OBJECTIVES: To investigate the synergistic mechanism of the traditional Chinese medicine Rosa laevigata Michx. (RLM) for treatment of pulmonary arterial hypertension (PAH). METHODS: Network pharmacological analysis was carried out to screen the active ingredients of RLM and PAH disease targets and construct the "component-target-disease" interaction network, followed by gene enrichment analysis and molecular docking studies. In the cell experiments, primary cultures of rat pulmonary arterial smooth muscle cells were exposed to hypoxia for 24 h and treated with solvent or 100, 200 and 300 mg/mL RLM, and the changes in cell proliferation were detected using Western blotting for PCNA and immunofluorescence staining. In the animal experiment, male SD rats were randomized into 5 control group, monocrotaline (MCT) solvent group, and MCT with RLM (100, 200 and 300 mg/mL) treatment groups. HE staining and immunofluorescence staining were used to observe histopathological changes in the pulmonary blood vessels of the rats. RESULTS: Seven core active ingredients (including β-sitosterol and kaempferol) in RLM and 39 key disease targets were identified, and molecular docking showed that SRC was a high-affinity target. KEGG enrichment analysis showed that the differential genes were significantly enriched in calcium signaling and PI3K-AKT pathways. In rat pulmonary arterial smooth muscle cells, hypoxic exposure significantly up-regulated cellular expression of PCNA and phosphorylation levels of Src and AKT1, which were obviously lowered by RLM treatment. In RLM-treated rat models, the mean pulmonary artery pressure and right ventricular hypertrophy index (Fulton index) were significantly reduced, the tricuspid annular plane systolic excursion (TAPSE) was improved, and pulmonary vascular wall thickening and fibrosis were obviously ameliorated. CONCLUSIONS RLM inhibits pulmonary arterial smooth muscle cell proliferation in rat models of hypertension possibly by regulating the Src-AKT1 axis, suggesting the potential of RLM as a new natural drug for treatment of pulmonary hypertension.
Animals ; Cell Proliferation/drug effects* ; Proto-Oncogene Proteins c-akt/metabolism* ; Rats, Sprague-Dawley ; Pulmonary Artery/cytology* ; Male ; Rats ; Myocytes, Smooth Muscle/cytology* ; Hypertension, Pulmonary/pathology* ; Drugs, Chinese Herbal/pharmacology* ; Signal Transduction/drug effects* ; Muscle, Smooth, Vascular/cytology* ; src-Family Kinases/metabolism* ; Cells, Cultured

Objective To assess the clinical value of a novel surgical technique—Tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device in the resection of anterior mediastinal masses. Methods Patients who underwent tubeless subxiphoid uniportal video-assisted thoracoscopic surgery via balance-shaped sternal elevation device in anterior mediastinal masses process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from March to April 2025 were included, and their clinical data were analyzed. Results A total of 4 patients were included, with 2 males and 2 females, aged 58-75 years. The diameter of the tumor was 2.5-3.0 cm. The operation time was 60.0-150.0 min, intraoperative blood loss was 5-10 mL, pain score on the 3rd day after surgery was 0 points, and postoperative hospital stay was 2-3 days. All patients achieved complete resection of the masses and thymus without perioperative complications. Conclusion The tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device technique optimizes surgical visualization and instrument maneuverability while avoiding complications related to conventional anesthesia and tubing, thereby markedly enhancing the minimally invasive profile of anterior mediastinal masses resections. In addition to maintaining procedural safety, this approach effectively reduces postoperative pain and accelerates patient recovery, highlighting its potential for widespread clinical adoption.

Objective To explore the status quo of domestic long-term care nursing team construction policy in January 2008—June 2024,analyze the favored direction and structure proportion of existing policy tools,so as to provide references for the follow-up policy and system optimization.Methods Based on McDonnell & Elmore policy tools and construction elements to two-dimensional analysis framework,the coding policy arrangement and quantitative analysis were conducted on the related policies of long-term care nursing team construction.Results Finally,63 policy documents were included,and the 355 pieces of policy were analyzed.In the policy instrument dimension,the proportions of mandate tools,incentive tools,capacity building tools,authority reorganization tools,and counseling tools were 48.45％,11.55％,5.35％,11.27％,and 23.38％,respectively.Team-building dimension in the post management,education training,rights management,post employment,professional development,respectively accounted for 27.04％,22.25％,11.27％,10.70％and 28.73％.Conclusion At present,there is uneven application of the policy tools related to nursing team building in the context of long-term care in China,and most of the entries are for goal planning.It is recommended that the ratio of the various policy tools should be optimised continuously,so as to ensure that the details of the policies are effectively implemented.The construction of the long-term care nursing team system needs to be improved,and the protection of the rights of nursing staff needs to be strengthened;specific,feasible,special and targeted strategies should be formulated.

