ObjectiveTo predict the mechanism through which Shasheng Maidong Tang enhances the efficacy of chemotherapy for lung cancer via network pharmacology and validate the prediction results in animal experiments. MethodsThe potential mechanism through which Shasheng Maidong Tang enhances the efficacy of chemotherapy for lung cancer was predicted by network pharmacology， liquid chromatography-mass spectrometry （LC-MS）， and molecular docking methods. C57/BL6 mice were assigned into normal， model， cisplatin， and Shasheng Maidong Tang+cisplatin groups. In addition to the normal group， the remaining groups were injected subcutaneously with 0.2 mL of 1×10⁷ cells·mL^-1 Lewis lung cancer cells to establish the Lewis lung cancer model. The daily gavage dose of Shasheng Maidong Tang was 3.58 g·kg^-1， and the concentration of cisplatin intraperitoneally injected on every other day was 2 mg·kg^-1. Drugs were administered for 14 d. The changes in the tumor volume and the rate of tumor suppression were monitored， and the tumor histopathological changes were observed by hematoxylin-eosin （HE） staining. Enzyme-linked immunosorbent assay was employed to measure the interleukin （IL）-6 and interferon （IFN）-γ levels in peripheral blood. Real-time PCR was performed to quantify the mRNA levels of Janus kinase 2 （JAK2）， signal transducer and activator of transcription 1 （STAT1）， and signal transducer and activator of transcription 3 （STAT3） in the tumor tissue of mice. Western blot was employed to determine the protein levels of JAK2， STAT3， B-cell lymphoma-2 （Bcl-2）， cysteinyl aspartate-specific proteinase-3 （Caspase-3）， and Pim-1 proto1 （PIM1） in the tumor tissue. Immunohistochemistry was employed to detect the expression of Bcl-2 and PIM1 in the tumor tissue. ResultsNetwork pharmacological predictions indicated that Shasheng Maidong Tang might enhance the efficacy of chemotherapy for lung cancer by regulating nitrogen metabolism， AGE-RAGE signaling pathway， cancer pathway， and JAK/STAT signaling pathway. The experimental results demonstrated that tumor volume in the cisplatin group and Shasheng Maidong Tang+cisplatin group was reduced compared with the model group， with statistically distinct differences observed on days 14， 17， 20 post modeling （P<0.05）. Notably， the Shasheng Maidong Tang+cisplatin therapy further decreased tumor volume compared with the cisplatin group， showing marked reductions on days 17 and 20 （P<0.05）， consistent with trends visualized in tumor volume comparison charts. The Shasheng Maidong Tang+cisplatin group exhibited higher tumor inhibition rate than the cisplatin group （P<0.05）. Histopathological analysis via HE staining revealed that the tumors in the model group displayed frequent nuclear mitosis， densely arranged cells， hyperchromatic nuclei， and no necrosis. Cisplatin treatment induced partial necrosis and vacuolization， while the Shasheng Maidong Tang+cisplatin group exhibited extensive necrotic regions， maximal vacuolization， disarranged tumor cells， and minimal mitotic activity. Compared with the model group， the cisplatin group and the Shasheng Maidong Tang+cisplatin group showed elevated level of IFN-γ （P<0.01） and declined level of IL-6 （P<0.01） in the peripheral blood. Compared with the cisplatin group， the Shasheng Maidong Tang+cisplatin group presented elevated level of IFN-γ （P<0.01） and lowered level of IL-6 （P<0.01） in the peripheral blood. Compared with the model group， the cisplatin group and the Shasheng Maidong Tang+cisplatin groups showed down-regulated mRNA levels of JAK2 and STAT3 （P<0.01） and up-regulated mRNA level STAT1 （P<0.01）. Compared with the cisplatin group， the Shasheng Maidong Tang+cisplatin group presented down-regulated mRNA levels of JAK2 and STAT3 （P<0.01） and up-regulated mRNA level of STAT1 （P<0.01）. Compared with the model group， the cisplatin group and the Shasheng Maidong Tang+cisplatin group showed down-regulated protein levels of JAK2 （P<0.01）， Bcl-2 （P<0.01）， PIM1 （P<0.01）， and STAT3 （P<0.05）， and up-regulated protein level of Caspase-3 （P<0.01）. Compared with the cisplatin group， Shasheng Maidong Tang+cisplatin group presented down-regulated protein levels of JAK2 （P<0.01）， Bcl-2 （P<0.01）， PIM1 （P<0.01）， STAT3 （P<0.05）， and up-regulated protein level of Caspase-3 （P<0.01）. The Bcl-2 and PIM1 expression results obtained by immunohistochemistry were consistent with those of Western blot. ConclusionShasheng Maidong Tang may enhance the efficacy of chemotherapy in the mouse model of Lewis lung cancer by regulating the JAK2/STAT3 signaling pathway.

