Heart failure （HF） is the end stage of various cardiovascular diseases， manifested as ventricular filling or impaired left ventricular ejection fraction （LVEF）. Type 2 diabetes mellitus （T2DM） is a metabolic disorder， mainly caused by insufficient insulin secretion and insulin resistance. The incidence rates of the two common clinical diseases are increasing year by year. HF and T2DM are mutually causal chronic diseases， and their mutual deterioration can form a HF-T2DM comorbidity. The comorbidity status significantly increases the mortality and readmission risk of patients， and seriously affects the quality of life of patients. At present， western medicine treatment mainly involves the use of anti HF drugs and hypoglycemic drugs， which can significantly alleviate the clinical symptoms of patients. However， these two categories of drugs are numerous in variety and differ in their mechanisms， and blind combination may produce adverse reactions. With its unique theoretical system， traditional Chinese medicine exhibits the advantages of multiple components， multiple targets， and high safety through traditional Chinese medicine monomers， Chinese patent medicine， traditional Chinese medicine compounds， and acupuncture， which significantly delays the development of HF-T2DM and shows great potential in clinical treatment. A large number of clinical studies have shown that the integrated traditional Chinese and western medicine in the treatment of HF-T2DM has a significant effect in improving cardiac function， controlling blood glucose levels， and improving the quality of life of patients. Based on relevant research at home and abroad， this paper reviewed the HF-T2DM pathogenesis， pharmacological effects， research status of traditional Chinese and western medicine， and early prevention strategies， and discussed current problems and future research directions， in order to provide new ideas and useful references for clinical prevention and treatment of HF-T2DM.

Heart failure （HF） is the end stage of various cardiovascular diseases， manifested as ventricular filling or impaired left ventricular ejection fraction （LVEF）. Type 2 diabetes mellitus （T2DM） is a metabolic disorder， mainly caused by insufficient insulin secretion and insulin resistance. The incidence rates of the two common clinical diseases are increasing year by year. HF and T2DM are mutually causal chronic diseases， and their mutual deterioration can form a HF-T2DM comorbidity. The comorbidity status significantly increases the mortality and readmission risk of patients， and seriously affects the quality of life of patients. At present， western medicine treatment mainly involves the use of anti HF drugs and hypoglycemic drugs， which can significantly alleviate the clinical symptoms of patients. However， these two categories of drugs are numerous in variety and differ in their mechanisms， and blind combination may produce adverse reactions. With its unique theoretical system， traditional Chinese medicine exhibits the advantages of multiple components， multiple targets， and high safety through traditional Chinese medicine monomers， Chinese patent medicine， traditional Chinese medicine compounds， and acupuncture， which significantly delays the development of HF-T2DM and shows great potential in clinical treatment. A large number of clinical studies have shown that the integrated traditional Chinese and western medicine in the treatment of HF-T2DM has a significant effect in improving cardiac function， controlling blood glucose levels， and improving the quality of life of patients. Based on relevant research at home and abroad， this paper reviewed the HF-T2DM pathogenesis， pharmacological effects， research status of traditional Chinese and western medicine， and early prevention strategies， and discussed current problems and future research directions， in order to provide new ideas and useful references for clinical prevention and treatment of HF-T2DM.

Objective To explore the application and effectiveness of the apprenticeship education model in Chinese herbal medicine teaching at Western medical college.Methods By comparing classic lecture-based teaching with a combined approach integrating apprenticeship education,the study assesses the impact on student learning outcomes.Participants included students from the 2018 cohort of the eight-year clinical medicine program and the 2022 cohort of the"4+4"pilot program at Peking Union Medical College,who received classic teaching methods and apprenticeship case-based teaching methods,respectively.Upon course completion,students completed a 14-item multiple-choice questionnaire covering essential theory of Chinese medicine,as well as specific categories such as qi-regulating,blood-activating herbs,among others.Results The overall accuracy rate in the apprenticeship case-based teaching group was significantly higher than that in the classic teaching group(P＜0.01).Conclusions The apprenticeship education model of Traditional Chinese Medicine has a positive effect on teaching of Chinese herbal medicine at West-ern medical college and warrants further promotion and application.

