Objective To study the different types of medication guidance for community doctors in the context of essential medicine system,and analyze its influencing factors.Methods SPSS 1 9.0 was called into play for statistical analysis of data gathered,and the medication guidance behavior of the doctors were graded on the two dimensions of personal willingness and practical action.With important quadrant method,the medication guidance behavior of such doctors was classified,while the multiple linear regression was used to study the influencing factors.Results Most of the community doctors of the fourteen counties fall into the area of “high willingness and less action”,with only a few falling into the area of the “high willingness and more action”. Major influencing factors of their willingness on medication guide were found to include impacts on job autonomy,attention to essential medicine system, and the forms to improve income.Major factors of the doctors'actions on medication guide include awareness of essential medicines,awareness of essential medicines catalog,and training outcomes. Conclusion The community doctors have high personal willingness for medication guidance related to essential medicines,but only a number of them carried it in their work.Therefore,it is necessary to take actions to strengthen awareness of the doctors for medication guidance and encourage them to carry it out.

Objective To identify the impact factors for community doctors with the essential medicine system in place,in support of mobilizing them and successful implementation of the essential medicine system in the community.Methods Based on the theory of ERG hierarchy of needs,the pathway analysis method was called into play to identify the three factors affecting community doctors,namely personal survival,interpersonal relations and self-development.Results Major factor of which is the interpersonal factor,with a score of 0.549,while the latter two factors do not directly affect the survival and development.The two however work on each other,and work on the interpersonal factor as well,with the impact coefficients of 0.320 and 0.402 respectively.Conclusion With the essential medicine system in place,the largest impact factor for community doctors'enthusiasm is the interpersonal one,involving the doctor-patient communications among others.This serving as the breakthrough point may improve the enthusiasm of the community doctors,paving the way for the system in the communities.

Objective To evaluate the township hospitals'medical service efficiency in Shandong province,and to provide references for the development in township hospitals under the background of the essential medicine system.Methods The method of data envelopment analysis(DEA)was used to analyze the township hospitals' medical service efficiency in Shandong province before and since the implementation of the essential medicine system.Results For the township hospitals in Shandong province in general,their relative efficiency ratio of the medical service efficiency dropped from 66.67% to 53.33% since the implementation of the essential medicine system.In terms of the input and output,the non-DEA effective township hospitals are found with insufficient output as measured by the output indicator,while some input indicators input were found as excessive.Conclusion The low scale efficiency has become the main factor for the low service efficiency of such hospitals since the implementation of the essential medicine system in Shandong province.In order to improve the medical service efficiency,it is important to continue to improve the essential medicine system,increase the medical staff's incentives, improve the fiscal compensation policy,and keep the policy continuity.

Objective To investigate the role of Notch signaling in the progression of peritoneal fibrosis in a rat model induced by high glucose dialysate. Methods Male Sprague Dawley rats were subjected to daily peritoneal dialysis (PD) with a lactate-buffered solution containing 4.25% glucose. They were sacrificed at 2 and 4 weeks after PD. The parietal thickness was measured with Masson staining. The expression of TGF-β1, E-cadherin, α-SMA and collagen Ⅰ was examined by immunoblotting. The expression of Notch ligand Jagged-1 and the negative Notch signaling regulato--Numb was analyzed by both immunoblotting and RT-PCR. The expression of a Notch nuclear target gene Hcs-1 was examined by RT-PCR. Results Both HE and Masson trichrome staining revealed an increase in peritoneal thickness with a loss of mesothelial cells and a rich of collagen matrix deposition in the submesothelial zone was evident at 4 weeks after PD. Meanwhile, compared to healthy rats, the expression of TGF-β1, ct-SMA and collagen Ⅰ was significantly increased, but the expression of E-cadherin was decreased in peritoneum after PD treatment. It was difficult to detect the Jagged-1 and Hes-1 expression in normal peritoneum, but their expression was graduaUy increased after PD. In contrast, the expression level of Numb, a negative regulator of Notch signaling, was dramatically decreased after PD. Conclusions Notch signaling is activated during the process of PD-induced peritoneal fibrosis and the activation of Notch signaling is associated with the loss of negative regulation of Notch signaling via decreased expression of Numb. Inhibition of Notch signaling via overexpression of its negative regulators such as Numb may be a novel therapeutic approach for peritoneal fibrosis in PD patients.

