BackgroundFear of progression is one of the typical psychological consequences in patients with chronic obstructive pulmonary disease （COPD）. The level of fear of progression is affected by the illness perception status， and the link between social support and fear of progression is acknowledged， whereas the mechanism underlying the three remains unclear due to the lack of empirical research evidence and needs to be further studied. ObjectiveTo explore the mediating role of social support in the relationship between illness perception and fear of progression in COPD patients， and to provide references for effectively alleviating fear in COPD patients. MethodsA total of 435 COPD patients admitted to the Department of Respiratory and Critical Care Medicine， the Affiliated Hospital of Southwest Medical University from March 9 to July 31， 2024 were selected as the study objects. The Chinese version of Fear of Progression Questionnaire-Short Form （FoP-Q-SF）， Chinese version of Brief Illness Perception Questionnaire （BIPQ） and Social Support Rate Scale （SSRS） were used for the evaluation. Pearson's coefficient was calculated to assess the correlation among above scales. Model 4 of the Process macro 3.4.1 for SPSS 25.0 was used to test the mediating effect of social support on the relationship between illness perception and fear of progression， with Bootstrapping used to evaluate the significance of mediating effect. ResultsA total of 412 patients （94.71%） completed this study.BIPQ score was positively correlated with FoP-Q-SF score （r=0.238， P<0.01）， and negatively correlated with SSRS score in COPD patients （r=-0.260， P<0.01）. FoP-Q-SF score was negatively correlated with SSRS score （r=-0.271， P<0.01）. Social support mediated the relationship between illness perception and fear of progression， with an indirect effect value of 0.025 （95% CI： 0.009~0.041）， accounting for 13.02% of the total effect. ConclusionIllness perception can affect the fear of progression in COPD patients both directly and indirectly through social support. ［Funded by Nursing Research Project of Sichuan Province （number， H22010）］

OBJECTIVE To explore the mechanism of limonin treating in hepatic fibrosis through network pharmacology, and validate its mechanism by molecular docking and animal experiments. METHODS Firstly, the targets of limonin and hepatic fibrosis were screened from the SwissTargetPrediction, GeneCards and DisGeNet database, etc. Meanwhile, the common targets of limonin and hepatic fibrosis were obtained from the bioinformatics website. The protein protein interaction network of common target was constructed by using STRING database and Cytoscape software, and the CytoNCA plug-in was used to screen core targets. And then the enrichment analysis of GO and KEGG on the common target was performed by Metascape database. Thereby, the possible mechanism of limonin against hepatic fibrosis were predicted. Finally, the AutoDock Vina was used for molecular docking verification, and the prediction results of network pharmacology were verified by animal experiments. RESULTS The prediction results indicated that limonin might acted on 86 targets including AKT1, VEGFA and HIF1A, and participated in biological processes including hormone response, protein phosphorylation, angiogenesis, and PI3K-Akt pathway, HIF-1 pathway, VEGF pathway and other signaling pathways related to hepatic fibrosis. The results of protein protein interaction network topology analysis showed that the 11 core targets including AKT1, VEGFA, HIF1A and PIK3CA, etc. Molecular docking results showed that limonin had strong affinity and relatively stable binding conformation with the core targets. In the animal experiments, compared with the model group, hyaluronidase(HA) and laminin(LN) in rat serume in high-dose group of limonin(LH) and low-dose group of limonin(LL)(except for LN in LL group) were declined(P<0.01 or P<0.05), and the degree of inflammation and hepatic fibrosis were relieved to different degrees in liver tissue of the LH group and LL group; Western blotting and qPCR detection showed that protein and mRNA expression levels of AKT, HIF-1α and VEGF(except for VEGF in LL group) was down-regulated in the LH group and LL group(P<0.01 or P<0.05). CONCLUSION Limonin may acts on AKT1, VEGFA, HIF1A and other core targets to treat hepatic fibrosis angiogenesis, which may be related to the inhibition of AKT/HIF-1α/VEGF signaling pathway.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

