ObjectiveTo reveal the active substances and mechanisms of modified Qing'e formula （MQEF） in delaying skin photoaging by ultra-performance liquid chromatography-quadrupole-time of flight mass spectrometry （UPLC-Q-TOF-MS），network pharmacology， and cell experiments. MethodsUPLC-Q-TOF-MS and a literature review were employed to analyze the transdermally absorbed components in mice after the topical application of MQEF. The potential targets of MQEF in treating skin photoaging were retrieved from databases.The compound-potential target network and protein-protein interaction network were constructed to screen the key components and core targets. A photoaging cell model was established by irradiating HaCaT cells with medium-wave ultraviolet B （UVB）. The safe doses of bakuchiol （BAK） and salvianolic acid B （SAB） for treating HaCaT cells and the effects of BAK and SAB on the viability of cells exposed to UVB irradiation were determined by the cell counting kit-8 （CCK-8） method.The reactive oxygen species （ROS） fluorescent probe was used to measure the ROS production in the cells treated with BAK and SAB.The expression levels of genes related to oxidative stress，inflammation，collagen metabolism，and circadian rhythm clock were measured by Real-time PCR. ResultsA total of 24 transdermally absorbed components of MQEF were identified，which acted on 367 potential targets，and 417 targets related to skin photoaging were screened out，among which 47 common targets were predicted as the targets of MQEF in treating skin photoaging. MQEF exerted the anti-photoaging effect via key components such as BAK and SAB，which acted on core proteins such as serine/threonine kinase 1 （Akt1） and mitogen-activated protein kinase 3 （MAPK3） and intervened in core pathways such as the tumor necrosis factor （TNF） and phosphatidylinositol-3-kinase （PI3K）/protein kinase B （Akt） signaling pathways.Compared with the model group，the administration of BAK and SAB increased the survival rate of HaCaT cells （P<0.01），down-regulated the mRNA levels of cyclooxygenase-2 （COX-2），interleukin-6 （IL-6），tumor necrosis factor-α （TNF-α），matrix metalloproteinase-1 （MMP-1），and matrix metalloproteinase-9 （MMP-9） （P<0.01），and up-regulated the mRNA levels of heme oxygenase-1 （HO-1） and NAD（P）H quinone dehydrogenase 1 （NQO-1） （P<0.05，P<0.01） in photoaged HaCaT cells.In addition，it eliminated excess ROS production induced by UVB and up-regulated the mRNA levels of brain and muscle ARNT-like 1 （BMAL1） and circadian locomotor output cycles kaput （CLOCK） associated with circadian clock （P<0.05，P<0.01）. ConclusionMQEF delays skin photoaging through the coordinated effects of various components，multiple targets，and diverse pathways.The key components BAK and SAB in MQEF exhibit anti-photoaging properties，which involve inhibiting oxidative stress，preventing collagen degradation，mitigating inflammation，and maintaining normal skin circadian rhythms by regulating clock gene expression.