Objective To explore the effectiveness of the"apprenticeship case-based teaching"method in the in-struction of traditional Chinese medicine(TCM)formulas for nursing students.Methods A quasi-experimental study was conducted with 135 undergraduate nursing students from the 2023 cohort at Peking Union Medical Col-lege.Participants were randomly assigned to an experimental group(receiving apprenticeship case-based teaching)or a control group(receiving conventional teaching).Teaching effectiveness was evaluated through classroom in-struction followed by a routine test.The test covered the indications and key diagnostic points of eight representative TCM formulas.Results The experimental group overruns the control group on most test items.Statistically signifi-cant differences(P＜0.05)were observed in questions related to Ma Huang Tang,Xiao Chai Hu Tang,Da Cheng Qi Tang,Liu Wei Di Huang Wan,and Ba Zheng San.Conclusions The apprenticeship case-based teaching meth-od significantly enhances students'learning gain about key diagnostic principles in TCM formulas and improves ca-pacity building of clinical reasoning.This method should be shared by schools of nursing in the teaching reformation of TCM curriculum.

The apprenticeship education of Traditional Chinese medicine(TCM)is an important pathway for the cultivation of talents in TCM education.The combination of institutional education and apprenticeship education is considered to be the most suitable educational model that aligns with the inherent characteristics of TCM education.The current status of TCM education in western medical institutions and the main challenges include the difficulty in transitioning between western and Chinese medical reasoning and limited clinical internship hours for TCM.The strengths and features of TCM apprenticeship education lie in cultural heritage,classical teachings,mentorship,practice orientation and personalized education.Therefore,integration of TCM apprenticeship education and clinical internships for western medical students represents a new educational model for medical undergraduates.

Hepatitis E virus(HEV)is one of the most common pathogens in acute viral hepatitis.There are at least eight distinct genotypes of HEV.Only humans can contract HEV genotypes 1 and 2,but zoonotic viruses like genotypes 3 and 4 are mostly spread by eating undercooked or in-fected pork in some affluent nations.As a result,boars,both domestic and wild,are typically regar-ded as primary hosts of HEV.Nevertheless,during the past few years,a growing body of research has demonstrated that a number of other wild ruminant animals,such as wild deer and goats,are also susceptible to HEV infection.Determining their participation in the epidemiological cycle of hepatitis E thus requires an understanding of the risk variables that influence the transmission be-tween wild ruminants and humans.With an emphasis on published serological and molecular re-search,this review offers a broad summary of the body of knowledge currently available on the epi-demiology of HEV in wild ruminants.It addresses potential risk factors that could impact the spread of HEV among animals as well as their potential to serve as a source of infectious zoonotic illnesses.It presents an overview of the most recent developments in the epidemiology of HEV in wild ruminants and offers a framework for HEV prevention and management based on science.

Objective To investigate the safety,feasibility,and efficacy of highly selective protective vagotomy in laparoscopic fundoplication.Methods Clinical data of 78 patients who underwent laparoscopic hiatal hernia repair plus fundoplication(short floppy Nissen procedure)for gastroesophageal reflux disease and hiatus hernia from January 2014 to December 2019 in our hospital were retrospectively analyzed.The patients were divided into two groups:the traditional operation group and the vagus nerve protection group.The operation time,blood loss during operation,hospital stay after operation and the incidence of postoperative complications were compared between the two groups.The GERD Q score,DeMeester score,lower esophageal sphincter pressure(LESP),and control of reflux symptoms at 6 months after operation in the two groups were analyzed.Results Both groups of surgeries were successfully completed,and there were no serious intraoperative side injuries.There was no significant difference between the traditionaloperationgroupandthevagusnerveprotectiongroupinoperationtime[(85.5±13.9)minvs.(88.3±18.6)min,t =0.729,P =0.468],intraoperative blood loss[(18.6±8.6)ml vs.(18.1±8.5)ml,t =-0.221,P =0.825],and postoperative transanal exhaust time[(2.0±0.7)d vs.(1.8±1.0)d,t =-1.227,P =0.224].The postoperative hospital stay in the traditional surgical group was significantly longer than that in the vagus nerve protection group[(9.4±3.0)d vs.(8.2±2.1)d,t =-2.172,P = 0.033].The incidence of surgical complications within 30 d after surgery in the traditional surgical group was 36.8%(14/38),which was significantly higher than that in the vagus nerve protection group[12.5%(5/40),χ2 = 6.267,P = 0.012].The traditional surgical group had a cure rate of 86.8%(33/48)at 6 months after surgery,which was not significantly different from the vagus nerve protection group[85.0%(34/40),Z =-0.232,P =0.816].There were no significant differences in GERDQscore,DeMeester score,LESP between the two groups at 6 months after surgery[(5.6±0.9)points vs.(5.8±0.8)points,t =1.232,P =0.222;(4.1±2.2)points vs.(4.2±2.2)points,t =0.261,P =0.795;(23.2±3.5)mm Hg vs.(23.5±3.8)mm Hg,t = 0.412,P = 0.681].Conclusion It is safe,feasible,and effective to apply the highly selective protective vagotomy in laparoscopic short floppy Nissen fundoplication to protect the vagus nerve.

