Endometritis, which can cause endometrial fibrosis, is one of the key factors leading to the decline of pregnancy and reproduction rates in cows. Macrophages can be polarized into M1 type pro-inflammatory phenotype to aggravate endometrial injury under pathological conditions. Paeoniflorin (PF) is a single glucoside extracted from Paeoniaceae, which has anti-fibrosis and anti-inflammatory effects. However, its effect on fibrosis in endometritis in cows is unknown. In this study, we examined uterine fibrosis and macrophage polarization in endometritic cows, and established a macrophage-bovine endometrial stromal cell (BESC) co-culture system to clarify PF’s protective mechanism. In vivo, endometritic cattle showed prominent collagen accumulation, elevated M1 markers CD86/iNOS, reduced epithelial E-cadherin, and increased fibrotic markers N-cadherin, α-SMA and Vimentin. In vitro, LPS-induced M1 macrophages were confirmed as a vital driver of BESC fibrosis, while M0 unpolarized or IL-4-stimulated M2 macrophages exerted no fibrotic effects. Mechanistically, PF suppressed NF-κB/STAT1 phosphorylation to block M1 polarization and reverse M1-mediated BESC fibrosis. In summary, the results of the present study indicate that PF attenuates endometrial fibrosis in cows by inhibiting M1 polarization of macrophages through the NF-κB and STAT1 pathway. These results provided insights into the exploration of therapeutic targets and intervention strategies for endometritis in cows.

IntroductionMaintaining remission in ulcerative colitis (UC) with traditional Chinese herbal medicine is challenging because fixed-intensity prescriptions may not accommodate changes in inflammatory burden. This study aimed to predict 52-week relapse and develop a data-driven policy for sequential adjustment of herbal treatment intensity.MethodsWe analysed a development cohort of 1,181 patients receiving herbal maintenance therapy and an independent external validation cohort of 96 patients. Twenty-one baseline clinical, biomarker, herbal-dose and behavioral variables, expanded to 31 features after one-hot encoding, were used to train and compare seven machine-learning models through stratified five-fold cross-validation and external validation. Discrimination, calibration and decision-curve net benefit were evaluated. Remission maintenance was subsequently modelled as a sequential decision problem using 4,141 scheduled-visit transitions. A gradient-boosted reward model was used for model-based off-policy evaluation of a net-clinical-benefit policy that penalized unnecessary treatment intensification in clinically quiescent patients.ResultsCalibrated logistic regression provided the best overall performance, with an internal cross-validation area under the receiver operating characteristic curve (AUROC) of 0.783 (95% confidence interval [CI], 0.755–0.809) and an external AUROC of 0.710 (95% CI, 0.600–0.820). The corresponding Brier scores were 0.180 (95% CI, 0.169–0.191) and 0.215 (95% CI, 0.170–0.263), respectively. Medication adherence was the strongest predictor of relapse, followed by fecal calprotectin, C-reactive protein and Coptidis Rhizoma dose. The learned policy increased herbal intensity with increasing fecal calprotectin and achieved a higher estimated mean reward than observed clinician behavior (0.552 ± 0.018 versus 0.063 ± 0.021). Policy-concordant visits were associated with a higher next-visit remission rate than discordant visits (70.0% versus 59.6%).DiscussionCombining interpretable relapse prediction with reinforcement learning offers a personalized decision-support framework for optimizing herbal treatment intensity during UC remission maintenance. Because the policy was derived and evaluated using observational data and model-based off-policy methods, prospective clinical evaluation is required before routine implementation.

