OBJECTIVE:To investigate whether peritumoral electroacupuncture (EA) suppresses tumor growth viaCD8+ T cell infiltration mediated by sympathetic nervous system (SNS) regulation. METHODS:Utilizing a mouse model of triple-negative breast cancer (TNBC), the SNS was activated through chronic restraint stress (CRS); chemical sympathetic denervation was induced by 6-hydroxydopamine (6-OHDA). The anti-tumor and immune regulatory effects of EA were evaluated by multidimensional methods, including in vivobioluminescence imaging, flow cytometry, immunofluorescence, and enzyme-linked immunosorbent assay. RESULTS:Peritumoral EA decreased the volume and weight of tumors within 22 d after the implantation. Intratumoral CD8+ T cells significantly increased after EA. C-C motif chemokine ligand 5, as a chemokine that recruits effector T cells to the tumor microenvironment, also up-regulated. Meanwhile, EA reduced intratumoral sympathetic innervation and norepinephrine level. Subsequently, we found CRS significantly accelerates tumor growth and reduces the density of CD8+ T cell infiltration. However, EA reversed the tumor-promoting effect and immune suppression caused by CRS effectively. Furthermore, chemical sympathetic ablation with 6-OHDA revealed that the anti-tumor effect of EA was dependent on sympathetic integrity, as the ablation impaired both tumor-suppressing effect and CD8+ T cell recruitment mediated by EA. CONCLUSION:EA enhances anti-tumor immunity through SNS emphasizing the effective remodeling of the tumor immune microenvironment in mice with TNBC by neuro-immune interactions.

[This corrects the article DOI: 10.3389/fmed.2026.1815559.].

BackgroundKRAS-mutated ultra-low rectal cancer is associated with poor response to conventional neoadjuvant therapy, making sphincter preservation particularly challenging. In addition, effective rehabilitation strategies for severe low anterior resection syndrome (LARS) remain limited.Case presentationA 55-year-old woman with KRAS-mutated ultra-low rectal adenocarcinoma experienced insufficient tumor regression after multiple lines of chemotherapy, chemoradiotherapy, and immunotherapy, complicated by oxaliplatin allergy. After referral to our center, she received bevacizumab plus XELIRI combined with traditional Chinese medicine therapies. Following five treatment cycles, the patient underwent laparoscopic radical rectal resection with transanal specimen extraction and Bacon-type pull-through reconstruction. Pathological examination demonstrated negative proximal, distal, and circumferential margins, no metastatic involvement among 12 examined lymph nodes, and a final pathological stage of ypT2N0. The patient subsequently developed major LARS and underwent a four-week rehabilitation program centered on electroacupuncture at the Baliao acupoints. Assessment was conducted using the LARS score, Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC-BFI), and EORTC QLQ-C30 scales. The patient’s bowel movement frequency decreased from over 30 times per day to approximately 10 times, and remained stable at 7–10 times during the 6-month follow-up.ConclusionIn this patient, an individualized conversion strategy was followed by R0 sphincter-preserving resection, and postoperative bowel function improved temporally during and after multimodal rehabilitation that included electroacupuncture. This observation provide preliminary evidence in support of this treatment approach. However, high-quality studies are still required to comprehensively evaluate the efficacy of this treatment regimen.

