Objective Focusing on gynecological surgery,we constructed a prediction model for surgical duration by extracting features from unstructured surgical planning texts and integrating multimodal data via artificial intelligence technology.Methods The clinical data of 34 614 patients who underwent gynecologic surgeries at West China Second University Hospital,Sichuan University between January 2022 and October 2024 were collected.An embedding-transformer model was constructed to convert surgical planning texts into a one-dimensional numerical feature,referred to as the step feature.The predictive value of the step feature was assessed by comparing the performance improvements of linear regression,random forest,eXtreme Gradient Boosting(XGBoost),support vector regression,K-nearest neighbor regression,and artificial neural network algorithms in two scenarios—with and without the step feature as an input.The out-of-sample prediction accuracy of the models was assessed using mean absolute error(MAE),root mean squared error(RMSE),and R-squared(R2).Furthermore,the model interpretability was examined using SHapley Additive exPlanations(SHAP)values.Results SHAP results showed that the step feature had the highest predictive contribution.Temporal factors in surgical scheduling also influenced gynecological surgery duration.The XGBoost model demonstrated optimal performance on the test set,significantly improving prediction accuracy with a 40.43%increase in R2,while reducing MAE and RMSE by 21.27%and 20.13%,respectively,compared to the baseline model without the step feature.Conclusion The embedding-transformer model developed in this study effectively extracts features from surgical planning texts and enhances the predictive performance of machine learning models.The XGBoost prediction model can assist hospital administrators in implementing more refined management of gynecological surgeries and improving the utilization efficiency of surgical resources.

Objective To investigate the antitumor effect of genetically engineered bacterial vesicles loaded with the photosensitizer Ce6.Methods Genetic engineering techniques were used to overexpress interferon α(IFNα)in Escherichia coli Nissle 1917(EcN),and the corresponding bacterial vesicles(BVs-IFNα)were extracted.The photosensitizer Ce6 was loaded onto the surface of the bacterial vesicles via ultrasonication to obtain BVs-IFNα@Ce6 nanoparticles.The BVs-IFNα@Ce6 complex was characterized using dynamic light scattering,nanoparticle tracking technology,confocal imaging,and ultraviolet absorption spectroscopy.The obtained BVs-IFNα@Ce6 nanoparticles were co-cultured with mouse melanoma cells(B16F10)and mouse bone marrow-derived dendritic cells(BMDC).The efficacy of photodynamic therapy was assessed using the CCK-8 method,and its ability to induce immune activation was verified using flow cytometry.Results The BVs-IFNα@Ce6 nanoparticles were successfully prepared with a stable particle size of around 180 nm.Under red light irradiation,BVs-IFNα@Ce6 exhibited significant cytotoxicity against B16F10 tumor cells and effectively promoted the expressions of immune-related molecules MHC-II,CD80/CD86 on the surface of BMDC cells,demonstrating its remarkable ability to induce immune activation.Conclusion The BVs-IFNα@Ce6 nanoparticles possess dual functions of enhancing photodynamic therapy efficacy and activating antitumor immunity,showing potential for clinical translation.

Objective To investigate the antitumor effect of genetically engineered bacterial vesicles loaded with the photosensitizer Ce6.Methods Genetic engineering techniques were used to overexpress interferon α(IFNα)in Escherichia coli Nissle 1917(EcN),and the corresponding bacterial vesicles(BVs-IFNα)were extracted.The photosensitizer Ce6 was loaded onto the surface of the bacterial vesicles via ultrasonication to obtain BVs-IFNα@Ce6 nanoparticles.The BVs-IFNα@Ce6 complex was characterized using dynamic light scattering,nanoparticle tracking technology,confocal imaging,and ultraviolet absorption spectroscopy.The obtained BVs-IFNα@Ce6 nanoparticles were co-cultured with mouse melanoma cells(B16F10)and mouse bone marrow-derived dendritic cells(BMDC).The efficacy of photodynamic therapy was assessed using the CCK-8 method,and its ability to induce immune activation was verified using flow cytometry.Results The BVs-IFNα@Ce6 nanoparticles were successfully prepared with a stable particle size of around 180 nm.Under red light irradiation,BVs-IFNα@Ce6 exhibited significant cytotoxicity against B16F10 tumor cells and effectively promoted the expressions of immune-related molecules MHC-II,CD80/CD86 on the surface of BMDC cells,demonstrating its remarkable ability to induce immune activation.Conclusion The BVs-IFNα@Ce6 nanoparticles possess dual functions of enhancing photodynamic therapy efficacy and activating antitumor immunity,showing potential for clinical translation.