Objective:To develop and validate a predictive model for delayed emergence in patients undergoing thoracoscopic radical lung cancer surgery with general anesthesia.Methods:A total of 1 468 patients admitted to the anesthesia recovery room after thoracoscopic radical lung cancer surgery at the First Affiliated Hospital of Zhejiang University School of Medicine from August 2020 to August 2021 were selected via convenience sampling. Patients who underwent surgery between August 2020 and June 2021 ( n=1 213) were assigned to the modeling group, while those from July to August 2021 ( n=255) were used as the validation group. Logistic regression analysis was used to identify risk factors for delayed emergence and to establish a predictive model. The performance of the model was evaluated using the area under the receiver operating characteristic curve ( AUC) and the Hosmer-Lemeshow goodness-of-fit test. Results:Among the modeling group, 200 patients experienced delayed emergence, with an incidence of 16.49% (200/1 213). Logistic regression analysis revealed that the use of reversal agents, use of neostigmine, albumin level, presence of shivering, pain score≥4 points, extubation time, partial pressure of CO 2, partial pressure of oxygen, serum potassium level, and intraoperative fentanyl dosage were significant influencing factors ( P<0.05). The predictive model demonstrated good performance with an AUC of 0.864 [95% CI (0.828, 0.899) ], a Hosmer-Lemeshow test χ 2=5.299 ( P=0.725), cut-off value of 0.442, sensitivity of 0.794, and specificity of 0.769. In the validation group, delayed emergence occurred in 44 cases (17.25%). The model showed good validation performance with an AUC of 0.852 [95% CI (0.826, 0.878) ], Hosmer-Lemeshow χ 2=5.912 ( P=0.336), cut-off value of 0.754, sensitivity of 0.674, and specificity of 0.877. Conclusions:The predictive model constructed in this study demonstrates strong performance and can assist clinicians in the early identification of patients at risk of delayed emergence following thoracoscopic radical lung cancer surgery under general anesthesia.

Objective To explore the status quo of domestic long-term care nursing team construction policy in January 2008—June 2024,analyze the favored direction and structure proportion of existing policy tools,so as to provide references for the follow-up policy and system optimization.Methods Based on McDonnell & Elmore policy tools and construction elements to two-dimensional analysis framework,the coding policy arrangement and quantitative analysis were conducted on the related policies of long-term care nursing team construction.Results Finally,63 policy documents were included,and the 355 pieces of policy were analyzed.In the policy instrument dimension,the proportions of mandate tools,incentive tools,capacity building tools,authority reorganization tools,and counseling tools were 48.45％,11.55％,5.35％,11.27％,and 23.38％,respectively.Team-building dimension in the post management,education training,rights management,post employment,professional development,respectively accounted for 27.04％,22.25％,11.27％,10.70％and 28.73％.Conclusion At present,there is uneven application of the policy tools related to nursing team building in the context of long-term care in China,and most of the entries are for goal planning.It is recommended that the ratio of the various policy tools should be optimised continuously,so as to ensure that the details of the policies are effectively implemented.The construction of the long-term care nursing team system needs to be improved,and the protection of the rights of nursing staff needs to be strengthened;specific,feasible,special and targeted strategies should be formulated.

