participants reported gastrointestinal symptoms, 72.65% had sleep disturbances, and 61.09% experienced affective disorders. The prevalence of gastrointestinal symptoms, sleep disturbances, and affective disorders increased significantly with greater infection severity. LCA identified a “Positive Triad” phenotype (60.7% of the cohort), characterized by concurrent gastrointestinal, sleep, and emotional symptoms. Higher infection severity was independently associated with this combined symptom cluster after adjusting for age, sex, and BMI. The effect of H. pylori infection on risk of positive triad was significant among different gender, age group, and BMI group.ConclusionH. pylori infection was associated with concurrent gastrointestinal discomfort, sleep disturbance, and affective disorders. These findings suggest a unified symptom cluster attributable to H. pylori infection, extending its clinical impact beyond the gastric tract. Recognizing this multidimensional presentation could inform more comprehensive diagnostic and therapeutic strategies for affected patients.

Background Diabetes has a high incidence rate and many complications,which was an urgent public health problem,but the prevention and management is still not ideal.Objective To observe the effect of Three Division management on metabolic indicators and self-management levels of diabetes patients with different courses of disease.Methods One hundred and 81 type 2 diabetes patients from April 2021 to April 2022 were managed by the mode of Three Division management and followed up for more than 6 months in Shenzhen Hospital Guangzhou University of Chinese Medicine(Futian).The patients were grouped according to the course of disease(Group A:course of disease＜1 year;Group B:course of disease 1-5 years;Group C:course of disease＞5-10 years;Group D:course of disease＞10 years);In outpatient,the three-division team composed of traditional Chinese medicine practitioners,endocrinologists and caregivers carries out comprehensive treatment such as physique identification,complication screening,medicine,food,exercises and emotion intervention;When patients are at home,the caregivers carry out intelligent management through intelligent Glucose meter equipment and mobile phone APP.We collected changes in blood glucose and body weight indicators in patients with different disease courses after six months of management.Additionally,we used a questionnaire to gather common issues in patient self-management and fill out the Summary of Diabetes Self-Care Activities Measure-6(SDSCA-6).Results Through the management of the Three Division management,Group A patients showed significant improvement in reducing fasting blood glucose and postprandial 2-hour blood glucose after the intervention(P＜0.05).The BMI and waist circumference of groups A,B,C,and D were all reduced compared to before the intervention(P＜0.05).Common dietary issues in patient self-management included an unreasonable dietary structure(38.12%),common exercise issues included insufficient exercise volume or intensity(36.46%),and common monitoring issues included insufficient monitoring(37.02%).The self-management levels of groups A,B,C,and D in the four dimensions of"healthy eating""self-monitoring""adherence to medical advice"and"education and communication"all improved compared to before the intervention(P＜0.001).Conclusion The three division management can improve the self-management ability of diabetes patients and play a good comprehensive role in diabetes.Clinical practice should particularly emphasize the management of patients with a diabetes course of less than one year.

