Objective:To investigate the impact of Tumor-Infiltrating Lymphocytes (TILs) density in the tumor stroma on the long-term prognosis of hepatocellular carcinoma (HCC) liver transplant patients meeting the Hangzhou criteria.Methods:This study is a retrospective cohort study. The clinical data of 83 patients with hepatocellular carcinoma who met the Hangzhou criteria and underwent allogeneic liver transplantation from January 2018 to December 2023 in the Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University were collected and analyzed. Hematoxylin and Eosin (HE) staining was used to study the density of TILs in the resected liver grafts. Patients were divided into TILs-negative group (TILs<10%, n=31) and TILs-positive group (TILs≥10%, n=52) based on whether the TILs density exceeded 10%. Clinical and pathological characteristics were analyzed, and the significance of alpha-fetoprotein (AFP), TILs density, and microvascular invasion on the prognosis of HCC patients who met the Hangzhou criteria was studied. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s) and compared between groups using t-test. Measurement data with skewed distribution were expressed as M ( Q1, Q3) and compared using rank-sum tests. Categorical data were compared using chi-square test. Kaplan-Meier method was used to study the relationship between various observation indicators and overall survival, and survival curves were plotted. Log-rank test was used to compare the survival rates between groups, and multivariate Cox regression model was used to adjust for the distribution of risk factors between groups. Results:The preoperative AFP level in the TILs-negative group was (15.69±1.21) U/mL, and in the TILs-positive group was (12.17±0.13) U/mL, with a statistically significant difference between the two groups ( P<0.05). In the TILs-negative group, 8 cases had microvascular invasion, and the number of low, moderate, and high differentiation tumors was 8, 23, and 0, respectively. In the TILs-positive group, 3 cases had microvascular invasion, and the number of low, moderate, and high differentiation tumors was 2, 31, and 19, respectively. The results indicated that patients in the TILs-negative group were more likely to have microvascular invasion and poorer tumor differentiation ( P<0.05). All patients were regularly followed up, and the 1-, 2-, and 3-year survival rates in the TILs-negative group and TILs-positive group were 84.0%, 77.6%, 69.8%, and 94.7%, 91.7%, 86.6%, respectively ( P<0.01). Cox proportional hazards model indicated that microvascular invasion ( RR=4.474, 95% CI: 1.172-17.072, P=0.028) and TILs-negative status ( RR=5.081, 95% CI: 1.420-18.184, P=0.012) were independent risk factors for the long-term prognosis of HCC patients who met the Hangzhou criteria. Conclusions:Among HCC patients meeting the Hangzhou criteria, the density of TILs in the tumor stroma is related to AFP levels, tumor differentiation, and the presence of microvascular invasion. TILs-negative status indicates a poorer prognosis for these patients.

Health system performance and its influencing factors are measured from a subjective perspective in the context of high-quality development.Using data from the Chinese Social Survey from 2015 to 2021,this study constructed a health system performance index from the perspective of the sense of acquisition of the population and analyzed the change trends and influencing factors of China's health system performance through a multilayer regression model.The results showed that the comprehensive index of health system performance in China increased by 12.47%(β=6.143,P<0.01)from 41.732 in 2015 to 46.935 in 2021,of which the process index increased by 4.57%(β=2.391,P<0.01)from 43.961 to 45.968,and the outcome index increased from 48.501 to 58.009,an increase of 19.60%(β=11.504,P<0.01).Meanwhile,the sense of access to health system performance showed obvious heterogeneity,with factors such as gender,age,education,marital status,employment status,economic status,type of health insurance and type of area of residence significantly affecting the sense of access to health system performance of residents.The health system performance in China in the context of high-quality development has significantly improved,and the sense of access of residents has significantly increased.However,the improvement in the process dimension of the health system is relatively limited,and"difficult and expensive to see a doctor"remains serious.It's necessary to strength the health system performance of vulnerable groups,as well as rural areas.