Ionizing radiation can induce the death of lymphatic endothelial cells, leading to structural damage, dysfunction, and reduction of lymphatic vessels, which poses a negative impact on radiotherapy. However, it can also induce tumor cells and tumor-infiltrated immune cells to secrete various cytokines and promote tumor-associated lymphangiogenesis, which favors anti-tumor therapy and improve anti-tumor immunity. Studying the changes in lymphatic vessels after ionizing radiation may be a way to explore the synergistic anti-tumor effects of radiotherapy and immunotherapy. This review summarized the morphological changes in lymphatics after ionizing radiation, the molecular mechanisms for the effects of ionizing radiation on lymphatic vessels, and the clinical value of lymphatic changes after ionizing radiation, aiming to provide ideas for the study of the effects of ionizing radiation on lymphatic vessels.

Objective:To analyze locoregional recurrence (LRR) pattern of patients with pT 1-2N 1 breast cancer after modified radical mastectomy, with and without adjuvant radiotherapy (RT). Methods:A total of 5442 eligible patients with breast cancer from 12 Chinese centers were included. The LRR sites and the effect of RT at different sites on recurrence in patients with and without RT were analyzed. The Kaplan-Meier method was used to calculate the cumulative LRR rate, and the difference was compared by the log-rank test.Results:With a median follow-up time of 63.8 months for the entire cohort, 395 patients developed LRR. The chest wall and supraclavicular fossa were the most common LRR sites, regardless of RT or molecular subtypes. The 5-year chest wall recurrence rates for patients with and without chest wall irradiation were 2.5% and 3.8%( P=0.003); the 5-year supraclavicular lymph nodal recurrence rates for patients with and without supraclavicular fossa irradiation were 1.3% and 4.1%( P<0.001); the 5-year axillary recurrence-free rates for patients with and without axillary irradiation were 0.8% and 1.5%( HR=0.31, 95% CI: 0.04-2.23, P=0.219); and the 5-year internal mammary nodal recurrence-free rates for patients with and without internal mammary nodal irradiation were 0.8% and 1.5%( HR=0.45, 95% CI: 0.11-1.90, P=0.268). Conclusions:The chest wall and supraclavicular fossa are the most common LRR sites of patients with pT 1-2N 1 breast cancer after modified radical mastectomy, which is not affected by adjuvant RT or molecular subtypes. The chest wall and supraclavicular fossa irradiation significantly reduce the risk of recurrence in the corresponding area. However, axillary and internal mammary nodal irradiation has no impact on the risk of recurrence in the corresponding area.

Objective:To establish an animal model of trichloroethylene (TCE) -induced liver cancer following chronic exposure and to understand the changes in SET expression and histone acetylation, potentially serving as a molecular mechanism for TCE-induced hepatocarcinogenesis.Methods:B6C3 mice at 6 weeks were treated with TCE at a series of doses (500, 1000 and 2000 mg/kg) by gastric gavage, with corn oil used as the negative control and carbon tetrachloride (CCl 4) as the positive control. The serum and liver were sampled for the determination of biochemical indexes and pathological examination after 56 weeks of chemical exposure. Western blot was used to determine the levels of SET, H2AK9ac and HDAC1 expression. Results:The overall survival rate of the mice in various groups was 90.4% (141/156) , with no statistical difference between groups ( P>0.05) . Compared with the negative control, the organ coefficient for the liver in the high dose TCE group and the positive control group were significantly increased ( P<0.05) . The levels of ALT, AST, LDH and BUN in the all the three TCE groups and the positive control were significantly higher than those in the negative control ( P<0.01) . CREA levels in the 1000 and 2000 mg/kg TCE groups were significantly higher than those in the negative control ( P<0.05) . Statistical increases in the incidence of hepatocellular carcinoma and the activities of ALT and AST in various doses of TCE-exposed mice as compared with the control were observed ( P<0.01) , in a dose-dependent manner. In the 1000 and 2000 mg/kg of TCE treated mice, levels of SET and H2AK9ac were increased ( P<0.05) , while HDAC1 was decreased ( P<0.05) , Compared to the tissue adjacent to liver cancer, in the 1000 and 2000 mg/kg TCE groups, the levels of SET were increased ( P<0.05) , while HDAC1 was decreased ( P<0.05) , and H2AK9ac increased in the 2000 mg/kg group. Conclusion:The hepatocellular carcinoma mouse model induced by chronic exposure to trichloroethylene was successfully established, with enhanced SET protein expression and H2AK9ac in the hepatic tissue.