Objectives: ATP-binding cassette sub-family B member 1 (ABCB1) is closely associated with multidrug resistance (MDR) in colorectal cancer; however, safe and effective clinical treatment options remain limited. This study aimed to evaluate electroacupuncture, a traditional Chinese medicine technique, for its potential to overcome ABCB1-mediated MDR in colorectal cancer and investigate the underlying mechanisms. Methods: The tumor-inhibitory effects of electroacupuncture were investigated in nude mice with ABCB1 overexpression-induced MDR. Chemotherapy drug metabolism in tumor tissues and blood was assessed using pharmacokinetic analysis. In vivo fluorescence imaging was employed to monitor the accumulation of the ABCB1 substrate Rhodamine 123 within tumors. ABCB1 expression was analyzed using Western blotting, polymerase chain reaction (PCR), and immunofluorescence. Proteomic and bioinformatic analyses were conducted to explore the mechanisms through which electroacupuncture overcomes ABCB1mediated drug resistance. Results: Electroacupuncture significantly enhanced the sensitivity of ABCB1-mediated MDR nude mice to paclitaxel, markedly inhibiting tumor growth and promoting apoptosis. Tumor drug concentrations increased, while the expression of hypoxia-inducible factor 1-alpha (HIF1A) and its downstream target, ABCB1, decreased. Proteomic analyses suggested that extracellular matrix (ECM) remodeling plays a key role, indicated by decreased TIMP-1 and increased collagen expressions (collagen alpha-1(I) chain [COL1A1], collagen alpha-2(I) chain [COL1A2], and collagen alpha-1 (XVIII) chain [COL18A1]). Collectively, these findings indicate that electroacupuncture may influence tumor mechanical properties and the hypoxic microenvironment by modulating the balance between ECM degradation and deposition, providing a potential mechanistic explanation for the reversal of ABCB1-mediated MDR. Conclusion: Electroacupuncture may reverse ABCB1-mediated tumor MDR, potentially through ECM remodeling and improvement of the tumor mechanical microenvironment. These insights provide a basis for developing new strategies to combat clinical drug resistance.

BackgroundApproximately 60–80% of rectal cancer patients develop low anterior resection syndrome (LARS) following sphincter-preserving surgery, which significantly impacts their quality of life. Existing treatments have various limitations. This case report evaluated the efficacy of electroacupuncture (EA) combined with moxibustion therapy for refractory LARS using a combined quantitative and qualitative approach. The patient was a 55-year-old man who continued to experience severe symptoms (LARS score: 34 points) 8 years after rectal cancer surgery, with sacral nerve modulation treatment proving ineffective.Case presentationThe patient received EA and moxibustion treatment between 5 December 2024 and 27 December 2024. EA was administered every other day (12 sessions total), targeting the bilateral sacral foramen acupoints: Shangliao (BL31), Ciliao (BL32), Zhongliao (BL33), and Xialiao (BL34). Electrical stimulation lasted 30 min per session with a continuous wave at 50 Hz. Daily moxibustion (23 sessions total) was applied to Shenshu (BL23) and Mingmen (DU4) to warm the kidneys and strengthen the yang. Moxa sticks (30 mm diameter) were held 2 cm above the skin for 45 min per session. After treatment, the LARS score decreased to 11. Daily defecation frequency reduced from 13–15 to 3–4 episodes. Qualitative interview results showed that urgency tolerance increased (from <1 min to 10 min), fecal leakage frequency decreased (from ≥1 daily to <1 weekly), and there was improvement in evacuation difficulties and flatus control. Systemic symptoms (cold extremities, abdominal distension) improved. However, therapeutic effects partially relapsed at 3 months and stabilized at minor LARS levels (score 24) through 1-year follow-up.ConclusionBy combining quantitative and qualitative outcome assessments, this case report offers initial evidence for short-term symptom management in refractory LARS. High-quality research is still needed to fully assess the efficacy of this treatment.