Objective:To evaluate the effect of preoperative chemotherapy on the intraoperative hemodynamics and quality of early postoperative recovery in patients undergoing tumor resection.Methods:This was a prospective cohort study. A total of 249 patients undergoing malignant tumor resection in the Affiliated Cancer Hospital of Xinjiang Medical University from January to August 2023 were divided into chemotherapy group (group C, n=104) and non-chemotherapy group (group N, n=145) based on their chemotherapy history. Heat rate and mean arterial pressure were recorded on admission (T 0), 1 min before endotracheal intubation (T 1), immediately after endotracheal intubation (T 2), at skin resection (T 3), 30 min after endotracheal incision (T 4), at the end of surgery (T 5) and 24 h after surgery (T 6), and the Quality of Recovery-15 score was recorded at T 6. The occurrence of hypoxemia, oropharyngeal airway implantation, bucking and aspiration after tracheal extubation was observed. The occurrence of postoperative nausea and vomiting was recorded. Results:Compared with group N, the mean arterial pressure was significantly decreased at T 1 and increased at T 2, 3, the heart rate was increased at T 2-5, the total Quality of Recovery-15 score, postoperative physical comfort score, emotional state score and pain score were decreased at T 6, and the incidence of hypoxemia and postoperative nausea and vomiting after tracheal extubation was increased in group C ( P<0.05). Conclusions:Preoperative chemotherapy can affect the intraoperative hemodynamic stability and the quality of early postoperative recovery is decreased in patients undergoing preoperative tumor resection.

Objective:To explore the clinical features of fatty liver disease (FLD) from non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MASLD), so as to elucidate its clinical application value under three renames.Methods:Patients who were hospitalized in the Department of Hepatology, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University, from January 2020 to September 2023 and met the diagnosis of NAFLD, metabolic-associated fatty liver disease (MAFLD), or MASLD were selected as the research subjects. The clinical indicators differences among the three groups of patients were compared, mainly including general information (age, gender, body mass index, past history, etc.), serological indicators (liver and kidney function, blood lipids, blood sugar, coagulation function, etc.), non-invasive liver fibrosis indicators, fat attenuation parameters, etc. Measurement data were analyzed using ANOVA and the rank sum test, while count data were analyzed using the χ2 test. Results:NAFLD, MAFLD, and MASLD prevalence rates among 536 cases were 64.0%, 93.7%, and 100%, respectively. 318 cases (59.3%) met the three fatty liver names at the same time among them. Male population proportions in NAFLD, MAFLD, and MASLD were 30.9%, 55.8%, and 53.9%, respectively. The alcohol consumption history proportion was 0, 36.7%, and 36.0%, respectively. The smoking history proportion was 7.0%, 31.9%, and 30.6%, respectively. The body mass index was (27.66 ± 3.97), (28.33 ± 3.63), and (27.90 ± 3.89) kg/m 2, respectively. The γ-glutamyltransferase levels were 26.6 (18.0, 47.0) U/L, 31.0 (20.0, 53.0) U/L, and 30.8 (19.8, 30.8) U/L, respectively. The high-density lipoprotein cholesterol levels were 1.07 (0.90, 1.23) mmol/L, 1.02 (0.86, 1.19) mmol/L, and 1.03 (0.87,1.21) mmol/L, respectively. Sequentially measured uric acid was (322.98 ± 84.51) μmol/L, (346.57 ± 89.49) μmol/L, and (344.89 ±89.67) μmol/L, respectively. Sequentially measured creatinine was 69.6 (62.9, 79.0) μmol/L, 73.0 (65.0, 83.5) μmol/L, and 73.0 (65.0, 83.0) μmol/L, respectively. The sequential analysis of obesity proportion was 74.3%, 81.7%, and 76.5%, respectively, with statistically significant differences ( P<0.05). Conclusion:Compared with the NAFLD population, the MAFLD and MASLD populations were predominantly male, obese, and had a history of smoking and drinking. The levels of γ-glutamyltransferase, uric acid, and creatinine were slightly higher, while the levels of high-density lipoprotein cholesterol were lower. MASLD appeared in NAFLD and MAFLD on the basis of inheritance and progression, emphasizing once again the important role of metabolic factors in a fatty liver.