This study aims to explore the mechanisms of "Huangqi(Astragali Radix)-Shengdihuang(Rehmanniae Radix)-Shanyao(Dioscoreae Rhizoma)"(HSS) in the intervention of type 2 diabetes mellitus(T2DM). The active ingredients and targets of the triangular herb HSS were searched from the TCMSP, BATMAN-TCM, and DrugBank databases. The disease-related targets of T2DM were searched from the PharmGkb, GeneCards, OMIM, and TTD. The intersection targets of HSS and T2DM were obtained, and the protein-protein interaction(PPI) analyses of the intersection targets were performed by using the STRING and Cytoscape software. The Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) signaling pathway enrichment analyses for the intersection targets were performed through R software. After continuous intragastric administration of HSS formula granules for one week, blood was collected from the abdominal aorta of SD rats to obtain herb-containing serum. An insulin resistance-HepG2(IR-HepG2) cell model was induced by insulin solution combined with high glucose medium. The groups were divided into a blank group, a control group, a model group, a low-dose HSS group, a medium-dose HSS group, and a high-dose HSS group. The cellular viability, glucose consumption, glycogen content, malondialdehyde(MDA), superoxide dismutase(SOD), and reactive oxygen species(ROS) were detected using the corresponding kits. The mRNA expression of phosphoinositide 3-kinase(PI3K), protein kinase B(Akt), and glycogen synthase kinase-3β(GSK-3β) was assayed through real-time PCR, and the protein expression of PI3K, Akt, phosphorylated(p)-Akt, GSK-3β, and p-GSK-3β was assayed through Western blot. A total of 10 903 disease-related targets of T2DM were obtained, and 29 active ingredients of HSS that may act on T2DM were screened out. These active ingredients were associated with 196 T2DM-related targets. Quercetin, kaempferol, and formononetin were the active ingredients that act on the largest number of T2DM targets. GO analysis of the intersection targets enriched 2 396 biological processes, 95 cellular components, and 198 molecular functions. KEGG analysis of the intersection targets enriched 175 pathways including PI3K/Akt signaling pathway, mitogen-activated protein kinase(MAPK) signaling pathway, and advanced glycation end-products/receptor for advanced glycation end-products(AGE/RAGE) signaling pathway. A total of 17 core proteins were obtained through the topology analyses of the PPI network. Low-, medium-, and high-dose HSS-containing serum had no significant effect on the proliferation of IR-HepG2 cells. HSS-containing serum could increase glucose consumption and glycogen content, reduce the MDA and ROS levels, and increase the SOD activity in IR-HepG2 cells. Additionally, the HSS-containing serum significantly up-regulated the PI3K mRNA expression, down-regulated the GSK-3β mRNA expression, up-regulated the PI3K, p-Akt, and p-GSK-3β protein expression, and down-regulated the GSK-3β protein expression, all in a dose-dependent manner. The mechanism of HSS acting on T2DM is a complex network with multiple targets and multiple pathways. HSS-containing serum could effectively ameliorate the insulin resistance of IR-HepG2 cells, and its therapeutic mechanism may be related to the activation of the PI3K/Akt/GSK-3β signaling pathway and the improvement of antioxidant stress resistance of model cells.

At present, environmental pollution is becoming more and more serious, the sustainable development of human society is facing severe challenges. As a crucial nexus for pollutant discharge and greenhouse gas emissions, the establishment of carbon-neutral wastewater treatment processes in wastewater treatment plants, aiming to achieve coordinated development of pollution reduction and carbon mitigation, constitutes a pivotal pathway for environmental governance in the new era. The bacteria-algae symbiotic culture system, based on microalgae biological treatment technology, integrates wastewater treatment, carbon fixation, and biomass energy recovery. It represents a green, low-carbon, economical, and sustainable integrated sewage treatment technology, aligning with the requirements of carbon neutrality. This study constructed an algae-assisted sequencing batch photobioreactor (A-SBPBR) and individual microalgal systems to compare the degradation efficiencies of soluble chemical oxygen demand (sCOD), ammonia nitrogen (AN), and total phosphorus (TP) in high-strength food waste anaerobic digestion effluent (ADE), with high-throughput sequencing conducted to analyze bacterial community dynamics and microbial ecological shifts, coupled with carbon accounting model integration to quantify system-specific carbon emission reduction capacities. Experimental results demonstrated that the bacteria-algae symbiotic system achieved removal efficiencies of 58.89 %, 91.94 %, and 78.89 % for sCOD, AN, and TP, respectively, when treating ADE. Notably, the sCOD degradation rate was approximately 8 % higher than that of the pure algal system. At the phylum level, the bacterial community structure within the symbiotic system exhibited greater diversity and balanced phylum distribution. At the class level, the relative abundances of Gammaproteobacteria, Anaerolineae, and Microgenomatia increased by 5-12 %, 11-14 %, and 2-6 %, respectively, compared to the pure algal system. Carbon footprint analysis revealed that treating 1 m3 of ADE with the symbiotic system reduced CO2 emissions by 51.2 g compared to conventional aerobic processes and lowered CH4 emissions (expressed as CO2 equivalents) by 111.94 g relative to anaerobic processes. These findings indicate that the bacteria-algae symbiotic technology synergistically combines high-efficiency pollutant removal with carbon sequestration capabilities, providing a viable solution for wastewater treatment aligned with carbon neutrality objectives.

