Breast cancer， as one of the major cancers threatening women's health globally， is characterized by high aggressiveness， high malignancy， and poor prognosis. In 2022， according to the World Health Organization， breast cancer ranked second in the incidence of female cancers globally， accounting for 11.6% of all new cancer cases. Western medical doctors mainly use surgery， chemotherapy， radiotherapy， endocrine therapy， and molecular targeted therapy to treat breast cancer， which can effectively improve the recurrence rate and death rate of breast cancer patients and prolong the survival period of patients. However， its treatment process is often accompanied by a series of side effects， which bring challenges to patients' quality of life. However， traditional Chinese medicine （TCM） has demonstrated significant therapeutic effects in inhibiting the proliferation and metastasis of breast cancer cells， reducing toxic side effects produced by chemotherapy， and improving patients' survival rate and quality of life. It is therefore particularly necessary to investigate the pharmacological effects and mechanisms of TCM in breast cancer treatment. The authors combed the pharmacological effects and mechanisms of the etiology and pathogenesis of breast cancer， identification and treatment of breast cancer， TCM compound， TCM single medicine， TCM monomer， and external treatment of TCM to prevent and control breast cancer and found that TCM has a therapeutic effect on breast cancer. It can play a role in increasing the effectiveness， reducing the toxicity， and alleviating the adverse reactions. It can inhibit breast cancer cell proliferation， cell cycle， migration， invasion， immune escape， epithelial-mesenchymal transition （EMT）， aerobic glycolysis， mitochondrial biosynthesis， aminoacyl-tRNA biosynthesis， reduce drug resistance， promote apoptosis， ferroptosis， cell autophagy， and regulate the tumor immune microenvironment by regulating signaling pathways. This paper aims to provide new ideas and methods for experimental research and clinical treatment of breast cancer.

Lung cancer has the highest morbidity and mortality rate among all cancers. Because of the complex pathogenesis， there are limitations in the common Western medicine treatment methods. Clinical and experimental studies have proved that traditional Chinese medicine （TCM） can not only effectively treat lung cancer and alleviate the clinical symptoms of cancer patients but also reduce the adverse reactions and complications caused by surgery， chemotherapy， and radiotherapy to improve the quality of life of the patients. The biological behaviors of lung cancer cells， such as proliferation， invasion， and metastasis， are closely related to their metabolic reprogramming. Metabolic reprogramming in lung cancer involves a series of metabolic changes such as increased glucose uptake and consumption， enhanced glycolysis， increased amino acid uptake and catabolism， and enhanced lipid and protein synthesis. Studies have reported that TCM active components， extracts， and compound prescriptions can effectively inhibit the biological behaviors of lung cancer by regulating metabolic reprogramming. Therefore， this paper reviews the pharmacological mechanisms of TCM active components， extracts， and compound prescriptions in regulating metabolic reprogramming of lung cancer， with the aim of providing a new way of thinking for the treatment of lung cancer by TCM regulation of metabolic reprogramming of lung cancer cells. The available studies suggest that TCM mainly inhibits the extracellular signal-regulated protein kinase （ERK）/c-Myc， phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR）， and hypoxia-inducible factor-α （HIF-1α） pathways. Furthermore， the expression of monocarboxylate transporter 4 （MCT4）， glucose transporter 1 （GLUT1）， pyruvate dehydrogenase （PDH）， phosphofructokinase 1 （PFK1）， pyruvate dehydrogenase kinase 1 （PDK1）， pyruvate kinase M2 （PKM2）， hexokinase （HK）， lactate dehydrogenase （LDH）， and lactate dehydrogenase A （LDHA） are inhibited. In this way， TCM inhibits the glucose uptake by lung cancer cells and glycolysis in lung cancer cells to reduce the energy metabolism of tumor cells， ultimately achieving the therapeutic effect on lung cancer.

To summarize the perioperative nursing care in 32 cases of pancreatic cancer undergoing radical surgery combined with intestinal autotransplantation.Key points:to set up a multidisciplinary surgical team and create surgical emergency plans;to well prepare equipment,supplies,and environment;to utilize node control concepts to control operation safety;to carry out the clustered surgical infection management and phased implementation of isolation technology;to prevent and control the inadvertent perioperative hypothermia;organ irrigation,repair and preservation;to prevent the complication.After above precise surgical cooperation and meticulous care,all operations were implemented successfully,and patients were transferred to the intensive care unit for further treatment safely.