Tropane alkaloids (TAs) are a class of anticholinergic drugs widely used in clinical practice and mainly extracted from plant, among which Atopa belladonna is the main commercial drug source. It is of great industrial value to obtain TAs in large quantities by plant metabolic engineering. In TAs pathway, cytochrome oxidase CYP82M3 catalyze the synthesis of tropinone and then tropinone reductase I (TRI) compete with TRII for tropinone to form tropine leading to the TAs synthesis (drainage). In this study, based on the "increasing flow and drainage" metabolic engineering strategy, two genes, namely HnCYP82M3 and DsTRI from Hyoscyamus niger and Datura stramonium, respectively, were overexpressed in the hair roots of A. belladonna, with a view to promote the TAs accumulation. The HnCYP82M3 gene was cloned from the root of H. niger, and it encoded amino acid with 91.7% sequence identity with AbCYP82M3 from A. belladonna. Overexpression of HnCYP82M3 alone did not affect the content of TAs in hair roots of A. belladonna, indicating that CYP82M3 was not a key enzyme in TAs biosynthesis. Simultaneous overexpression of HnCYP82M3 and DsTRI greatly promoted the accumulation of the three TAs, and the contents of hyoscyamine, anisodamine and scopolamine were 4.97 times, 2.83 times and 2.19 times that of the control, respectively, and the increase amplitude was greater than that of single overexpression of DsTRI. This study showed that the "increasing flow and drainage" strategy of enzyme genes co-expression at branch points was a promising metabolic engineering method to effectively improve the biosynthesis of TAs in A. belladonna, and laid a theoretical and technical foundation for the large-scale industrial acquisition of TAs.

Conventional chemotherapy based on cytotoxic drugs is facing tough challenges recently following the advances of monoclonal antibodies and molecularly targeted drugs. It is critical to inspire new potential to remodel the value of this classical therapeutic strategy. Here, we fabricate bisphosphonate coordination lipid nanogranules (BC-LNPs) and load paclitaxel (PTX) to boost the chemo- and immuno-therapeutic synergism of cytotoxic drugs. Alendronate in BC-LNPs@PTX, a bisphosphonate to block mevalonate metabolism, works as both the structure and drug constituent in nanogranules, where alendronate coordinated with calcium ions to form the particle core. The synergy of alendronate enhances the efficacy of paclitaxel, suppresses tumor metastasis, and alters the cytotoxic mechanism. Differing from the paclitaxel-induced apoptosis, the involvement of alendronate inhibits the mevalonate metabolism, changes the mitochondrial morphology, disturbs the redox homeostasis, and causes the accumulation of mitochondrial ROS and lethal lipid peroxides (LPO). These factors finally trigger the ferroptosis of tumor cells, an immunogenic cell death mode, which remodels the suppressive tumor immune microenvironment and synergizes with immunotherapy. Therefore, by switching paclitaxel-induced apoptosis to mevalonate metabolism-triggered ferroptosis, BC-LNPs@PTX provides new insight into the development of cytotoxic drugs and highlights the potential of metabolism regulation in cancer therapy.

Objective:To explore the influence of different depths of anesthesia under guidance of anesthesia depth detector on the awakening quality of elderly patients with colon cancer after laparoscopic surgery.Methods:A total of 96 elderly patients with colon cancer who underwent surgical resection and admitted to Beijing Changping District Hospital from February 2017 to June 2020 were selected.They were randomly divided into mild anesthesia group,moderate anesthesia group and deep anesthesia group according to the random sampling,with 32 in each group.The bispectral index(BIS)of deep anesthesia group was within 30-39 interval,and the BIS of moderate anesthesia group was within 40-49 interval,and the BIS of mild anesthesia group was within 50-60 interval.The Prince-Henry pain scale scores of patients with different depths of anesthesia under anesthesia depth detector were observed.The stress response-related indicators included adrenocorticotropic hormone(ACTH),cortisol(Cor)and interleukin-6(IL-6)of patients at three different time points:pre operation(S1),intra operation(S2)and post operation(S3)were monitored.Additionally,the differences of the incidences of complications and the cognitive function also were analyzed.Results:The postoperative Prince-Henry pain scores of the three groups of patients with colon cancer showed there were no statistically significant differences among anesthesia groups with different depths(P>0.05).The stress response indicators included ACTH,Cor and IL-6 appeared significant time-dependent changes among anesthesia groups with different depths.The stress response indicators of all groups significantly increased at S2 point,and the ACTH,Cor and IL-6 levels of mild anesthesia group were respectively(13.73±1.63)nmol/L,(269.24±31.46)nmol/L and(83.67±3.44)μg/L,and these of moderate anesthesia group were respectively(18.26±2.52)nmol/L,(242.56±36.75)nmol/L and(109.35±6.44)μg/L,and these of deep anesthesia group were respectively(19.42±2.42)nmol/L,(432.35±31.34)nmol/L and(132.42±2.31)μg/L.There were significant differences in these indicators in same group between S2 point and S1 point(tmild group=7.99,12.48,16.48,tmoderate group=2.19,6.82,3.03,tdeep group=14.21,5.11,20.14,P＜0.05),respectively.The differences of the incidence rates of complication between the mild anesthesia group and the moderate anesthesia group,and between the mild anesthesia and the deep anesthesia group were statistically significant(x2=6.342,5.238,P<0.05),respectively.The MMSE scores 24 hours after surgery indicated that the difference of that between mild anesthesia group and deep anesthesia group,and between moderate anesthesia group and deep anesthesia group were significant(t=4.74,3.77,P<0.05),respectively.Conclusion:The depth of anesthesia has a significant influence on postoperative recovery quality,stress response and cognitive function.Using anesthesia depth detector to adjust the different depth of anesthesia can help to improve the awakening quality of elderly patients with colon cancer post-surgery and reduce the incidence of adverse reactions.

