ObjectiveTo explore the mechanism of Shenmai injection in improving cisplatin resistance in non-small cell lung cancer （NSCLC） based on the endoplasmic reticulum stress through protein kinase R-like endoplasmic reticulum kinase （PERK）/activated transcription factor 4 （ATF4）/C/EBP homologous protein （CHOP） signaling pathway. MethodsBALB/c nude mice bearing cisplatin-resistant human lung cancer cell line （A549/cisplatin） were randomly divided into four groups： Blank control group （0.9% sodium chloride）， cisplatin group （5 µg·g^-1cisplatin）， Shenmai injection group （5.2 mg·g^-1 Shenmai injection）， and combination therapy group （5.2 mg·g^-1 Shenmai injection +5 µg·g^-1cisplatin）. The drug intervention lasted for 4 weeks， and the changes in body weight and tumor volume were monitored. Hematoxylin-eosin （HE） staining was performed to observe tumor tissue pathology. Transmission electron microscopy （TEM） was used to assess the morphology of the endoplasmic reticulum. Immunohistochemical assay was conducted to measure the positive expressions of PERK， ATF4， and CHOP in tumor tissues. Western blot quantified the protein expression of immunoglobulin heavy chain binding protein （BIP）， PERK， phosphorylated PERK （p-PERK）， eukaryotic translation initiation factor 2α （eIF2α）， phosphorylated eIF2α （p-eIF2α）， ATF4， CHOP， B-cell lymphoma -2 （Bcl-2）， and Bcl-2 Associated X protein （Bax）. A549/cis cells were divided into blank group： Blank control group （normal culture medium）， cisplatin group （23.3 µmol·L^-1 cisplatin）， Shenmai Injection group （20 g·L^-1 Shenmai injection）， and combination therapy group （20 g·L^-1 Shenmai injection+23.3 µmol·L^-1 cisplatin）. Cell counting kit-8 （CCK-8） method was used to detect cell viability， TEM was used to observe the morphology of endoplasmic reticulum， and Western blot was used to detect endoplasmic reticulum stress and apoptosis-related proteins. ResultsCompared with the cisplatin group， the combination therapy group showed increased body weight （P<0.05）， decreased tumor volume （P<0.05）， and expanded endoplasmic reticulum in tumor cells. The positive expressions of PERK， ATF4， and CHOP increased （P<0.05）. Western blot revealed elevated protein expression levels of BIP， p-PERK/PERK， p-eIF2α/eIF2α， ATF4， CHOP， and Bax （P<0.05）， while Bcl-2 expression decreased （P<0.05）. As shown in the in vitro experiment， compared with the cisplatin group， the combination therapy group exhibited a reduced cell survival rate （P<0.05）. TEM revealed increased endoplasmic reticulum dilation and vesicular degeneration. Western blotting showed increased protein levels of BIP， p-PERK/PERK， p-eIF2α/eIF2α， ATF4， CHOP and Bax （P<0.05）， with decreased Bcl-2 expression （P<0.05）. ConclusionShenmai injection combined with cisplatin has a synergistic antitumor effect in NSCLC， which may be attributed to the activation of endoplasmic reticulum stress response mediated by the PERK/eIF2α/ATF4/CHOP signaling pathway and the induction of tumor cell apoptosis.

Depressive disorder is a mental illness characterized by poor mood and cognitive dysfunction caused by a range of complicated factors. Antidepressants have strong short-term efficacy in clinical application, yet with significant adverse effects and resistance in long-term use. Essential oils are small molecular compounds mainly composed of monoterpenes and sesquiterpenes, most of which are characterized by aromatic odors, easy permeability through the blood-brain barrier, and low toxic side effects. Volatile oil from traditional Chinese medicine can regulate neurotransmitter monoamine, hypothalamic-pituitary-adrenal axis, brain-derived neurotrophic factor, neuroinflammation and oxidative stress, and intestinal microbiota-gut-brain axis to exert an antidepressant effect through multiple pathways and targets. This review summarizes the main antidepressant chemical components of essential oil of traditional Chinese medicine, their pharmacological mechanisms and clinical application, aiming to provide some reference for further development and clinical application of essential oil of traditional Chinese medicine.