AIM:To investigate the therapeutic efficacy of curcumin(Cur)-loaded engineered cell membrane mimetic nanoparticles(PD1-Cur@PLGA NPs)in treating breast cancer in mice,and to explore their tumor immunomodu-latory effects.METHODS:Engineered mouse breast cancer 4T1-PD1 cell line expressing programmed death 1(PD1)was established,and PD1 expression level was analyzed by flow cytometry.The 4T1-PD1 cell membranes were extracted and coated on the surface of Cur-loaded poly(lactic-co-glycolic)acid(PLGA)nanoparticles(Cur@PLGA NPs)using ice bath sonication to obtain PD1-Cur@PLGA NPs.The Cur loaded in various NPs was detected using UV-visible spectropho-tometry.Particle size and morphology were analyzed by using dynamic light scattering and transmission electron microsco-py.The 4T1 cells were divided into negative control(PLGA NPs and PD1-NVs),experimental(PD1-Cur@PLGA NPs),parallel control(Cur@PLGA NPs),and positive control(Cur)groups.In each group,cell viability was assessed by CCK-8 assay,and cell apoptosis was determined through flow cytometry.To perform treatment experiments in vivo,4T1 cell-bearing tumor mice were randomly divided into PBS,PD1-NVs,and PD1-Cur@PLGA NPs groups.At the end of treat-ments,tissues of major organs were stained to detect pathological changes,as well as indicators of tumor proliferation(Ki67),apoptosis(TUNEL),and infiltration and activity of T cells(CD4+and CD8+)in tumor tissues.RESULTS:The PD1 expression in 4T1-PD1 cell lines reached 78%.PD1-Cur@PLGA NPs exhibited a core-shell structure with particle sizes ranging from 100 to 200 nm.PD1-Cur@PLGA NPs enhanced the biocompatibility compared to free Cur and exhibited a strong apoptosis-inducing effect on 4T1 cells.Compared with control group,PD1-Cur@PLGA NPs significantly inhibited 4T1 breast tumor growth in vivo(P<0.01),without apparent toxic side effects.Treatment with PD1-Cur@PLGA NPs re-duced Ki67 expression,increased cell apoptosis,and enhanced infiltration and activity of CD4+and CD8+T cells in tumor tissues.CONCLUSION:PD1-Cur@PLGA NPs enhanced Cur biocompatibility and exhibited cytotoxicity against mouse breast cancer cells.This nanoformulation demonstrated promising therapeutic efficacy and safety in vivo,exerting poten-tial antitumor immune regulatory effects.

Objective To investigate the effects of a 45％high-fat diet(HFD)with isocaloric intake on energy metabolism and endurance exercise capacity in SD rats.Methods Twenty-four male SD rats were randomly divided into normal chow diet group(CON),HFD group,normal chow diet+exercise training group(CONT),and HFD+exercise training group(HFDT).The CON and CONT groups received normal chow diet,while the HFD and HFDT groups received a 45％high-fat diet with isocaloric intake.The HFDT and CONT groups underwent an endurance training of moderate-intensity running for 6 weeks.Body weight,fat mass,and lean mass were measured weekly.Energy expenditure and basal metabolic rate during rest and exercise states were measured using Pheno Master/Calo Treadmill system.Blood glucose,lipids,and creatine kinase levels were detected after the exhaustion test.Results In 6 weeks after intervention,the endurance exercise capacity was significantly enhanced in the HFDT group than the CONT group(P＜0.05).There were no obvious differences in body weight and body composition among the groups under isoenergetic feeding conditions.At rest,no statistical differences were observed in total energy expenditure and basal metabolic rate among the groups.However,prior to the 4th week,the CON group primarily metabolized carbohydrates while the HFD group primarily metabolized fats.But the carbohydrate metabolism was decreased and then increased,and the substrate metabolism rates eventually reached similar levels between the 2 groups on the 5th to 6th week.The HFDT group primarily metabolized fats while the CONT group primarily metabolized carbohydrates,with significant differences persisting after 6 weeks of training(P＜0.05).HFD led to elevated levels of serum cholesterol,triglycerides(TG),and high-density lipoprotein cholesterol(HDL-C),but,endurance training resulted in decreased lipid levels in the HFDT group,accompanied by an increase inβ-hydroxybutyrate(βHB)level(P＜0.05).Isoenergetic diets had no significant differences in their effects on liver and kidney function or muscle damage indicators.Conclusion An isoenergetic HFD can improve fat utilization ability and extend endurance exercise time in rats without altering body composition or affecting liver and kidney function.

