OBJECTIVE: This study aimed to explore the association between body mass index (BMI) and mortality based on the 10-year population-based multicenter prospective study. METHODS: A general population-based multicenter prospective study was conducted at four sites in rural China between 2013 and 2023. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to assess the association between BMI and mortality. Stratified analyses were performed based on the individual characteristics of the participants. RESULTS: Overall, 19,107 participants with a sum of 163,095 person-years were included and 1,910 participants died. The underweight (< 18.5 kg/m ²) presented an increase in all-cause mortality (adjusted hazards ratio [ aHR] = 2.00, 95% confidence interval [ CI]: 1.66-2.41), while overweight (≥ 24.0 to < 28.0 kg/m ²) and obesity (≥ 28.0 kg/m ²) presented a decrease with an aHR of 0.61 (95% CI: 0.52-0.73) and 0.51 (95% CI: 0.37-0.70), respectively. Overweight ( aHR = 0.76, 95% CI: 0.67-0.86) and mild obesity ( aHR = 0.72, 95% CI: 0.59-0.87) had a positive impact on mortality in people older than 60 years. All-cause mortality decreased rapidly until reaching a BMI of 25.7 kg/m ² ( aHR = 0.95, 95% CI: 0.92-0.98) and increased slightly above that value, indicating a U-shaped association. The beneficial impact of being overweight on mortality was robust in most subgroups and sensitivity analyses. CONCLUSION This study provides additional evidence that overweight and mild obesity may be inversely related to the risk of death in individuals older than 60 years. Therefore, it is essential to consider age differences when formulating health and weight management strategies.
Humans ; Body Mass Index ; China/epidemiology* ; Male ; Female ; Middle Aged ; Prospective Studies ; Rural Population/statistics & numerical data* ; Aged ; Follow-Up Studies ; Adult ; Mortality ; Cause of Death ; Obesity/mortality* ; Overweight/mortality*

Objective This study aimed to comprehensively analyze and compare the clinicopathological features and prognosis of Chinese patients with human epidermal growth factor receptor 2(HER2)-low early breast cancer(BC)and HER2-IHC0 BC. Methods Patients diagnosed with HER2-negative BC(N=999)at our institution between January 2011 and December 2015 formed our study population.Clinicopathological characteristics,association between estrogen receptor(ER)expression and HER2-low,and evolution of HER2 immunohistochemical(IHC)score were assessed.Kaplan-Meier method and log-rank test were used to compare the long-term survival outcomes(5-year follow-up)between the HER2-IHC0 and HER2-low groups. Results HER2-low BC group tended to demonstrate high expression of ER and more progesterone receptor(PgR)positivity than HER2-IHC0 BC group(P<0.001).The rate of HER2-low status increased with increasing ER expression levels(Mantel-Haenszel χ2 test,P<0.001,Pearson's R=0.159,P<0.001).Survival analysis revealed a significantly longer overall survival(OS)in HER2-low BC group than in HER2-IHC0 group(P=0.007)in the whole cohort and the hormone receptor(HR)-negative group.There were no significant differences between the two groups in terms of disease-free survival(DFS).The discordance rate of HER2 IHC scores between primary and metastatic sites was 36.84%. Conclusion HER2-low BC may not be regarded as a unique BC group in this population-based study due to similar clinicopathological features and prognostic roles.

The compounds were isolated and purified by silica gel, MCI, Sephadex LH-20 and semi-preparative high performance liquid chromatography. The structures of the compounds were determined by NMR and MS spectroscopic data. Twenty monomer compounds were isolated from the ethyl acetate extract of Lindera reflexa root from Hunan province, and identified as: (1″S,3″S,6″R)-2′,4′,6′-trihydroxy-3′-[1″-(3″-hydroxy)-p-menthanyl]-chalcone (1), sumadain D (2), quercetin (3), catechin (4), epicatechin (5), N-cis-feruloyltyramine (6), N-trans-feruloyltyramine (7), N-trans-feruloyl-3-methoxytyramine (8), flavifloramides B (9), northalifoline (10), isolariciresinol (11), syringaresinol (12), pinoresinol (13), medioresinol (14), dehydroconiferyl alcohol (15), 4-methoxyl-denudaquinol (16), miliusanal (17), syringic acid (18), abscisic acid (19), (E)-cinnamyl-(E)-cinnamate (20). Compound 1 is a new compound, and compounds 2‒20 have been isolated from Lindera reflexa for the first time. The results showed that compounds 1, 2, 3 and 16 could significantly reduce the survival ability of MGC-803 cells with IC₅₀ values of 5.58, 23.41, 25.72 and 20.96 μmol·L^-1, respectively. Compounds 5 and 20 can reduce the survival ability of MGC-803 cells with IC₅₀ values of 98.83 and 89.26 μmol·L^-1, respectively.

