Extraskeletal Ewing's sarcoma（EES） in the head and neck is extremely rare, with non-specific clinical manifestations, high malignancy, easy recurrence and metastasis, and poor prognosis. This paper reports a case of EES of the parapharyngeal skull base presenting with secretory otitis media as the initial symptom.The treatment consisted of surgery, chemotherapy and radiotherapy. No further metastasis or recurrence was observed during the two years and six months follow-up. Now we reviewed the relevant literatures and summarized the experience of diagnosis and treatment in EES.
Humans ; Otitis Media with Effusion/etiology* ; Sarcoma, Ewing/therapy* ; Skull Base ; Skull Base Neoplasms/therapy*

Ergothioneine is a natural antioxidant known for its potent anti-inflammatory and antioxidative properties. It has been applied in various sectors such as food, cosmetics, and pharmaceuticals. Edible fungi, both wild and cultivated, stand as the primary natural sources capable of synthesizing ergothioneine. This paper reviews the research progress in the content, physiological functions, extraction and detection methods, synthetic genes and pathways, mycelium fermentation, and engineering strain construction for ergothioneine production. The aim is to provide a comprehensive reference for advancing the research and industrial development related to ergothioneine in edible fungi.
Ergothioneine/isolation & purification* ; Fungi/genetics* ; Antioxidants/metabolism* ; Fermentation

Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.

OBJECTIVE：To isolate and purify baicalin metabolites from rat bile ，and to study its effect on the proliferation of liver cancer HepG 2 cells. METHODS ：Totally of 6 SD rats were collected ，anesthetized and then intubated with bile ducts. They were given baicalin （168 mg/kg）intragastrically after the rats were awake as well as the bile sample 1 was collected during 24 h after intragastric administration. After processed ，bile sample 1 was preliminarily analyzed by HPLC. Another 5 SD rats were anesthetized and intubated in the same way as above ，and then given baicalin intragastrically （400 mg/kg）. The bile sample 2 was collected during 48 h after intragastric administration. After processed ，the bile sample 2 was isolated and purified by semi-preparative HPLC. The isolated metabolites were identified by using UV ，IR，MS and NMR ，as well as based on physical and chemical properties. MTT method combined with high content cell imaging analysis system was used to study the effect of the metabolites on the proliferation of HepG 2 cells. RESULTS ：Baicalin was mainly metabolized into metabolite 1 and metabolite 2 through bile. After isolation and purification ， they were identified as oroxylin A- 7-O-β-D-glucuronide and 2726719792@qq.com baicalein 6-O-β-D-glucuronide. The results of MTT assay showed that the metabolite 2 had a significant inhibitory effect 分析。E-mail：gaoxl@gmc.edu.cn on the proliferation of HepG 2 cells，and its IC 50 was 90 µg/mL；the results of high content cell imaging analysis showed that at a certain concentration metabolite 2 may inhibit proliferation by changing the mitochondrial distribution and membrane permeability of HepG 2 cells（studies on the pharmacological activities of metabolism 1 had been reported ，it was skipped in this study ）. CONCLUSIONS ：In this study ，two baicalin bile metabolites were successfully isolated and identified ，of which baicalein 6-O-β-D-glucuronide has a significant inhibitory effect on the proliferation of HepG 2 cells.

OBJECTIVE：To provide refere nce f or the quality control and evaluation of rice-wine processed Coptidis Rhizoma decoction piece. METHODS ：Taking 17 batches of rice-wine processed Coptidis Rhizoma decoction piece from different manufacturers as samples ，HPLC method was adopted to determine the contents of 4 kinds of alkaloids as epiberberine ，coptisine， palmatine and berberine. The compound weights of epiberberine ，berberine，palmatine and berberine were calculated by the subjective and objective combination weighting method （AHP combined with variation coefficient ）. Then the quality evaluation method was used to evaluate the quality of decoction pieces combined with the appearance of decoction pieces and the contents of 4 alkaloids. The percent mass constant was calculated and the grade of rice-wine processed Coptidis Rhizoma decoction piece was classified. RESULTS ：According to the results of content determination of 4 kinds of alkaloids ，among 17 batches of samples ，a total of 13 batches of samples met the requirements of 2015 edition of Chinese Pharmacopoeia （part Ⅳ）. Mass constants of 13 batches of qualified samples were 10.03-26.96，and the percent mass constants were 37.20％-100％. If the percent mass constant ≥ 80％ of the sample was listed as the first-class product ，the sample with the percent mass constant between 50％-＜80％ was classified as the second-class product ，and the rest was listed as the third-class product ，therefore the quality constant of first-class product was ≥21.57，that of second-class product was 13.48-＜21.57，and that of third-class product was ＜13.48. According to the grading standard ，3 batches of 13 batches of qualified samples are classified as first-class products ，6 batches are classified as second-class products ，4 batches are classified as third-class products. CONCLUSIONS ：The established subjective and objective combination weighting method and quality constant method can more scientifically and reasonably classify rice-wine processed Coptidis Rhizoma decoction piece.

