Objective The study aimedto investigate the effects and metabolic mechanisms of Gegen Qinlian Decoction(GQD)containing serum on hypoxia-induced glucose metabolism in L02 cells.Methods The effects of five hypoxia durations(6,12,18,24,and 48 hours)on glucose consumption and cell viability of L02 cells were examined under hypoxic conditions to determine the optimal hypoxia time.Normal hepatocytes served as the normal control group.L02 cells with hypoxia-induced reduction in glucose consumption were divided into several groups:hypoxia group,metformin 2 mmol/L group,and 25 g/kg GQD groups treated with 5%,10%,and 15%GQD contain-ing serum.Glucose consumption was used as an indicator of drug efficacy.High-resolution liquid chromatography tandem quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS)was employed to collect metabolite signals from each group.Data were analyzed by using Progenesis QI software,and potential biomarkers were identified through online databases such as HMDB.Finally,metabolic pathways of potential biomarkers were analyzed via the Metabo Analyst 5.0 website.Results An 18 hour hypoxia period was identified as the optimal duration for the replication of the hypoxia-induced L02 cell model.GQD containing serums at 5%and 10%significantly increased glucose consumption in hypoxia-induced L02 cells after 18 hours.14 biomarkers of hypoxia-induced L02 cells were identified,with the levels of 13 biomarkers significantly increased and 1 biomarker significantly decreased.GQD containing serum notably regulated the levels of 3 biomarkers.Conclusion GQD containing serum might improve hypoxia-induced abnormal glucose metabolism in L02 cells and enhance glucose consumption by modulating glycero-phospholipid metabolism,glycosylphosphatidylinositol biosynthesis,and sphingolipid metabolism.

Objective The study aimedto investigate the effects and metabolic mechanisms of Gegen Qinlian Decoction(GQD)containing serum on hypoxia-induced glucose metabolism in L02 cells.Methods The effects of five hypoxia durations(6,12,18,24,and 48 hours)on glucose consumption and cell viability of L02 cells were examined under hypoxic conditions to determine the optimal hypoxia time.Normal hepatocytes served as the normal control group.L02 cells with hypoxia-induced reduction in glucose consumption were divided into several groups:hypoxia group,metformin 2 mmol/L group,and 25 g/kg GQD groups treated with 5%,10%,and 15%GQD contain-ing serum.Glucose consumption was used as an indicator of drug efficacy.High-resolution liquid chromatography tandem quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS)was employed to collect metabolite signals from each group.Data were analyzed by using Progenesis QI software,and potential biomarkers were identified through online databases such as HMDB.Finally,metabolic pathways of potential biomarkers were analyzed via the Metabo Analyst 5.0 website.Results An 18 hour hypoxia period was identified as the optimal duration for the replication of the hypoxia-induced L02 cell model.GQD containing serums at 5%and 10%significantly increased glucose consumption in hypoxia-induced L02 cells after 18 hours.14 biomarkers of hypoxia-induced L02 cells were identified,with the levels of 13 biomarkers significantly increased and 1 biomarker significantly decreased.GQD containing serum notably regulated the levels of 3 biomarkers.Conclusion GQD containing serum might improve hypoxia-induced abnormal glucose metabolism in L02 cells and enhance glucose consumption by modulating glycero-phospholipid metabolism,glycosylphosphatidylinositol biosynthesis,and sphingolipid metabolism.