This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

Objective:To analyze the effects of SARS-CoV-2 infection and vaccination on virus mutation.Methods:The whole genome sequencing sequences of 2 659 local SARS-CoV-2 specimens from Jiangsu Province in 2023 were selected for analysis, and relevant information such as demographic and clinical characteristics were collected, and the effects of infection and vaccination on the genome-wide mutation rate and S gene′s selective pressure of the virus were analyzed by univariate and multivariate linear regression models.Results:The average age of these infected patients was 55.0 (31.0, 74.0) years, 1 150 cases (43.2%) in the age group of ≥60 years, 1 367 cases (51.4%) were males, 2 044 cases (76.9%) had a history of COVID-19 vaccination, and 1 629 cases (61.3%) had the first-time infection. The clinical symptoms of the infected patients were mainly mild, with a total of 2434 cases (91.5%), and 29 cases (1.1%) with severe symptoms or more. The average substitution rate of SARS-CoV-2 was 9.69 (9.38, 9.98)×10 -4 subs/site/year, and the dN/dS value of the S gene was 6.08 (5.56, 8.66), which was significantly greater than that of 1 ( P<0.001), indicating positive selection. The result of univariate and multivariate linear regression model analysis showed that the SARS-CoV-2 substitution rate was higher in those with vaccination history and reinfection, aged 20-30 years, ≥60 years, and the SARS-CoV-2 substitution rate was lower in males with moderate clinical symptoms and severe disease and above. Those with a history of vaccination and reinfection, aged 50-60 years old, ≥60 years old have smaller S gene dN/dS. Conclusions:Under the immune pressure exerted by vaccination and infection, the genome-wide mutation of SARS-COV-2 accelerated, but the non-synonymous mutation rate of the S gene decreased. The mechanism causing these phenomena needs further study.

Objective To explore the effects of Shenqi Fuzheng injection on the apoptosis of xenograft cells and expression of B-cell lym-phoma-2 (Bcl-2),Bcl-2-associated X protein (Bax),and cleaved caspase-3 proteins in cisplatin-resistant A549/DDP lung adenocarcinoma cells. Methods An A549/DDP xenograft model was constructed using BALB/c-nu nude mice as the research object. Nude mice were treated with normal saline,cisplatin,Shenqi Fuzheng injection,low-dose Shenqi Fuzheng injection combined with cisplatin,or high-dose Shenqi Fuzheng injection combined with cisplatin to observe xenograft growth. Ultrastructural changes in the tumor cells in each group were observed using transmission electron microscope (TEM) . Apoptotic cells were visualized using the terminal deoxynucleotidyl trans-ferase dUTP nick end labeling (TUNEL) assay. The expression of the apoptosis-related proteins Bax,Bcl-2,and cleaved caspase-3 in the xenograft tissue was measured using Western blotting and immunohistochemistry (IHC) . Results Compared with the cisplatin group,the tumor volume was significantly reduced in the combination groups (P<0.05) . The TEM results showed that,compared with the cisplatin group,the cells in the cisplatin combined with Shenqi Fuzheng injection group exhibited overall edema,severe shrinkage,chromosomal aggregation,and a specific apoptotic morphology. TUNEL staining showed that,compared with the cisplatin group,the apoptotic rate of the cisplatin combined with Shenqi Fuzheng injection group increased (P<0.05) . The IHC and Western blotting results showed that the cleaved caspase-3 and Bax expression levels were significantly higher in the combination group than in the cisplatin group,whereas Bcl-2 expression was down-regulated (P<0.05) . Conclusion Shenqi Fuzheng injection strengthens the antitumor sensitivity of cisplatin,and its mechanism of action may be related to the upregulation of Bax,downregulation of Bcl-2,and activation of cleaved caspase-3 to induce apoptosis.

Objective To explore the effects of Shenqi Fuzheng injection on the apoptosis of xenograft cells and expression of B-cell lym-phoma-2 (Bcl-2),Bcl-2-associated X protein (Bax),and cleaved caspase-3 proteins in cisplatin-resistant A549/DDP lung adenocarcinoma cells. Methods An A549/DDP xenograft model was constructed using BALB/c-nu nude mice as the research object. Nude mice were treated with normal saline,cisplatin,Shenqi Fuzheng injection,low-dose Shenqi Fuzheng injection combined with cisplatin,or high-dose Shenqi Fuzheng injection combined with cisplatin to observe xenograft growth. Ultrastructural changes in the tumor cells in each group were observed using transmission electron microscope (TEM) . Apoptotic cells were visualized using the terminal deoxynucleotidyl trans-ferase dUTP nick end labeling (TUNEL) assay. The expression of the apoptosis-related proteins Bax,Bcl-2,and cleaved caspase-3 in the xenograft tissue was measured using Western blotting and immunohistochemistry (IHC) . Results Compared with the cisplatin group,the tumor volume was significantly reduced in the combination groups (P<0.05) . The TEM results showed that,compared with the cisplatin group,the cells in the cisplatin combined with Shenqi Fuzheng injection group exhibited overall edema,severe shrinkage,chromosomal aggregation,and a specific apoptotic morphology. TUNEL staining showed that,compared with the cisplatin group,the apoptotic rate of the cisplatin combined with Shenqi Fuzheng injection group increased (P<0.05) . The IHC and Western blotting results showed that the cleaved caspase-3 and Bax expression levels were significantly higher in the combination group than in the cisplatin group,whereas Bcl-2 expression was down-regulated (P<0.05) . Conclusion Shenqi Fuzheng injection strengthens the antitumor sensitivity of cisplatin,and its mechanism of action may be related to the upregulation of Bax,downregulation of Bcl-2,and activation of cleaved caspase-3 to induce apoptosis.