Background: Crohn's disease (CD) is a challenging digestive system disorder, and the role of solute carrier-related genes (SLCRGs) in CD remains unknown.Methods: We acquired two CD-related datasets from the Gene Expression Omnibus (GEO) database. GWAS IDs for CD and exposure factors were obtained from the Integrative Epidemiology Unit Open GWAS database. Using SLCRGs, we conducted differential expression analysis between CD and normal cohorts, and CD-involved and CD-uninvolved cohorts, to identify differentially expressed SLCRGs (DE-SLCRGs). Single-variable Mendelian randomization (SVMR) estimated the risk of DE-SLCRGs in CD. Sensitivity analysis ensured the reliability of MR results.Results: We identified 1561 upregulated and 830 downregulated differentially expressed genes (DEGs) between CD and normal cohorts. Additionally, 294 upregulated and 350 downregulated DEGs were found between CD-involved and CD-uninvolved cohorts. Based on DEGs, we identified two upregulated DE-SLCRGs and seven downregulated DE-SLCRGs. SVMR indicated SLC22A5 as a protective factor for CD. Functional enrichment showed SLC22A5's association with the 'chemokine-signaling pathway,' 'collagen binding,' and 'cell-substrate junction.' SLC22A5 was negatively correlated with natural killer cells. Predictively, we found 8 miRNAs and 19 compounds related to SLC22A5.Conclusions: Our research validates the potential impact of SLC22A5, providing a foundation for exploring its regulatory mechanism in CD.

Irritable bowel syndrome (IBS) is a type of chronic bowel disorder with a poorly understood pathophysiology. Recently, the imbalance of copper has been reported to influence the progression of IBS, suggesting cuproptosis, a new type of copper-induced cell death, may play a role in IBS. This study found 17 cuproptosis-related differentially expressed genes in IBS through bioinformatic analysis. Six hub genes were identified after the protein-protein interaction network analysis, namely myeloid cell leukemia 1 (MCL1), epidermal growth factor receptor 2, cadherin-associated protein beta 1, solute carrier family 25 members 37, solute carrier family 39 members 14, and six transmembrane epithelial antigens of the prostate 3. We selected MCL1 for further verification. Human normal colon epithelial cell line (NCM460) was used to construct models of IBS or cuproptosis in vitro by lipopolysaccharide (LPS) or LPS combined with copper (II) chloride (CuCl2). We observed that overexpression of MCL1 promoted cell viability and proliferation ability, and inhibited the secretion of inflammatory factors and expression of Bax and caspase-3 of NCM460 cells treated with LPS or LPS combined with CuCl2. In addition, up-regulated MCL1 significantly suppressed the protein levels of ferredoxin 1 and lipoyl synthase, two key regulators of cuproptosis. In conclusion, our study demonstrates that cuproptosis is involved in IBS and identifies a cuproptosis-related gene, MCL1, that helps alleviate IBS by promoting cell growth, reducing inflammation, and suppressing cuproptosis, making it a promising therapeutic target in IBS.

