OBJECTIVE To explore the effect and mechanism of Zexie tang （ZXT） on reducing lipid accumulation through network pharmacology， and compare the difference of traditional decoction versus formula granules. METHODS The active components and targets of ZXT were identified using TCMSP and SwissTargetPrediction databases. GeneCards， OMIM， DisGeNET and TTD databases were used to analyze the related targets of non-alcoholic fatty liver disease （NAFLD）； protein-protein interaction network model was constructed by String database；“ ZXT-NAFLD target-pathway” network diagram was constructed by using CytoScape software； target enrichment analysis was performed by using Metascape platform. Fat accumulation model of human hepatocellular carcinoma HepG2 cells was established to observe the effects of traditional decoction and formula granules of ZXT on lipid accumulation of cells. RESULTS Alisol B， alisol C， 1-monolinolein and alisol B monoacetate were the key active components of ZXT in the treatment of NAFLD. The core targets included MDM2， MAPK1， PIK3CB， PRKCQ and MAPK14， etc. The core signaling pathways included endocrine resistance， insulin resistance and Th17 cell differentiation. Compared with model group， except for the Zexie formula granules group and Baizhu formula granules group， the absorbance values in all other administration groups were significantly decreased （P＜0.01）； the absorbance value of Baizhu traditional decoction group was significantly higher than that of ZXT traditional decoction group （P＜0.01）； the absorbance values of Zexie formula granule group and Baizhu formula granule group were significantly higher than that of ZXT formula granule group （P＜0.01）； the absorbance value of Zexie formula granule group was significantly higher than that of Zexie traditional decoction group （P＜0.01）； the absorbance value of Baizhu formula granule group was significantly higher than that of Baizhu traditional decoction group （P＜0.01）. CONCLUSIONS ZXT reduces lipid accumulation of human hepatocellular carcinoma cells through multiple components， multiple target and multiple pathways， and its traditional decoction and formula granules exhibit slightly different lipid-lowering effects.

ObjectiveTo improve the quality and service performance of community visual health services in Shanghai, and to establish a set of reasonable and effective evaluation index system for community visual health services. MethodsCentered on the national and Shanghai-based visual health policies and based on the current status and development trends of community visual health service program in Shanghai, the candidate indicators were formed through literature review and expert interviews, firstly. The framework of an evaluation index system was formulated through qualitative research successively, which was further revised and perfected using the Delphi method. Coefficient weights were calculated using the analytic hierarchy process (AHP), culminating in the establishment of the community visual health evaluation index system, lastly. ResultsA total of 22 visual health experts from district-level center for disease control, hospital ophthalmology and leaders in charging of visual health service in community health centers participated in the Delphi questionnaire survey, with a questionnaire recovery rate of 100% and an expert authority coefficient of 0.86, indicating high credibility. After a round of correspondence to experts’ importance ratings and discussions, a comprehensive evaluation index system comprising 3 primary indicators, 12 secondary indicators, and 47 tertiary indicators, along with 5 additional indicators, was finalized. ConclusionAn index system tailored to effective evaluation for community visual health initiatives was drawn up in this study, which can promote the capacity building in community eye health services, facilitating the high-quality development of visual health courses, and enhancing residents’ eye health.

Objective To understand the current status of death anxiety in patients with primary liver cancer and analyze its influencing factors,so as to provide basis for developing individualized psychological guidance and intervention measures.Methods A convenient sampling method was used to select 302 patients with primary liver cancer who were hospitalized in a tertiary hospital in Jiangsu Province from March to November 2022.The General Demographic Information Questionnaire,the Templer's Death Anxiety Scale(T-DAS),the State-Trait Anxiety Inventory(STAI),the Rosenberg Self-esteem Scale(SES)and the Self-perceived Burden Scale(SPBS)were used to conduct questionnaire survey during hospitalization.Single factor analysis and multiple linear regression analysis were applied to analyze the factors influencing the death anxiety in patients with primary liver cancer.Results A total of 298 patients with primary liver cancer were included in the study.The effective recovery rate was 98.68％.The total score of the F-DAS was(7.10±3.43)points;56.38％of the patients had high death anxiety.Multiple linear regression analysis results showed that the factors influencing the death anxiety in patients with primary liver cancer included gender,China liver cancer staging,duration of diagnosis,self-esteem,trait anxiety and self-perceived burden.A total of 49.00％of the variation in death anxiety was explained.Conclusion The death anxiety of patients with primary liver cancer is at a high level.It is suggested that medical staff should pay more attention to female patients with China liver cancer staging IV,diagnosis time＞3 months and low self-esteem,high levels of trait-anxiety and self-perceived burden,in order to develop personalized intervention measures,carry out psychological counseling and emotional support to relieve patients'death anxiety.