背景 基层医师在基层医疗卫生服务中发挥重要作用，临床实践指南是指导临床实践的重要工具，了解基层医师对指南的知悉程度与使用现状，可为基层指南推广与培训、提高基层医疗质量提供新思路。目的 调查、了解基层医师对糖尿病中医类指南的知悉程度与参考使用现状，并探讨其影响因素。方法 2021-09-22—10-29，通过线上调查方式向中华中医药学会糖尿病基层防治专家指导委员会发放电子问卷，并采用滚雪球抽样的方法 扩散至更多医师。问卷包括3部分：基本信息、医师使用中医药防治糖尿病现状与需求、医师对糖尿病指南认知现状与需求调查。采用有序多分类Logistic回归分析探讨基层医师对糖尿病中医类指南知悉程度与使用现状的影响因素。结果 共回收基层医师填写的有效问卷382份。35.34%(135/382)的医师对糖尿病中医类指南非常熟悉或比较熟悉，28.80%(110/382)的医师经常参考使用糖尿病中医类指南。单因素分析结果显示，不同性别、专业方向、所在科室、每周诊疗糖尿病患者数量、对中医药治疗糖尿病疗效评价、医师所在单位是否可以购买指南推荐的中药饮片或中成药、对指南知悉程度的基层医师对糖尿病中医指南参考情况比较，差异有统计学意义（P<0.05）。有序多分类Logistic回归分析结果显示，基层医师对糖尿病中医类指南知悉程度的影响因素为对中医药疗效评价为“非常有效”（OR=5.783,95%CI=1.283～26.102），医师所在单位可以购买指南推荐的中药饮片或中成药（OR=2.399,95%CI=1.548～3.717），既往接受过糖尿病防治指南的专题培训（OR=1.751,95%CI=1.149～2.667）3个因素；基层医师对糖尿病中医类指南参考情况的影响因素为医师对指南的知悉程度[非常或比较熟悉（OR=15.721,95%CI=7.584～32.557）、一般熟悉（OR=5.392,95%CI=2.841～10.237）]，工作年限≤5年（OR=14.083,95%CI=1.390～142.594），不同专业[中医专业（OR=6.869,95%CI=1.483～31.849）、中西医结合专业（OR=6.613,95%CI=1.551～28.219）]，不同地理区域[东北部（OR=2.962,95%CI=1.064～8.240）、东南部（OR=2.686,95%CI=1.004～7.178）]4个因素。结论 基层医师对糖尿病中医类指南的知悉程度和参考使用情况尚需提高。对指南的知悉程度、工作年限、专业方向、地理区域是影响医师参考使用指南的重要因素。今后应加强对基层医师的培训力度，尤其是对西北部和西南部地区、具有中医专业背景 的基层医师应加强中医防治糖尿病相关指南的培训。

OBJECTIVE:This study aims to investigate physicians' familiarity and awareness of four diabetes guidelines and their practice of the recommendations outlined in these guidelines.DESIGN:A cross-sectional study.SETTING:An online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians.PARTICIPANTS:1150 physicians from 192 cities across 30 provinces in China provided complete data.RESULTS:Tertiary care hospital physicians (TCPs) exhibited the highest familiarity with the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China (91.3%), followed by the National Guidelines for the Prevention and Control of Diabetes in Primary Care (76.8%), the Standards of Medical Care in Diabetes (72.2%) and the Guidelines for Prevention and Treatment of Diabetes in Chinese Medicine (63.8%). Primary care practitioners (PCPs) exhibited familiarity with these four guidelines at about 50% or less. Self-reported reference to modern diabetes guidelines by physicians is more frequent than traditional Chinese medicine (TCM) diabetes guidelines, with rates at 73.2% and 33.8%, respectively. Approximately 90% of physicians provided instructions on self-monitoring of blood glucose to their patients with diabetes. Less than one-third of physicians referred patients to a specialised nutritionist. In terms of health education management, TCPs reported having a diabetes health management team at the rate of 75.7%, followed by secondary care hospital physicians at 57.0% and PCPs at 27.5%. Furthermore, approximately 40% of physicians did not fully grasp hypoglycaemia characteristics.CONCLUSIONS:Familiarity and awareness of the screening guidelines varied among physicians in different hospital settings. Importantly, significant discrepancies were observed between physicians' awareness and their self-reported reference to modern medicine guidelines and TCM guidelines. It is essential to consistently provide education and training on diabetes management for all physicians, particularly PCPs.

《国家糖尿病基层中医防治管理指南（2022）》是我国首部基层糖尿病中医指南。指南制订过程严格遵循循证临床实践指南的制订方法和步骤，重视中医理论的指导，吸纳了近年来中医药治疗糖尿病的最新研究证据。通过对全国1 150名医师进行调研、31名医师进行访谈，了解基层医疗现状，从而构建了指南的临床问题，力求该指南在基层具有实用性和可操作性。指南编撰过程中，召开多轮专家会议，来自全国50多所医院的80多名中西医专家参与了讨论。指南充分发挥中医“治未病”的优势，强调早筛查、早评估、早干预，倡导针刺、耳穴、穴位贴敷、穴位按摩、穴位埋线等中医非药物疗法，并将代茶饮、传统锻炼功法融入防治体系，从重点解决患者常见症状入手提升患者的生命质量，强调综合管理模式，尤其对内分泌糖尿病专科医师、中医师、健康管理师共同参与的“三师共管”团队诊疗模式进行了推荐。为便于医务人员深入理解及更好地应用本指南，现对指南的制订背景和方法学要点进行概述，并对指南关键内容进行解读。