Although Western Medicine is considered as the mainstream medicine in China, Traditional Chinese Medicine (TCM) still has its own advantages and characteristics. The attitudes and behaviors to TCM are divided, some West Medicine Doctors prefer TCM during treatment, while others consider it not effective. The objective of this study is to find out the attitudes and treatment behaviors of Chengdu physicians toward TCM, and identify factors associated with their attitude and behaviors. A representative sample of 2049 Chengdu physicians were recruited online to investigate their attitudes and behaviors toward TCM. During this research, previous Integrative Medicine Attitude Questionnaire were referred and modified, and adjusted questionnaire was made based on the actual situation of TCM in Chengdu. This questionnaire contains 3 distinct parts. The first part aimed at the attitudes of respondents toward TCM, and contains 15 questions in 3 sections, Holism, Knowledge, and Evidence. The second part tried to determine the behaviors toward TCM in terms of self-use, recommendations, as well as prescriptions. In addition, 6 modalities including Chinese Patent Medicine, Chinese Herbal Medicine, Acupuncture, Massage & Bone Setting, Qigong, and TCM diet were introduced in the behavioral part. In the third part, we aimed to collect personal, professional, and structural factors that may significantly influence TCM attitudes and behaviors. Physicians hold positive attitudes toward TCM in general, all the mean/highest possible subscales scores value of Holism (90.53%), Knowledge (63.77%), and Evidence (62.73%) domain were over 60%. On the other hand, physicians were more positive on self-use (49.40%) and recommendation (55.98%) of TCM than giving TCM prescriptions (36.60%) to patients. The attitudes and behaviors toward may not be consistent, which means physicians may not give prescriptions to patients even they have good attitudes to TCM. Education and self-use of TCM are important positive factors that influence the behaviors of physicians.

Wound healing is a dynamic and complex restorative process, and traditional dressings reduce their therapeutic effectiveness due to the accumulation of drugs in the cuticle. As a novel drug delivery system, microneedles (MNs) can overcome the defect and deliver drugs to the deeper layers of the skin. As the core of the microneedle system, loaded drugs exert a significant influence on the therapeutic efficacy of MNs. Metallic elements and herbal compounds have been widely used in wound treatment for their ability to accelerate the healing process. Metallic elements primarily serve as antimicrobial agents and facilitate the enhancement of cell proliferation. Whereas various herbal compounds act on different targets in the inflammatory, proliferative, and remodeling phases of wound healing. The interaction between the two drugs forms nanoparticles (NPs) and metal-organic frameworks (MOFs), reducing the toxicity of the metallic elements and increasing the therapeutic effect. This article summarizes recent trends in the development of MNs made of metallic elements and herbal compounds for wound healing, describes their advantages in wound treatment, and provides a reference for the development of future MNs.

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is guided by traditional Chinese medicine (TCM) syndrome differentiation theory and employs acupoint stimulation and heat to alleviate pain. Although prior research has shown that these are dependable methods for pain relief, the combined effect of the two techniques has not been described. In our research, we found that compared to using diclofenac sodium enteric-coated capsules alone, adding acupoint needle-embedding combined with ironing therapy was more effective for reducing pain levels at different stages after hemorrhoid surgery. Although this technique is efficient and commonly used in clinics, due to its invasive practice, acupoint needle embedding still carries risks relating to hospital-acquired infections and broken needles. Ironing therapy, on the other hand, can result in burns and connective tissue injuries. Therefore, there is an urgent need to develop a standardized protocol for medical staff. Our protocol refines the traditional techniques and provides detailed instructions on patient preparation, operation techniques, and postoperative care to ensure the therapy is carried out safely and efficiently. By standardizing this therapy, this technique is expected to become an important complementary therapy for postoperative pain relief in hemorrhoids, which will significantly improve patients 'life quality after anal surgery.

近年来,随着生活压力增加、生存环境恶化,因"肛门湿疹"一病于曹老门诊就诊人数明显增加.该病发病部位隐私、瘙痒难耐,严重影响患者生活质量,由于较高的复发率,导致治愈难度增大.曹吉勋教授为全国中医肛肠专业重要奠基人,从事中医肛肠工作近70年,长期致力于人类肛肠疾病研究与治疗.他根据此病发展过程中的虚实转化、湿热轻重关系将肛门湿疹分为三期,主张以"消、托、补"三步法分期论治,联合中医外治疗法,未病先防,既病防变.本文总结了曹吉勋教授以"消、托、补"三步法分期论治肛门湿疹的经验,加强四川省名老中医学术思想传承.