Objective To investigate the effect of Gegen Qinlian Decoction on liver energy metabolism and free fatty acid(FFA)in rats with insulin resistance(IR).Methods IR rat model was established by feeding 60%fat high-fat diet for 13 consecutive weeks.SD rats were randomly divided into normal group,model group,Rosiglitazone(5 mg·kg-1)group and Gegen Qinlian Decoction low-,medium-and high-dose groups(1.65,4.96,14.86 g·kg-1),with 6 rats in each group.Intragastric administration was given once a day,continuous administration intervention lasted for 16 weeks.Determination of IR-related indicators:serum fasting insulin(FINS),fasting blood glucose(FPG),calculate the IR index;HPLC method was established for the determination of adenosine triphosphate(ATP),adenosine diphosphate(ADP)and adenosine monophosphate(AMP)in rat liver tissue;ELISA was used to determine the content of FFA in rat liver tissue.The contents of serum total cholesterol(TC)and triglyceride(TG)were detected by automatic biochemical analyzer.The pathological changes of liver tissue were observed by HE staining.Results(1)After the model replication,compared with the normal group,the FINS,FPG levels and IR index of the model group were significantly increased(P＜0.05).(2)Compared with the normal group,the levels of FINS,FPG and IR index in the model group were significantly increased(P＜0.01),the contents of ATP,ADP and AMP in liver tissue were significantly decreased(P＜0.01),the content of FFA was significantly increased(P＜0.01),and the levels of TC and TG in serum were significantly increased(P＜0.05).Liver cells arranged in disorder,fatty degeneration,and there are a large number of lipid droplets.Compared with the model group,the FINS level and IR index of rats in each administration group were significantly decreased(P＜0.05,P＜0.01),and the FPG level of rats in the Rosiglitazone group was significantly decreased(P＜0.05).The contents of ADP and AMP in liver tissue of rats in each administration group were significantly increased(P＜0.05,P＜0.01),and the contents of ATP in liver tissue of rats in low-,medium-and high dose-groups of Gegen Qinlian Decoction were significantly increased(P＜0.05,P＜0.01).The content of FFA in liver tissue of rats in Rosiglitazone group and Gegen Qinlian Decoction low-and high-dose groups was significantly decreased(P＜0.01).The serum TC level of rats in the low-and high-dose groups of Gegen Qinlian Decoction was significantly decreased(P＜0.05,P＜0.01),and the serum TG level of rats in the Rosiglitazone group and the low-dose group of Gegen Qinlian Decoction was significantly decreased(P＜0.05,P＜0.01).The steatosis of hepatocytes in rats of each administration group was alleviated to varying degrees,and the lipid droplets were reduced,and the pathological damage was improved.Conclusion Gegen Qinlian Decoction may improve liver lipid metabolism disorder and restore lipid and energy balance by regulating energy metabolism and reducing FFA level,thus improving IR.

Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

【Objective】 To improve the understanding and diagnosis and treatment level of ALK negative anaplastic large cell lymphoma (ALK-ALCL) by sharing the diagnosis and treatment process of a patient with ALK-ALCL treated in Hangzhou Bay Hospital of Ningbo. 【Methods】 The clinical data and diagnosis and treatment process of the patient were retrospectively analyzed, and relevant literature was reviewed. 【Results】 The patient was a young male, with recurrent gross hematuria and right low back pain as the initial symptoms.Imaging examination indicated bladder tumor.After resection, the tumor was reduced and confirmed to be ALK-ALCL.After chemotherapy and autologous hematopoietic stem cell transplantation, the patient’s condition continued to improve.During the follow-up, no recurrence was observed. 【Conclusion】 Primary ALK-ALCL in the bladder is very rare and prone to misdiagnosis and missed diagnosis in clinical practice.The successful diagnosis and treatment experience of this patient can provide clinical reference.

Objective To study the treatment outcome and endoscopic characteristics of Helicobacter pylori(Hp)after endoscopic resection in the patients with early gastric cancer.Methods The 82 patients with early-stage gastric cancer who had Hp infection history and received the standardized Hp radical treatment in the Sixth Affiliated Hospital of Nantong University and the Affiliated Hospital of Nantong University from January 2021 to July 2023 served as the research subjects.The patients with carbon 13 breath test negative re-sults after Hp eradication treatment were included in the Hp eradication group(n=60),and the patients with positive results of rapid urease test,Hp fecal antigen test or carbon 13 breath test under gastroscopy were in-cluded in the Hp non-eradication group(n=22).The clinical and endoscopic characteristic data and the preva-lence rate of uncertain gastric cancer by targeted biopsy were compared between the two groups.Results There was no statistically significant difference in the gender,age and atrophy degree between the two groups(P＞0.05).There were statistically significant differences in the lesion location,macroscopic type,color tone and tumor size between the two groups(P＜0.05).Among them,the proportion of the lower 1/3 of stomach in the Hp eradication group was the highest(53.33％),while the proportion of the upper 3/1 of the stomach in the Hp non-eradication group was the highest(63.64％).In terms of macroscopic type,the proportion of depression type in the Hp eradication group was the highest(65.00％),while the proportion of uplift type in the Hp non-eradication group was the highest(59.09％).In terms of hue,the proportion of red in the Hp eradication group was the highest(83.33％).The proportion of tumor diameter＜20 mm in the Hp eradication group was higher(76.67％),while the proportion of tumor diameter 20 mm in the Hp non-eradication group was higher(72.73％).During the pretreatment endoscopy period,the prevalence rate of un-diagnosed gastric cancer by targeted biopsy in the Hp eradication group was 28.33％(17/60),which was higher than 4.55％(1/22)in the Hp non-eradication group,and the difference was statistically significant(X2=4.019,P=0.045).Conclusion Hp eradication has an important influence on the diagnosis of early gas-tric cancer.