BACKGROUND:The local immune microenvironment plays an important regulatory role in the process of bone formation,and the immune system is intricately linked to the skeletal system.OBJECTIVE:To systematically review the promotion of bone regeneration from three aspects:immune cell regulation of microenvironment,regulation of immune response by small extracellular vesicles,and induction of immune response by bone biomaterials,and to elucidate the immune regulatory mechanisms involved in bone regeneration.METHODS:Relevant literature was retrieved from PubMed,CNKI,WanFang Database,and VIP Database,using the search terms of"osteoimmunology,immune microenvironment,small extracellular vesicles,bone regeneration,bone tissue repair,biomaterials,and tissue engineering"in English and Chinese.Repeat and irrelevant literature was screened and removed,and 92 articles that met the criteria were selected for intensive reading and review.RESULTS AND CONCLUSION:Multiple immune cells and bone cells are in the same microenvironment,and immune cells can regulate the differentiation and activity of bone cells,collectively forming an immune microenvironment that affects bone regeneration.Neutrophils can significantly reduce local inflammatory responses in the early stages of bone injury,creating a favorable microenvironment for bone regeneration.M1 macrophages can clear foreign bodies and reduce early inflammatory responses,while M2 macrophages can promote the expression of osteogenic markers and factors,playing an important role in the repair process of bone injury.B cells and T cells can directly or indirectly affect the generation and activity of osteoblasts and osteoclasts,regulate bone metabolism,and promote bone regeneration.Extracellular vesicles of small cells regulate the local immune microenvironment through paracrine secretion,promoting bone formation and angiogenesis at the site of bone injury.The metal ions,surface hydrophilicity,porosity,pore size,surface morphology,and surface roughness on the surface of biomaterials can directly regulate local immune responses,and have anti-inflammatory,angiogenic,and osteogenic effects,thereby accelerating bone regeneration.

Objective: This study compared the effects of personalized exercise versus acupuncture on multidimensional cognitive function in individuals at high risk for stroke with mild cognitive impairment (MCI). Methods: A randomized controlled trial enrolled 200 stroke-risk adults aged 50−80 years. Ninety participants diagnosed with MCI (MMSE, HIS, CDR criteria) were randomly assigned to exercise (n = 30), acupuncture (n = 30), or control (n = 30) groups. Interventions lasted 6 months. Cognitive outcomes (MMSE, Raven’s Progressive Matrices, Digit Symbol Substitution Test, Animal Fluency, Rey-Osterrieth test, Stroop test) were assessed before and after intervention. Multivariate regression identified risk factors for MCI. ANOVA was used for group comparisons. Results: Hypertension (aOR = 1.5) and diabetes (aOR = 1.3) were significant risk factors for MCI. After intervention, the exercise group showed the largest MMSE improvement (Δ = 5.0), compared with acupuncture (Δ = 3.0) and control (Δ = 1.0) (p < 0.001). Exercise produced greater gains in non-verbal reasoning (31.8% vs. 26.1% in acupuncture, p < 0.01). Acupuncture more effectively enhanced processing speed and attention (DSST: Δ = 26 vs. Δ = 20 in exercise, p = 0.03) and executive function (Stroop interference time: Δ = 16 vs. Δ = 15 seconds in exercise, p = 0.04). Both interventions significantly improved verbal fluency (p < 0.001), with larger benefits in those with baseline MMSE ≤ 20. Conclusion Hypertension and diabetes are key risk factors for MCI in stroke-prone individuals. Exercise yields greater improvement in global cognition and memory, whereas acupuncture is more effective for enhancing attention and executive function. Both modalities benefit verbal fluency, particularly in lower-functioning participants.

