Objective:To discuss the effects of different doses of ganoderic acid A(GAA)on the biological activities,glycolysis,and the expression of rate-limiting enzymes of non-small cell lung cancer(NSCLC)PC9 cells,and to clarify the mechanism.Methods:The NSCLC PC9 cells were cultured in vitro and divided into blank control group,low dose(25 μmol·L-1)of GAA group,medium dose(50 μmol·L-1)of GAA group,and high dose(100 μmol·L-1)of GAA group.The methylthiazolydiphenyltetrazolium(MTT)assay was used to detect the survival rates of the PC9 cells in various groups;Transwell chamber assay was used to detect the number of migration cells of the PC9 cells in various groups;the glucose uptakes of the PC9 cells in various groups were detected by glucose assay kit;the levels of ATP in the PC9 cells in various groups were detected by ATP assay kit;the levels of lactic acid in the PC9 cells in various groups were detected by lactate assay kit;the expression levels of hexokinase 2(HK2)and pyruvate kinase M2(PKM2)mRNA in the PC9 cells in various groups were detected by real-time fluorescence quantitative PCR(RT-qPCR)method;the expression levels of HK2 and PKM2 proteins in the PC9 cells in various groups were detected by Western blotting method.Results:The MTT assay results showed that,at 24,48,and 72 h of culture,compared with blank control group,the survival rates of the cells in medium and high doses of GAA groups were significantly decreased(P<0.05).At 72 h of culture,compared with low dose of GAA group,the survival rate of the cells in high dose of GAA group was significantly decreased(P<0.05).The Transwell chamber assay results showed that compared with blank control group,the numbers of migration cells in medium and high doses of GAA groups were significantly decreased(P<0.05);compared with low doses of GAA group,the number of migration cells in high dose of GAA group was significantly decreased(P<0.05).Compared with blank control group,the glucose uptakes and levels of lactic acid in the cells in medium and high dose of GAA groups were significantly decreased(P<0.05),and the level of ATP in the cells in high dose of GAA group was significantly decreased(P<0.05).The RT-qPCR results showed that compared with blank control group,the expression levels of HK2 and PKM2 mRNA in the cells in medium and high doses of GAA groups were significantly decreased(P<0.05).The Western blotting results showed that compared with blank control group,the expression levels of HK2 and PKM2 proteins in the cells in medium and high doses of GAA groups were significantly decreased(P<0.05).Conclusion:Medium and high doses of GAA can inhibit the biological activities of proliferation and migration of the PC9 cells,reduce the glycolysis,and its mechanism may be related to the inhibition of the expressions of the key rate-limiting enzymes HK2 and PKM2.

Objective:To investigate the midterm and long-term efficacy of flow-diverter device in treating intracranial aneurysms (IAs) and analyze its clinical outcomes in anterior circulation aneurysms and posterior circulation aneurysms.Methods:This is a retrospective case series study. The data of 566 intracranial aneurysm patients (681 aneurysms) treated with the flow-diverter device at Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University from January 2018 to January 2021 were retrospectively analyzed. There were 205 males and 361 females, with an age ( M(IQR)) of 55 (14) years (range:18 to 77 years). Twelve patients (12 aneurysms) had ruptured aneurysms before surgery, and 75 patients (172 aneurysms) had multiple aneurysms. Preoperative modified Rankin scale (mRS) >2 points in 16 patients.There were 444 patients (552 aneurysms) in the anterior circulation group and 122 patients (129 aneurysms) in the posterior circulation group. Postoperative follow-up was conducted via outpatient visits or telephone calls at 3 to 12 months after the procedure. Baseline aneurysm parameters, surgical information, and imaging and clinical outcomes were collected. Univariate and multivariate Logistic regression analyses were used to identify independent factors associated with long-term incomplete aneurysm occlusion. Results:Intraoperative use of flow diverter-assisted coil embolization was performed in 221 patients (226 aneurysms), and balloon assistance was used in 20 patients (22 aneurysms).The intraoperative rupture rate was 0.5% (3/566), and the intraoperative thrombosis rate was 0.7% (4/566). The in-hospital mortality rate was 1.2% (7/566). Postoperative complications included subarachnoid hemorrhage in 5 patients (0.9%), intracerebral hemorrhage in 2 patients (0.4%), ischemic stroke in 19 patients (3.6%), and transient ischemic attack in 16 patients (3.0%). Imaging follow-up was available for 447 patients (548 aneurysms) with a follow-up duration of (16.7±6.7) months (range:3 to 45 months). Incomplete aneurysm occlusion occurred in 79 patients (95 aneurysms), accounting for 17.3% (95/548). Parent artery stenosis was observed in 63 patients (72 aneurysms), accounting for 13.1% (72/548). Clinical follow-up was available for 530 patients (644 aneurysms) with a follow-up duration of (29.4±11.3) months (range:3 to 54 months). One case of mRS score >2 points was observed in 18 patients, accounting for 3.4% (18/530). Among them, the rate of incomplete occlusion in the anterior and posterior circulation group was 16.9% (76/450) and 19.4% (19/98), respectively, and the rate of parent artery stenosis was 10.9% (49/450) and 23.5% (23/98), respectively; the rate of mRS score>2 points was 2.4% (10/415) and 7.0% (8/115), respectively. Univariate and multivariate Logistic regression analysis showed that aneurysm neck size ( β=0.075, OR=1.08, P=0.028) and coil use ( β=-1.070, OR=0.034, P=0.001) were independent factors influencing long-term aneurysm occlusion. Conclusions:The flow-diverter device demonstrates good safety and efficacy in the midterm and long-term treatment of overall IAs. However, further research is needed to focus on the midterm and long-term treatment outcomes of aneurysms with relatively wide neck and posterior circulation aneurysms.

