BACKGROUND:Previous studies by our research group discovered that Jiawei Xiaoyao San has a significant anti-liver cancer effect,but the specific mechanism of action was unclear. OBJECTIVE:To investigate the regulatory effects of the traditional Chinese medicine formula Jiawei Xiaoyao San on the levels of miRNAs in plasma exosomes of rats with diethylnitrosamine chronically induced primary liver cancer,based on high-throughput sequencing combined with bioinformatics. METHODS:SD rats were randomly divided into a blank control group,a liver cancer model group,and a Jiawei Xiaoyao San treatment group.Liver cancer models were induced by continuous administration of diethylnitrosamine for 12 weeks.Starting from the 17th week,rats in the Jiawei Xiaoyao San treatment group were administered Jiawei Xiaoyao San once daily until the end of the 20th week,while rats in the blank control and liver cancer model groups were given an equivalent volume of saline.Anti-hepatocellular carcinoma effects were validated by assessing the morphological structure of rat liver tissues,along with the expression of the hepatocellular carcinoma markers,Glypican-3 protein and serum alpha-fetoprotein.Plasma exosomes from each group of rats were isolated using ultracentrifugation.High-throughput sequencing technology was used to screen for differentially expressed miRNAs in rat plasma exosomes.Bioinformatics was used to predict the potential biomarkers through which Jiawei Xiaoyao San exerts its anti-liver cancer effects via liver cancer-derived exosomal miRNAs,followed by functional analysis. RESULTS AND CONCLUSION:(1)Jiawei Xiaoyao San significantly improved the morphological structure of liver tissues in a rat model of liver cancer.Compared with the liver cancer model group,the expression of liver cancer markers Glypican-3 protein and serum alpha-fetoprotein was significantly reduced in the Jiawei Xiaoyao San treatment group.(2)Bioinformatics analysis showed that in the Jiawei Xiaoyao San group,upregulated miR-223-3p in the liver cancer model group had target binding sites with genes E2F1 and NCOA1,which were closely related to liver cancer survival and prognosis.Therefore,Jiawei Xiaoyao San has a therapeutic effect on liver cancer,possibly by targeting negative regulation of NCOA1/E2F1 through liver cancer plasma-derived exosomal miR-223-3p,thereby playing anti-liver cancer effect.

Colorectal cancer is currently one of the most common malignant tumors in the world,and its incidence and mortality rates have gradually increased in recent years.As insidious symptoms characterize early colorectal cancer,most of the patients have already developed into late or advanced stages in the primary survey.For stage Ⅳ metastatic colorectal cancer(mCRC),surgery supplemented with chemotherapy or radiotherapy for mCRC patients has a low 5-year survival rate.With the development of immunology in recent years,PD-1/PD-L1 inhibitors have made breakthroughs in treating malignant tumors.They also have improved the therapeutic efficacy of some mCRC patients,especially those with microsatellite instability-high/mismatch repair deficient.The guidelines recommend this approach.However,patients with microsatellite stable/mismatch repair proficiency,which accounts for more than 90%,are poorly treated with PD-1/PD-L1 inhibitors.Fortunately,there are several clinical studies that reported that some of this type of mCRC can gain some benefit.In this review,we examined the anti-tumor mechanism of PD-1/PD-L1 inhibitors and the latest progress of PD-1/PD-L1 inhibitor's clinical application in patients of mCRC with different genotypes.We discussed the prospect of PD-1/PD-L1 inhibitor combination therapy to provide a reference to the benefit of this type of patients and provide information for optimizing the dosing regimen of PD-1/PD-L1 inhibitors in the treatment of mCRC.