Objective In this research,we constructed a nurse-led intra-abdominal pressure(IAP)management program in children undergoing liver transplantation,and explored its clinical application effect.Methods Based on literature review,semi-structured interviews,and expert meetings,a nurse-led program for IAP management is constructed.By convenience sampling method,162 children admitted to the pediatric liver transplant intensive care unit of a tertiary hospital in Zhejiang Province from January to December 2023 were selected.The experimental group implemented a nurse-led IAP management program,while the control group received routine postoperative care after liver transplantation.The average IAP values during ICU period,incidence and grading of intra-abdominal hypertension(IAH),duration of mechanical ventilation,and length of ICU stay were compared between 2 groups.Results Finally,the IAP management program in children undergoing liver transplantation included 4 first-level items,10 second-level items and 20 third-level items.During the application of this program,4 cases dropped,and 78 cases were finally included in the experimental group and 80 cases in the control group.After the intervention,the IAP value in the experimental group was(8.63±2.40)mmHg(1 mmHg=0.133 kPa),lower than(9.23±3.19)mmHg in the control group,but there was no statistically significant difference between the 2 groups(P=0.186).The incidence of IAH in the experimental group was 23.07％,lower than 41.25％in the control group.The difference between the 2 groups was statistically significant(P=0.015).13 cases(16.67％)in the experimental group developed grade Ⅰ IAH,while 22 cases(27.50％)in the control group;5 cases(6.41％)in the experimental group developed grade Ⅱ IAH,while 9 cases(11.25％)in the control group;no cases in the experimental group developed grade Ⅲ IAH,while 2 cases(2.50％)in the control group.There was no statistically significant difference between the 2 groups(P＞0.05).The mechanical ventilation time in the experimental group was 3.00(1.00,13.25)hours,and 7.50(1.00,27.75)hours in the control group.The difference between the 2 groups was statistically significant(P=0.034).The length of ICU stay in the experimental group was 6.00(4.00,8.25)days,and 5.00(3.00,8.00)days hours in the control group.The difference between the 2 groups was statistically significant(P=0.061).Conclusion The nurse-led IAP management program in children undergoing liver transplantation can effectively reduce the incidence of IAH,shorten the duration of mechanical ventilation.

Objective To explore the application effect of"three-station"teaching rounds in standardized training teach-ing rounds of general surgery residents.Methods 50 trained doctors from the general surgical base from July 2022 to July 2023 were randomly selected and divided into two groups,with 25 patients in each.The observation group used a"three-station"teaching ward round,while the control group used a traditional teaching ward round mode.The exam scores,ward round effects,satisfaction,and experience were compared.Results The total scores of the observation group were significantly higher than those of the control group(P＜0.05),and the scores of the medical history collection and physical examination in the case anal-ysis test and skill test were significantly higher than those of the control group(P＜0.05).There was no significant difference in the theoretical test scores between the two groups(P＞0.05).The proportion of"Yes"in the questionnaire of the observation group was higher than that of the control group in the aspects of improving the diagnosis and treatment of diseases,clinical think-ing,doctor-patient communication ability and increasing learning interest(P＜0.05).The satisfaction of questionnaire teaching round in the observation group was 84.0％,significantly higher than that in the control group(60.0％)(P＜0.05).In the observation group,the percentages of the attending physicians and the teaching rounds were 64.0％and 68.0％,respectively,which were significantly higher than those of the control group(28.0％and 32.0％,P＜0.05).Conclusion The"three-sta-tion"teaching ward round can improve the exam scores,ward round effectiveness and satisfaction,improve the experience of attending physicians and teaching ward round subjects,and is worth promoting in various resident training bases.

Objective:To summarize the nursing experience of liver transplantation in a patient with acute liver failure, renal injury, shock, hepatic encephalopathy and hyperlactic acidemia caused by K-amine poisoning.Methods:A case of severe K-amine poisoning admitted to the First Affiliated Hospital of Zhejiang University Medical College on June 29, 2022 was treated by multidisciplinary team cooperation. The treatment scheme of blood purification combined with liver transplantation was adopted, individualized nursing measures were implemented, including fluid resuscitation, blood purification, prevention and treatment of complications such as brain edema and infection of hepatic encephalopathy, immunosuppressive treatment after liver transplantation, occupational protection, health education and follow-up management.Results:After careful treatment and nursing, the liver and kidney function of the patient recovered smoothly and was discharged on the 33rd day after liver transplantation.Conclusions:In view of the rapid progress of acute liver failure caused by K-amine poisoning and the involvement of multiple organs, blood purification combined with liver transplantation successfully saved the lives of patients under the cooperation of multidisciplinary teams. Do a good job in disease monitoring and individualized nursing to improve the long-term survival rate of patients.

【Objective】 To explore the prediction of clinical red blood cells (RBCs) consumption under major public health emergencies, so as to provide scientific basis for blood collection and blood inventory management. 【Methods】 The clinical consumption of different types of RBCs in Yichang from 2001 to 2017 was analyzed and modeled using the recurrent neural network (RNN) model, and the clinical RBCs consumption between January 2019 and December 2021(36 months) were scientifically predicted. 【Results】 The RNN model showed good prediction performance. The root mean square errors (RMSE) of RNN prediction values of A, B, O, AB type of RBCs were 156.7, 133.4, 204.2 and 51.3, respectively, with the average relative errors (MRE) at 6.4%, 6.6%, 8.5% and 7.1%, respectively. The model predicted the changing trend of RBCs consumption during the first round of COVID-19 outbreak (January to June, 2020) and forecasted the lowest level of consumption in February 2020 and a subsequent recovery in growth. The prediction of RBCs consumption during the second round of COVID-19 pandemic (January to June, 2021) was of high accuracy. For example, the relative errors of RNN models for A type RBCs consumption were 5.2% in Feb 2021 (the lowest level, 1 621.5 U) and 2.5% in May 2021 (the highest level, 2 397.0 U). 【Conclusion】 The artificial intelligence RNN model can predict clinical RBCs consumption well under major public health emergencies.