ObjectiveTo construct a large language model （LLM）-based intelligent pre-consultation system for traditional Chinese medicine （TCM） to improve efficacy of clinical practice. MethodsA TCM large language model was fine-tuned using DeepSpeed ZeRO-3 distributed training strategy based on YAYI 2-30B. A weighted undirected graph network was designed and an agent-based syndrome differentiation model was established based on relationship data extracted from TCM literature and clinical records. An agent collaboration framework was developed to integrate the TCM LLM with the syndrome differentiation model. Model performance was comprehensively evaluated by Loss function， BLEU-4， and ROUGE-L metrics， through which training convergence， text generation quality， and language understanding capability were assessed. Professional knowledge test sets were developed to evaluate system proficiency in TCM physician licensure content， TCM pharmacist licensure content， TCM symptom terminology recognition， and meridian identification. Clinical tests were conducted to compare the system with attending physicians in terms of diagnostic accuracy， consultation rounds， and consultation duration. ResultsAfter 100 000 iterations， the training loss value was gradually stabilized at about 0.7±0.08， indicating that the TCM-LLM has been trained and has good generalization ability. The TCM-LLM scored 0.38 in BLEU-4 and 0.62 in ROUGE-L， suggesting that its natural language processing ability meets the standard. We obtained 2715 symptom terms， 505 relationships between diseases and syndromes， 1011 relationships between diseases and main symptoms， and 1 303 600 relationships among different symptoms， and constructed the Agent of syndrome differentiation model. The accuracy rates in the simulated tests for TCM practitioners， licensed pharmacists of Chinese materia medica， recognition of TCM symptom terminology， and meridian recognition were 94.09%， 78.00%， 87.50%， and 68.80%， respectively. In clinical tests， the syndrome differentiation accuracy of the system reached 88.33%， with fewer consultation rounds and shorter consultation time compared to the attending physicians （P＜0.01）， suggesting that the system has a certain pre- consultation ability. ConclusionThe LLM-based intelligent TCM pre-diagnosis system could simulate diagnostic thinking of TCM physicians to a certain extent. After understanding the patients' natural language， it collects all the patient's symptom through guided questioning， thereby enhancing the diagnostic and treatment efficiency of physicians as well as the consultation experience of the patients.

Objective: To explore the effects of Cldn14 gene knockout on renal metabolism and stone formation in rats，so as to provide reference for research in the field of urinary calium metabolism and stone formation. Methods: Cldn14 gene knockout homozygous rats and wild-type rats of the same age were randomly divided into 4 groups：wild-type control (WC) group，wild-type ethylene glycol (WE) group，gene knockout control (KC) group and gene knockout ethylene glycol (KE) group，with 10 rats in each group.The WE and KE groups were induced with ethylene glycol + ammonium chloride to form kidney stones，while the WC and KC groups received normal saline gavage.After 4 weeks of standard maintenance feeding，the urine samples were collected to detect the venous blood.The kidneys were collected for HE，Pizzolatto's staining and transmission electron microscopy.The protein in renal tissues was extracted to detect the expressions of Claudin16 and Claudin19. Results: Crystal deposition was observed in the renal tubular lumen of the WE and the KE groups，and more crystals were detected in the KE group.The WE group had a large number of intracytoplasmic black crystalline inclusions observed in renal tubular epithelial cells under transmission electron microscope，followed by the KE and KC groups.Compared with WC and WE groups，KC and KE groups had significantly decreased serum calcium and magnesium levels but significantly increased urinary calcium level.In addition，the urinary calcium level was higher in the WE group than in the WC group and higher in the KE group than in the KC group.The KE group had lower level of Claudin16，but there was no significant difference in the level of Claudin19 among the 4 groups(P>0.05). Conclusion: Knockout of Cldn14 gene alone cannot effectively reduce urinary calcium excretion or reduce the risk of stone formation in rats，which may be related to the decrease of Claudin16 level.

BACKGROUND: Telesurgery has the potential to overcome spatial limitations for surgeons, which depends on surgical robot and the quality of network communication. However, the influence of network latency and bandwidth on telesurgery is not well understood. METHODS: A telesurgery system capable of dynamically adjusting image compression ratios in response to bandwidth changes was established between Beijing and Sanya (Hainan province), covering a distance of 3000 km. In total, 108 animal operations, including 12 surgical procedures, were performed. Total latency ranging from 170 ms to 320 ms and bandwidth from 15-20 Mbps to less than 1 Mbps were explored using designed surgical tasks and hemostasis models for renal vein and internal iliac artery rupture bleeding. Network latency, jitter, frame loss, and bit rate code were systemically measured during these operations. National Aeronautics and Space Administration Task Load Index (NASA-TLX) and a self-designed scale measured the workload and subjective perception of surgeons. RESULTS: All 108 animal telesurgeries, conducted from January 2023 to June 2023, were performed effectively over a total duration of 3866 min. The operations were completed with latency up to 320 ms and bandwidths as low as 1-5 Mbps. Hemostasis for vein and artery rupture bleeding models was effectively achieved under these low bandwidth conditions. The NASA-TLX results indicated that latency significantly impacted surgical performance more than bandwidth and image clarity reductions. CONCLUSIONS This telesurgery system demonstrated safety and reliability. A total of 320 ms latency is acceptable for telesurgery operations. Reducing image clarity can effectively mitigate the potential latency increase caused by decreased bandwidth, offering a new method to reduce the impact of latency on telesurgery.
Animals ; Robotic Surgical Procedures/methods* ; Laparoscopy/methods*