【Objective:】 To understand the current situation of nurses’ professional quality of life in China and its correlation with benefit findings, so as to provide reference for formulating targeted measures to improve nurses’ professional quality of life in China. 【Methods:】 Questionnaire star was used to conduct a cross-sectional survey of 11 924 registered nurses in China from January 2022 to April 2022 using the General Information Questionnaire, the Professional Quality of Life Scale (ProQOL) and the General Benefit Discovery Scale (GBFS). SPSS 22.0 software was used for data analysis. 【Results:】 The scores of various dimensions of nurses’ ProQOL scale were: compassion satisfaction was (32.71±6.81) points, burnout was (27.38±5.20) points, secondary traumatic stress was (28.44±6.67) points, and the total score of GBFS was (100.90±18.04) points. The results of multiple linear stepwise regression showed that the main influencing factors of compassion satisfaction were marital status, position, work unit level and educational background (P<0.05). The main influencing factors of burnout were position, professional title, work unit level and whether there were children to be taken care of at home (P<0.05). The main influencing factors of secondary traumatic stress were education background, marital status, professional title, whether there was an old person to be taken care of at home, whether to take care of COVID-19 patients, whether to be an epidemic support staff and position (P<0.05). Benefit finding independently predicted the three dimensions of nurses’ professional quality of life (P<0.001). 【Conclusions:】 Chinese nurses’ professional quality of life was at a moderate level and it was significantly affected by benefit finding. Attention should be paid to factors such as marital status, work unit level, position, professional title, education background, whether there was an old person to be taken care of at home, whether to take care of COVID-19 patients, so as to improve the level of nurses’ benefit finding, promote their personal growth, provide good job guarantee, and improve Chinese nurses’ professional quality of life.

ObjectiveTo investigate the features of liver injury and related influencing factors in adolescents and adults with infectious mononucleosis (IM). MethodsA retrospective analysis was performed to investigate the features of liver injury in adolescents and adults with IM who were hospitalized in Peking University First Hospital from January 2005 to December 31 2018, and the patients were divided into subgroups based on age, Epstein-Barr virus (EBV) DNA level, and presence or absence of jaundice or infection with cytomegalovirus or hepatitis E virus (HEV). The t-test was used for comparison of continuous data meeting analytical conditions between two groups, and the Mann-Whitney U test was used for comparison of continuous data which did not meet analytical conditions between two groups; the chi-square test was used for comparison of categorical data between two groups, and the Fisher’s exact test was used for comparison of categorical data which did not meet the analytical conditions of the chi-square test. A logistic regression analysis was used for multivariate analysis. ResultsA total of 274 patients were enrolled, with 154 male patients (56.2%) and 120 female patients (43.8%), and the mean age of onset was 22.3±67 years. The incidence rate of liver injury ［defined as alanine aminotransferase (ALT) ＞50 U/L and/or aspartate aminotransferase (AST)＞40 U/L］ was 97.4% (267/274), and that of jaundice was 27.6% (74/268). The patients, aged ≥20 years, tended to have a higher level of gamma-glutamyl transpeptidase (GGT) (Z=2.070, P=0.038). Serum EBV DNA was measured for 167 patients, among whom 90 had positive results and 77 had negative results. The positive serum EBV DNA group had significantly higher levels of GGT (Z=3.005, P=0.003) and lactate dehydrogenase (Z=2.162, P=0.031) than the negative serum EBV DNA group. The patients with cytomegalovirus infection tended to have a higher level of alkaline phosphatase (Z=2.351, P=0.019), and the patients with HEV infection presented with a higher level of GGT (Z=1.988, P=0.047). AST (odds ratio ［OR］=1.006, 95% confidence interval ［CI］: 1.002-1.010, P=0.005) and ALP (OR=1.012, 95%CI: 1.005-1.020, P=0.001) were independent risk factors for jaundice. ConclusionThere is a high incidence rate of liver injury in adolescents and adults with IM, and the patients with an older age or positive serum EBV DNA tend to have more severe liver injury.