ObjectiveTo explore the clinical and phenomics characteristics of patients with phlegm-stasis binding syndrome and its accompanied patterns in stable angina pectoris （SAP） of coronary heart disease （CHD）. MethodsA multicenter cross-sectional study design was adopted. A total of 300 patients with SAP of CHD were enrolled and classified into 120 cases of phlegm-stasis binding syndrome， 125 cases of qi deficiency-accompanied syndrome， 38 cases of qi stagnation-accompanied syndrome， and 17 cases of toxin accumulation-accompanied syndrome according to traditional Chinese medicine （TCM） patterns. Data of patients with different TCM patterns were collected， including general condition， TCM symptoms， blood lipids， coagulation function， immune indicators， and serum metabolomics. Metabolic pathway enrichment analysis was used to compare differences in phenomics characteristics among groups. Metabolites with variable importance in projection （VIP） ≥1 and fold change （FC） ≥2 were considered as representative differential metabolites. ResultsPatients in each TCM pattern type were most commonly in the 60-75 years age group， with a relatively high proportion of males. Regarding TCM symptoms， patients with phlegm-stasis binding syndrome most commonly presented with wiry-choppy or wiry-slippery pulse， chest pain， and chest tightness； in patients with qi deficiency-accompanied syndrome， fatigue， chest pain， and weak pulse were most common； in patients with qi stagnation-accompanied sydnrome， wiry-choppy or wiry-slippery pulse， chest pain， and symptoms that increase or decrease with emotional changes， belching， or flatulence were most common； in patients with toxin accumulation-accompanied syndrome， bitter taste in the mouth， chest tightness， irritability， restlessness or manic delirium， and dry and hard stools or foul-smelling diarrhea were most common. Comparisons among the different TCM patterns showed statistically significant differences in coagulation parameters （P＜0.05）， whereas no statistically significant difference was found in blood lipid levels and immune indicators （P＞0.05）.Metabolomics analysis suggested that disorders of glycerophosphate metabolism and valine， leucine， and isoleucine metabolism are characteristic features of phlegm-stasis binding syndrome and its accompanied patterns. The representative differential metabolites between phlegm-stasis binding syndrome and qi deficiency-accompanied syndrome were 7,8-dihydrobiopterin （FC = 3.58） and oxypurinol （FC = 124.50）. Those between phlegm-stasis binding syndrome and qi stagnation-accompanied syndrome were cytidine 5′-diphosphocholine （FC = 2.62） and D-mannosamine （FC = 2.99）. Those between phlegm-stasis binding syndrome and toxin accumulation-accompanied syndrome were anserine （FC = 7.83） and canrenone （FC = 8.94）. ConclusionThere are certain differences in the clinical characteristics and phenomics characteristics among patients with SAP due to CHD exhibiting phlegm-stasis binding syndrome and its accompanied patterns. The phenomics characteristics mainly involve biological alterations such as lipid metabolism disorders， amino acid metabolism abnormalities， and multiple immune indicators activation， which may provide a reference for precise differentiation and treatment of SAP of CHD in TCM clinical practice.