Cuproptosis and ferroptosis， two recently identified metal ion-dependent forms of cell death， are triggered by homeostasis dysregulation of intracellular copper and iron， as well as oxidative stress. They demonstrate considerable potential in anti-tumor therapy. Cuproptosis arises from mitochondrial dysfunction and proteotoxic stress caused by copper overload， while ferroptosis is driven by iron-dependent lipid peroxidation. Although traditional Chinese medicine （TCM） exhibits regulatory effects on cuproptosis and ferroptosis， its clinical application is hindered by poor solubility and low bioavailability. Through physical nanonization or carrier-based delivery technologies adopted by nano-TCM， the targeting specificity， stability， and bioavailability of drugs are significantly improved. By integrating sustained-release and controlled-release properties， metal ion homeostasis and redox balance in the tumor microenvironment （TME） can be precisely modulated. Research demonstrates that nano-TCM， such as celastrol-copper nanocomplexes （Cel-Cu NPs）， induces cuproptosis by augmenting intracellular copper accumulation and suppressing glutathione （GSH） levels. Nano-systems encapsulating camptothecin or artemisinin trigger ferroptosis via Fenton reaction and GSH depletion. Synergistic strategies of nano-materials， including ferrum-based metal-organic frameworks （Fe-MOFs） combined with piperlongumine， further amplify antitumor efficacy. Despite advancements in targeting cuproptosis and ferroptosis， challenges persist in nano-TCM development， including complex fabrication processes， suboptimal dosage optimization， and insufficient integration with the holistic principles of TCM. Future research should focus on exploring the interaction between cuproptosis and ferroptosis， developing multi-targeted nanodelivery systems， and fostering deeper integration of TCM theory with nanomedicine to advance novel therapeutic strategies for oncology.

Cuproptosis and ferroptosis， two recently identified metal ion-dependent forms of cell death， are triggered by homeostasis dysregulation of intracellular copper and iron， as well as oxidative stress. They demonstrate considerable potential in anti-tumor therapy. Cuproptosis arises from mitochondrial dysfunction and proteotoxic stress caused by copper overload， while ferroptosis is driven by iron-dependent lipid peroxidation. Although traditional Chinese medicine （TCM） exhibits regulatory effects on cuproptosis and ferroptosis， its clinical application is hindered by poor solubility and low bioavailability. Through physical nanonization or carrier-based delivery technologies adopted by nano-TCM， the targeting specificity， stability， and bioavailability of drugs are significantly improved. By integrating sustained-release and controlled-release properties， metal ion homeostasis and redox balance in the tumor microenvironment （TME） can be precisely modulated. Research demonstrates that nano-TCM， such as celastrol-copper nanocomplexes （Cel-Cu NPs）， induces cuproptosis by augmenting intracellular copper accumulation and suppressing glutathione （GSH） levels. Nano-systems encapsulating camptothecin or artemisinin trigger ferroptosis via Fenton reaction and GSH depletion. Synergistic strategies of nano-materials， including ferrum-based metal-organic frameworks （Fe-MOFs） combined with piperlongumine， further amplify antitumor efficacy. Despite advancements in targeting cuproptosis and ferroptosis， challenges persist in nano-TCM development， including complex fabrication processes， suboptimal dosage optimization， and insufficient integration with the holistic principles of TCM. Future research should focus on exploring the interaction between cuproptosis and ferroptosis， developing multi-targeted nanodelivery systems， and fostering deeper integration of TCM theory with nanomedicine to advance novel therapeutic strategies for oncology.

OBJECTIVETo compare the accuracy of CT and MR including diffusion-weighted imaging(DWI) in preoperative diagnosis and T staging of gastric cancer.

METHODSForty-one patients with gastric cancers proved by gastroscopy biopsy from November 2011 to August 2012 were prospectively enrolled. They underwent contrast enhanced CT and MR imaging (including DWI, T2 weighted and dynamic enhanced imaging) preoperatively. Two radiologists interpreted CT and MR images for detecting and staging each patient independently. With the reference of post-operative histopathological findings, T staging accuracy of CT and MR imaging was calculated and compared. Inter-observer agreement was also evaluated.

RESULTSOverall T staging accuracy in MR including DWI was significantly higher than that in CT imaging(87.8% vs. 65.9%, P=0.004). MR had a better inter-observer agreement than CT(Kappa=0.813, 0.603, respectively).