The aim of this study was to refold the OvisAries leukocyte antigen (OLA) class Ⅰ protein with peptides derived from sheeppox virus (SPPV) to identify SPPV T cell epitopes. Two pairs of primers were designed based on the published sequence of a sheep major histocompatibility complex Ⅰ to amplify the heavy chain gene of OLA Ⅰ α-BSP and the light chain gene of OLA Ⅰ-β₂m. Both genes were cloned into a pET-28a(+) expression vector, respectively, and induced with ITPG for protein expression. After purification, the heavy chain and light chain proteins as well as peptides derived from SPPV were refolded at a ratio of 1:1:1 using a gradual dilution method. Molecular exclusion chromatography was used to test whether these peptides bind to the OLA Ⅰ complex. T-cell responses were assessed using freshly isolated PBMCs from immunized sheep through IFN-γ ELISPOT with peptides derived from SPPV protein. The results showed that the cloned heavy chain and light chain expressed sufficiently, with a molecular weight of 36.3 kDa and 16.7 kDa, respectively. The protein separated via a Superdex^TM 200 increase 10/300 GL column was collected and verified by SDS-PAGE after refolding. One SPPV CTL epitope was identified after combined refolding and functional studies based on T-cell epitopes derived from SPPV. An OLA Ⅰ/peptide complex was refolded correctly, which is necessary for the structural characterization. This study may contribute to the development of sheep vaccine based on peptides.
Animals ; Capripoxvirus ; Epitopes, T-Lymphocyte/genetics* ; Peptides/genetics* ; Poxviridae Infections ; Sheep ; Sheep Diseases

Objective:To investigate the values of right ventricular free wall longitudinal strain (RVFWLS) by three-dimensional speckle tracking echocardiography (3D-STE) in predicting the degree of RV myocardial fibrosis (MF) in patients with end-stage heart failure (HF).Methods:A total of 102 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2018 to December 2019. Echocardiographic examinations were performed in these patients before heart transplantation. The conventional RV function parameters were obtained, including fractional area change, tricuspid annular plane systolic excursion(TAPSE), myocardial performance index, tricuspid lateral annular systolic velocity(Tricuspid s′). Two-dimensional (2D) RVFWLS was calculated by two-dimensional speckle tracking echocardiography (2D-STE). Right ventricular (RV) end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV stroke volume (RVSV), RV ejection fraction (RVEF) and 3D-RVFWLS were measured by 3D-STE. The degree of MF was quantified using Masson′s trichrome stain in RV myocardial samples after heart transplantation. Patients were divided into mild, moderate, and severe groups according to the degree of MF on histology, then echocardiographic parameters were compared among the 3 groups. Pearson correlation analysis and the multiple linear regression analysis between echocardiographic parameters and RV MF were analyzed.Results:Compared with patients with mild and moderate MF, 3D-RVFWLS, 2D-RVFWLS and conventional parameters of RV function were significantly decreased in patients with severe MF.RV MF strongly correlated with 3D-RVFWLS ( r=-0.71, P<0.01), modestly correlated with 2D-RVFWLS ( r=-0.53, P<0.01), and weakly correlated with RVFAC, TAPSE, RVEF, Tricuspid s′, RVSV ( r=-0.47, -0.44, -0.35, -0.29, -0.38; all P<0.01). 3D-RVFWLS correlated best with the degree of MF compared with 2D-RVFWLS and conventional RV function parameters ( r=-0.71 vs r=-0.29~-0.53, all P<0.05). A stepwise multivariate analysis showed that 3D-RVFWLS was independently associated with RV MF (β=1.554, P<0.01, adjusted R2=0.539). Conclusions:3D-RVFWLS can provide an important imaging reference for detecting the degree of RV MF in patients with end-stage HF.

Objective:To search, evaluate and integrate the available evidence on pediatric sedation monitoring, and summarize the best evidence.Methods:Up To Date, BMJ Best Practice, Canadian Medical Association Clinical Practice Guidelines (CMA Infobase), Registered Nurses′ Association of Ontario (RNAO), National institute for Health and Care Excellence (NICE), Evidence-Based Medicine, Cochrane Library, Yimaitong, PubMed, Embase, Wanfang Database, CNKI were searched to collect evidence related to the monitoring of pediatric sedation, including clinical decision-making, guidelines, expert consensus, and evidence-related original research. The search time limit was from the establishment of the database to August 2020. The quality of the literature was evaluated by the suitable evaluated tool based on their types. The level and recommedation grade of the evidence were appraised by the suitable tools of JBI.Results:A total of 13 articles were finally included. Twenty best evidences were summarized, including three aspects of monitoring content, monitoring timing, and monitoring tools.Conclusions:The research summarized the best evidence for pediatric sedation monitoring, and provided evidence-based references for clinical practice and standard formulation. Most of the evidence was form foreign resource. It is suggested that clinical departments or institutions should fully consider the clinical situation. At the same time, high-quality randomized controlled trials should be conducted one step further.