Objective To explore the application effect of enteral nutrition-related diarrhea in postoperative esophageal cancer patients.Methods Based on literature search and expert meeting,a management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients was constructed.A convenience sampling method was used to select a total of 68 patients with enteral nutrition-related diarrhea after esophageal cancer surgery admitted to the thoracic surgery department of a tertiary A cancer hospital in Jiangsu Province.Among them,patients admitted from January 2022 to December 2022 were set as an experimental group.The experimental group was implemented the management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients.Those admitted from January 2021 to December 2021 were set as a control group with routine nursing.Then,the time of stopping diarrhea,the King's of Stool Chart(KSC-Tr)diarrhea score,and abnormal incidence of nutrition-related indexes,electrolytes abnormalities(low sodium,low potassium,and low calcium)were compared between 2 groups.Results The time of stopping diarrhea,KSC diarrhea score after 3 days of intervention and the time to achieve target feeding volume of the experimental group were lower than those in the control group,and the difference was statistically significant(P＜0.05).There were no significant differences in hemoglobin,albumin,prealbumin after 3 days of intervention,the incidence of electrolyte abnormalities(low sodium,low potassium,and low calcium)after 3 days of intervention,and the BMI index after 7 days of intervention between 2 groups(P＞0.05).Conclusion The management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients can reduce the time of diarrhea,improve the severity of diarrhea,and shorten the time to achieve the target feeding,but has no significant change in the incidence of electrolyte abnormalities.

The pulsatile flow experiment can not only evaluate the preclinical safety and risk of prosthetic heart valve (PHV) but also play an important role in the computational model and fluid simulation, providing an experimental basis for the performance optimization of PHV. This paper mainly reviews the development and the latest progress of PHV pulsatile flow experiments and the characteristics of experimental pulse duplicator, and discuss the research direction of pulsatile flow experiments, expecting a further development in this field.

Based on the traditional Chinese medicine （TCM）'s understanding of consumptive thirst disease and modern medicine's understanding of the etiology of diabetes mellitus and the evolution of the disease， this article discussed the rationality and clinical significance of using "sugar collateral disease" as the name of diabetes mellitus in TCM， to provide a reference for modernization and development of TCM diseases' names. It is argued that the clinical manifestations described in the TCM disease name of consumptive thirst disease are only at a certain stage of diabetes mellitus， and it is difficult to cover the clinical characteristics of modern diabetes mellitus comprehensively. In 2003， academician TONG Xiaolin proposed to use "sugar collateral disease" as the TCM disease name of diabetes mellitus， which on the one hand can reflect the essence of diabetes mellitus， and on the other hand can embody the disease location， disease mechanism and the evolution of the disease， highlight the harms of complications， and serve as a warning for the early diagnosis and treatment of the disease， which can help to enhance the level of diagnosis and treatment of diabetes mellitus in TCM.