美国糖尿病学会（ADA）在历年更新的《糖尿病医学诊疗标准》中一直强调“以患者为中心”理念的重要性，践行该理念有利于提高医疗服务效率和患者满意度、减少患者并发症发生、提升患者生命质量、降低患者医疗成本等。中医学素有“以人为本”的诊疗思想及丰富的个性化治疗手段，与ADA指南中“以患者为中心”的理念相契合。故该文基于ADA指南“以患者为中心”的理念，结合我国糖尿病防治现状，探讨我国糖尿病综合诊疗的发展思路，以期为我国糖尿病综合诊疗的完善和推广提供参考和可借鉴的经验。

Objective To observe the clinical effect of finger-pushing hand Yangming large intestine channel combined with abdominal massage on patients with functional constipation.Methods A total of 80 patients with functional constipation admitted to the department of traditional chinese medicine outpatient and the department of traditional chinese medicine appropriate technology outpatient,the First Affiliated Hospital of Xiamen University from July 2021 to May 2023 were divided into the experimental group(40 cases)and the control group(40 cases)according to the principle of block random allocation.Both groups were given routine health education.The control group was treated with abdominal massage,while the experimental group was treated with finger massage combined with the finger-pushing hand Yangming large intestine channel.After 2 weeks of treatment,the patients'stool characteristics,defecation difficulty and constipation symptom score were collected,and the treatment effect of the two groups was compared.Results After 2 weeks of treatment,the experimental group was better than the control group in terms of stool characteristics,defecation difficulty and constipation symptom scores(P<0.05).The clinical efficacy of the experimental group was better than that of the control group,the difference was statistically significant(P<0.05).Conclusion The combination of finger-pushing hand Yangming large intestine channel and abdominal massage therapy can more effectively improve patients'functional constipation.

"中西医并重"是我国糖尿病防治的重要策略和方针.为规范基层糖尿病诊疗,2022年3月中华医学会糖尿病学分会,国家基层糖尿病防治管理办公室共同发布了《国家基层糖尿病防治管理指南(2022)》,此次更新首次增加了糖尿病的中医药防治内容.笔者结合《中国2型糖尿病防治指南(2020)》,对指南中医药纳入背景和要点进行解读和对比分析,为临床应用提供参考.

目的 探讨各项人体测量学指标在基层地区成人糖尿病筛查中的应用价值.方法 这项横断面研究以2017年10月—2018年10月在新疆吉木萨尔县泉子街镇卫生院常规体检的成人作为研究对象,测量并计算腰围、身体质量指数(body mass index,BMI)、腰高比(waist-to-height ratio,WHtR)、A型形态指数(A body shape index,ABSI)、身体圆度指数(body roundness index,BRI)、锥削度指数(conicity index,CI)、BMI√腰围和WHt.5R等一系列人体测量学指标.采用Logistic回归模型和受试者工作特征曲线(receiver operating characteristic,ROC)对比分析各项人体测量学指标对于糖尿病筛查的应用价值.结果 总共纳入4215例(男性1653例,女性2562例)研究对象,其中糖尿病患者为452例(占比10.2％).Logistic回归模型显示,糖尿病患病风险增加与WHtR和BRI水平升高的相关性最强,而与ABSI的相关性最弱.ROC曲线分析显示,WHtR和BRI的AUC最大;WHtR的诊断切点分别为0.48(男)和0.49(女),BRI的诊断切点分别为3.02(男)和3.05(女).结论 各项人体测量学指标对基层地区成人糖尿病患病均有一定的预测价值,其中以WHtR和BRI的效能最高.