BackgroundRefractory wound is a common postoperative complication in anal fistula surgery, when combined with type 2 diabetes mellitus (T2DM) it presents a slower recovery time and more complex wound physiology. The study aims to investigate factors associated with wound healing in patients with T2DM.Materials and methods365 T2DM patients who underwent anal fistula surgery at our institution were recruited from June 2017 to May 2022. Through propensity score-matched (PSM) analysis, multivariate logistic regression analysis was applied to determine independent risk factors affecting wound healing.Results122 pairs of patients with no significant differences were successfully established in matched variables. Multivariate logistic regression analysis revealed that uric acid (OR: 1.008, 95% CI: 1.002–1.015, p = 0.012), maximal fasting blood glucose (FBG) (OR: 1.489, 95% CI: 1.028–2.157, p = 0.035) and random intravenous blood glucose (OR: 1.130, 95% CI: 1.008–1.267, p = 0.037) elevation and the incision at 5 o’clock under the lithotomy position (OR: 3.510, 95% CI: 1.214–10.146, p = 0.020) were independent risk factors for impeding wound healing. However, neutrophil percentage fluctuating within the normal range can be considered as an independent protective factor (OR: 0.906, 95% CI: 0.856–0.958, p = 0.001). After executing the receiver operating characteristic (ROC) curve analysis, it was found that the maximum FBG expressed the largest under curve area (AUC), glycosylated hemoglobin (HbA1c) showed the strongest sensitivity at the critical value and maximum postprandial blood glucose (PBG) had the highest specificity at the critical value. To promote high-quality healing of anal wounds in diabetic patients, clinicians should not only pay attention to surgical procedures but also take above-mentioned indicators into consideration.

应用中医药调节 2 型糖尿病合并非酒精性脂肪性肝病患者的肠道内环境稳态,对该疾病的防治具有重要意义.从中医角度看,土壅木郁为其发病关键.土壅木郁理论是肝脾同病的一种,因脾失健运、水湿内停、湿热内蕴、上蒸肝胆,致疏泄不利;通过肝脾同调,使运化顺畅,代谢正常.中医辨证论治有利于 2 型糖尿病合并非酒精性脂肪性肝病患者肠道内环境的稳定,减轻患者临床症状,延缓疾病进展.本文对土壅木郁理论下 2 型糖尿病合并非酒精性脂肪性肝病患者肠道内环境稳态相关研究进展进行综述,为该疾病的临床诊治提供依据.

目的 探究眼针埋针疗法联合体针治疗周围性面瘫伴味觉障碍的临床疗效.方法 将60例周围性面瘫伴味觉障碍患者随机分为对照组、试验组,各30例.对照组在常规治疗基础上采用体针干预,试验组在对照组基础上加眼针埋针治疗.通过House-Brackmann(H-B)分级、味觉评分测试、疗效评定标准进行评估.结果 与治疗前比较,治疗后试验组与对照组H-B分级评分均显著降低(P＜0.01);治疗后,与对照组相比,试验组H-B分级评分有下降趋势,但差异未见统计学意义(P＞0.05).与治疗前比较,治疗后试验组与对照组甜味、咸味、酸味味觉评分均显著升高(P＜0.01);治疗后,与对照组相比,试验组味觉评分升高更为明显,其中两组甜味、咸味比较差异有统计学意义(P＜0.05).治疗后,试验组有效率为90.00％,显效率为66.67％,均明显高于对照组.结论 眼针埋针疗法联合体针对周围性面瘫的疗效显著,并可改善面瘫引起的味觉障碍.

