ObjectiveTo investigate the molecular mechanism by which Feiyanning formula（FYN） regulated exosomal miR-328 to suppress the invasion and metastasis of lung cancer. MethodsIn vitro models using low-metastatic 95C and high-metastatic 95D lung cancer cell lines， along with isolated exosomes， were established. Initially， 95C and 95D cells were cultured， and exosomes were isolated from their supernatants. The exosomes were identified using transmission electron microscopy （TEM）， nanoparticle tracking analysis （NTA）， and Western blot. Exosome uptake assays confirmed that both 95C and 95D cells could internalize exosomes derived from lung cancer patients' plasma. Cell counting kit-8 （CCK-8） assays were performed to assess the inhibitory effects of FYN （0， 0.1， 0.2， 0.4， 0.8， 1.6， 3.2， 6.4 g·L^-1） on 95C and 95D cell proliferation. Subsequent experiments were divided into three groups of control， low-dose FYN （1 g·L^-1）， and high-dose FYN （2 g·L^-1） groups. Wound-healing and Transwell assays were used to evaluate the inhibitory effects of FYN on the migration and invasion of 95C and 95D cells. Western blot was employed to detect the protein expression levels of Janus kinase 2 （JAK2）， signal transducer and activator of transcription 3 （STAT3）， cellular oncogene Fos （c-Fos）， and nuclear factor of activated T cells 1 （NFATc1）. The mRNA expression of miR-328 was measured by Real-time quantitative polymerase chain reaction （Real-time PCR）. ResultsLung cancer plasma-derived exosomes （EXO） enhanced the migration， invasion， and miR-328 expression levels in 95C and 95D cells （P<0.05， P<0.01）. FYN inhibited the proliferation， invasion， and metastasis of 95C and 95D cells in a dose-dependent manner （P<0.01）， with more pronounced effects on 95C cells. Additionally， FYN downregulated exosomal miR-328 expression and suppressed the protein levels of JAK2， STAT3， and its downstream target genes c-Fos and NFATc1 （P<0.01）. ConclusionFYN may inhibit lung cancer metastasis by downregulating exosomal miR-328 expression， potentially through the STAT3/c-Fos/NFATc1 signaling pathway. Further studies are warranted to elucidate its detailed mechanisms and facilitate clinical application， providing insights into traditional Chinese medicine-based strategies for lung cancer treatment.

Objective:To assess the level of moral distress among pediatric nurses in China and explore its influencing factors, providing a reference for future interventions.Methods:A cross-sectional survey was conducted using a convenience sampling method from May 2022 to March 2023. Pediatric nurses meeting the inclusion and exclusion criteria were selected from children′s specialized hospitals, general hospitals, and maternal and child health hospitals across 16 provinces in China. Moral distress was assessed using the Chinese version of the Moral Distress Scale-Revised (MDS-R). Data analysis included descriptive statistics, non-parametric analysis, and multiple linear regression.Results:A total of 509 pediatric nurses participated in the survey, including 10 males and 499 females. Among them, 45 were aged ≤25 years, 268 were aged 26-35 years, 172 were aged 36-45 years, and 24 were aged >45 years.The median moral distress score was 58.00 (26.00, 77.50). Factors independently associated with higher levels of moral distress included having a master′s degree ( t = 2.33), working in a ward with more than 40 beds ( t = 3.38), working in a ward without parental accompaniment ( t = 2.60), being passively assigned to the nursing profession ( t = 2.63), and considering resignation but not leaving the job ( t = 3.85) (all P<0.05). Conclusions:Pediatric nurses in China experience a moderate level of moral distress. Further research is needed to understand its underlying causes and to develop preventive and intervention strategies.