CONCLUSIONMR including DWI can improve preoperative T staging accuracy of gastric cancer significantly, which deserves recommendation for clinical application.

OBJECTIVETo explore the preoperative diagnostic value of MR diffusion weighted imaging (DWI) for metastatic lymph nodes in patients with gastric cancer.

METHODSBetween December 2011 and December 2012, 52 gastric cancer patients(34 men, 18 women) underwent preoperative MR DWI. The apparent diffusion coefficient(ADC) and short diameter of lymph nodes were measured and compared with the postoperative histopathological findings. Diagnostic value of ADC and short diameter for metastatic lymph nodes in patients with gastric cancer was investigated by receiver characteristic curve(ROC) analysis.

RESULTSA total of 180 metastatic and 57 non-metastatic lymph nodes were detected as hyperintense on DWI obtained from 52 patients. The ADC of metastatic lymph nodes [(1.059±0.196)×10(-3) mm(2)/s] was significantly lower than that of non-metastatic nodes [(1.402±0.285)×10(-3) mm(2)/s, P<0.001]. With ADC threshold of 1.189×10(-3) mm(2)/s, the sensitivity, specificity and area under the curve(AUC) were 78.9%, 72.8% and 0.840, respectively. The overall diagnostic accuracy of preoperative N staging of ADC was 75%(39/52). The short diameter of metastatic lymph nodes [(8.08±3.99) mm] was significantly longer than that of non-metastatic lymph nodes [(6.75±2.70) mm, P=0.005]. With short diameter threshold of 5.05 mm, the sensitivity, specificity and AUC were 88.3%, 29.8% and 0.602, respectively. The overall diagnostic accuracy of short diameter in preoperative N staging was 67.3%(35/52).

CONCLUSIONSMR DWI is a useful technique in diagnosing metastatic lymph nodes in patients with gastric cancer. ADC value and short diameter can be used as diagnostic criterion for the diagnosis of preoperative N staging.

Objective To investigate the role and existing dilemmas of policies related to traditional Chinese medicine talents in China in terms of their growth paths and attitudes towards existing policies.Methods A questionnaire survey was conducted to investigate the current situation of the development of traditional Chinese medicine talents and their views on the existing policies.Results 278 valid questionnaires were collected.In general,traditional Chinese medicine talents are quite satisfied with the current talent policy,the interviewees with senior professional titles have a better understanding of the talent policy,and the young members and members of the Chinese society of traditional Chinese medicine have a more positive and urgent attitude towards building a talent policy and evaluation index system with traditional Chinese medicine characteristics.Respondents generally believe that the current financial support for talent projects of traditional Chinese medicine is average,but it can stimulate the growth of young scholars.The title of talents and the achievements of scholars'scientific research complement each other.Conclusion In the process of the development of the field of traditional Chinese medicine,we should speed up the training of innovative talents of traditional Chinese medicine,establish talent evaluation indicators with traditional Chinese medicine characteristics,improve the evaluation and project management system of traditional Chinese medicine talents,and reasonably optimize the incentive mechanism brought by the title of talents.

Cardiometabolic disease (CMD), characterized with metabolic disorder triggered cardiovascular events, is a leading cause of death and disability. Metabolic disorders trigger chronic low-grade inflammation, and actually, a new concept of metaflammation has been proposed to define the state of metabolism connected with immunological adaptations. Amongst the continuously increased list of systemic metabolites in regulation of immune system, bile acids (BAs) represent a distinct class of metabolites implicated in the whole process of CMD development because of its multifaceted roles in shaping systemic immunometabolism. BAs can directly modulate the immune system by either boosting or inhibiting inflammatory responses via diverse mechanisms. Moreover, BAs are key determinants in maintaining the dynamic communication between the host and microbiota. Importantly, BAs via targeting Farnesoid X receptor (FXR) and diverse other nuclear receptors play key roles in regulating metabolic homeostasis of lipids, glucose, and amino acids. Moreover, BAs axis per se is susceptible to inflammatory and metabolic intervention, and thereby BAs axis may constitute a reciprocal regulatory loop in metaflammation. We thus propose that BAs axis represents a core coordinator in integrating systemic immunometabolism implicated in the process of CMD. We provide an updated summary and an intensive discussion about how BAs shape both the innate and adaptive immune system, and how BAs axis function as a core coordinator in integrating metabolic disorder to chronic inflammation in conditions of CMD.