Purpose Ferroptosis is a form of cell death driven by iron-dependent lipid peroxidation. Intriguingly, KRAS-mutant cancers are particularly vulnerable to ferroptosis. Osthole is a natural coumarin extracted from Cnidium spp. and other Apiaceous plants. In the present study, we explored the antitumor potential of osthole in KRAS-mutant colorectal cancer (CRC) cells. Methods Cell viability assay, EdU incorporation assay, flow cytometry, tumor xenograft model, western blot, immunochemistry staining, immunofluorescence, transcriptome RNA sequencing and quantitative reverse transcription-PCR were performed to evaluate the influence of osthole treatment on KRAS-mutant CRC cells. Results We found that osthole treatment suppressed proliferation and tumor growth of KRAS-mutant CRC cell lines HCT116 and SW480. Moreover, osthole treatment increased ROS production and induced ferroptosis. Osthole treatment also promoted autophagy, but inhibition of autophagy by ATG7 knockdown or 3-MA showed no influence on osthole-induced ferroptosis. In comparison, osthole increased lysosomal activation, and co-treatment with lysosome inhibitor Baf-A1 attenuated osthole-induced ferroptosis. Besides, osthole treatment reduced the phosphorylation of AMPK, Akt and mTOR in HCT116 and SW480 cells, while restored AMPK signaling by AMPK agonist AICAR partially abrogated ferroptosis induced by osthole treatment. Finally, co-treatment with osthole increased the cytotoxicity of cetuximab in KRAS-mutant CRC cells in vitro and in vivo. Conclusion Our results suggested that the natural product osthole exerted its anticancer effects in KRAS-mutant CRC cells via inducing ferroptosis, and this was partially through inhibiting AMPK/Akt/mTOR signaling. Our results may expand our current knowledge for the use of osthole as an anticancer agent.

Although changes in gut microbiome have been associated with the development of T2D and its complications, the role of the gut virome remains largely unknown. Here, we characterized the gut virome alterations in T2D and its complications diabetic nephropathy (DN) by metagenomic sequencing of fecal viral-like particles. Compared with controls, T2D subjects, especially those with DN, had significantly lower viral richness and diversity. 81 viral species were identified to be significantly altered in T2D subjects, including a decrease in some phages (e.g. Flavobacterium phage and Cellulophaga phaga). DN subjects were depleted of 12 viral species, including Bacteroides phage, Anoxybacillus virus and Brevibacillus phage, and enriched in 2 phages (Shigella phage and Xylella phage). Multiple viral functions, particularly those of phage lysing host bacteria, were markedly reduced in T2D and DN. Strong viral-bacterial interactions in healthy controls were disrupted in both T2D and DN. Moreover, the combined use of gut viral and bacterial markers achieved a powerful diagnostic performance for T2D and DN, with AUC of 99.03% and 98.19%, respectively. Our results suggest that T2D and its complication DN are characterized by a significant decrease in gut viral diversity, changes in specific virus species, loss of multiple viral functions, and disruption of viral-bacterial correlations. The combined gut viral and bacterial markers have diagnostic potential for T2D and DN.

目的 观察三仁汤联合穴位注射治疗湿热下注型肛门坠胀的临床疗效.方法 选择 2021 年 1 月—2022 年 1 月成都中医药大学附属医院收治的湿热下注型肛门坠胀患者120 例,根据随机数字法,将患者随机分为观察组和对照组,每组 60 例.对照组给予穴位注射治疗,观察组给予三仁汤联合穴位注射治疗,连续治疗3 周后,比较2 组临床疗效、治疗前后肛门坠胀评分、焦虑量表评分、半年内的复发率以及不良反应发生率.结果 治疗后,观察组总有效率高于对照组(P<0.01),观察组在肛门坠胀评分、焦虑量表评分以及半年内的复发率上均低于对照组(P<0.01),2 组均未出现明显不良反应.结论 三仁汤联合穴位注射治疗湿热下注型肛门坠胀可有效缓解肛门坠胀患者的临床症状,值得在临床应用.

腰椎管狭窄症(LSS)是骨科临床上常见的难治性疾病之一,发病人群多为老年人.随着社会老龄化问题日趋严重,发病率增高,引起国内外的重视,治疗方法的研究成为热点.目前国内外治疗腰椎管狭窄症以保守治疗为主.文章通过对中医外治法治疗腰椎管狭窄症文献的整理与分析,为优化腰椎管狭窄症临床治疗提供参考.