The new-generation non-invasive prenatal screening technology (NIPT2.0) is a new method successfully realized in recent years based on high-throughput sequencing to synchronously and accurately detect fetal chromosomal aneuploidies, microdeletion/microduplication syndromes and dominantly inherited monogenic disorders. NIPT2.0 can circumvent the shortcomings of previous non-invasive prenatal screening techniques (NIPT and NIPT Plus) including incapability to detect fetal monogenic disorders, insufficient accuracy of detection and low positive predictive values for certain chromosomal abnormalities (in particular trisomy 13, sex chromosomal abnormalities, and small-segment microdeletions and microduplication syndromes). How to apply NIPT2.0 reasonably and normatively to maximize its clinical value has become an issue which requires clarification. The Reproductive Health Branch of the Chinese Maternal and Child Health Care Association has organized experts to fully discuss and jointly drafted this consensus, which has put forwards suggestions over the clinical application strategy for NIPT2.0, including the scope of application, target disease, pre-test consultation, clinical application pathway, post-test genetic counseling and intervention, quality control and limitations, for the reference by peers, with a view to standardize its application and provide better clinical service.

ObjectiveTo observe the mechanism of Jiawei Guizhi Fuling decoction （JGFD） in alleviating sciatic nerve injury in painful diabetic peripheral neuropathy （PDPN） rats by regulating mitophagy through the PTEN-induced putative kinase 1 （PINK1）/Parkin signaling pathway. MethodThe PDPN model was established by intraperitoneal injection of streptozotocin （STZ）. After modeling， the rats were randomly divided into JGFD high， medium， and low dose groups （JGFD-H， JGFD-M， JGFD-L； 39.6， 19.8， 9.9 g·kg^-1·d^-1， respectively）， a positive drug group （lipoic acid capsules， LA； 50 mg·kg^-1·d^-1）， and a model group （PDPN）. A blank control group （CON） was established. Drug intervention was administered continuously for 8 weeks after modeling. Measurements included body weight and fasting blood glucose of PDPN rats at weeks 0， 2， 4， and 8， mechanical pain threshold and thermal pain threshold at weeks 0 and 8， and motor nerve conduction velocity at week 8. Hematoxylin-eosin （HE） staining was used to observe the morphology of sciatic nerve tissue. The ultrastructure of mitochondria and autophagosomes was observed by transmission electron microscopy. Western blot was performed to detect the protein expression levels of PINK1， Parkin， p62， Beclin-1， and LC3 in sciatic nerve tissue. Additionally， real-time quantitative PCR （Real-time PCR） was performed to detect the mRNA expression levels of PINK1， Parkin， p62， Beclin-1， and LC3 in sciatic nerve tissue. ResultCompared with the CON group， the PDPN group showed a significant decrease in body weight at all time points， a significant increase in fasting blood glucose， significantly shortened mechanical pain and thermal pain thresholds， and significantly reduced motor nerve conduction velocity. The protein and mRNA expression of PINK1， Parkin， Beclin-1， and microtubule-associated protein light chain 3（LC3） in sciatic nerve tissue was significantly reduced， while p62 protein and mRNA expression was significantly increased （P<0.01）. Pathological changes included edema of sciatic nerve fibers， segmental demyelination， loose and disordered arrangement of the myelin sheath layers， significant swelling of mitochondria， reduced electron density， disappearance of cristae， and absence of typical autophagosome and autolysosome structures. Compared with the PDPN group， each JGFD dose group showed a significant increase in body weight and a significant reduction in fasting blood glucose （P<0.05， P<0.01）. The mechanical pain threshold and thermal pain threshold were significantly prolonged， and motor nerve conduction velocity was significantly increased across all JGFD and LA groups. The expression levels of PINK1， Parkin， Beclin-1， and LC3 proteins and mRNA in sciatic nerve tissue were significantly increased， while p62 protein and mRNA expression levels were significantly decreased （P<0.05， P<0.01）. Pathological damage to the sciatic nerve was alleviated to varying degrees， with a relatively intact myelin sheath morphology and intact or slightly edematous outer mitochondrial membrane. Autophagolysosome structures were observed in the JGFD-M and JGFD-H groups. Compared with the LA group， the JGFD-H group showed a significant increase in body weight， a significant reduction in fasting blood glucose， a significant increase in motor nerve conduction velocity， a significant increase in PINK1 protein expression and PINK1， Parkin， and Beclin-1 mRNA expression in sciatic nerve tissue， and a significant decrease in p62 mRNA expression （P<0.05， P<0.01）. ConclusionJGFD may alleviate sciatic nerve injury in PDPN rats by activating mitophagy through the regulation of the PINK1/Parkin signaling pathway.