Objective To investigate the protective effects of stilbene glycoside(2,3,5,4'-tetrahydroxy-stilbene-2-O-β-D-glucoside,TSG) on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mice model of Parkinson's disease(PD).Methods Mice were randomly divided into the blank control group,the negative control group,the TSG high-dose group,the TSG low-dose group and the positive drug group(n=20 each).Mice were weighted daily to observe the changes of body weight,and mice motor and behavior function were tested by open field test.Level changes of α/β synuclein in brain cortex,cerebellum,midbrain,and hippocampal were detected by Western blot.Results Compared with the blank control group,the negative control group showed that the body weight was decreased (P ＜ 0.05).Compared with the negative control group,the body weight was increased in the TSG high-and low-dose groups and the positive drug group (P ＜ 0.05).The spontaneous behavior was impaired in the negative control group.Compared with the blank control group,the negative control group showed that the open field test showed traveled distance over a 10-min period was significantly shortened at 1 st,7th,28th days after testing(all P＜0.05).The trajectory of motor axons indicated that mice in the negative control group showed dyskinesia,but the groups of positive drug and high-and low-dose of TSG could reverse this dyskinesia.Compared with the blank control group,brain α/β synuclein protein levels were increased in the negative control group,and decreased in positive drug and TSG high-and low-dose groups (P ＜0.05).Conclusions Stilbene glycosides exert neuroprotective effects in MPTP-induced mice model of PD.

Objective: To understand the filialpiety values, anxiety and caregiving burden of caregivers of patients with chronic heart failure and to analyze the mediating effect of filialpiety values on the relationship between anxiety and caregiving burden. Methods: During April 2017 to April 2018, 191children caregivers of patients with chronic heart failure from 3 secondary and tertiary medical institutions in Suzhou, Nanjing and Kunshan were selected to complete Visual Analogue Scale for Anxiety, Chinese Filial Values Index scale (FVI) and Dutch Objective Burden Inventory (DOBI). Results: The total score of caregivers' anxiety, filialpiety values and caregiving burden were 3(0, 6), 96(84, 107) and 1(0, 9) respectively. Correlation analysis showed that the caregivers' anxiety was positively correlated with the caregiving burden (r=0.328, P<0.01), while filialpiety values were negatively correlated with caregiving burden (r=-0.537, P<0.01). Mediating-effect analysis showed that anxiety had a negative effect on filialpiety values (a=-0.61, P=0.02), and had a positive effect on caregiving burden (c=0.64, P=0.01). The filialpiety values had a negative effect on caregiving burden (b=-0.43, P<0.01). Filialpiety values played a partial mediating role between anxiety and caregiving burden (c' = 0.26, P<0.05). Conclusions Medical staff should establish targeted interventions to improve caregivers′ filialpiety values, thereby reducing their caregiving burden.

Viral infection is the main death cause of infectious diseases in China. The establishment of an animal model to mimic the progression of viral infectious diseases in humans is of great significance to the study of pathogenesis and prevention of viral infectious diseases. As a new animal model established and developed in recent years, tree shrew has showed obvious advantages and potentials compared with other non-human primates and mice which are commonly used as virus-infected animal models. In this paper, the biological advantages of tree shrew as a novel animal model of viral infectious diseases are summarized, including taxonomy, physiology and immunology. In addition, the latest application of tree shrew in the research of many viral infectious diseases such as hepatitis virus, herpes simplex virus, influenza virus and enterovirus infections are compared and summarized.

Systems-based integrated course is the core and hot spot in current advanced medical education reform.An integrated organ-system oriented curriculum system of endocrinology and metabolism was applied in eight year clinical medicine and five year excellent doctor education.The teaching contents of endocrinology and metabolism from traditional Basic Medicine,Internal Medicine and Surgery were integrated and optimized to compile the integrated syllabus and teaching cases.Curriculum integration oriented PBL teaching and comprehensive morphology experimental teaching were implemented into the integrated endocrinology and metabolism system curriculum.This endocrinology and metabolism course integration based on organ-system based learning is conducive to establishing the organic connection between Basic Medicine and Clinical Medicine,and cultivating high-quality medical talents.

Teaching rounds is an important part of clinical teaching but it is difficult to implement in place for a variety of reasons. To endocrine and metabolic section as an example, Lack of enthusiasm, inadequate preparation and other issues result that teaching rounds is difficult to achieve the desired effect in the teaching rounds, especially in the English teaching rounds. In view of the above situation, based on the concept of PBL to carry out teaching rounds in English is not only an important method to cultivate the clinical thinking of medical students, but also an important measure to improve teachers' and students' English proficiency, as well as to cultivate medical students' clinical thinking. The last but not the least, carrying out teaching rounds in English is an important measure for medical education reform and improve-ment. Facts have proved that carrying out teaching rounds in English has a high practicality and feasibility in clinical practice.