Tooth transposition is a challenge for orthodontists, especially in correcting the order of teeth. At present, the literature on transposition canines mainly focuses on epidemiological studies and case reports, and no systematic treatment guidance has been formed. In this article, the definition and classification, epidemiology and etiology, imaging diagnosis, treatment and risk control of transposed canines are systematically described in order to provide reference for clinical practice.

Objective:To explore the clinical value of 18F-fluoromisonidazole (FMISO) PET/CT hypoxia imaging in early response to heavy ion radiotherapy in patients with non-small cell lung cancer(NSCLC). Methods:From April 2018 to January 2021, the 18F-FMISO PET/CT images of 23 NSCLC patients (19 males, 4 females; age (64.9±10.3) years) who received heavy ion radiotherapy in Shanghai Proton and Heavy Ion Center were retrospectively analyzed. The evaluation parameters included tumor volume (TV), tumor to background ratio (TBR) before and after radiotherapy. Patients were divided into hypoxia group and non-hypoxia group with the baseline TBR value≥1.4 as hypoxia threshold. Wilcoxon signed rank test was used to compare the differences of TV and TBR before and after radiotherapy in 2 groups. Results:Of 23 NSCLC patients, 17 were hypoxia and 6 were non-hypoxia. Compared with the baseline, TV after the radiotherapy (59.44(22.86, 99.43) and 33.78(8.68, 54.44) cm 3; z=-3.05, P=0.002) and TBR after the radiotherapy (2.25(2.09, 2.82) and 1.42(1.24, 1.67); z=-3.39, P=0.001) of the hypoxia group were significantly lower, while TV (16.19(6.74, 36.52) and 8.59(4.38, 25.47) cm 3; z=-1.57, P=0.120) and TBR (1.19(1.05, 1.27) and 1.10 (0.97, 1.14); z=-1.89, P=0.060) of the non-hypoxia group decreased with no significant differences. Conclusions:Hypoxic NSCLC tumors are sensitive to heavy ion radiation. Compared with non-hypoxic tumors, hypoxic tumors respond more quickly, and a significant reduction in TV can be observed early after radiotherapy. Heavy ion radiation can significantly improve tumor hypoxia.

At present, there are still some problems in the standardized residency training. Some standardized training bases often regard the resident trainees as ordinary practitioners, and devote their time and energy to the daily medical procedural work without giving enough training and teaching, ignoring the basic skills training of resident trainees. Therefore, this study constructed an active knowledge push system based on business scenarios. The system mainly includes three parts: sensitive operation identification layer, knowledge index layer and resource push layer in order to cultivate the norms of diagnosis and treatment of standardized training students and reasonably solve the problem of inconvenient resource acquisition in clinical work. Through the preliminary application, it was found that the system has effectively improved the mini-clinical evaluation exercise (Mini-CEX) score of the trainees and achieved good results.

ObjectiveChemical components in ethanol extract of Cyclocarya paliurus dried leaves were analyzed by ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry （UHPLC-Q-TOF/MS）. MethodAn Agilent Poroshell 120 EC-C₁₈ column （3.0 mm×100 mm， 2.7 μm） was used with 0.1% formic acid aqueous solution （A）-acetonitrile （B） as the mobile phase for gradient elution （0-26 min，2%-18%B； 26-60 min， 18%-72%B； 60-70 min， 72%-100%B； 70-71 min， 100%-2%B； 71-72 min， 2%B）， and the flow rate of 0.4 mL·min^-1 and injection volume of 3 μL. The electrospray ionization （ESI） was used in positive and negative modes， and detection range was m/z 50-1 100. The collected data were processed by Agilent MassHunter workstation. According to the retention time and MS information of each compound， combined with existing literature and MS database information， the compounds were identified and analyzed for the fragmentation rule. ResultA total of 52， 55 components were identified in the positive and negative ion modes， respectively. Among them， 14 flavonoids， 3 triterpenoids， 15 organic acids and 20 other compounds were identified under positive ion mode， while 18 flavonoids， 9 triterpenoids， 18 organic acids and 10 other compounds were identified under the negative ion mode. By summarizing the positive and negative ion modes and removing the common compounds， 87 compounds were identified， including 22 flavonoids， 27 organic acids， 11 triterpenoids and 27 other compounds. ConclusionUHPLC-Q-TOF/MS can be used to quickly analyze the chemical constituents in C. paliurus dried leaves. 1-Kestose and 18β-glycyrrhetinic acid and other components related to hypoglycemic activity of this herb are identified for the first time， which can provide reference for clarifying the pharmacodynamic substance basis of C. paliurus dried leaves.