Tuberculosis （TB） and human immunodeficiency virus infection / acquired immune deficiency syndrome （HIV/AIDS） are both serious global public health threats. Early detection of infected persons and/or patients through TB/HIV bi-directional screening is crucial for prevention and control strategy in China and globally. In recent years， with the promotion and application of new TB and HIV detection technologies worldwide， TB/HIV bi-directional screening technologies and strategies have made remarkable changes. This expert consensus introduces the significance and challenges of TB/HIV bi-directional screening， summarizes important progress of research and applications， and makes recommendations on screening measures and procedures to further strengthen TB/HIV bi-directional screening in China.

Objective To explore the diagnostic value of acetic acid indigocarmine mixture(AIM)sandwich staining combined with flexile spectral imaging color enhancement(FICE)technology for colonoscopic Pit pattern classification for colorectal lesions.Methods 100 patients with colorectal lesions from June 2022 to October 2023 were selected as the research subjects,and 222 lesions;Patients were examined using conventional endoscopy,FICE,AIM sandwich staining+FICE,and the detection status and pathological type of Pit pattern classification were recorded.Calculate the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of Pit pattern classification diagnosis under different modes.Kappa was used to evaluate the consistency between Pit pattern classification and pathological examination under different modes.Evaluate diagnostic effectiveness using receiver operator characteristic curve(ROC curve).Results Compared with ordinary endoscopy(74.32％),FICE technology(92.34％)and AIM staining+FICE(97.30％)detected more lesions that matched the pathological results through Pit pattern classification,and AIM sandwich staining+FICE detected more than FICE,the differences were statistically significant(P＜0.05).Compared with ordinary endoscopy,the diagnostic accuracy of FICE and AIM staining+FICE for colorectal carcinoma lesions were higher,and AIM sandwich staining+FICE higher than FICE,the differences were statistically significant(P＜0.05).Compared with ordinary endoscopy,the diagnostic accuracy of FICE and AIM sandwich staining+FICE for early colorectal cancer were higher,the differences were statistically significant(P＜0.05).The area under the curve(AUC)predicted by ordinary endoscopy,FICE and AIM sandwich staining+FICE for colorectal carcinoma lesions were 0.815(95％CI:0.711～0.859),0.881(95％CI:0.752～0.904),and 0.933(95％CI:0.793～0.961),respectively;The AUC predicted by ordinary endoscopy,FICE and AIM sandwich staining+FICE for early colorectal cancer were 0.850(95％CI:0.720～0.866),0.938(95％CI:0.764～0.951),and 0.947(95％CI:0.803～0.972),respectively.For predicting colorectal carcinoma lesions and early colorectal cancer,the Youden index of AIM staining+FICE technology was the highest,with values of 0.955 and 0.968,respectively.Conclusion Under AIM sandwich staining+FICE,Pit pattern classification can detect more carcinoma lesions and early colorectal cancer,with high diagnostic accuracy and effective improvement of endoscopic diagnosis and treatment quality.