Ethnopharmacological relevance: Shuxie Compound (SX) combines the composition and efficacy of Suanzaoren decoction and Huanglian Wendan decoction. It can soothe the liver, regulate the qi, nourish the blood and calm the mind. It is used in the clinical treatment of sleep disorder with liver stagnation. Modern studies have proved that circadian rhythm disorder (CRD) can cause sleep deprivation and liver damage, which can be effectively ameliorated by traditional Chinese medicine to soothe the liver stagnation. However, the mechanism of SX is unclear.Aim of the study: This study was designed to demonstrate the impact of SX on CRD in vivo, and confirm the molecular mechanisms of SX in vitro.Materials and methods: The quality of SX and drug-containing serum was controlled by UPLC-Q-TOF/MS, which were used in vivo and in vitro experiments, respectively. In vivo, a light deprivation mouse model was used. In vitro, a stable knockdown Bmal1 cell line was used to explore SX mechanism.Results: Low-dose SX (SXL) could restore (1) circadian activity pattern, (2) 24-h basal metabolic pattern, (3) liver injury, and (4) Endoplasmic reticulum (ER) stress in CRD mice. CRD decreased the liver Bmal1 protein at ZT15, which was reversed by SXL treatment. Besides, SXL decreased the mRNA expression of Grp78/ATF4/Chop and the protein expression of ATF4/Chop at ZT11. In vitro experiments, SX reduced the protein expression of thapsigargin (tg)-induced p-eIF2 alpha/ATF4 pathway and increase the viability of AML12 cells by increasing the expression of Bmal1 protein. Conclusions: SXL relieved CRD-induced ER stress and improve cell viability by up-regulating the expression of Bmal1 protein in the liver and then inhibiting the protein expression of p-eIF2 alpha/ATF4.

目的:探讨福建省厦门市新型冠状病毒Delta变异株感染患者的临床特征与中医体质分布规律,为早期干预及辨证论治提供参考依据.方法:采用真实世界研究方法,收集新型冠状病毒肺炎确诊患者基本信息,并以问卷星形式调查患者初始症状与中医体质情况,通过数据统计分析,探讨厦门地区新型冠状病毒肺炎患者症状特征、体质类型分布及两者之间的关联性.结果:此次纳入研究的183例新冠肺炎患者轻型36例,普通型141例,重型6例,平均核酸转阴天数为(15.39±8.95)天,整体预后较好.临床特征:厦门地区新型冠状病毒肺炎患者以咳嗽、发热、睡眠不佳、胃口差、咽干咽痒等为首发症状;其中恶心不适、咳嗽、咳痰、气喘、胃口差等症状持续天数较长;咽痛、恶心不适、大便不成形、周身酸痛、气喘等症状较为严重;体质类型发生前4位依次为平和质、痰湿质、阳虚质、湿热质,轻型以平和体质、痰湿质为主,普通型以平和质、痰湿质、阳虚质多见.结论:厦门地区感染新型冠状病毒的患者中,以湿为主要特征,偏于湿热;偏颇体质以痰湿质、阳虚质、湿热质多见.因此,对新冠病毒肺炎的防治可结合地域、饮食,在中医体质辨识的基础上,实行个体化诊疗.

中华医学会糖尿病学分会发布《中国2型糖尿病防治指南(2020年版)》(以下简称"2020年版《指南》")阐述了中医药在防治糖尿病中的作用.中成药是中医防治糖尿病的重要手段,本文结合2020年版《指南》推荐的中成药品种,分析其组成、功效及循证证据等,就中成药在临床应用中的定位及研究方向进行探讨,为充分发挥中成药在2型糖尿病中防治的作用提供参考.