A retrospective analysis was conducted on data of 13 patients with rectal or anal canal lesions involving the dentate line who underwent endoscopic submucosal dissection (ESD) at the Digestive Endoscopy Center of Jiangsu Province Hospital of Chinese Medicine from January 2022 to July 2023. The efficacy and safety of ESD were evaluated. ESD was performed on 14 lesions in 13 patients. The lesions had a length of 1.4 to 12.5 cm and 5.4 cm in average, which were removed entirely in a single session, with an R0 resection rate of 92.31% (12/13). The ESD procedure duration ranged from 35 to 225 minutes, with an average of 88.3 minutes. Anal canal stenosis occurred in 1 case after ESD, which was improved after treatment with anal dilatation. No delayed bleeding, perforation, or other complications occurred. Pathological examination after ESD revealed 6 tubulovillous adenoma, 2 tubular adenoma, 3 tubular adenocarcinoma, and 2 squamous epithelial intraepithelial neoplasia (both 2 lesions were combined with human papillomavirus infection). In one case of tubular adenocarcinoma, the local resection margin showed focal tubulovillous adenoma, while the other cases were negative on lateral margins around and basal margins. The median follow-up period was 7.0 months (range 2 to 13 months), with no local residue, recurrence or metastasis observed. ESD is safe and effective for early rectal or anal canal lesions involving the dentate line, and is worthy of clinical promotion and application.

Objectives: To investigate the role of donor change in the second hematopoietic stem cell transplantation (HSCT2) for hematological relapse of malignant hematology after the first transplantation (HSCT1) . Methods: We retrospectively analyzed patients with relapsed hematological malignancies who received HSCT2 at our single center between Mar 1998 and Dec 2020. A total of 70 patients were enrolled[49 males and 21 females; median age, 31.5 (3-61) yr]. Results: Forty-nine male and 21 female patients were enrolled in the trial. At the time of HSCT2, the median age was 31.5 (3-61) years old. Thirty-one patients were diagnosed with acute myeloid leukemia, 23 patients with ALL, and 16 patients with MDS or other malignant hematology disease. Thirty patients had HSCT2 with donor change, and 40 patients underwent HSCT2 without donor change. The median relapse time after HSCT1 was 245.5 (26-2 905) days. After HSCT2, 70 patients had neutrophil engraftment, and 62 (88.6%) had platelet engraftment. The cumulative incidence of platelet engraftment was (93.1±4.7) % in patients with donor change and (86.0±5.7) % in patients without donor change (P=0.636). The cumulative incidence of CMV infection in patients with and without donor change was (64.0±10.3) % and (37.0±7.8) % (P=0.053), respectively. The cumulative incidence of grade Ⅱ-Ⅳ acute graft versus host disease was (19.4±7.9) % vs (31.3±7.5) %, respectively (P=0.227). The cumulative incidence of TRM 100-day post HSCT2 was (9.2±5.1) % vs (6.7±4.6) % (P=0.648), and the cumulative incidence of chronic graft versus host disease at 1-yr post-HSCT2 was (36.7±11.4) % versus (65.6±9.1) % (P=0.031). With a median follow-up of 767 (271-4 936) days, 38 patients had complete remission (CR), and three patients had persistent disease. The CR rate was 92.7%. The cumulative incidences of overall survival (OS) and disease-free survival (DFS) 2 yr after HSCT2 were 25.8% and 23.7%, respectively. The cumulative incidence of relapse, OS, and DFS was (52.6±11.6) % vs (62.4±11.3) % (P=0.423), (28.3±8.6) % vs (23.8±7.5) % (P=0.643), and (28.3±8.6) % vs (22.3±7.7) % (P=0.787), respectively, in patients with changed donor compared with patients with the original donor. Relapses within 6 months post-HSCT1 and with persistent disease before HSCT2 were risk factors for OS, DFS, and CIR. Disease status before HSCT2 and early relapse (within 6 months post-HSCT1) was an independent risk factor for OS, DFS, and CIR post-HSCT2. Conclusion: Our findings indicate that changing donors did not affect the clinical outcome of HSCT2.
Humans ; Male ; Female ; Adult ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Middle Aged ; Retrospective Studies ; Hematologic Neoplasms/therapy* ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Leukemia, Myeloid, Acute/therapy* ; Recurrence ; Graft vs Host Disease/etiology* ; Chronic Disease