Objective:To analyze the differential expressions of proteins in aqueous humor in patients with exfoliation syndrome (XFS).Methods:A total of 20 patients were enrolled in the Department of Ophthalmology, People's Hospital of Hotan District from June 2020 to January 2021, including 10 patients with age-related cataract and 10 XFS patients combined with cataract, which were classified as cataract group and XFS group, respectively.A total of 50 to 100 μl aqueous humor was obtained in the middle of the anterior chamber through the intraoperative phacoemulsification channel.The proteins extracted from aqueous humor were analyzed by label-free quantitative proteomics technology.The cataract group was set as the control group, and the differentially expressed proteins (DEPs) in XFS group were screened according to P<0.05 and fold change >1.5.Gene ontology (GO) function analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway analysis were used to explore the function and regulatory signaling pathways of DEPs in the XFS group.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2020KY[L]-21).Written informed consent was obtained from each subject. Results:In comparison with the cataract group, 25 DEPs were identified in the XFS group, primarily involved in cell adhesion, receptor, hydrolase, and molecular transport.Specifically, there were 14 down-regulated proteins including complement factor H-related protein 1 (CFHR1), endoplasmic reticulum chaperone BiP (HSPA5), biglycan (BGN), FRAS1-related extracellular matrix protein 2 (FREM2), hemoglobin subunit delta (HBD), hemoglobin subunit gamma-1 (HBG1), lysosomal thioesterase PPT2 (PPT2) etc., and 11 up-regulated proteins including latent-transforming growth factor beta-binding protein 2 (LTBP2), very low-density lipoprotein receptor (VLDLR), laminin subunit alpha-2 (LAMA2), coagulation factor Ⅸ (F9).Among them, FREM2 was the most significantly differentially expressed protein in XFS group with consistent expression levels across individual samples.GO analysis revealed that these DEPs mainly localized to the extracellular matrix of collagen, bound globin-hemoglobin complex, plasma lipoprotein particles and lysosomes.Molecular functions and biological processes showed that HBD and HBG1 were involved in cellular detoxification, PPT2 in hydrolase activity, and BGN and LTBP2 in glycosaminoglycan binding.KEGG signaling pathway analysis indicated that CFHR1 and F9 were associated with complement and coagulation cascade pathways, and FREM2 and LAMA2 were linked to the extracellular matrix interaction pathway.Conclusions:Disease progression of XFS may be associated with changes in extracellular matrix proteins, disruption of the blood-aqueous humor barrier, and potential inflammatory responses.The significant down-regulation of FREM2 protein may be a potential biomarker for XFS.

Objective:To investigate the current status of bedside teaching at pediatric bases and existing problems in pediatric bedside teaching, and to discuss how to improve bedside teaching in pediatrics.Methods:A questionnaire on pediatric bedside teaching was administered to 475 instructors who had participated in the backbone teacher training course of pediatric standardized residency training bases in 2022. The instructors were divided into two groups according to their medical professional titles: attending physician group and associate chief physician/chief physician group. The general information, bedside teaching rate, bedside teaching difficulties, and abilities that need to be strengthened were compared between the two groups of instructors. SPSS 21.0 was used to perform the chi-square test.Results:A total of 475 instructors responded to the questionnaire. Among them, 96.84% (460/475) were from tertiary class-A hospitals; 54.11% (257/475) had more than 10 years of clinical teaching practice; and 97.26% (462/475) conducted bedside teaching, but the proportion of bedside teaching time in routine clinical teaching was low, with only 30.11% (143/475) reaching >50.00%. The main difficulties in bedside teaching in pediatrics included noisy environments at pediatric wards or clinics (75.58%, 359/475), the lack of teaching time (71.16%, 338/475), intense clinical pressure (64.63%, 307/475), poor cooperation with children (54.95%, 261/475), the presence of parents at pediatric wards or clinics (44.84%, 213/475), varying levels of qualifications of residents (41.68%, 198/475), and high pressure of scientific research (30.11%, 143/475). There were 41.20% (96/233) of the attending physicians and 28.57% (68/238) of the associate chief physicians/chief physicians spending less than 30.00% of their teaching time at the bedside, respectively, which were significantly different ( P<0.05). Conclusions:The low proportion of time spent on bedside teaching among pediatric instructors is driven by various factors such as noisy pediatric environments and the great clinical pressure of pediatric teachers.