目的:基于真实世界数据分析厦门地区境外输入新型冠状病毒肺炎患者内服中药的用药规律,以期为临床防治提供参考.方法:采用古今医案云平台(V2.2.1)对2021年4月至2021年10月于厦门大学附属第一医院杏林分院收住治疗的223例境外输入的新型冠状病毒肺炎患者的中药处方进行中药使用频次分析,中药性味、归经及功效分析,中药关联分析,中药聚类分析及中药复杂药理分析.结果:在223例患者的中药处方中,涉及156味中药,总用药频次3181次,药性以温、微寒为主,药味以苦、辛、甘为主,主要归肺经、脾经、胃经,药物主要功效为清热解毒、燥湿化痰、降逆止呕;柴胡-黄芩、半夏-柴胡、黄芩-甘草等为主要药对;复杂网络分析得出核心物组合为柴胡、黄芩、半夏、茯苓、陈皮、甘草、桔梗、贯众、北沙参、前胡;高频中药聚类分析可归纳为4个聚类方,主要为小柴胡汤、达原饮、麻黄汤及麻杏石甘汤等聚类方.结论:湿邪为此次境外输入新冠肺炎的核心病机,偏于湿热;治疗上当宣肺祛邪,清热燥湿,开达膜原,通利三焦;用药当寒温并举,以温为主,肺脾同治,间者并行.

Introduction: Chronic stress has been shown to cause liver damage in addition to psychological depression. Besides, drug-induced liver injury is frequently caused by antidepressants. Shuxie-1 decoction (SX-1) is a formula of traditional Chinese medicine commonly used in nourishing liver blood, and relieving depression. However, the underlying molecular mechanism remains unclear. Therefore, this study was designed to explore the effects and mechanisms of SX-1 in treating chronic stress-induced depression as well as liver injury. Methods: Chronic unpredictable mild stress (CUMS) was applied to male Wistar rats for 4 weeks, with or without administration of SX-1 at low-dose and high-dose for 6 weeks, using Fluoxetine (Flu) as a positive control. Body weight was monitored once every 2 weeks. In the sixth week, the sugar preference test and open field test were carried out to evaluate the depression status. After that, the serum and liver tissues were collected. The quality control of SX-1 decoctions and drug-containing serum was controlled by UHPLC-QE-MS. The cell viability was measured by Cell Counting Kit-8 (CCK8). Enzyme-linked immunosorbent assay (Elisa), Western Blot and immunohistochemistrical staining was obtained to detect the protein levels in the plasma and the hepatic tissues, respectively. Results: CUMS led to decreased 1) body weight, 2) the preference for sugar water, 3) the desire to explore in open field, and increased serum levels of corticosterone. All these factors were completely reversed by SX-1 treatment. Hematoxylin-eosin staining (HE) showed that SX-1 improved the hepatocyte vacuolization in CUMS treated rats, decreased the serum levels of alanine aminotransferase (ALT) and the deposition of type I collagen (Col I) in hepatocytes as well. CUMS increased the levels of hepatic Interleukin-6 (IL-6), and provoked the activation of Janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3), which was abrogated by SX-1 treatment. Cobalt chloride (CoCl2) increased the protein expression of IL-6 and p-STAT3 in AML12 cells. Besides, nuclear pyknosis was observed under electron microscope, which were recovered after rat SX serum. Conclusion: SX-1 effectively ameliorated CUMS-induced depression-like behaviors as well as hepatic injuries, probably by the blockade of hepatic IL-6/JAK2/STAT3 signaling.

气机失调、津液输布障碍是糖尿病的主要病机,根据疏泄理论,治以和胃、健脾、化湿、宣肺、补肾之法,使三焦气机通畅,水湿得化,津液升降出入正常,精微物质归于"正化"则糖尿病自会好转.并举2型糖尿病验案为例进行说明.

近期中华医学会最新发布的《中国2型糖尿病防治指南(2020年版)》首次纳入针灸疗法,对针灸在2型糖尿病治疗中的应用进行了治疗推荐,本文总结了国内外针灸在2型糖尿病三级预防中的实践及获益,并对当前针灸治疗2型糖尿病的现状与研究进展进行总结.

基层是糖尿病防控的重点，中医药是基层防控的重要方法之一。近日由中华医学会糖尿病学分会、国家基层糖尿病防治管理办公室组织修订的《国家基层糖尿病防治管理指南（2022）》正式发布。新版指南首次增设了“糖尿病的中医药防治”一章。本文对该指南的中医药内容进行解读，希望能更好指导临床，提高基层糖尿病中医药服务能力。