Objective:To analyze the effectiveness of antiviral therapy on adolescents and adults with infectious mononucleosis (IM).Methods:The clinical data of patients aged≥16 years old with IM who were hospitalized in Peking University First Hospital from January 1, 2005 to December 31, 2018 were analyzed retrospectively, and the patients were divided into antiviral treatment group and non-antiviral treatment group. The duration of hospitalization day, fever duration, ratio of lymphocytes and duration for normalization of Epstein-Barr virus (EBV) markers were compared between the two groups through single factor and propensity score matching analysis. Statistical analysis was conducted by independent sample t test, Mann-Whitney U test, chi-square test or Fisher exact probability method. Results:A total of 274 cases were enrolled and 176 cases (64.23%) were divided into antiviral treatment group and 98 cases (35.77%) into non-antiviral treatment group. The proportion of male (56.25%(99/176) vs 56.12%(55/98)), age (21.0(18.0, 26.0) years old vs 21.0(18.0, 27.0) years old), the ratio of fever (98.30%(173/176) vs 93.88%(92/98)), sore throat (90.34%(159/176) vs 88.78%(87/98)), lymphocyte ratio (0.648(0.568, 0.707) vs 0.663(0.581, 0.711)), atypical lymphocyte ratio (0.150(0.100, 0.235) vs 0.135(0.060, 0.250)) and serum EBV DNA level (2.71(2.70, 3.47) lg copies/mL vs 2.70(2.70, 3.28) lg copies/mL) were comparable between two groups at admission, and the differences were all not statistically significant(all P>0.05). The durations of hospitalization and fever in antiviral treatment group were 14.0(10.0, 18.0) d and (14.91±7.24) d, respectively, which were both significantly longer than those in non-antiviral treatment group (11.0(7.0, 15.0) d and (9.95±5.67) d, respectively). The differences were both statistically significant ( Z=-3.294 and t=-5.035, respectively, both P<0.01). Twenty-six patients each in the antiviral treatment group and non-antiviral treatment group were included in the propensity score matching assessment. The fever days of the two groups were 15.0(10.0, 18.0) d and 7.5(5.0, 12.5) d, respectively, and the hospitalization days were (15.4±5.5) d and (12.0±5.7) d, respectively. The differences were both statistically significant ( Z=-3.781 and t=-2.187, respectively, both P<0.05). However, there were no significant differences in the time required for the ratio of lymphocytes returning to normal, the time required for the ratio of atypical lymphocytes decreasing to <0.100, and the time required for serum EBV DNA becoming negative(all P>0.05). Conclusion:The antiviral treatment could not improve the prognosis of adolescent and adult IM patients.

Objective: To assess the food and nutrition literacy level of school-age children and its related factors, and to provide targets for further nutrition health education and nutrition improvement action. Methods: A total of 4 359 school-age children, from third to eighth grade in 2 middle schools and 3 primary schools of Baoding city of Hebei Province, were selected as subjects using convenient sampling method. For all participants’ food and nutrition literacy evaluation, social demographic characteristics and family food environment were investigated. Results: The average score of food and nutrition literacy of valid respondents was (61.91±9.22), and the scores of functional, interactive and critical literacy increased successively. The score of food and nutrition knowledge was higher than that of skill, and the score of "food intake" skill was the lowest(60.45±11.00). Children’s food and nutrition literacy increased with age and grade during primary school period, but the literacy of junior school students was lower than that of high-level graders in primary school(P<0.05). Children who were female, the only children, non-resident in school, urban registered permanent residence, in a more affluent family, cared by their parents/grandparents with a higher education level, and had nutrition education experience in school, had significantly higher food and nutrition literacy(P<0.05). But the interactive literacy of only children, non-resident in school and urban registered children was significantly lower(P<0.05). The family food environment was significantly correlated with children’s food and nutrition literacy. The total score of food nutrition literacy was higher for the children who often had fruits at home, rarely ate out, eating without screen, and communicated food and nutrition information with families frequently(P<0.05). Conclusion The food and nutrition literacy of school-age children is not high, which is related with individual and family’s demographic characteristic, nutrition education experience in school and family food environment. Children in rural areas and younger age, with a large number of family children and poor family economic status and food environment, should be the main target population of nutrition education and nutrition improvement.