Objective To investigate the expression of long non-coding RNA(lncRNA)brain-derived neurotrophic factor-antisense(BDNF-AS)and semaphorin 3B-antisense 1(SEMA3B-AS1)in patients with gastric cancer and the application value of combined ultrasound in the diagnosis of gastric cancer.Methods From January 2021 to February 2023,118 gastric cancer patients admitted to our hospital were retrospectively selected as the gastric cancer group,another 113 cases with benign gastric lesions in our hospital were as the benign lesion group.Real-time fluorescence quantitative PCR(qRT-PCR)was applied to detect the expression levels of serum BDNF-AS and SEMA3B-AS1,and patients were divided into BDNF-AS high expression group(n=55)and BDNF-AS low expression group(n=63),SEMA3B-AS1 high expression group(n=57),and SEMA3B-AS1 low expression group(n=61)based on the average value;Kappa test was applied to analyze the consistency between ultrasound diagnosis and clinical pathological diagnosis;receiver operating characteristic curve(ROC)was applied to analyze the diagnostic value of serum BDNF-AS and SEMA3B-AS1 combined with ultrasound for gastric cancer.Results Compared with the benign lesion group,the serum levels of BDNF-AS and SEMA3B-AS1 in the gastric cancer group were obviously lower(t=10.205,t=9.590,P＜0.05);the expression levels of BDNF-AS and SEMA3B-AS1 were obviously lower in gastric cancer patients with tumor diameter≥3 cm,deeper infiltration depth,lower differentiation,and lymph node metastasis(P＜0.05);Kappa test results showed a high consistency between ultrasound diagnosis and clinical pathological diagnosis(Kappa value=0.723,P＜0.05);ROC results showed that the AUC of serum levels of BDNF-AS,SEMA3B-AS1,and ultrasound in diagnosis of gastric cancer was 0.848,0.835,and 0.861,respectively,the AUC(0.949)diagnosed by the combination of the three was obviously higher than that diagnosed by serum BDNF-AS alone(Z=4.713,P=0.000),serum SEMA3B-AS1 level alone(Z=4.112,P=0.001 5),and ultrasound diagnosis(Z=3.350,P=0.000 8),the sensitivity and specificity of the combined diagnosis were superior to those diagnosed by the three alone.Conclusion The combination of serum BDNF-AS and SEMA3B-AS1 ultrasound has high practical value in the diagnosis of gastric cancer.

Objective:To construct a safety intelligent early warning system,and to explore its application effect in the management of medical equipment in laminar flow room of hematology department.Methods:The safety intelligent early warning system was constructed by using the browser and server(B/S)mode.The system was consisted of three layers:client layer,application server layer and database server layer,as well as four core modules:data acquisition,data transmission,data processing and data application.A total of 45 equipment in clinical use in the laminar flow room of the Department of Hematology,Tangdu Hospital,Air Force Medical University from November 2021 to October 2023 were selected.Routine management was implemented during the use period of the equipment from November 2021 to October 2022,and the safety intelligent early warning system management(hereinafter referred to as the intelligent management)was applied during the equipment use period from November 2022 to October 2023.The equipment safety risk evaluation index,the potential safety risk rate of the equipment sampled randomly and the average accuracy rate of the equipment use in 600 checks(300 times for each method)under the two management methods were compared.Results:The safety risk assessments of 45 equipment adopted the intelligent management method were poor,fair,good,and excellent with risk indices of 0.02±0.01,0.06±0.02,0.18±0.04 and 0.39±0.07,respectively,the poor,fair,and good risk indices were lower than those of routine management method,and the safety risk index assessed as excellent was higher than that of routine management method,the difference was statistically significant(t=19.092,12.457,6.751,15.809,P＜0.05).Among the 137 cases of 45 equipment randomly sampled using intelligent management method,4,5 and 1 cases of mechanical injury,cross-infection and electric shock injury occurred,with the incidence rates of 2.92％,3.65％and 0.73％,respectively,which were lower than those of routine management methods,the difference was statistically significant(x2=9.336,16.286,17.328,P＜0.05).The average accuracy rates(％)of the 45 equipment adopted the intelligent management method in terms of correct placement,correct connection sequence,correct parameter setting and organization and standard use of the equipment were 99.52±3.51,98.63±4.05,99.74±4.18 and 97.37±5.36,respectively,which were higher than those of the routine management method,the difference was statistically significant(Z=12.231,9.075,13.584,8.933,P＜0.05).Conclusion:The application of safety intelligent warning system for the equipment management of laminar flow room in the department of hematology can effectively prevent potential safety risks of the equipment and improve the accuracy of equipment use.