Objective:To develop and validate a predictive model for delayed emergence in patients undergoing thoracoscopic radical lung cancer surgery with general anesthesia.Methods:A total of 1 468 patients admitted to the anesthesia recovery room after thoracoscopic radical lung cancer surgery at the First Affiliated Hospital of Zhejiang University School of Medicine from August 2020 to August 2021 were selected via convenience sampling. Patients who underwent surgery between August 2020 and June 2021 ( n=1 213) were assigned to the modeling group, while those from July to August 2021 ( n=255) were used as the validation group. Logistic regression analysis was used to identify risk factors for delayed emergence and to establish a predictive model. The performance of the model was evaluated using the area under the receiver operating characteristic curve ( AUC) and the Hosmer-Lemeshow goodness-of-fit test. Results:Among the modeling group, 200 patients experienced delayed emergence, with an incidence of 16.49% (200/1 213). Logistic regression analysis revealed that the use of reversal agents, use of neostigmine, albumin level, presence of shivering, pain score≥4 points, extubation time, partial pressure of CO 2, partial pressure of oxygen, serum potassium level, and intraoperative fentanyl dosage were significant influencing factors ( P<0.05). The predictive model demonstrated good performance with an AUC of 0.864 [95% CI (0.828, 0.899) ], a Hosmer-Lemeshow test χ 2=5.299 ( P=0.725), cut-off value of 0.442, sensitivity of 0.794, and specificity of 0.769. In the validation group, delayed emergence occurred in 44 cases (17.25%). The model showed good validation performance with an AUC of 0.852 [95% CI (0.826, 0.878) ], Hosmer-Lemeshow χ 2=5.912 ( P=0.336), cut-off value of 0.754, sensitivity of 0.674, and specificity of 0.877. Conclusions:The predictive model constructed in this study demonstrates strong performance and can assist clinicians in the early identification of patients at risk of delayed emergence following thoracoscopic radical lung cancer surgery under general anesthesia.

Objective:To analyze the incidence and progression of overactive bladder(OAB)symp-toms following radical prostatectomy for prostate cancer patients and to identify related risk factors.Methods:A retrospective study was conducted on 263 local stage prostate cancer patients who underwent radical prostatectomy at Peking University Third Hospital from January 2013 to May 2017.Clinical base-line information,comprehensive imaging features,perioperative parameters,preoperative urinary control status,pathological diagnosis,and the incidence of OAB within one year postoperatively were collected and analyzed.In the imaging features,two parameters were defined:Bladder wall thickness(BWT)and bladder mucosal smoothness(BMS),which were used to predict the occurrence of OAB.Patients were evaluated based on their clinical baseline characteristics,including age,body mass index(BMI),co-morbidities,and prostate-specific antigen(PSA)levels.The imaging characteristics were assessed using preoperative MRI,focusing on BWT and BMS.Perioperative parameters included operative time,blood loss,and length of hospital stay.The OAB symptoms were assessed using the overactive bladder symptom score(OABSS)and the international prostate symptom score(IPSS).These scores were correlated with the postoperative incidence of OAB.Results:Among the 263 patients who underwent radical prostatecto-my,52(19.8％)exhibited OAB within one year postoperatively.Of the 40 patients with preoperative OAB symptoms,17(42.5％)showed remission postoperatively,while 23(57.5％)had persistent symptoms.Additionally,29 patients developed new-onset OAB,accounting for 55.77％of all postopera-tive OAB cases.Univariate analysis indicated that BWT,BMS,OABSS,and IPSS score were all associ-ated with the occurrence of postoperative OAB.Further multivariate analysis identified BMS as an inde-pendent risk factor for long-term OAB(P＜0.001).Conclusion:Long-term postoperative overactive bladder is a common complication following radical prostatectomy.The findings suggest that preoperative MRI measurements of bladder wall thickness and bladder mucosal smoothness during bladder filling phase can predict the risk of OAB occurrence postoperatively.Identifying these risk factors preoperatively can help in counseling patients about potential complications and in developing strategies to mitigate the risk of developing OAB after surgery.Early detection and management of these parameters might improve the quality of life for patients undergoing radical prostatectomy.