Humans ; Consensus ; Pancreatic Neoplasms/therapy* ; Neuroendocrine Tumors/therapy*

Objective:To establish new scar-endoscopic submucosal dissection (scar-ESD) classification based on the relationship between scars and lesion location under endoscopy, and to explore the clinical efficacy of ESD.Methods:Clinical data of 132 patients who underwent ESD with scars from January 2015 to August 2022 at the Digestive Endoscopy Center of Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine. According to the scar-ESD classification, the lesions without surgical anastomosis at the same location were classified as type A: A0, A1, A2, and A3; and those with surgical anastomosis were classified as type B: B0, B1, and B2. The ESD operation time, specimen size, intraoperative assistant methods, intraoperative perforation, en-bloc resection rate, specimen damage rate, and postoperative complications were recorded for each subtype.Results:The age of the 132 patients was 64.22±9.51, with a male-to-female ratio of 3∶1. Forty-nine lesions (37.12%) were located in the esophagus, 40 cases (30.30%) in the stomach, and 43 cases (32.58%) in the colon. The operation time was 49.66±32.96 minutes. The operation time for A0 subtype was 30.38±12.85 minutes, which was significantly shorter than that of the A2 (52.10±36.55 minutes, t=2.15, P<0.05). The operation time for B0 subtype was 45.03±24.35 minutes, which was significantly shorter than that of the B2 (90.71±44.95 minutes, t=3.95, P<0.05). Intraoperative assistance was used in 38 cases (28.79%). Intraoperative perforation occurred in 5 cases (3.79%), including 4 cases of A2 and 1 case of A3, and the highest incidence occurred in the colon [9.30% (4/43)]. The en-bloc resection rate was 97.73% (129/132), the R0 resection rate was 88.64% (117/132), and the curative resection rate was 84.09% (111/132). The specimen damage occurred in 23 cases (17.42%), with the highest incidence in the stomach [32.50% (13/40)]. There were significant differences between A2 and A0 subtypes ( t=2.31, P<0.05) in this variable, and between B2 subtype and A0, A1, A2, A3, and B0 subtypes ( P<0.05). Conclusion:The scar-ESD classification is beneficial for describing and predicting difficulty of ESD. ESD is still the preferred treatment for early digestive lesions with scars, and the efficacy is satisfactory. But it requires experienced physicians to perform the operation.

Objective:To investigate the placenta tissue expression levels of monocyte chemotactic protein-1 (MCP-1), nuclear factor-κBp65 (NF-κBp65) and proliferating cell nuclear antigen (PCNA) in pregnant women with gestational diabetes mellitus (GDM), and to analyze their correlation with pregnancy outcomes.Methods:The clinical data of 124 pregnant women with GDM from May 2020 to December 2021 in PLA Northern Theater General Hospital were retrospectively analyzed. Among them, 62 pregnant women were willing to receive treatment (treatment group), while 62 pregnant women were unwilling to receive treatment (untreated group). In addition, 80 healthy pregnant women in the same period were selected as the healthy control group. The natural birth rate, neonatal Apgar score and the incidences of macrosomia, neonatal hypoglycemia, neonatal hyperbilirubinemia were record. The placenta tissue expression levels of MCP-1, NF-κBp65 and PCNA were detected by immunohistochemical.Results:The natural birth rate in untreated group was significantly lower than that in treatment group and healthy control group: 24.19% (15/62) vs. 75.81% (47/62) and 88.75% (71/80), the natural birth rate in treatment group was significantly lower than that in healthy control group, and there was statistical difference ( P<0.05). The Apgar score in untreated group was significantly lower than that in treatment group and healthy control group: (8.45 ± 2.02) scores vs. (9.46 ± 2.59) and (9.71 ± 3.21) scores, the incidences of macrosomia, neonatal hypoglycemia and neonatal hyperbilirubinemia were significantly higher than those in treatment group and healthy control group: 35.48% (22/62) vs. 11.29% (7/62) and 3.75% (3/80), 29.03% (18/62) vs. 8.06% (5/62) and 2.50% (2/80), 24.19% (15/62) vs. 9.68% (6/62) and 2.50% (2/80), and there were statistical differences ( P<0.05); there were no statistical difference in the indexes treatment group and healthy control group ( P>0.05). The positive expression rates of MCP-1, NF-κBp65 and PCNA in untreated group were significantly higher than those in treatment group and healthy control group: 72.58% (45/62) vs. 25.81% (16/62) and 12.50% (10/80), 69.35% (43/62) vs. 27.43% (17/62) and 13.75% (11/80), 69.35% (43/62) vs. 24.19% (15/62) and 11.25% (9/80), the indexes in treatment group were significantly higher than those in healthy control group, and there were statistical differences ( P<0.05). Conclusions:The placenta tissue expression levels of MCP-1, NF-κBp65 and PCNA in pregnant women with GDM are associated with adverse pregnancy outcomes. After active treatment, the positive rates of the three indexes in pregnant women with GDM significantly decrease, and the prognosis got improved.