Background: Angiogenesis significantly contributes to breast cancer progression. While glyoxalase I (GLO1) has been extensively studied in endothelial cells related to cardiovascular and metabolic diseases, its role in breast cancer-associated endothelial cells (BCECs) remains unclear. Moreover, Additionally, a comprehensive analysis of GLO1 inhibitors is lacking. This study aims to systematically evaluate the pharmacological profiles of GLO1 inhibitors, identify those with potential effects on BCECs, and validate these findings experimentally. Materials and methods: Seventeen GLO1 inhibitors were analyzed using SwissADME and pkCSM for their pharmacological profiles. Target identification employed SwissTargetPrediction and SuperPred, and intersected with differentially expressed genes (DEGs) from the GSE80506 dataset to construct a BCECs-relevant target network. This network underwent enrichment analysis, expression correlation analysis, and molecular docking. Experimental validation was conducted using cellular assays and an aortic ring assay in mice. Results: Among 515 targets associated with the 17 GLO1 inhibitors, 36 were linked to BCECs regulation. Enrichment analysis highlighted the cell cycle as a pivotal pathway, with key targets including CCNA2, CCNE1, CDC25A, CDC25B, CDK6, CHEK1, PLK1, and TTK. Molecular docking indicated that Glyoxalase I inhibitor 6 plays a significant role in regulating these targets. Experimental assays demonstrated that this inhibitor arrested cells in the G0/G1 phase by modulating CCNA2 and CCNE1, suppressed BCECs proliferation, migration, and angiogenesis, and promoted cell death. Conclusions: GLO1 inhibitors exhibit significant regulatory effects on BCECs. Notably, Glyoxalase I inhibitor 6 effectively inhibits cell cycle progression, proliferation, migration, and angiogenesis in these cells, suggesting a promising therapeutic approach for targeting tumor-associated endothelial cells in breast cancer.

Acupuncture and moxibustion are increasingly gaining recognition in the clinical and research fields of integrative oncology. This review synthesizes findings from clinical guidelines, systematic reviews, meta-analyses, and randomized controlled trials (RCTs) of acupuncture and moxibustion for cancer care. Clinical evidence highlights acupuncture’s efficacy in managing symptoms such as hot flashes, pain, insomnia, fatigue, and constipation. Acupuncture also demonstrates potential effects in reducing chemotherapy and radiotherapy-induced side effects. Recent advancements in China shows integrated therapies combining acupuncture with chemotherapy to enhance therapeutic outcomes. Additionally, laboratory studies reveal the potential of acupuncture and moxibustion to modulate the tumor microenvironment, boost chemotherapy efficacy, and strengthen immunity. Despite these promising results, there is a pressing need for well-designed trials and real-world studies to evaluate the long-term effects of standardized acupuncture and moxibustion treatments in cancer care.

Background Triple-negative breast cancer is a particularly aggressive type of breast cancer that is closely associated with abnormal vascularization within the tumor. However, traditional anti-VEGF therapies and other treatments have limited efficacy. Tumor-associated macrophages (TAMs) induce and regulate tumor angiogenesis. In recent years, regulating TAMs polarization has become a hot topic for research with objectives to normalize tumor vasculature and improve drug delivery and the tumor microenvironment. Our previous studies have found that peritumoral electroacupuncture (EA) can regulate tumor angiogenesis, but the underlying mechanism remains unclear. Methods In this study, we examined the phenotype of TAMs and inflammatory factors to observe the effect of peritumoral electroacupuncture on the phenotypic polarization of TAMs. Based on this, we evaluated the structure and function of tumor vasculature. Finally, we conducted a preliminary exploration of the mechanism underlying the regulation of TAMs phenotypic polarization by peritumoral electroacupuncture. Results In this study, we found that peritumoral electroacupuncture could promote the phenotypic polarization of TAMs toward the M1 type, thereby reducing microvascular density in tumor tissue, increasing pericyte coverage, improving the stability of the basement membrane, promoting vascular maturation, and enhancing perfusion while reducing tissue hypoxia. Conclusions Peritumoral electroacupuncture can promote the phenotypic polarization of TAMs toward the M1 type, leading to normalization of tumor vascular structure and function. The mechanism may be related to the downregulation of glyoxalase-1 and subsequent activation of the MGO-AGEs/RAGE axis.

