This paper summarizes Professor WANG Xiuxia's clinical experience in treating hyperprolactinemia using the liver soothing therapy. Professor WANG identifies liver qi stagnation and rebellious chong qi （冲气） as the core pathomechanisms of hyperprolactinemia. Furthermore， liver qi stagnation may transform into fire or lead to pathological changes such as spleen deficiency with phlegm obstruction or kidney deficiency with essence depletion. The treatment strategy centers on soothing the liver， with a modified version of Qinggan Jieyu Decoction （清肝解郁汤） as the base formula. Depending on different syndrome patterns such as liver stagnation transforming into fire， liver stagnation with spleen deficiency， or liver stagnation with kidney deficiency， heat clearing， spleen strengthening， or kidney tonifying herbs are added accordingly. In addition， three paired herb combinations are commonly used for symptom specific treatment， Danggui （Angelica sinensis） with Chuanxiong （Ligusticum chuanxiong）， Zelan （Lycopus lucidus） with Yimucao （Leonurus japonicus） ， and Jiegeng （Platycodon grandiflorus） with Zisu （Perilla frutescens）.

Objective To explore the association of working hours and shift work with occupational stress, fatigue accumulation, and depressive symptoms among primary community medical workers. Methods A total of 516 medical workers from five community medical service centers in Pudong New Area, Shanghai City, were selected as the research subjects using the convenience sampling method. The Core Scale of Occupational Stress Measurement, the Workers' Fatigue Accumulation Self-diagnosis Questionnaire, and the Patient Health Questionnaire were used to assess research subjects' occupational stress, fatigue accumulation, and depressive symptoms, respectively. Results Long working hours (>40 hours/week) were reported by 50.4% of workers among the research subjects, while shift works were reported by 16.9% of the workers. The detection rates of occupational stress, fatigue accumulation, and depressive symptoms were 26.6%, 41.7%, and 30.8%, respectively. Multivariate logistic regression analysis result revealed that, after adjusting for confounders such as age, sex, and education level, longer working hours were associated with higher risks of occupational stress, fatigue accumulation, and depressive symptoms (all P<0.05). Shift workers in community medical centers had higher risks of occupational stress, fatigue accumulation, and depressive symptoms compared with non-shift workers (all P<0.05). Conclusion Long working hours and shift work could increase the risks of occupational stress, fatigue accumulation, and depressive symptoms among community medical workers.

The glucagon receptor (GCGR) is a critical target for the treatment of metabolic disorders such as Type 2 Diabetes Mellitus (T2DM) and obesity. Activation of GCGR enhances systemic insulin sensitivity through paracrine stimulation of insulin secretion, presenting a promising avenue for treatment. However, the discovery of effective GCGR agonists remains a challenging and resource-intensive process, often requiring time-consuming wet-lab experiments to synthesize and screen potential compounds. Recent advances in artificial intelligence technologies have demonstrated great potential in accelerating drug discovery by streamlining screening and efficiently predicting bioactivity. In the present work, we propose DeepGCGR, a two-layer deep learning model that leverages graph convolutional networks (GCN) integrated with a multiple attention mechanism to expedite the identification of GCGR agonists. In the first layer, the model predicts the bioactivity of various compounds against GCGR, efficiently filtering large chemical libraries to identify promising candidates. In the second layer, DeepGCGR classifies high bioactive compounds based on their functional effects on GCGR signaling, identifying those with potential agonistic or antagonistic effects. Moreover, DeepGCGR was specifically applied to identify novel GCGR-regulating compounds for the treatment of T2DM from natural products derived from traditional Chinese medicine (TCM). The proposed method will not only offer an effective strategy for discovering GCGR-targeting compounds with functional activation properties but also provide new insights into the development of T2DM therapeutics.
Deep Learning ; Drug Discovery/methods* ; Humans ; Diabetes Mellitus, Type 2/metabolism* ; Medicine, Chinese Traditional ; Drugs, Chinese Herbal/pharmacology*

Ferroptosis has received great attention as an iron-dependent programmed cell death for efficient cancer therapy. However, with the accumulation of iron in tumor cells, the antioxidant system is activated by reducing glutathione (GSH) with glutathione peroxidase 4 (GPX4), which critically limits the ferroptosis therapeutic effect. Herein, an iron and GPX4 silencing siRNA (siGPX4) co-encapsulated ferritin nanocage (HFn@Fe/siGPX4) was developed to enhance ferroptosis by disruption of redox homeostasis and inhibition of antioxidant enzyme synergistically. The siGPX4 were loaded into the nanocages by pre-incubated with iron, which could significantly improve the loading efficiency of the gene drugs when compared with the reported gene drug loading strategy by ferritin nanocages. And more iron was overloaded into the ferritin through the diffusion method. When HFn@Fe/siGPX4 was taken up by human breast cancer cell MCF-7 in a TfR1-mediated pathway, the excess iron ions in the drug delivery system could for one thing induce ferroptosis by the production of reactive oxygen species (ROS), for another promote siGPX4 escaping from the lysosome to exert gene silencing effect more effectively. Both the in vitro and in vivo results demonstrated that HFn@Fe/siGPX4 could significantly inhibit tumor growth by synergistical ferroptosis. Thus, the developed HFn@Fe/siGPX4 afforded a combined ferroptosis strategy for ferroptosis-based antitumor as well as a novel and efficient gene drug delivery system.