ObjectiveTo explore the clinical and phenomics characteristics of patients with phlegm-stasis binding syndrome and its accompanied patterns in stable angina pectoris （SAP） of coronary heart disease （CHD）. MethodsA multicenter cross-sectional study design was adopted. A total of 300 patients with SAP of CHD were enrolled and classified into 120 cases of phlegm-stasis binding syndrome， 125 cases of qi deficiency-accompanied syndrome， 38 cases of qi stagnation-accompanied syndrome， and 17 cases of toxin accumulation-accompanied syndrome according to traditional Chinese medicine （TCM） patterns. Data of patients with different TCM patterns were collected， including general condition， TCM symptoms， blood lipids， coagulation function， immune indicators， and serum metabolomics. Metabolic pathway enrichment analysis was used to compare differences in phenomics characteristics among groups. Metabolites with variable importance in projection （VIP） ≥1 and fold change （FC） ≥2 were considered as representative differential metabolites. ResultsPatients in each TCM pattern type were most commonly in the 60-75 years age group， with a relatively high proportion of males. Regarding TCM symptoms， patients with phlegm-stasis binding syndrome most commonly presented with wiry-choppy or wiry-slippery pulse， chest pain， and chest tightness； in patients with qi deficiency-accompanied syndrome， fatigue， chest pain， and weak pulse were most common； in patients with qi stagnation-accompanied sydnrome， wiry-choppy or wiry-slippery pulse， chest pain， and symptoms that increase or decrease with emotional changes， belching， or flatulence were most common； in patients with toxin accumulation-accompanied syndrome， bitter taste in the mouth， chest tightness， irritability， restlessness or manic delirium， and dry and hard stools or foul-smelling diarrhea were most common. Comparisons among the different TCM patterns showed statistically significant differences in coagulation parameters （P＜0.05）， whereas no statistically significant difference was found in blood lipid levels and immune indicators （P＞0.05）.Metabolomics analysis suggested that disorders of glycerophosphate metabolism and valine， leucine， and isoleucine metabolism are characteristic features of phlegm-stasis binding syndrome and its accompanied patterns. The representative differential metabolites between phlegm-stasis binding syndrome and qi deficiency-accompanied syndrome were 7,8-dihydrobiopterin （FC = 3.58） and oxypurinol （FC = 124.50）. Those between phlegm-stasis binding syndrome and qi stagnation-accompanied syndrome were cytidine 5′-diphosphocholine （FC = 2.62） and D-mannosamine （FC = 2.99）. Those between phlegm-stasis binding syndrome and toxin accumulation-accompanied syndrome were anserine （FC = 7.83） and canrenone （FC = 8.94）. ConclusionThere are certain differences in the clinical characteristics and phenomics characteristics among patients with SAP due to CHD exhibiting phlegm-stasis binding syndrome and its accompanied patterns. The phenomics characteristics mainly involve biological alterations such as lipid metabolism disorders， amino acid metabolism abnormalities， and multiple immune indicators activation， which may provide a reference for precise differentiation and treatment of SAP of CHD in TCM clinical practice.

BACKGROUND:The local immune microenvironment plays an important regulatory role in the process of bone formation,and the immune system is intricately linked to the skeletal system.OBJECTIVE:To systematically review the promotion of bone regeneration from three aspects:immune cell regulation of microenvironment,regulation of immune response by small extracellular vesicles,and induction of immune response by bone biomaterials,and to elucidate the immune regulatory mechanisms involved in bone regeneration.METHODS:Relevant literature was retrieved from PubMed,CNKI,WanFang Database,and VIP Database,using the search terms of"osteoimmunology,immune microenvironment,small extracellular vesicles,bone regeneration,bone tissue repair,biomaterials,and tissue engineering"in English and Chinese.Repeat and irrelevant literature was screened and removed,and 92 articles that met the criteria were selected for intensive reading and review.RESULTS AND CONCLUSION:Multiple immune cells and bone cells are in the same microenvironment,and immune cells can regulate the differentiation and activity of bone cells,collectively forming an immune microenvironment that affects bone regeneration.Neutrophils can significantly reduce local inflammatory responses in the early stages of bone injury,creating a favorable microenvironment for bone regeneration.M1 macrophages can clear foreign bodies and reduce early inflammatory responses,while M2 macrophages can promote the expression of osteogenic markers and factors,playing an important role in the repair process of bone injury.B cells and T cells can directly or indirectly affect the generation and activity of osteoblasts and osteoclasts,regulate bone metabolism,and promote bone regeneration.Extracellular vesicles of small cells regulate the local immune microenvironment through paracrine secretion,promoting bone formation and angiogenesis at the site of bone injury.The metal ions,surface hydrophilicity,porosity,pore size,surface morphology,and surface roughness on the surface of biomaterials can directly regulate local immune responses,and have anti-inflammatory,angiogenic,and osteogenic effects,thereby accelerating bone regeneration.