Emerging research suggested a potential role of immune cells in colorectal cancer (CRC) development. However, the causal relationship between immune phenotypes and CRC remains elusive. Hence, this two-sample Mendelian randomization (MR) study aimed to explore the causal association. In this study, a bidirectional, two-sample MR analysis and multivariate MR was conducted, leveraging public genetic data. Four types of immune phenotypes were employed. A comprehensive sensitivity analysis was carried out to validate the robustness, heterogeneity, and horizontal pleiotropy of the results, with Bonferroni correction applied for accurate interpretation. It was revealed that four immune cell phenotypes were significantly associated with CRC risk. Specifically, lymphocyte

ETHNOPHARMACOLOGICAL RELEVANCE:Xihuang pill (XHP), a traditional prescription for treating "Ru yan (breast cancer)" for 270 years, has the efficacies of clearing heat and improving blood circulation. Previous research has demonstrated that XHP yields significant therapeutic effects in the management of triple-negative breast cancer (TNBC). AIM OF THE STUDY:To explore and validate the usage of a traditional Chinese medicine formula XHP in combating TNBC by epithelial-mesenchymal transition (EMT) and apoptosis mechanisms. MATERIALS AND METHODS:The cytotoxic effects of XHP were evaluated using the CCK-8 assay after incubating with 4T1 and MDA-MB-231 TNBC cell lines. WB assay was conducted to detect the expression of proteins associated with EMT and apoptosis signaling pathways, elucidating the mechanism by which XHP inhibits TNBC. DAPI staining, and mitochondrial membrane potential (MMP) assays (JC-1) were utilized to further confirm the effect of apoptosis in TNBC. Moreover, morphological examination, wound healing assays, and transwell experiments were used to investigate the EMT properties of XHP. Besides, this study constructed 4T1-xenograft model to assess the anti-tumor efficacy of XHP, while the underlying mechanism was revealed by H&E staining. RESULTS:XHP suppressed tumor growth and metastasis in Balb/c transplanted tumor model by inducing EMT and apoptosis. XHP modulated the expression of the AXL/TGF-β1/RhoA/ROCK pathway, reducing tumor cell EMT, and influencing the ERK signaling pathway. Moreover, XHP inhibited the expression level of Bcl2, Bax and caspase 9 to promote apoptosis in tumor cells. These phenomena eventually manifested as inhibiting the proliferation and migration of TNBC cells. CONCLUSIONS:XHP inhibits TNBC and regulates EMT and apoptosis phenotypes by regulating the AXL/TGF-β1/RhoA/ROCK and ERK pathways. Therefore, it could be further utilized in the discovery of anti-cancer drugs.

In this case report, we describe the successful treatment of a patient with complete small bowel obstruction following gastric cancer surgery, employing an integrated approach of traditional Chinese medicine and Western medicine. Initial treatment consisted of conventional biomedical interventions, including intestinal obstruction catheterization, but after 16 days without improvement, surgical intervention was recommended. The patient, however, refused surgery and opted for treatments based on traditional Chinese medicine. Comprehensive traditional Chinese medicine therapies such as acupuncture, moxibustion, flash cupping, oral administration of compound herbal formulas, and enemas using Chinese herbal medicine were implemented alongside modern medical care. The obstruction resolved, and the patient was discharged without requiring surgery. Follow-up revealed no recurrence of the condition. This case highlights the potential of integrating traditional Chinese medicine with Western medical practices in the conservative management of complete small bowel obstruction, offering a reference for clinical application.

Hepatocellular carcinoma (HCC), a common and lethal form of liver cancer, includes mitochondrial dysfunction in its pathogenesis. This study investigated the relationship between mitochondrial function-related genes and HCC progression. We systematically retrieved mitochondrial genetic data from the MitoCarta database and identified differentially expressed genes through Gene Expression Omnibus analysis. Weighted gene co-expression network analysis was subsequently employed to construct co-expression networks and identify key modules associated with HCC progression. We evaluated 113 machine learning algorithms to develop mitochondrial gene-based prognostic models. Gene set enrichment analysis further delineated the pathways and biological processes enriched in the module hub genes, offering mechanistic insights into HCC. Immune infiltration analysis using CIBERSORT highlighted the pivotal roles of M1 and M2 macrophages in HCC. Finally, therapeutic candidates targeting critical genes were explored using computational drug prediction, molecular docking, and molecular dynamic simulations, providing novel strategies for HCC-targeted therapy. Stepwise Logistic Regression with Gradient Boosting Machine was chosen as the optimal model (area under the curve [AUC] = 0.977). Moreover, 15 potential HCC biomarkers were identified, including PSMD4 (AUC = 0.888), TBCE (AUC = 0.879), and CKS1B (AUC = 0.860). Additionally, fluoxetine and paroxetine were predicted as potential HCC drugs and validated through molecular docking and dynamic simulations. This study highlights the prognostic significance of mitochondrial function-related genes in HCC and establishes a framework for developing innovative diagnostic and therapeutic interventions. Future research should prioritize clinical validation of these findings and evaluate the translational potential of the identified drug candidates in HCC.