Objective To observe the therapeutic effect of Shenshuai Formula(composed of Pinelliae Rhizoma Praeparatum Cum Zingibere et Alumine,Citri Reticulatae Pericarpium,Poria,Atractylodis Macrocephalae Rhizoma,Bambusae Caulis in Taenia,Morindae Officinalis Radix,Centellae Herba,Rhei Radix et Rhizoma,etc.)on patients with chronic kidney disease(CKD)at stage 3-4 of spleen-kidney qi deficiency with internal accumulation of turbid-phlegm and stasis type.Methods Seventy patients with CKD at stage 3-4 of spleen-kidney qi deficiency with internal accumulation of turbid-phlegm and stasis type were randomly divided into a treatment group and a control group,with 35 patients in each group.The control group was given the conventional western medicine integrated treatment for CKD,and the treatment group was given the Chinese herbal decoction of Shenshuai Formula on the basis of treatment for the control group.The course of treatment for the two groups covered 8 weeks.The changes of traditional Chinese medicine(TCM)syndrome scores,renal function indicators of serum creatinine(Scr),blood urea nitrogen(BUN),serum cystatin C(CysC),blood uric acid(UA)and estimated glomerular filtration rate(eGFR),and the level of hypersensitive C-reactive protein(hs-CRP)in the two groups before and after the treatment were observed.Moreover,the TCM syndrome efficacy and clinical safety in the two groups were evaluated.Results(1)During the trial,5 cases in the treatment group and 3 cases in the control group fell off,and eventually a total of 62 patients were included in the trial,including 30 cases in the treatment group and 32 cases in the control group.(2)After 8 weeks of treatment,the total effective rate for TCM syndrome efficacy of the treatment group was 86.67%(26/30),and that of the control group was 59.38%(19/32).The intergroup comparison showed that the TCM syndrome efficacy in the treatment group was significantly superior to that in the control group(P＜0.01).(3)After treatment,the scores of TCM syndromes in the two groups were significantly decreased when compared with those before treatment(P＜0.01),and the decrease in the treatment group was more obvious than that in the control group(P＜0.01).(4)After treatment,the renal function indicator levels of Scr,BUN,CysC and UA in the two groups were decreased when compared with those before treatment(P＜0.05),and the level of eGFR was increased when compared with that before treatment(P＜0.05).The intergroup comparison showed that the decrease in the levels of Scr,BUN,CysC and UA and the increase in the level of eGFR in the treatment group were superior to those in the control group(P＜0.05).(5)After treatment,the inflammatory factor level of serum hs-CRP in the two groups was improved when compared with that before treatment(P＜0.05),and the improvement in the treatment group was superior to that in the control group(P＜0.05).(6)During the treatment period,no significant changes in the safety indicators such as blood routine test,stool routine test and occult blood test,liver function,electrolyte,and electrocardiogram were presented in the two groups.Conclusion Shenshuai Formula exerts certain effect in the treatment of patients with CKD at stage 3-4 of spleen-kidney qi deficiency with internal accumulation of turbid-phlegm and stasis type.It can relieve the clinical symptoms of the patients to certain extent,effectively decrease the levels of Scr,BUN,CysC and UA,increase the eGFR,improve renal function,lower the level of serum hs-CRP,reduce the micro-inflammatory state of patients,and delay the progress of the disease.