Objective:To evaluate the feasibility, safety and effects of tumor resection in the anterior space of the styloid process via transoral endoscopic medial parapterygomandibular ligament approach. Methods:This retrospective study included 24 patients who were diagnosed with tumors in the anterior space of the styloid process and treated with the transoral endoscopic medial parapterygomandibular ligament approach. Twenty-four patients who underwent surgery by traditional approach were selected on a 1∶1 ratio as control group. We compared the en bloc resection rate, the operation time, amount of blood loss, the postoperative pain VAS score, recurrence rate, length of hospital stay, complication rate between the two groups. Results:Among the 24 patients, pleomorphic adenoma was confirmed in 18 cases （75.0%）, basal cell adenoma in 2 cases （8.3%）, and neurilemmoma in 4 cases （16.7%）. In the transoral endoscopic group, the en bloc resection rate was 91.7%, the maximum tumor diameter was （42.2±12.2） mm, the operative time was （117.9±29.8）min, the blood loss was （36.7±18.7） mL, the postoperative pain VAS score （1.5±0.7）, no recurrence was observed, length of hospital stay was （10.8±2.9） d. Wound dehiscence occurred in one case in the transoral endoscopic group, and no other postoperative complication was observed. There were significant differences in the operation time, blood loss, the postoperative pain VAS score between the two groups, while no difference was found in gender, age, en bloc resection rate and length of hospital stay. Conclusion:The tumor resection in the anterior space of the styloid process via transoral endoscopic medial parapterygomandibular ligament approach was safe, minimally invasive and feasible.
Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Adult ; Endoscopy/methods* ; Temporal Bone/surgery* ; Aged ; Young Adult ; Ligaments/surgery*

Probiotics are natural systems bridging synthetic biology, physical biotechnology, and immunology, initiating innate and adaptive anti-tumor immune activity. We previously constructed an all-in-one engineered food-grade probiotic Lactococcus lactis (FOLactis) which could boost the crosstalk among different immune cells such as dendritic cells (DCs), natural killer cells, and T cells. Herein, considering the limited clinical efficacy of naked personalized neoantigen peptide vaccines, we decorate FOLactis with tumor antigens by employing a Plug-and-Display system comprising membrane-inserted peptides. Intranodal injection of FOLactis coated with neoantigen peptides (Ag-FOLactis) induces robust DCs presentation and neoantigen-specific cellular immunity. Notably, Ag-FOLactis not only triggers a 45-fold rise in the quantity of locally reactive neoantigen-specific T cells but also induces epitope spreading in both subcutaneous and metastatic tumor-bearing models, leading to potent inhibition of tumor growth. These findings imply that Ag-FOLactis represents a powerful platform to rapidly and easily display antigens, facilitating the development of a bio-activated platform for personalized therapy.

In recent years, significant progress has been made in the study of the complex pathophysiology of sepsis. However, sepsis remains the main cause of high mortality among critically ill patients worldwide. Early diagnosis, timely treatment, and accurate prediction of the prognosis are crucial for the successful treatment of septic patients. Lactic acid not only serves as a diagnostic indicator for septic shock but also participates in the immune response process of sepsis. It regulates gene epigenetic regulation through lactylation, thereby affecting the expression of related genes, cellular metabolism, and the immune response of the body. Therefore, it may become a new target for the treatment of sepsis. Lactate-related indicators, such as lactic acid/albumin ratio (LAR) and lactic acid/hematocrit ratio (LHR), also have important value in the prognosis assessment of septic patients and are superior to the evaluation efficacy of a single indicator. This is of great significance for timely detection of the changes in the condition of septic patients and their risk stratification and precise treatment. This review focused on the relationship between lactylation, lactatization, lactate-related indicators and sepsis, as well as the latest research progress. By revealing their roles in the occurrence, development and prognosis of sepsis, it provided new ideas for clinical diagnosis and treatment, uncovered new mechanisms of disease onset, guided disease risk stratification, optimized existing treatment strategies, and also offered new references and directions for basic research on lactate-related indicators.
Humans ; Sepsis/metabolism* ; Lactic Acid/metabolism* ; Prognosis ; Biomarkers/blood*