This study reports two cases of rectal cancer patients who developed low anterior resection Syndrome (LARS) following rectal cancer surgery. Both patients presented with significant bowel dysfunction, including frequent defecation, urgency, fecal incontinence, and incomplete evacuation. Current treatments for LARS are limited by variable responses, high costs, and adherence issues, highlighting the need for practical, safe therapies with minimal side effects. The patients underwent a 6-month electroacupuncture treatment targeting Baliao points. Assessments were conducted using the LARS score, Wexner fecal incontinence score, and the EORTC QLQ-C30 scale. Results indicated a marked reduction in bowel frequency, significant relief of fecal incontinence symptoms, and improvement in overall health status and quality of life. In addition, emotional and cognitive functions were enhanced. These case reports suggest that electroacupuncture may be a valuable adjunctive treatment for managing LARS and improving patient emotional status and quality of life. Further high-quality research is necessary to evaluate the long-term efficacy of this treatment fully.

Ethnopharmacological relevance: Xihuang pill (XHP), a traditional prescription for treating "Ru yan (breast cancer)" for 270 years, has the efficacies of clearing heat and improving blood circulation. Previous research has demonstrated that XHP yields significant therapeutic effects in the management of triple-negative breast cancer (TNBC). Aim of the study: To explore and validate the usage of a traditional Chinese medicine formula XHP in combating TNBC by epithelial-mesenchymal transition (EMT) and apoptosis mechanisms. Materials and methods: The cytotoxic effects of XHP were evaluated using the CCK-8 assay after incubating with 4T1 and MDA-MB-231 TNBC cell lines. WB assay was conducted to detect the expression of proteins associated with EMT and apoptosis signaling pathways, elucidating the mechanism by which XHP inhibits TNBC. DAPI staining, and mitochondrial membrane potential (MMP) assays (JC-1) were utilized to further confirm the effect of apoptosis in TNBC. Moreover, morphological examination, wound healing assays, and transwell experiments were used to investigate the EMT properties of XHP. Besides, this study constructed 4T1-xenograft model to assess the anti-tumor efficacy of XHP, while the underlying mechanism was revealed by H&E staining. Results: XHP suppressed tumor growth and metastasis in Balb/c transplanted tumor model by inducing EMT and apoptosis. XHP modulated the expression of the AXL/TGF-(31/RhoA/ROCK pathway, reducing tumor cell EMT, and influencing the ERK signaling pathway. Moreover, XHP inhibited the expression level of Bcl2, Bax and caspase 9 to promote apoptosis in tumor cells. These phenomena eventually manifested as inhibiting the proliferation and migration of TNBC cells. Conclusions: XHP inhibits TNBC and regulates EMT and apoptosis phenotypes by regulating the AXL/TGF-(31/ RhoA/ROCK and ERK pathways. Therefore, it could be further utilized in the discovery of anti-cancer drugs.