To analyze the impact of salt reduction interventions on the knowledge, attitude and behavior regarding the salt reduction of students′ parents based on the home-school interaction model. In April 2021, parents of students in grades 3-5 from three primary schools in Yichang City were selected as the target population using a cluster sampling method, and the parent population was divided into an intervention group and a control group. In the intervention group, a comprehensive home-school interaction salt reduction intervention was implemented, and in the control group, no intervention measures were taken for students′ parents. Baseline and final surveys were conducted before and after the intervention period, which included general information, previous salt reduction interventions received, and salt reduction knowledge, attitude and behavior. Difference-in-difference (DID) method was used to compare the knowledge, attitude and behavior status of two groups before and after the intervention, and stratified analysis of parents with different literacy levels was conducted to assess the net effect of intervention implementation. The results showed that 740 parents completed the baseline and final surveys, with 231 in the intervention group and 509 in the control group. After propensity score matching, there were 231 (33.33%) in the intervention group and 462 (66.67%) in the control group. After the intervention, the proportion of the intervention group who obtained salt control spoons and pots, as well as salt reduction knowledge and advice through school, was 87.45%, 86.58% and 75.45%, respectively, which was significantly higher than that in the control group ( P<0.05). After the intervention, the proportion of parents with a high school and lower education who obtained salt control pots was higher in the intervention group (89.23%) than in the control group (74.49%), with significant differences ( P<0.05). The proportion of parents with a college degree or above who obtained salt control spoons and pots, as well as salt reduction knowledge and advice through school, was higher than that of the control group ( P<0.05). The results of DID method showed that after controlling for monthly income and other factors, the scores of parents′ salt reduction-related knowledge and low-salt behavior in the intervention group increased significantly higher than those in the control group, with DID values (95% CI) of 1.18 (0.15-2.21) and 0.62 (0.16-1.09), respectively, indicating a significant net effect of intervention implication. After stratification according to the education level of parents, this difference still existed in the college degree or above group, with DID values (95% CI) of 1.39 (0.13-2.66) and 0.76 (0.16-1.36), respectively. The home-school interaction model for salt reduction measures can improve the salt-related knowledge and low-salt behavioral choices of students′ parents.

Objective To clarify the anti-fibrotic effect of hypericin on preventing renal fibrosis.To explore if hypericin can improve renal tubulointerstitial fibrosis by inhibiting the Yes-associated protein(YAP).Methods Thirty-six male mice were randomly allocated into 6 groups(n=6 per group):sham group,sham+hypericin(120 mg/kg)group,UUO model group,hyperi-cin(30,60,120 mg/kg)treatment groups.Except for the sham group,renal interstitial fibrosis was induced in all other groups via unilateral ureteral obstruction(UUO).Mice in the hypericin treatment group received corresponding doses of hypericin sus-pension via oral gavage,while sham group and UUO model group were administered equivalent volumes of normal saline through the same route for 14 consecutive days.Additionally,an in vitro model was established using NRK-52E cells treated with TGF-β1(10 ng/mL).To evaluate the anti-fibrotic effects of hypericin,protein expression levels of α-SMA,fibronectin,col-lagen Ⅰ and collagen Ⅲ were assessed in both the UUO mouse kidney tissues and TGF-β1-stimulated NRK-52E cells using Western blotting.Blood urea nitrogen(BUN)and creatinine(Cr)levels in mice were measured to assess the renal protective effects of hypericin.Histological changes and collagen deposition in the kidneys were observed using hematoxylin-eosin and Masson staining.The expression levels of YAP and its downstream target gene CTGF were also determined using Western blot-ting.The specific mechanism of hypericin in improving renal interstitial fibrosis was further explored using the YAP inhibitor verteporfin.Results The protein expression levels of α-SMA,FN,collagen Ⅰ,and collagen Ⅲ in renal tissues of UUO mice and TGF-β1-induced NRK-52E cells were markedly reversed by hypericin(all P＜0.01).The levels of Cr and BUN in UUO mice se-rum were effectively reduced(both P＜0.01),and renal histopathological alterations and interstitial collagen deposition were markedly ameliorated.Potent inhibitory effects on YAP and CTGF protein expression were observed both in vivo and in vitro(both P＜0.01),exhibiting similar effects to verteporfin.Both treatments dramatically reduced TGF-β1-induced fibrosis in NRK-52E cells.Conclusion Hypericin can inhibit renal tubulointerstitial fibrosis by inhibiting YAP.