Oral squamous cell carcinoma (OSCC) is a common malignant tumor of the head and neck. In recent years, the incidence rate has been increasing. Mitochondria are dynamic organelles involved in various cell behaviors in eukaryotic cells. Mitochondrial dysfunction is closely related to tumor development. As a switch that determines cancer cell death, targeting mitochondria has become the focus of OSCC treatment. This article reviews the relationship between mitochondria and tumorigenesis and development, OSCC treatment, and cisplatin resistant OSCC. Current studies have found that mitochondrial dysfunction promotes cell carcinogenesis, and the mitochondrial morphology and function of cancer cells are significantly changed. The increase of mitochondrial fission improves the invasiveness of cancer cells, and mitophagy dysfunction can induce cancer cell apoptosis. The emergence of drugs and the development of nanotechnology in targeted drug delivery systems have opened up new methods for targeting mitochondria to treat OSCC, reducing the side effects of systemic medication. The cisplatin resistance of OSCC is generated through the mitochondrial pathway, and the mitochondrial function and mutation mechanism of mitochondrial DNA are clarified in order to provide new ideas for targeting mitochondria to treat cisplatin resistant OSCC.

OBJECTIVE To explore the effect and mechanism of limonin on liver fibrosis in rats. METHODS Forty-two SD male rats were randomly divided into normal group， model group， positive control group （colchicine， 0.1 mg/kg）， low-dose group of limonin （12.5 mg/kg） and high-dose group of limonin （50 mg/kg）， with 9 rats in normal group and model group， and 8 rats in other groups. Except for normal group， the model of liver fibrosis was established by carbon tetrachloride. After modeling， normal group and model group were given distilled water intragastrically， and administration groups were given relevant medicine intragastrically，once a day，for consecutive 4 weeks. After the last medication， the serum contents of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， hyaluronic acid （HA） and laminin （LN） in rats were detected by enzyme-linked immunosorbent assay （ELISA） method. HE and Masson staining were used to observe the pathological changes and fibrotic change of liver tissue. Western blot assay was used to detect the protein expressions of protein kinase B （Akt）， phosphorylated-protein kinase B （p-Akt）， E-cadherin and vimentin in liver tissue； ratio of p-Akt/Akt was calculated. RESULTS Compared normal group， the serum contents of ALT， AST， HA and LN in rats were all increased significantly in model group （P＜0.01）； HE and Masson staining showed that a large number of fibrous tissue hyperplasia， protein expressions of Akt， p-Akt and vimentin as well as p-Akt/ Akt ratio in liver tissue were significantly increased （P＜0.01）， while E-cadherin protein expression was significantly decreased （P＜0.01）. Compared with model group， the degree of fibrosis hyperplasia in liver tissue was relieved in high-dose group and low- dose group of limonin， and other indexes were all reversed significantly except for LN and E-cadherin in the low-dose group of limonin （P＜0.01 or P＜0.05）. CONCLUSIONS Limonin can improve liver fibrosis in rats， the mechanism of which may be related to the inhibition of Akt phosphorylation and reversal of epithelial-mesenchymal transition process.