Neutropenia, a common side effect of chemotherapy for ovarian cancer, was observed in a 47-year-old female patient undergoing a six-cycle chemotherapy regimen. She experienced recurrent neutropenia and leukopenia but refused granulocyte colony-stimulating factor (G-CSF) due to severe bone pain and high costs. Moxibustion combined with guasha therapy (MGT) was administered each time neutropenia occurred. The treatment involved guasha therapy on the bladder meridian (BL) and the governor vessel (GV), followed by moxibustion at Zhongwan (CV 12), Guanyuan (CV 4), and Shenzhu (GV 12) points over 2-3 days. This approach led to the recovery of neutrophil and leukocyte counts, enabling the patient to complete six chemotherapy cycles without G-CSF. These findings suggest that MGT may enhance neutrophil and leukocyte counts in patients with chemotherapy-induced myelosuppression, presenting a potential alternative for those intolerant to G-CSF. However, further high-quality research is needed to confirm its efficacy.

Background Epidemiological studies have provided evidence that there is an association between diet and colorectal cancer. However, the causal relationship between dietary habits and colorectal cancer remains unknown. Methods The UK Biobank provided summary-level genome-wide association study data for nine dietary habits, including alcohol consumption (n = 549,703), instant coffee consumption (n = 250,308), fruit consumption (n = 210,947), meat consumption (n = 210,947), full cream milk consumption (n = 41,306), sweets consumption (n = 25,521), tea consumption (n = 501,494), vegetable consumption (n = 210,947), and yogurt/ice cream consumption (n = 210,947). Additionally, data on colorectal cancer were collected, consisting of 5,567 cases and 372,016 controls. The MR analysis employed inverse variance weighted, weighted median, MR-Egger regression, and MR multivariate residuals tests. Results In the predominantly European population, a positive association was observed between vegetables (OR = 1.014, 95% CI = 1.000-1.029, p = 0.048) and an increased risk of colorectal cancer. The results for vegetable did not survive correction for multiple comparisons. However, no strong evidence was found for other dietary factors, such as alcohol (OR = 1.012, 95% CI = 0.974–1.051, p = 0.556), fruit (OR = 1.007, 95% CI = 0.986–1.029, p = 0.512), meat (OR = 1.000, 95% CI = 0.987–1.026, p = 0.968), full cream milk (OR = 1.019, 95% CI = 0.979–1.061, p = 0.357), sweets (OR = 0.998, 95% CI = 0.991–1.004, p = 0.524), and tea (OR = 1.002, 95% CI = 0.994–1.009, p = 0.672), with regards to colorectal cancer risk in the European population. Conclusions Our study highlights the need for a more nuanced approach to dietary recommendations for CRC prevention, with greater emphasis adherence to the Mediterranean dietary pattern.

Recent therapeutic strategies for the treatment of triple-negative breast cancer (TNBC) have shifted the focus from vascular growth factors to endothelial cell metabolism. This study highlights the underexplored therapeutic potential of peri-tumoral electroacupuncture, a globally accepted non-pharmacological intervention for TNBC, and molecular mechanisms. Our study showed that peri-tumoral electroacupuncture effectively reduced the density of microvasculature and enhanced vascular functionality in 4T1 breast cancer xenografts, with optimal effects on day 3 post-acupuncture. The timely integration of peri-tumoral electroacupuncture amplified the anti-tumor efficacy of paclitaxel. Multi-omics analysis revealed Glyoxalase 1 (Glo1) and the associated methylglyoxal-glycolytic pathway as key mediators of electroacupuncture-induced vascular normalization. Peri-tumoral electroacupuncture notably reduced Glo1 expression in the endothelial cells of 4T1 xenografts. Using an in vivo matrigel plug angiogenesis assay, we demonstrated that either Glo1 knockdown or electroacupuncture inhibited angiogenesis. In contrast, Glo1 overexpression increased blood vessel formation. In vitro pharmacological inhibition and genetic knockdown of Glo1 in human umbilical vein endothelial cells inhibited proliferation and promoted apoptosis via downregulating the methylglyoxal-glycolytic pathway. The study using the Glo1-silenced zebrafish model further supported the role of Glo1 in vascular development. This study underscores the pivotal role of Glo1 in peri-tumoral electroacupuncture, spotlighting a promising avenue for enhancing vascular normalization and improving TNBC treatment outcomes.