Objective:To investigate the related factors of cognitive impairment in middle-aged and old-aged patients with type 2 diabetes mellitus(T2DM).Methods:A total of 970 patients with T2DM(585 middle-aged group and 385 old-aged group)were selected from residents of a large community in Beijing from September to December 2018.The Mini-Mental State Examination(MMSE)was used to assess the cognitive func-tion.Multivariate logistic regression was used to analyze the related factors.Results:The detection rates of cognitive impairment were 12.0％and 13.5％in middle-aged and old-aged patients with T2DM,respectively.Among mid-dle-aged patients with T2DM,work(OR=0.22,95％CI:0.03-0.77)and education at the junior college or un-dergraduate level and above(OR=0.18,95％CI:0.04-0.55)were protective factors for cognitive impair-ment.Myocardial infarction(OR=4.13,95％CI:1.26-13.63)was a risk factor for cognitive impairment.Among old-aged patients with T2DM,drinking tea 1-2 times a week(OR=0.11,95％CI:0.01-0.58)and education at the junior college or undergraduate level and above(OR=0.19,95％CI:0.05-0.54)were protective factors for cognitive impairment.Stroke(OR=3.64,95％CI:1.55-8.39)and good sleep self-assessment(OR=2.75,95％CI:1.13-7.35)were risk factors for cognitive impairment.Conclusion:Cognitive impairment in middle-aged pa-tients with T2DM is related to work,education level and myocardial infarction,and cognitive impairment in old-aged patients with T2DM is related to lifestyle,education level and stroke.

Objective:To explore the application value of CT-guided percutaneous coaxial needle biopsy (CT-PTCB) in the diagnosis of malignant tumors.Methods:A retrospective case series study was conducted. The clinical data of 802 suspected malignant tumor patients who underwent CT-PTCB upon admission to Beijing Chaoyang District Huanxing Cancer Hospital from January 2019 to December 2023 were analyzed. All patients underwent imaging follow-up combined with CT-PTCB or surgical pathology to determine the final diagnosis. The CT-PTCB puncture effect, diagnosis effect and incidence of complications were recorded.Results:Among the 802 patients, 488 (60.8%) were male and 314 (39.2%) were female, with the age of (51±11) years. The puncture sites included 610 cases (76.1%) in the chest, 169 cases (21.1%) in the abdomen, 17 cases (2.1%) in the bones, and 6 cases (0.7%) in the pelvic cavity. The success rate of CT-PTCB puncture upon admission was 99.5% (798/802), the diagnostic accuracy was 96.5% (774/802), and the false negative rate was 3.5% (28/802). The incidence of pneumothorax and bleeding in patients undergoing pulmonary CT-PTCB was 13.0% (75/575) and 17.9% (103/575), respectively; the incidence of puncture bleeding in patients undergoing liver CT-PTCB was 0.8% (1/125), and the incidence of pain was 1.6% (2/125); the incidence of pneumothorax in patients undergoing mediastinal CT-PTCB was 8.7% (2/23); no obvious complications were observed in other puncture sites. All complications were cured through active treatment.Conclusions:The application of CT-PTCB for the diagnosis of malignant tumors has high success rate and diagnosis rate, and is safe and minimally invasive.