Objective: To investigate and summarize the effect of narrative nursing on anxiety and depression in patients undergoing coronary artery bypass grafting, and to provide reference for the formulation of clinical nursing plan. Methods: A total of 61 patients underwent coronary artery bypass grafting were selected. 31 cases of narrative nursing were taken as the research group, and routine nursing was used in the other 30 cases as control group. Depression and anxiety were assessed by Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) before, 7 days after and 14 days after surgery. Results: Totally 61 patients were successfully operated and no case died during hospitalization. There was no significant difference in SAS and SDS scores between the 2 groups before surgery. The SAS scores in the study group were 57.9±4.2, 50.8±4.9, 47.1±5.0 on the day of admission,7 days after operation and 14 days after operation, respectively, while those in the control group were 58.4±3.7, 57.9±5.2, 55.7±6.2. There were significant differences between the two groups after intervention (t=5.490, 5.973, P<0.01). The SAS score of the study group decreased 7 days after operation and 14 days after operation compared with that of the admission day (t= 6.125, 9.209, P < 0.01). The SDS scores in the study group were 54.3±4.6, 49.4±4.7, 42.7±4.8 on the day of admission,7days after operation and 14 days after operation, respectively, while those in the control group were 54.1±5.1, 52.3±5.6, 51.6±5.2. There were significant differences between the two groups after intervention (t=2.194, 6.949, P<0.01). SDS scores in the study group decreased 7 days after operation and 14 days after operation compared with the day of admission in this group, with significant differences (t=4.148, 9.715, P < 0.01). Conclusions Narrative nursing is helpful to relieve anxiety and depression in patients undergoing coronary artery bypass grafting.

Objective To evaluate and summarize the best evidence for prevention and management of chemotherapy-induced alopecia and to provide a reference for clinical practice. MethodsIn February 2018, literatures including Evidence-based guidelines, best practices, systematic reviews, original research (including randomized controlled trials, quasi-experimental studies and cohort studies) and expert consensus were retrieved from guideline websites such as National Guideline Clearinghouse (NCC), Scottish Intercollegiate Guidelines Network (SIGN), National Institute for Health and Clinical Excellence (NICE), New Zealand Guidelines Group (NZGG), Registered Nurses Association of Ontario (RNAO) and Medline, professional websites such as American Society of Clinical Oncology (ASCO), National Comprehensive Cancer Network (NCCN), American Association for Cancer Research (AACR), Oncology Nursing Society (ONS), European Society of Clinical Oncology (ESMO) and Clinical Oncology Society of Australian(COSA) as well as databases such as Australian JBI Evidence-based Healthcare Database, Cochrane Library, PubMed, CINAHL, EMBASE, CNKI and Wanfang Datebase. Two researchers evaluated the quality of various literatures, and extracted recommendations and research conclusions related to the prevention and management of chemotherapy-induced alopecia from the included literatures. ResultsTotally 13 literatures were included, including 3 evidence-based guidelines, 1 recommended practice, 3 expert consensus, 4 systematic reviews, and 2 original studies. A total of 32 evidences in 2 aspects on the prevention and management of chemotherapy-induced alopecia were summarized. ConclusionsThe evidence for scalp cooling is sufficient in the prevention of chemotherapy-induced alopecia, but higher quality evidence is still needed for preventive medication and alopecia management.