Background The effects of sleep duration on the development of mental illness remain controversial. Therefore, it is necessary to identify the effects of long or short sleep duration on psychological disorders, which could reveal new ways for preventing and treating mental health conditions cheaply. Methods Identifying published papers was accomplished by using the following five English databases on March 16, 2022: PubMed, MEDLINE, Embase, Web of Science databases, and Scopus. Cross-sectional and cohort studies were considered if they evaluated the association of sleep duration with all kinds of mental illness in adults. We excluded case reports, editorials, narrative reviews, and studies without detailed information on sleep duration. Summary effect-size estimates were expressed as risk ratios (RRs) or odds ratios (ORs) with 95% confidence intervals and were evaluated using random-effect models. Mantel-Haenszel’s random-effects model was used to estimate the inconsistency index ( I 2 ) and Tau 2 index (measurement of heterogeneity). Results A total of 52 studies were included in this analysis, consisting of 14 cohort studies and 38 cross-sectional studies. These studies involved a combined sample size of 1,407,891 participants who met the inclusion criteria. Cohort (adjusted RR = 1.42, 95% CI: 1.26–1.60, P < .001, I 2 = 37.6%, Tau 2 = 0.014) and cross-sectional studies (adjusted OR = 1.67, 95% CI: 1.57–1.77, P < .001, I 2 = 79.7%, Tau 2 = 0.060) concluded that short sleep duration increased mental disorder risks. The same conclusions were acquired in the subgroup analysis, especially for depression (adjusted RR = 1.43, 95% CI: 1.24–1.65, P < .001, I 2 = 80.4%, Tau 2 = 0.082), anxiety (adjusted RR = 1.30, 95% CI: 1.04–1.63, P = .002, I 2 = 0.0%, Tau 2 = 0.000), and PTSD (adjusted RR = 1.35, 95% CI: 1.04–1.76, P = .022, I 2 = 24.1%, Tau 2 = 0.013) in cohort studies. The results of subgroup analysis indicated that long sleep duration was not a risk factor for depression (adjusted RR = 1.15, 95% CI: 0.98–1.34, P = .088, I 2 = 63.4%, Tau 2 = 0.045) and anxiety (adjusted RR = 1.37, 95% CI: 0.93–2.03, P = .114, I 2 = 0.0%, Tau 2 = 0.000). Conclusions Short sleep duration, not long sleep duration, is an independent predictor of developing mental disorders, particularly anxiety and depression.

Xiatianwu is a traditional Chinese medicine. This study investigates the function of Xiatianwu in treating HCC through database analyses and in vitro experiments. The active ingredients of Xiatianwu were identified from TCMSP and HERB databases and their targets were predicted by Swiss TargetPrediction. The HCC dataset was screened using the GEO database, and the differentially expressed genes between HCC and non-tumor liver tissues were analyzed to identify overlapping targets with Xiatianwu. The intersecting targets underwent enrichment analysis using R software to elucidate the molecular mechanisms of Xiatianwu against HCC. Core targets were identified using the PPI network and MCODE algorithm. Clinical relevance and disease prognosis in HCC were verified using the TCGA database. Meanwhile, binding affinities among components and targets were validated with molecular docking. Finally, the anti-HCC efficacy of the active ingredient was validated in vitro. Our findings revealed that eight active ingredients of Xiatianwu interacted with 11 key targets, providing anti-HCC efficacy. Molecular docking indicated that bicuculline and fumarine exhibited superior binding abilities. Bicuculline, a representative ingredient of Xiatianwu, was chosen for in vitro validation. Results demonstrated that bicuculline, in a dose-dependent manner inhibited HCC cell viability, reduced migration, suppressed the G0/M cell cycle, and decreased core protein expression. Xiatianwu demonstrates significant potential for clinical application in treating HCC. Bicuculline, a key active ingredient of Xiatianwu, exerts anti-HCC effects by inhibiting the cell cycle.