Objective To investigate the status quo of self-regulated fatigue in patients with recurrent ovarian cancer,and analyze the correlation between self-perceived burden,social support level and self-regulated fatigue.Methods From January 2020 to January 2023,120 patients with recurrent ovarian cancer in Fujian Cancer Hospital were selected by convenient sampling method,and data were collected by self-made general information questionnaire,self-perceived burden scale,social support scale and self-regulated fatigue scale.Results The score of self-regulated fatigue in 120 patients with recurrent ovarian cancer was(57.39±8.88)points,which was positively correlated with the score of self-perceived burden(68.28±18.98)points(r=0.431,P＜0.05)and negatively correlated with the score of social support(31.32±10.28)points(r=-0.321,P＜0.05).The results show that self-perceived burden,social support,education level,per capita monthly average income and course of disease are independent factors affecting self-regulated fatigue in patients with recurrent ovarian cancer.Conclusion Self-regulated fatigue in patients with recurrent ovarian cancer is in the middle and high level,which is positively correlated with self-perceived burden and negatively correlated with social support level.Clinical nurses should take corresponding measures to reduce the degree of self-regulation fatigue in patients with recurrent ovarian cancer.

Seizures are a prevalent clinical manifestation during the neonatal period.The majority of neonatal seizures are transient symptoms caused by acute lesions，but in a few cases they are developmental epileptic encephalopathy with neonatal onset.Continuous video-EEG monitoring is the gold standard for diagnosing seizures in newborns,and complex seizures require comprehensive judgment using multi-channel monitoring such as synchronized EMG,blood oxygen,ECG,and respiratory monitoring.In 2021,the International League Against Epilepsy (ILAE) published the updated guidelines for the classification of neonatal seizures,proposing that neonatal seizures cannot be diagnosed if there is only clinical seizure without EEG evidence.Instead,they should be categorized into two types based on the presence of clinical movements and the characteristics of EEG changes during the seizure: electroclinical seizures and electrical seizures.Electroclinical seizures are categorized into motor seizures,non-motor seizures,sequential seizures,and unclassified seizures based on the symptoms exhibited during an attack.In 2023,the ILAE developed evidence-based recommendations for the management of antiseizure medications,discussed the treatment of neonatal seizures based on the latest evidence and emphasized the importance of video EEG in the treatment of neonatal seizures.Phenobarbital remains the first-line antiseizure medication,with phenytoin,levetiracetam,midazolam,or lidocaine as second-line agents.Pyridoxine should be considered for the treatment of neonatal seizures when first- and second-line drugs are ineffective.

AIM: To compare the clinical outcomes of trabeculectomy combined with phacoemulsification intraocular lens implantation with suture-guided penetrating Schlemm canaloplasty combined with phacoemulsification intraocular lens implantation for the treatment of primary open angle glaucoma(POAG).METHODS: A retrospective case-control study was conducted on 53 cases(53 eyes)with advanced-stage POAG and cataract that received surgery at our hospital from June 2021 to June 2022, among which 26 eyes underwent trabeculectomy combined with phacoemulsification and intraocular lens implantation(group A), and 27 eyes underwent suture-guided penetrating Schlemm canaloplasty combined with phacoemulsification and intraocular lens implantation(group B). The best-corrected visual acuity(BCVA), intraocular pressure, and the number of intraocular pressure lowering drugs were compared between the two groups. Furthermore, the intraoperative and postoperative complications and success rate of surgery were recorded.RESULTS: The intraocular pressure of two groups of patients at 1 wk, 1, 3 and 6 mo after surgery were lower than that before preoperatively(all P<0.017). There was a notable disparity in the frequency of anterior chamber hemorrhage between the two groups(P<0.05), but there was no significant variance in the occurrence of superficial anterior chamber and choroid detachment(all P>0.05). There was no significant difference in BCVA(LogMAR)between the two groups at 6 mo after surgery(group A: 1.29±1.19, group B: 0.78±1.01, P=0.098), and there was no significant difference in the number of anti-glaucoma drugs [group A: 0(0, 2.75), group B: 0(0, 1), P=0.209]. Additionally, there was no significant difference in the success rate of surgery between the two groups at 6 mo postoperatively(Z=0.448, P=0.654).CONCLUSIONS: Suture-guided penetrating Schlemmcanaloplasty is a safe and effective treatment for advanced-stage POAG, with a success rate comparable to that of trabeculectomy.