Objective To compare the effects of nalbuphine combined with etomidate and nalbuphine combined with propofol in painless colonoscopy for elderly patients with hypertension. Methods Elderly patients with hypertension who underwent painless colonoscopy in the Department of Anesthesiology of Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from August 2022 to February 2023 were selected and randomly divided into three groups: nalbuphine combined with etomidate group (E group), nalbuphine combined with propofol group (P group), and the nalbuphine combined with etomidate and propofol group (EP group). The primary endpoint was the incidence of hypotension during anesthesia. Secondary endpoints included mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) at five time points: before anesthesia (T₀), before colonoscopy (T₁), 5 minutes after colonoscopy (T₂), at the end of the examination (T₃), upon leaving the post-anesthesia care unit (PACU, T₄). Additionally, examination time, awakening time, Ramsay score, and adverse reactions were compared among the three groups. Results A total of 180 patients were included in the analysis, with 60 cases in each group. The incidence of hypotension was 11.7%, 55.0%, and 33.3% in the E group, P group, and EP group, respectively. The incidence of hypotension in the E group was lower than that in the P and EP groups (P＜0.05). At T₁, T₂, T₃, and T₄, MAP, SBP, and DBP in the E group were significantly higher than those in the P and EP groups (P＜0.05). There were no statistically significant differences among the three groups in awakening time, Ramsay score, or incidence of adverse reactions. Conclusions Compared with nalbuphine combined with propofol, nalbuphine combined with etomidate for painless colonoscopy in elderly patients with hypertension resulted in a lower incidence of hypotension, less impact on hemodynamics, and higher safety.

The volume of research funding in public hospitals is increasing year by year,with the majority of research funding being used to purchase research materials and services.Traditional offline procurement methods have problems such as inadequate management systems,difficulty in ensuring product quality,blind spots in procurement processes,and high risks in invoice receipt and storage.Public hospitals urgently need to adopt digital methods,introduce research procurement platforms,and implant key control points into the platform based on reshaping the procurement business process,achieve full process supervision and traceability control of research procurement business,and strengthen internal control and risk management of research

Frailty is a complex age-related clinical condition characterized by a decline in physiological capacity across several organ systems, with a resultant increased susceptibility to stressors.The relationship between frailty assessment and elderly patients’ safety during perioperative period has received widespread attention.This paper reviews research progress of frailty assessment in elderly patients during perioperative period in the department of urology.

Background Sleep quality is one of the important factors affecting soldiers’ task performance. Objective To explore the effects of mindful attention awareness, burnout, and occupational stress on sleep quality among soldiers in plateau areas. Methods A total of 1090 soldiers were selected from four units in plateau areas by cluster sampling method and were asked to participate a cross-sectional questionnaire survey using the Pittsburgh Sleep Quality Index (PQSI), Occupational Stress Inventory (OSI), Maslach Burnout Inventory-General Survey (MBI-GS), and Mindful Attention Awareness Scale (MAAS). Correlation analysis, regression analysis, and mediated effect test were conducted for the study. Results Of the 1090 soldiers recruited, 1082 soldiers returned valid questionnaires, and the valid recovery rate was 99.26%. The median (P₂₅, P₇₅) score of PSQI was 4.00 (2.00,7.00), the median score of OSI was 26.00 (17.00, 34.00), the median score of MBI-GS was 3.53 (3.13, 4.00), and the median score of MAAS was 71.00 (59.00, 82.00). The burnout and mindful attention awareness levels varied among military personnel of different age groups (P<0.05), so did the burnout and occupational stress levels among military personnel of different length of service groups (P<0.05), and the occupational stress, PSQI, burnout, and mindful attention awareness levels among military personnel with different educational backgrounds and genders (P<0.05). The results of mediated effect test showed that occupational stress and burnout had both a parallel mediated effect and a sequential mediating effect on the relationship between mindful attention awareness and sleep quality, with effect sizes of 15.3%, 21.5% and 31.8%, respectively. Conclusion There is a mediated effect on the relationship between mindful attention awareness and sleep quality by the occupational stress and burnout of military personnel in plateau areas, and sleep quality is also affected by mindful attention awareness through the chain-mediated effect of occupational stress and burnout.

Objective:To study the risk factors of venous thromboembolism(VTE)and the predictive value of the improved VTE score model to identify the risk of VTE in gynecological surgery patients.Methods:From Janu-ary 1,2020 to December 31,2022,41 patients with VTE after gynecological surgery were selected as the VTE group,and a total of 164 patients with adjacent gynecological surgeries during the same period were selected as the non-VTE group with a ratio of 1 :4.Univariate and multivariate Logistic regression analysis were used to ana-lyze the risk factors of VTE after gynecological surgery,and a modified VTE risk factor rapid assessment model(referred to as the improved VTE score model)was constructed.The receiver operating characteristic(ROC)curve was used to study the predictive value for VTE for in gynecological surgery,and compared with the Caprini score model(Caprini table for short).Results:①Multivatiate Logistic regression analysis showed that there were independent risk factors for postoperative VTE in gynecology surgery(OR＞1,P＜0.05),including age≥60 years,BMI≥28 kg/m2,malignant tumors,surgery time＞3 hours,history of thrombosis,and the increased D-di-mer difference before and after surgery.②The Area under Curve(AUC)of ROC was 0.963 in the improved VTE score model with a Youden index 81.10％,sensitivity 87.80％and specificity 93.29％.The AUC of the Caprini score model was 0.888 with Youden index 63.41％,sensitivity 73.17％and specificity 90.24％.The improved VTE score model the Caprini score model identified 92.68％and 85.37％of VTE patients as high-risk or ex-tremely high-risk,respectively,but the difference was not statistically significant(P＜0.05).Conclusions:More attention should be paid to the six independent risk factors for postoperative VTE in gynecology surgery.The two score models showed a similar identified level.However,the improved VTE score model is more simple and easier to operate,has better practicality,and has certain clinical promotion value.