Objective:To investigate the pediatricians' needs in the contents of continuing medical education (CME), and the influencing factors of participating in CME, so as to provide references for improving their vocational ability.Methods:Questionnaire survey was carried out for the pediatricians from county-level medical institutions in the nine provinces of China. The questionnaire contents included: basic information, CME contents needs, and influencing factors of participating in CME. SPSS 22.0 was used for chi-square test.Results:A total of 465 questionnaires was recovered, among which 463 were qualified, with a pass rate of 99.6%. Research showed that ① In terms of competency training needs, pediatricians had higher training demand for ability of diagnosis and treatment of children's diseases, pediatrics basic skills and skills related to children's health care, etc. Pediatricians with junior or intermediate title had higher training demand for ability of self-learning and access to learning resources ( P < 0.01); and pediatricians with senior title had higher training demand for teaching ability ( P < 0.05). ② In terms of pediatrics specialty content training needs, pediatricians had higher demand for neonatology, infectious, respiratory, critical medicine, developmental behavior and digestion in order. ③ Regarding the influencing factors of CME, too few opportunities to participate in training, too busy to have time to participate, and defects in curriculum arrangement were the main factors affecting the CME participation of pediatricians. Conclusion:Pediatricians with different professional title had different training needs for CME contents. Lack of CME resources, contradiction between work and study, and curriculum arrangement deficiencies might be the main influencing factors affecting the CME participation of pediatricians working at county-level medical institutions.

Objective:To explore the application effect and feedback of online pediatrics teaching for the clerkship and internship stage of medical students of clinical medicine eight-year program.Methods:In this study, 38 clerkship medical students and 12 internship medical students of clinical medicine eight-year program in pediatrics department of Peking University First Hospital from February to March, 2020 were selected as research objects. They had two weeks of online teaching, including online flipped classroom, case-based learning (CBL), and problem-based learning (PBL). The effect of online teaching, and the feedback from these students were all investigated through the questionnaire survey.Results:All students were satisfied with the overall arrangement of the online teaching and believed that the results exceed [42% (21/50)] or meet [58% (29/50)] their expectations. According to the feedback, network congestion [82% (41/50)] was the biggest problem in online teaching, followed by the inability of effective interaction [20% (10/50)]. Students all believed that the online teaching arrangement was most helpful for the cultivation of theoretical knowledge (Total scores 4.58±0.50), autonomous learning ability (Total scores 4.42±0.58) and clinical reasoning (Total scores 4.42±0.58), but had minimal impact on the skills operation (Total scores 2.68±0.87) and scientific research ability (Total 2.98±0.98). For the ability of communication between doctors and patients, the scores of clerkship students (3.79±0.99) were significantly higher than those of internship students (3.08±0.67), ( P<0.05). Clerkship students considered that online flipped classroom was the most helpful teaching mode, while internship students believed online CBL teaching was the most helpful one. Majority of the students (94%) think it's necessary to keep online teaching in the future. Conclusion:Online teaching of pediatrics is approved by the medical students of clinical medicine eight-year program in the stage of clerkship and internship, and plays an important role in the cultivation of the ability of medical students, but it can't completely replace offline clinical practice.

Objective To evaluate the effects of artemisinin on proliferation,cell cycle and apoptosis of gallbladder cancer cells.Methods Gallbladder carcinoma cell lines (GBC-SD and NOZ) were cultured in vitro.The effects of artemisinin in different concentration on proliferation of the two cell lines in vitro were examined using MTT assay.The cell cycle distribution of GBC-SD and NOZ cells 24 h after treatments with artemisinin(20 μ mol/L) were examined using flow cytometry.The apoptosis of GBC-SD and NOZ cells 24 h after treatments with artemisinin (20 μ mol/L) were examined using Annexin V/PI staining.The expressions of p-ERK1/2,CDK4,cyclin D1,p16,cytochrome C and caspase-3 were examined by Western blot assay.t-test and one way ANOVA were used to evaluate the differences between two groups and more than two groups,respectively.Results The cell proliferation was significantly inhibited by artemisinin,the ICS0 of artemisinin against GBC-SD and NOZ cells were 14.05 μmol/L and 12.42 μmol/L,respectively.Artemisinin induced cycle arrest,and G1 population of GBC-SD and NOZ cells increased to 74.60％ and 78.86％.Cell apoptosis and apoptotic population of GBC-SD and NOZ cells were increased to 15.67％ and 16.51％ after dealt with artemisinin,respectively.In addition,expression of pl6 was increased,and expressions of p-ERK1/2,CDK4 and cyclin D1 were down-regulated by artemisinin(all P ＜0.05).Cytochrome C was released from mitochondria to cytoplasm leading to the activation of caspase-3 and PARP after dealt with artemisinin (P ＜ 0.05).Conclusion The inhibition effect of artemisinin on the proliferation gallbladder cancer cells is accompanied by down-regulation of ERK1/2 signaling pathway,G1 phase arrest and triggering caspase-3-mediate apoptosis.