Purpose:To study the efficiency and safety on vinorelbine combined with capecitabine in the treatment of metastatic breast cancer. Methods:Twenty-eight patients with measurable lesions of metestetic breast cancer received vinorelbine 6 mg/m 2 d 1-5 civ,cycles were repeated every 21 days. Patients received capecitabine for 2-4 cycles at the same time. All patients received more than one course of chemotherapy regimens and 19 patients had adriamycin and (or) paclitaxel treatment. Results:Thirteen patients received two cycles treatment and fifteen patients received four cycles of treatment. Complete response in one patient,partial response in six patients,minor response in seven patients,stable response in seven patients and progressive disease in seven patients were observed. Overall responsed rate was 50%.The common side effects were neutronpenia,hand-foot syndrome,skin pigmentation,fatigue. Conclusions:The combination of vinorelbine and capecitabine in the treatment of metastatic breast cancer was effective and the toxicities were tolerable. It is possible that this regimen is an ideal second line chemotherapy for metastatic breast cancer.

OBJECTIVETo determine the content of podophyllotoxin and total lignans in Sinopodophyllum emodi Ying from different areas and evaluate the resource utilization of this endangered medicinal plant.

METHODHPLC and UV spectrophotometry were used to determine the content of podophyllotoxin and total lignans in 126 samples from different habitats and the total lignans content was determined by the reference wavelength method.

RESULTAccording to the results, the highest content was determined from the samples from Yongdeng Nature Reserve in Gansu province, and the lowest ones was found in the samples from Tibet. The former's podophyllotoxin and total lignans contents were 7.40% and 20.66%, respectively, which were 19 times and 4 times more than those of the latter. The content of podophyllotoxin and total lignans in S. emodi were significantly positively related, meanwhile, samples from both low altitude and high latitude showed the higher content.

CONCLUSIONThe two determination methods are simple, rapid, accurate and repeatable. It is more scientific and rational to evaluate the resource utilization of S. emodi with two indicators, those are the content of podophyllotoxin and the content of total lignans. This paper is instructive to the collection of wild resources and the establishment of production bases.

The five movements and six qi theory(hereinafter referred to as"movement qi theory")runs through Liu Wansu's med-ical theoretical system,which is mainly reflected in its influence on the theory of pathogenesis,the creation of fiery heat theory,and the influence of Liu Wansu's clinical diagnosis and treatment thoughts.The influence of movement qi theory on Liu Wansu's pathogen-esis theory includes three aspects:six qi alternation on pathogenesis,five movement hyperactivities on pathogenesis,and the root and branch of movement qi on pathogenesis.Liu's understanding of the pathogenesis of six qi and the philosophical thought of"water is good and fire is evil"mainly influenced the creation of Liu Wansu's"fire theory".The influence of movement qi theory on Liu Wansu's clinical diagnosis and treatment thoughts is mainly reflected in the classification of viscera,meridian and collateral diseases based on the theory of root and branch of middle qi,the diagnosis of pulses based on movement qi theory,the deduction of disease transmission and change using movement qi thinking,and the preparation of medicines based on qi.Liu Wansu initiated the innovation and debate of medical theory in the Jin and Yuan Dynasties,and had a profound impact on the rise of warm febrile diseases in the Ming and Qing Dynasties.

Objective To compare the efficacy and safety of intravenous chemotherapy plus operation and interventional arterial chemotherapy plus operation in treatment of patients with local-ly advanced cervical carcinoma (phases Ib2~IIb).Methods 140 patients with locally advanced cervical carcinoma (phases Ib2~IIb)were divided into experimental group (uterine artery interven-tional chemotherapy plus surgery)and control group (venous chemotherapy plus surgery)according to different initial therapeutic methods,70 cases in each group.Short-term efficacy,tumor diameter changes before and after treatment,rate of radical operation,3 and 5 years overall survival (OS), progression-free survival (PFS),complications as well as pathological risk factors (rates of para-u-terine invasion and lymph node metastasis)were observed.Results Short-term efficacy improved in both groups.The decreased tumor diameter in experimental group was significantly greater than control group,and the probability rate of patients with radical operation was significantly larger than the control group.Corresponding rates of para-uterine invasion and lymph node metastasis in the ex-perimental group were significantly lower than the control group.There were no significant differ-ences of 3 years OS and PFS between two groups,and the 5 years OS and PFS in the experimental group were higher than the control group.Conclusion For patients with locally advanced cervical carcinoma,neo-adjuvant chemotherapy with artery interventional therapy is better than intravenous chemotherapy in aspects of surgical resection rate and 5 years OS,so it is a safe and effective thera-peutic method.