Purpose To investigate the clinicopathological characteristics of pediatric diffuse midline gliomas(DMG)with H3K27-altered.Methods Clinical data of 102 patients with diffuse midline glioma with H3K27-altered were collected,HE and immunohistochemistry EnVision two-step staining was used,and Sanger sequencing for molecular detection was used to ana-lyze their clinical and pathological characteristics and reviewed relevant literatures.Results The age of patients ranged from 1 to 14 years(median age,7 years).Brainstem was the predilec-tion site(81.4％)while other sites included basal ganglia,pin-eal,etc(18.6％).The main clinical manifestations were dizzi-ness,headache,gait instability,etc.The lesions mainly showed hypointensity or isointensity on T1 and hyperintensity on T2 in MRI.Histology showed high-grade gliomas in 64 cases(62.7％)and low-grade gliomas in 38 cases(37.3％).Immunohisto-chemistry showed downexpression or loss of H3K27me3 in 81 ca-ses(100％),H3K27M expression in 100 cases(98％)cases,and EZHIP expression in 2 cases(2％).BRAF V600E expres-sion was detected in only 2.2％(2/89)while p53 mutation in 53.6％(52/97).Additionally,loss of ATRX expression was de-tected in 19.1％(18/94)while the expression of IDH1 was neg-ative in all cases(89/89).Molecular tests showed that of BRAF mutation was 1.7％(1/59)and EGFR mutation was 9.1％(1/11).Conclusion Children DMG with H3K27-altered tend to occur in the brainstem.The histological grade is mostly high.Immunohistochemistry staining of H3K27me3 show varying de-grees of deficiency.Molecular variants include H3K27M muta-tion or EZHIP overexpression and EGFR mutation.

Objective:To investigate the clinicopathological features of children with metachronous or synchronous primary tumors and to identify related genetic tumor syndromes.Methods:The clinicopathological data of 4 children with multiple primary tumors diagnosed in the Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China from 2011 to 2023 were collected. The histological, immunophenotypic and molecular characteristics were examined using H&E staining, immunohistochemical staining, PCR, Sanger sequencing and next-generation sequencing (NGS). The patients were followed up.Results:Case 1 was an 8-year-old boy with the adrenal cortical carcinoma, and 5 years later a poorly differentiated gastric adenocarcinoma was detected. Case 2 was a 2-year-old boy, presented with a left ventricular choroid plexus carcinoma, and a hepatoblastoma was detected 8 months later. Case 3 was a 9-month-old girl, diagnosed with renal rhabdoid tumor first and intracranial atypical teratoid/rhabdoid tumor (AT/RT) 3 months later. Case 4 was a 7-year-old boy and had a sigmoid colon adenocarcinoma 3 years after the diagnosis of a glioblastoma. The morphology and immunohistochemical features of the metachronous or synchronous primary tumors in the 4 cases were similar to the corresponding symptom-presenting/first-diagnosed tumors. No characteristic germ line mutations were detected in cases 1 and 2 by relevant molecular detection, and the rhabdoid tumor predisposition syndrome was confirmed in case 3 using NGS. Case 4 was clearly related to constitutional mismatch repair deficiency as shown by the molecular testing and clinical features.Conclusions:Childhood multiple primary tumors are a rare disease with histological morphology and immunophenotype similar to the symptom-presenting tumors. They are either sporadic or associated with a genetic (tumor) syndrome. The development of both tumors can occur simultaneously (synchronously) or at different times (metachronously). Early identification of the children associated with genetic tumor syndromes can facilitate routine tumor screening and early treatment.