Eye acupuncture with acupuncture rehabilitation therapy refers to the organic combination of eye acupuncture therapy and modern rehabilitation technology. According to the different functional disorders of rehabilitation objects, the corresponding acupoints of "Eight Areas and Thirteen Points of Eye Acupuncture" were selected to bury the needles, and various rehabilitation training were carried out simultaneously during the needle retention period. The main purpose of establishing the operational standard for eye acupuncture with acupuncture rehabilitation therapy is to standardize management and guide the professionals and technical personnel of traditional Chinese medicine to correctly use the eye acupuncture and acupuncture rehabilitation therapy for rehabilitation treatment. This standard includes the technical scope of eye acupuncture and acupuncture rehabilitation therapy, normative references, terminology and definitions (eye acupuncture physical therapy, eye acupuncture occupational therapy, eye acupuncture speech training, eye acupuncture cognitive rehabilitation training, eye acupuncture pain rehabilitation techniques), operating procedures and requirements (selection of eye acupuncture needles, acupoint selection principle, body position selection, environmental requirements and operation methods, etc.), main indications, contraindications, precautions and other aspects. This operational standard could be applied to guide the professionals and technical personnel of traditional Chinese medicine in hospitals at all levels and medical and health care institutions to carry out eye acupuncture with acupuncture rehabilitation therapy, with wide generality and effectiveness.

Introduction: Anal fistula is one of the commonest ailments seen by anorectal surgeons as surgery is currently the preferred treatment for it. Diabetes mellitus is a risk factor that can lead to slow wound healing after anal fistula surgery. Because of the large postoperative wound surface of anal fistula, patients with diabetes can have an increased probability of wound infection, which makes it hard to heal. There is an extensive clinical experience for wound healing in traditional Chinese medicine (TCM). The Jiedu Shengji decoction (JSD) is a widely used external washing decoction in clinical practice. However, the current evidence on it is still insufficient. Therefore, we report this carefully designed clinical trial to assess the efficacy and safety of JSD in the treatment of postoperative wounds in diabetic patients with anal fistula. Methods and analysis: This study was designed to be a randomized, double-blind, placebo-controlled, multi-center clinical trial. There were 60 eligible participants who were randomized at a 1:1 ratio to the intervention and placebo groups. Both groups received the same standard treatment. The intervention group was given external washing decoction of TCM (JSD), while the placebo group was given the placebo made of excipients and flavoring agents. The main outcome measures include wound healing, distribution of wound pathogens, levels of inflammatory mediators, and blood glucose. The secondary outcome measures included lipids, the quality of the life evaluation scale (Short-Form Health Survey 36). Assessments were performed before the start of the study, at 1st, 2nd, 3rd, and 4th weeks after the intervention, and at 8th, 12th, and 16th follow-up weeks. Discussion: The clinical study we proposed will be the first randomized, double-blind, placebo-controlled, multi-center clinical trial study to assess the efficacy and safety of TCM external washing (JSD) in the treatment of postoperative wounds in diabetic patients with anal fistula. Ethics and dissemination: The Medical Ethics Committee of Hospital of Chengdu University of Traditional Chinese Medicine has reviewed this study protocol and gave its approval and consent on 17 March, 2022 (Ethical Review Number: 2022KL-018).

Diabetes mellitus (DM) is a chronic noninfectious disease that is mainly featured by pancreatic β-cell (β-cell) dysfunction and impaired glucose homeostasis. Currently, the pathogenesis of dysfunction of the β-cells in DM remains unclear, and therapeutic approaches to it are limited. Emodin (EMD), a natural anthraquinone derivative, has been preliminarily proven to show antidiabetic effects. However, the underlying mechanism of EMD on β-cells still needs to be elucidated. In this study, we investigated the protective effects of EMD on the high glucose (50 mM)-induced INS-1 cell line and the underlying mechanism. INS-1 cells were treated with EMD (5, 10, and 20 μM) when exposed to high glucose. The effects of EMD were examined by using the inverted phase-contrast microscope, qRT-PCR, ELISA, and western blot. The results showed that EMD could alleviate cellular morphological changes, suppress IL-1β and LDH release, and promote insulin secretion in high-glucose-induced INS-1 cells. Furthermore, EMD inhibits NOD-like receptor protein 3 (NLRP3) activation and gasdermin D (GSDMD) cleavage to alleviate pyroptosis induced by high glucose. Overexpression of NLRP3 reversed the above changes caused by EMD. Collectively, our findings suggest that EMD attenuates high-glucose-induced β-cell pyroptosis by inhibiting NLRP3/GSDMD signaling.