Objective To explore the applicability,safety and effectiveness of hepatic arterial infusion chemotherapy(HAIC)combined with sintilimab and bevacizumab in the patients with intermediate and ad-vanced hepatocellular carcinoma(HCC)failed by lenvatinib treatment.Methods A total of 62 patients with intermediate and advanced liver cancer failed by lenvatinib treatment in this hospital from February 2023 to February 2024 were selected as the study subjects and divided into the HAIC group(n=13),HAIC+targeted therapy group(n=18)and HAIC+combined therapy group(n=31)according to different treatment regi-mens.The HAIC group only received the HAIC treatment,the HAIC+targeted therapy group adopted the HAIC+lenvatinib combined treatment and the HAIC+combined treatment group received the HAIC+sintil-imab and bevacizumab combined treatment.The objective remission rate(ORR),disease control rate(DCR),median progression-free survival time(mPFS),median overall survival time(mOS),carcinoembryonic antigen(CEA),vascular endothelial growth factor(VEGF),carbohydrate antigen 125(CA125)levels after treatment were observed in 3 groups,and the treatment related adverse reactions were recorded.The Kaplan-Meier method was used for conducting the survival analysis.Results According to RECIST1.1 criteria,ORR of the HAIC+combined treatment group was higher than that of the HAIC group and HAIC+targeted therapy group(35.5％vs.23.1％vs.22.2％),DCR was lower than that of the other two groups(83.8％vs.92.3％vs.88.9％),but the differences were not statistically significant and the differences were not statistically sig-nificant(P＞0.05).mOS of the HAIC+combined treatment group was longer than that of the HAIC group and HAIC+targeted therapy group[18.1(95％CI:13.3-22.9)months vs.12.6(95％CI:9.0-16.2)months vs.15.9(95％CI:11.5-20.3)months].mPFS in the HAIC+combined treatment group was longer than that in the the HAIC group and HAIC+targeted therapy group[12.0(95％CI:9.4-14.6)months vs.9.7(95％CI:2.2-17.2)months vs.10.1(95％CI:8.3-11.9)months],and the differences were not statistically sig-nificant(P＞0.05).The levels of CEA,VEGF and CA125 after treatment in 3 groups were decreased com-pared with before treatment,moreover the levels in the HAIC+combined treatment group was the lowest(P＜0.05).There was no statistically significant difference in the incidence rate of adverse reactions among the three groups(P＞0.05).Conclusion The HAIC combined with immunotherapy regimen is effective in the pa-tients with intermediate and advanced HCC failed by lenvatinib treatment,moreover which has high safety.

Objective To compare the efficacy and safety of intravenous chemotherapy plus operation and interventional arterial chemotherapy plus operation in treatment of patients with local-ly advanced cervical carcinoma (phases Ib2~IIb).Methods 140 patients with locally advanced cervical carcinoma (phases Ib2~IIb)were divided into experimental group (uterine artery interven-tional chemotherapy plus surgery)and control group (venous chemotherapy plus surgery)according to different initial therapeutic methods,70 cases in each group.Short-term efficacy,tumor diameter changes before and after treatment,rate of radical operation,3 and 5 years overall survival (OS), progression-free survival (PFS),complications as well as pathological risk factors (rates of para-u-terine invasion and lymph node metastasis)were observed.Results Short-term efficacy improved in both groups.The decreased tumor diameter in experimental group was significantly greater than control group,and the probability rate of patients with radical operation was significantly larger than the control group.Corresponding rates of para-uterine invasion and lymph node metastasis in the ex-perimental group were significantly lower than the control group.There were no significant differ-ences of 3 years OS and PFS between two groups,and the 5 years OS and PFS in the experimental group were higher than the control group.Conclusion For patients with locally advanced cervical carcinoma,neo-adjuvant chemotherapy with artery interventional therapy is better than intravenous chemotherapy in aspects of surgical resection rate and 5 years OS,so it is a safe and effective thera-peutic method.

Objective This paper investigates the effect of a multi-physical field fusion intervention based on transcranial direct current stimulation(tDCS),transcranial magnetic stimulation(TMS)and music on mental fatigue.Methods After fatigue induction,10 subjects received blank group stimulation,music group stimulation and tDCS-TMS-Music stimulation,respectively.tDCS stimulation sites were located in the bilateral frontal regions of the subjects,and TMS stimulation sites were located in the bilateral occipital regions of the hindbrain.Heart rate variability and reaction performance were measured before and after each intervention to determine the elimination effect of different intervention programs on mental fatigue.Results Compared with the control group,the tDCS-TMS-Music group showed significantly greater improvements in subjective mental workload,response performance,and heart rate variability.Conclusion The results of this study support that tDCS-TMS-Music can effectively alleviate mental fatigue induced by long-term cognitive performance tasks,and the intervention effect is better than music intervention and resting-state relief at the same time.

Mycophenolic acid (MPA, ) and its derivatives are first-line immunosuppressants used in organ transplantation and for treating autoimmune diseases. Despite chemical synthetic achievements, the biosynthetic formation of a seven-carbon carboxylic acid pharmacophore side chain of , especially the processes involving the cleavage of the prenyl side chain between DHMP () and DMMPA (), remains unknown. In this work, we identified a membrane-bound prenyltransferase, PgMpaA, that transfers FPP to to yield FDHMP (). Compound undergoes the first cleavage step a new globin-like enzyme PgMpaB to form a cryptic intermediate . Heterologous expression of genes in demonstrates that the second cleavage step (from to ) of is a cluster-independent process . Our results, especially the discovery of the broad tolerance of substrates recognized by PgMpaB, set up a strategy for the formation of "pseudo-isopentenyl" natural products using fungal globin-like enzymes.

Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.