Objective: To explore factors associated with return intention and behavior among young lapsed blood donors from three psychological dimensions: blood donation values, moral identity and internalized responsibility, and to provide a contextualized interpretation of these psychological factors within the traditional Chinese ethical framework of “benevolence-righteousness-virtue”. Methods: A prospective cohort study was performed among 732 young lapsed blood donors in Hangzhou, China, recruited via stratified random sampling. At baseline, participants completed measures of blood donation values, moral identity and identified regulation. Six months later, return intention was assessed among 344 participants who completed the follow-up survey, while actual return behavior was determined from blood center records for all 732 participants at baseline. Univariate and multivariate logistic regression analyses were used to analyze the predictive effects of these psychological variables on return intention and behavior. Results: Blood donation motivations varied significantly across participants with different educational levels (P<0.05). Among the 344 participants who completed the follow-up survey, blood donation values, moral identity, and identified regulation were each significantly associated with return intention (P<0.05). These associations remained significant after adjustment for demographic factors (P<0.01). When the three psychological factors were simultaneously entered into the model, only identified regulation remained independently associated with return intention (OR=1.95, 95%CI:1.35-2.82, P<0.001). Among all 732 participants, the three psychological factors were each significantly associated with actual return behavior in univariate and adjusted analyses；however, none remained independently associated with actual return behavior when entered simultaneously into the model (all P>0.05). Conclusion: Identified regulation may be an important psychological factor underlying the formation of return intention among young lapsed blood donors. From the perspective of the “benevolence - righteousness - virtue” ethical framework, blood donation values, identified regulation, and moral identity represent distinct dimensions of donation motivation, with the dimension of “righteousness” reflected in internalized responsibility, showing a relatively prominent role in return intention. The translation of psychological motivation into actual return behavior may additionally depend on other factors and warrants further investigation.

Objective:To compare the efficacy of transpulmonary pressure (Ptp) and driving pressure (DP) in guiding lung-protective ventilation strategies in patients with acute respiratory distress syndrome (ARDS).Methods:In this randomized controlled trial, 22 ARDS patients of either sex, aged 18-80 yr, with a body mass index of 18-30 kg/m 2, were divided into 2 groups ( n=11 each) using a random number table method: Ptp group and DP group. DP group received a tidal volume of 4-6 ml/kg with a plateau pressure<30 cmH 2O (1 cm H 2O=0.098 kPa) and driving pressure<16 cmH 2O. In Ptp group, the positive end-expiratory pressure (PEEP) and tidal volume were adjusted to maintain end-inspiratory Ptp <25 cmH 2O and end-expiratory Ptp 0-5 cmH 2O based on the setting mentioned in DP group. Oxygenation index, PEEP, plateau pressure, central venous pressure, heart rate, mean arterial pressure, parameters of liver and kidney function, mechanical ventilation duration, and the mortality in the intensive care unit were recorded on admission to the operating room and at 24 and 48 h after treatment. Results:Compared to DP group, significant changes were found in the main effects of oxygenation indices and time effects in Ptp group, and significant changes were found in the main effect of PEEP, with mean arterial pressure increasing ( P<0.05), and no significant differences were observed in the other parameters regarding group effects, time effects, or interactions in PEEP group ( P>0.05). Conclusions:Ptp provides a superior efficacy than DP in guiding lung-protective ventilation strategies for the patients with ARDS.

Standardized training of newly recruited nurses is crucial for enhancing their clinical competencies and facilita-ting rapid adaptation to clinical environments.This approach aims to develop nursing professionals with advanced clinical skills and expertise.This paper reviews and analyzes the training paradigms for new nurses globally,focusing on the challenges faced in the standardized training of new nurses in China,to provide insights and references for future training programs.

Objective To evaluate the effectiveness of WeChat group integrating with BOPPPS instructional model in the standardized training of nurses in an orthopedics department.Methods A total of 56 nurses in orthopedical standardized training from a hospital were selected and divided into a control group(28 nurses from September 2022 to August 2023)and an interven-tion group(28 nurses trained via WeChat groups and the BOPPPS model from September 2023 to August 2024).The two groups were compared in terms of their final assessment scores,critical thinking,and self-directed learning capabilities.Results After training,the intervention group had significantly higher scores in the final assessment,all items of the California Critical Thinking Disposition Inventory,and all dimensions of the Learning Ability Assessment Scale compared to the control group(all P＜0.05).Conclusion WeChat groups combined with the BOPPPS teaching mode effectively improves the self-directed learning ability,critical thinking skills,and assessment results of orthopedic nurses.