Background and aims:Kehuang(KH)capsule is an herbal medical product approved for the treatment of liver diseases,including liver injury,in China.However,the mechanism is still unclear.This study aimed to elucidate the protective effects of KH capsule against carbon tetrachloride(CCl4)-induced acute liver injury(ALI)in a murine model.Methods:Mice were randomly divided into control,model(CCl4),CCl4+KH_Low and CCl4+KH_High group.Liver enzyme levels and histological changes were assessed to evaluate liver injury.Oxidative stress markers and inflammatory cell infiltration in liver tissues were measured.Additionally,network pharmacology was employed to explore the potential mechanisms of KH capsule.Results:KH capsule significantly reduced serum alanine aminotransferase(ALT)and aspartate amino-transferase(AST)levels,as well as the necrotic area in liver tissue.KH capsule also decreased the infil-tration of macrophages and neutrophils,thereby inhibiting the expression of interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),and interleukin-1 beta(IL-1β).Furthermore,KH capsule decreased liver malondialdehyde(MDA)levels and increased superoxide dismutase(SOD)activity.The number of ter-minal deoxynucleotidyl transferase(TdT)-mediated dUTP nick-end labeling(TUNEL)-positive cells in liver tissue was also reduced.The expression of nuclear factor erythroid 2 related factor 2(Nrf2)and heme oxygenase-1(HO-1)proteins was significantly elevated,while the protein expression of cyto-chrome P450 2E1(CYP2E1)was significantly reduced.Mass spectrometry identified genistein,galangin,wogonin,skullcapflavone Ⅱ,and hispidulin as potential active ingredients of KH capsule.Network pharmacology analysis revealed enrichment in the mitogen-activated protein kinase(MAPK)and phosphatidylinositol 3-kinase(PI3K)-protein kinase B(AKT)signaling pathways.Western blot analysis confirmed that KH capsule suppressed AKT,extracellular signal-regulated kinase(ERK),and p38 signaling.Conclusions:These findings suggest that KH capsule could exert protective effects against CCl4-induced ALI,with the inhibition of MAPK and PI3K-AKT signaling pathways playing a crucial role in its mecha-nism of action.

Objective To systematically evaluate the relationship between the dietary inflammatory in-dex(DII)and the onset risk of gestational diabetes mellitus(GDM).Methods The databases such as PubMed,Web of Science,Embase,Cochrane Library,CNKI and Wanfang Data were retrieved.The retrieval time was from the database establishment to September 10,2023.Two researchers separately screened the lit-eratures,extracted the data and conducted the bias risk assessment.The meta analysis was conducted by the RevMan 5.4 software.Results A total of 8 observational studies were included,involving 96 904 pregnant women.The results of meta-analysis showed that in the classified DII,compared with the DII anti-inflammato-ry tendency group,the risk of GDM onset in the DII pro-inflammatory tendency group was increased(OR=1.27,95％CI:1.07-1.50,P=0.006).In the continuous DII,for every unit increase in DII,the risk of GDM was increased by 29％(OR=1.29,95％CI:1.13-1.48,P＜0.001).In the subgroup analysis,the most of the stratified analysis results were consistent with the main analysis results.Conclusion The current evidence suggests that the high DII scores will increase the risk of GDM onset,but the aforementioned conclusion re-quires the validation through more high quality,large samples and multicenter studies.

Objective To evaluate the analgesic effects of ultrasound-guided hip capsule block and fascia iliaca block in elderly patients undergoing hip replacement surgery and their impacts on postoperative rehabilitation.Methods A total of 44 patients who underwent total hip replacement in the Second Affiliated Hospital of Wenzhou Medical University from May to December in 2023 were selected and divided into fascia iliaca block group(group F)and hip capsule block group(group H)according to the random number table,with 22 cases in each group.All patients were anesthetized by lumbar anesthesia combined with nerve block.The primary indicators included the recovery of lower limb muscle strength at 8h,24h,48h after operation and the rest and movement visual analogue scale(VAS)scores at each observation point.The secondary indicators were sufentanil consumption of analgesic pump,the number of compressions,the use rates of additional parecoxib sodium in ward,the length of hospital stay and the occurrence of adverse reactions.Results The recovery of lower limb muscle strength in group H was better than that in group F at 8h and 24h after operation,and the difference was statistically significant(P<0.05).The rest and movement VAS scores at 30min after block and 4h after operation in group H were significantly lower than those in group F(P<0.05),while there were no significant differences in the rest and movement VAS scores between two groups at other time points(P>0.05).The rest and movement VAS scores at each time point after blockade were lower than those before blockade in two groups(P<0.05).The sufentanil consumption in analgesic pump and the number of compressions in group H was lower than that in group F at 4h after operation(P<0.05),and there were no significant differences in analgesic pump data and the use rates of parecoxib sodium between two groups at subsequent time points(P>0.05).There were no statistically significant difference in the incidence of nausea within 48h after operation and hospital stay between two groups(P>0.05).Conclusion Both fascia iliaca block and hip capsule block can be safely and effectively used in elderly patients with hip replacement,but the analgesic effect of hip capsule block is faster,the early postoperative analgesic effect is better,and the impact on lower limb movement is less.