Based on the literature review and the analysis of specific cases of postpartum frequent micturition,pediatric enuresis,elderly uremia complicated with bradyarrhythmia in clinic,the clinical application of the action of Ephedrae Herba in stimulating yang qi is discussed.Ephedrae Herba has the meridian tropism of the lung and bladder meridians,and is pungent,warm and dispersing,which is the most important medicine for the treatment of external contraction.Ephedrae Herba has the actions of inducing diaphoresis,calming asthma and inducing diuresis,and is widely used for the treatment of external contraction,coughing and asthma,and edema.For the patients with deficiency of both kidney yin and kidney yang without obvious bias of yin-yang consumption which result from the postpartum impairment of qi and blood,deficient innate endowment,and gradually exhaustion of essence in the kidney in the elderly or during chronic illness,a small dosage of Ephedrae Herba can stimulate yang qi during the treatment of warming kidney yang,which is helpful for promoting the drug arriving at the back shu-points of the internal organs distributed along the bladder meridian and enhancing the recovery of zang-fu organ function.Ephedrae Herba is strong in inducing diaphoresis with an intense action.When Ephedrae Herba is used to stimulate yang,the dosage of 3～9 g is appropriate,and medicines for warming yang are needs to be used together.The course of treatment with Ephedrae Herba should be avoided to be too long,in order to prevent the vital energy from the damage by its large cumulative dose.

The spike (S) protein plays a crucial role in the entry of SARS-CoV-2 into host cells. The S protein contains two subunits, S1 and S2. The receptor-binding domain (RBD) of the S1 subunit binds to the receptor angiotensin-converting enzyme 2 (ACE2) to enter the host cells. Therefore, degrading S1 is one of the feasible strategies to inhibit SARS-CoV-2 infection. The purpose of this study is to develop a degradation tool targeting S1. First, we constructed a HEK 293 cell line stably expressing S1 by using a three-plasmid lentivirus system. The overexpression of the mitochondrial E3 ubiquitin protein ligase 1 (MUL1) in this cell line promoted the ubiquitination of S1 and accelerated its proteasomal degradation. Further research showed the polyubiquitination of S1 catalyzed by MUL1 mainly occurred via the addition of K48-linked chains. Moreover, the specific peptide LCB1, which targets and recognizes S1, was combined with MUL1 to create the chimeric E3 ubiquitin ligase LCB1-MUL1. In comparison to MUL1, this chimeric enzyme demonstrated improved catalytic efficiency, resulting in a reduction of S1's half-life from 12 h to 9 h. In summary, this study elucidated the mechanism by which MUL1 promotes the ubiquitination modification of S1 and facilitates its degradation through the proteasome, and preliminarily validated the effectiveness of targeted degradation of S1 by chimeric enzyme LCB1-MUL1.
Ubiquitin-Protein Ligases/genetics* ; Humans ; HEK293 Cells ; Ubiquitination ; Spike Glycoprotein, Coronavirus/genetics* ; SARS-CoV-2/metabolism* ; Recombinant Fusion Proteins/metabolism* ; Proteasome Endopeptidase Complex/genetics* ; COVID-19/metabolism* ; Angiotensin-Converting Enzyme 2/genetics*

OBJECTIVES: This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction. METHODS: Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction. RESULTS: At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations. CONCLUSIONS The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.
Male ; Female ; Humans ; Mandibular Condyle/surgery* ; Cicatrix/surgery* ; Fracture Fixation, Internal/methods* ; Mandibular Fractures/surgery* ; Oral Surgical Procedures/methods* ; Treatment Outcome

OBJECTIVES: To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia. METHODS: A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively. RESULTS: Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (P<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%CI: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia. CONCLUSIONS The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.
Infant, Newborn ; Humans ; Male ; Pregnancy ; Female ; Nomograms ; Retrospective Studies ; Cesarean Section ; Risk Factors ; Asphyxia Neonatorum/etiology*