Objective:To evaluate the feasibility of a six-step suspension technique for endoscopic lateral neck dissection (LND) through the chest-breast approach in patients with papillary thyroid carcinoma (PTC).Methods:This is a retrospective case series study.Clinical data of 81 PTC patients who underwent endoscopic LND via the chest-breast approach using the six-step suspension method at the Department of Thyroid Surgery, Shenzhen People′s Hospital were collected from January 2022 to October 2024. The cohort consisted of 15 male and 66 female patients, with age of (35.2±10.2)years (range:8.5 to 65.0 years). Key variables, including LND duration, total operative time, postoperative hospital stay, details of lymph node metastasis, postoperative complications, and follow-up data were recorded and analyzed.Results:The duration of LND was (131.8±42.2)minutes (range: 65 to 275 minutes), and the total operative time was (195.5±49.6)minutes (range: 110 to 390 minutes). The postoperative hospital stay was (4.8±1.5)days(range:3 to 15 days). The number of dissected lateral cervical lymph nodes was 32.7±10.1 (range: 11 to 54). The maximum tumor diameter was (16.1±10.1)mm(range:2 to 30 mm), while the maximum size of metastatic lymph nodes was (16.7±6.2)mm(range:7 to 30 mm). The positivity rate was 24.7% (841/3 410) in the lateral cervical+central lymph node and 16.1% (427/2 646) in the lateral cervical lymph node. Postoperative lymphatic leakage occurred in 2 patients, both of whom were successfully treated conservatively. No other significant complications were reported. During the postoperative follow-up period, which lasted for (18.3±7.4) months (range: 1.1 to 34.4 months), the mean postoperative serum thyroglobulin (Tg) level ( M(IQR)) was 0.05 (0.50) μg/L (range: 0.01 to 7.90 μg/L), with 86.4% of patients showing a Tg ≤1.00 μg/L. Through imaging evaluations, no evidence of residual disease or recurrence was detected. Conclusion:Endoscopic LND via the chest-breast approach, utilizing the six-step suspension method, maybe a feasible and effective technique with promising clinical outcomes.

Objective:To explore the genetic basis of a patient suspected for Loeys-Dietz syndrome (LDS).Methods:An adult male patient with aneurysmal dilation of the aortic root identified during the treatment for chronic myeloid leukemia at Anzhen Hospital of Capital Medical University in 2021 was enrolled as the study subject. Clinical data of the patient were retrospectively collected. Peripheral blood samples were collected from the patient and his family members and subjected to whole-exome sequencing (WES). Candidate variant was verified by bioinformatic analysis, with a focus on the genes associated with hereditary aortic aneurysms. Candidate variant was validated by Sanger sequencing. The online SpliceAI software was used for the prediction of protein function. The results, combined with information from public databases, were used to classify the pathogenicity of the candidate variant according to the guidelines from the American College of Medical Genetics and Genomics (ACMG). This study was approved by the Ethics Committee of Beijing Anzhen Hospital (Ethics No. 2023163X).Results:Imaging analysis revealed that the patient had aneurysmal dilation of the aortic root. Based on his clinical features and past history, a provisional diagnosis of LDS was established. WES revealed that the patient had harbored a heterozygous splice site variant c. 206+ 2T>G in the SMAD3 gene (NM_005902). The variant was not reported in public databases and was predicted to be pathogenic by SpliceAI. Sanger sequencing showed that the variant was also present in the patients mother, sister, nephew, and daughter, but not in his father. Based on the guidelines from the ACMG, the variant was classified as likely pathogenic (PVS1+ PM2_Supporting). Conclusion:The heterozygous splice site variant c. 206+ 2T>G of the SMAD3 gene probably underlay the disease of this patient. The discovery has enriched the mutational spectrum of LDS, which may facilitate delineation of the genotype-phenotype correlation and provide a basis for further risk stratification and personalized treatment of LDS.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

As the harvest and clinical application of anterolateral thigh flap (ALTF) are now well established, attentions are gradually shifted to the quality of closure of donor site. Considering aesthetics and functionality of donor site while having a recipient site reconstructed has become a challenge for surgeons in reconstructive surgery. In recent years, with in-depth researches on flap anatomy, a variety of innovative closure techniques for donor site have emerged, aiming to improve healing quality and minimise complications. This article summarises and categorises the management strategies for ALTF donor site through extensive literature review, and provides a reference for surgeons on individualised treatment of patients.