Objective: To investigate ApoD expression in preoperative serum and tissues of patients with esophageal squamous cell car-cinoma of different survival terms, to explore its correlation with disease prognosis, and to speculate whether it can act as a biomarker for predicting the prognosis of patients with esophageal cancer. Methods: A total of 731 patients with radical resection of esophageal cancer were collected from Anyang Tumor Hospital in an area of high incidence of esophageal cancer in Henan Province from March 2008 to September 2009. General data, serum samples, and tissue specimens were collected. Patients with two extreme survival terms (34 cases)-a survival period≤3 years and a survival period≥5 years were randomly selected from the database, and the healthy population was used as the normal control group. iTRAQ combined with MALDI-TOF/TOF MS was used to analyze the preoperative se-rum proteins in patients with esophageal cancer and lock the target protein ApoD. Western blot analysis was used to verify the level of ApoD expression in preoperative serum and healthy individuals with esophageal squamous cell carcinoma of different survival terms. Immunohistochemical techniques were used to detect the expression level of ApoD in esophageal cancer tissues and normal tissues. Results: The results of iTRAQ combined with MALDI-TOF/TOF MS showed that the expression of 52 proteins was up-regulated with prolonged survival, and the difference was significant; ApoD was one amongst them. Western blot results showed that ApoD had the highest serum expression in the≥5 years survival group, followed by normal human serum, and the lowest expression in the group having survival period≤3 years. The difference was statistically significant. Immunohistochemistry results showed that ApoD exhibited the highest expression in normal esophageal squamous epithelium, followed by the ≥5 years survival group, and lowest in the ≤3 years survival group. The difference was statistically significant. Conclusions: The expression of ApoD is positively correlated with the survival of patients with esophageal cancer, which may be related to the prognosis of patients with esophageal cancer. Thus, ApoD could be a potential biomarker for predicting the prognosis of patients with esophageal cancer.

Objective To explore the possible associations between EBV capsid antigen-immunoglobulin M antibody (EBV-VCA-IgM ) ,serum EBV DNA load and clinical severity ,laboratory results in adolescent and adult patients with infectious mononucleosis (IM ).Methods Clinical data of 250 adolescent and adult IM patients were retrospectively analyzed .Patients were divided into two groups by EBV-VCA-IgM titer (＞160 U/mL or≤160 U/mL) and serum EBV DNA level (＞3 .38 lg copies/mL or ＜3.38 lg copies/mL) ,respectively . Clinical data were compared between the two groups ,respectively .The t test was used for intergroup comparison and the Mann-Whitney U test was used for non-normally distributed data .Results Compared with those with lower VCA-IgM antibody titer (≤160 U/mL) ,sore throat (83.0%[122/147] vs 67.2%[43/64] ,χ2＝ 6.534 ,P＝0 .011) ,pharynx secretion (59 .9%[88/147] vs 40 .6%[26/64] ,χ2＝6.645 , P＝0 .010) ,and swollen tonsils (78 .9%[116/147] vs 59.4%[38/64] ,χ2＝8.631 , P＝0.003) were more common in those with higher VCA-IgM antibody titer (＞160 U/mL).ALT level was higher as well in those with higher VCA-IgM antibody titer (290 .5 [168.0 ,460.5] U/L vs 221 .0[113 .0 ,440.5] U/L ,Z＝ －2.251 ,P＝0.024).The peak body temperature ([39.2 ± 0.7]°C vs [38.7 ± 0 .7]°C ,t＝ －3 .150 ,P＝0.002) ,maximum WBC counts (16 .2 [12 .2 ,20.4]×109/L vs 13.4[11 .1 ,17.3]×109/L ,Z＝ －2 .098 , P＝0.036) ,maximum percentage of lymphocyte ([72.0 ± 7.8]% vs [68.2 ± 7 .0]%,t＝ －2.238 ,P＝0.028) ,and lymphocyte EBV DNA load ([5 .5 ± 0.9] lg copies/mL vs [4 .8 ± 1 .0] lg copies/mL ,t＝ －2 .602 ,P＝0.012)in those with higher serum EBV DNA load ＞3 .38 lg copies/mL were higher than those with serum EBV DNA load ＜3.38 lg copies/mL . Regression analysis showed that serum EBV DNA load was associated with the peak body temperature (regression coefficient 0.368 , P＝0.003) and lymphocyte EBV DNA load (regression coefficient 0.389 , P＝0.002).Conclusions In adolescents and adults ,EBV-VCA-IgM antibody titer and serum EBV DNA load are associated with severity of patients with infectious mononucleosis .