ObjectiveTo explore the clinical features and causative genes of short stature children with unknown etiology， providing evidence for precise clinical diagnosis and treatment. MethodsThe study recruited children with suspected but undiagnosed short stature from the pediatric endocrinology department in our hospital between January 2018 and August 2022. A retrospective analysis was performed on the clinical manifestations， laboratory test and whole exome sequencing （WES） results. Causative genes were classified and analyzed according to different pathogenic mechanisms. ResultsA total of 48 children （30 boys and 18 girls） were enrolled， aged 7.73 ± 3.97 years， with a height standard deviation score （ HtSDS） of -3.63 ± 1.67. Of the patients， 33 （68.8%） suffered from facial anomalies， 31 （64.6%） from skeletal abnormalities， 26 ［54.2%， 61.5% of whom born small for gestational age （SGA）］ from perinatal abnormalities， 24 ［50.0%， 87.5% of whom with growth hormone （GH） peak concentration below normal］ from endocrine disorders and 21（43.8%） had a family history of short stature. Laboratory tests showed that GH peak concentration following stimulation test was （9.72 ± 7.25） ng/mL， IGF-1 standard deviation score was -0.82 ± 1.42， the difference between bone age and chronological age was -0.93 ± 1.39 years. Of the 25 cases with mutant genes found by WES， 14 （56.0%） had pathogenic mutation， 6 （24.0%） likely pathogenic mutation， and 5 （20.0%） mutation of uncertain significance. Pathogenic and likely pathogenic variants were identified in 14 genes， including 10 affecting intracellular signaling pathways （PTPN11， RAF1， RIT1， ARID1B， ANKRD11， CSNK2A1， SRCAP， CUL7， SMAD4 and FAM111A） and 4 affecting extracellular matrix （ECM） components or functions （ACAN， FBN1， COL10A1 and COMP）. ConclusionsA rare monogenic disease should be considered as the possible etiology for children with severe short stature accompanied by facial anomalies， disproportionate body types， skeletal abnormalities， SGA， GH peak concentration below normal and a family history of short stature. WES played an important role in identifying the monogenic causes of short stature. This study indicated that affecting growth plate cartilage formation through intracellular signaling pathways and ECM components or functions was the main mechanism of causative genes leading to severe short stature in children. Further research may help discover and study new pathogenic variants and gene functions.

Methamphetamine(METH)is highly addictive and neurotoxic,which causes cognitive and memory dysfunction in abusers.The harm of METH lies not only in its own toxicity,but also in the high physical and mental dependence of drug addicts,often causing mental disorders and violent behavior,bringing great safety risks to society.Non-coding RNA(ncRNA)does not encode proteins and is an important factor in regulating gene expression at the post-transcriptional level.Studies have shown that ncRNA plays an important regulatory role in methamphetamine-induced addiction and neurotoxicity,but the specific mechanism is unclear.This article reviews the current research progress of ncRNA in regulating METH-induced addiction and neurotoxicity to provide a reference for ncRNA as a forensic identification index and potential therapeutic target for METH abusers.

The cognitive impairment of diabetes mellitus type 2(T2DM)is closely related to neurovascular coupling(NVC)changes,but the exact mechanism remains unclear.Functional MRI(fMRI)technology were able to jointly analyze NVC changes of T2DM,providing new ideas for revealing the mechanism of cognitive dysfunction caused by T2DM.The progresses of fMRI for exploring NVC changes in T2DM were reviewed in this article.

Background::Bladder cancer, characterized by a high potential of tumor recurrence, has high lifelong monitoring and treatment costs. To date, tumor cells with intrinsic softness have been identified to function as cancer stem cells in several cancer types. Nonetheless, the existence of soft tumor cells in bladder tumors remains elusive. Thus, our study aimed to develop a microbarrier microfluidic chip to efficiently isolate deformable tumor cells from distinct types of bladder cancer cells.Methods::The stiffness of bladder cancer cells was determined by atomic force microscopy (AFM). The modified microfluidic chip was utilized to separate soft cells, and the 3D Matrigel culture system was to maintain the softness of tumor cells. Expression patterns of integrin β8 (ITGB8), protein kinase B (AKT), and mammalian target of rapamycin (mTOR) were determined by Western blotting. Double immunostaining was conducted to examine the interaction between F-actin and tripartite motif containing 59 (TRIM59). The stem-cell-like characteristics of soft cells were explored by colony formation assay and in vivo studies upon xenografted tumor models. Results::Using our newly designed microfluidic approach, we identified a small fraction of soft tumor cells in bladder cancer cells. More importantly, the existence of soft tumor cells was confirmed in clinical human bladder cancer specimens, in which the number of soft tumor cells was associated with tumor relapse. Furthermore, we demonstrated that the biomechanical stimuli arising from 3D Matrigel activated the F-actin/ITGB8/TRIM59/AKT/mTOR/glycolysis pathways to enhance the softness and tumorigenic capacity of tumor cells. Simultaneously, we detected a remarkable up-regulation in ITGB8, TRIM59, and phospho-AKT in clinical bladder recurrent tumors compared with their non-recurrent counterparts.Conclusions::The ITGB8/TRIM59/AKT/mTOR/glycolysis axis plays a crucial role in modulating tumor softness and stemness. Meanwhile, the soft tumor cells become more sensitive to chemotherapy after stiffening, that offers new insights for hampering tumor progression and recurrence.