Celastrol and wilforlide A are the main active triterpenoids of the traditional Chinese medicine Lei Gong Teng, which have anti-tumour, anti-inflammatory and immunosuppressive activities, and are the material basis for the clinical efficacy of Lei Gong Teng-related Chinese medicinal preparations. By analysing the biosynthetic pathway of active ingredients, optimizing genetic elements and utilizing "cell factory" to produce triterpenoids heterologously will be an effective way to obtain from Tripterygium wilfordii in the future in a "low-cost and high-efficient" manner. CYP712Ks are the first cytochrome P450s involved in the skeleton modification of friedelane-type and oleanane-type triterpenoids in T. wilfordii, and they can catalyse the generation of polpunonic acid from friedelin and 3-epi-katonic acid from β-amyrin by carboxylation at C-29 position. In this study, four multifunctional TwCYP712K1/2/3/5 were used to clarify the catalytic function and substrate selection preference using in vivo functional characterization in Saccharomyces cerevisiae. The spatial structure of the protein-substrate binding was clarified through homology modeling and molecular docking, and then the differential amino acids in the active pocket of the protein were mutated to clarify the crucial amino acids determining the catalytic function and the selection of substrate structure. A total of 63 mutant elements were constructed, and the amino acid sites affecting the carboxylation function of TwCYP712Ks were analyzed. In particular, the key amino acids affecting the substrate selectivity of TwCYP712K2 towards oleanane-type and friedelane-type triterpenoids were revealed and the TwCYP712K2^F127I and TwCYP712K2^A227T mutants would result in a reversal of the product ratio. In conclusion, four proteins of TwCYP712Ks were semi-rationally designed by homologous protein alignment and mutual mutation to elucidate multiple amino acid sites determining the catalytic function of the proteins, and a series of activity-enhancing or altering mutants were obtained, which provide abundant catalytic elements for the biosynthesis of active triterpenoids from T. wilfordii, and the mechanism of carboxylation in the C-29 position was initially elucidated.

In the process of seeking new strategies to improve the efficacy of antidepressants,traditional Chinese medicine inter-vention has gradually revealed its unique prevention and treat-ment advantages.The dopamine reward system is closely in-volved in the pathological occurrence and development of depres-sion.Currently,research has mostly focused on the functional mechanism of a specific nucleus in the dopamine reward system,and there is less research focused on the functional mechanism of the neural circuit.In the current micro research on reward cir-cuits,the association between abnormal reward circuits and neg-ative emotions such as anxiety and depression has been widely recognized.Traditional Chinese medicine intervention can exert antidepressant effects by influencing reward circuits.This article provides a review on the loop mechanism of dopamine reward system involvement in depression and research on traditional Chinese medicine intervention.

We investigated the prevalence and spatial distribution characteristics of T.gondii infection in cats in China,to provide a scientific basis for the prevention and con-trol of T.gondii.We searched PubMed,CNKI,Wanfang Da-tabase,and Baidu Academic Database to retrieve studies on the seroprevalence of T.gondii in domestic cats published by December 31,2023,in China,to investigate the spatial loca-tion and expression of T.gondii infection in China by using Geographical Information Systems(GIS).SPSS 26.0 software was used for statistical analysis.A total of 86 eligible studies published between 1984 and 2023 were included in this study,covering 28 provincial administrative regions and involving 20 722 cats.The ArcGIS classification results indicated that the overall positivity rate of T.gondii in domestic cats was 14.78％(3 080/20 836,95％CI:14.07％-15.03％).No epidemiological study of T.gondii infection in cats has been reported in Tibet,Tianjin,Hainan,Hong Kong,Ma-cao,or Taiwan.The prevalence of T.gondii infection in cats was highest in Shanxi Province(60％,54/90,95％CI:49.82％-70.18％),followed by Hebei Province(57.33％,43/75,95％CI:46.07％-68.59％),Henan Province(45.53％,173/380,95％CI:46.07％-68.59％),and Yunnan Province(43.64％,24/55,95％CI:30.49％-56.79％).The lowest seroprevalence of T.gondii antibody was found in Jiangxi Province(2.47％,2/81,95％CI:-0.90％-5.90％).Furthermore,the seropreva-lence of T.gondii in cats in northern China was 14.12％(2 044/14 491 95％CI:12.34％-15.90％),whereas that in southern China was 16.30％(1 036/6 355 95％CI:15.40％-17.20％).Significant differences were observed between them(x2=16.60,P＜0.05).The temporal distribution results indicated a decrease in the overall seroprevalence of T.gondii in cats in China from 1984 to 2023.Our findings suggested that T.gondii in cats is widespread in China,with a stable epidemic cycle,and the rates of Toxoplasma positivity vary greatly among regions.The increasing prevalence of pet cats in China,and the close rela-tionship between these cats and humans,may pose substantial exposure risks to a large susceptible population.Therefore,the association between cat ownership and T.gondii infection in humans,and how to decrease human environmental contamination through cat exposure to T.gondii and T.gondii oocysts,requires further investigation.

Objective To explore the clinical value of anti-Müllerian hormone(AMH)to optimize endocrine therapy for peri-menopausal early breast cancer.Methods Two hundred and four patients of pre-menopausal breast cancer aged 45-55 years old between 2020 and 2023 were enrolled,and AMH≤0.1 ng/mL was considered as cut-off value for menopause.Switching from selective estrogen receptor modulator(SERM)to aromatase inhibitor aromatase inhibitor(AI)and initial endocrine therapy regimens were based on AMH,follicle-stimulating hormone(FSH)and estradiol(E2).Results Pre-chemotherapy AMH level was significantly negatively correlated with FSH level(P<0.001).Among 100 cases who were amenorrhea for one year during SERM treatment,42 cases did not have AMH testing.Fourteen out of the 42 cases switched to AI within one year,and ovarian function recovery(OFR)occurred in 2 cases after AI switching.Fifteen cases with AMH>0.1 ng/mL did not switch to AI within one year.Forty among 43 cases with AMH≤0.1 ng/mL switched to AI,after a significantly shorter median SERM treatment duration(3.15 months vs.8.14 months,P<0.001)and a significantly lower OFR rate(0 vs.12.5%,P=0.023)compared with those who did not test AMH but switched to AI.AMH≤0.1 ng/mL was an independent risk factor of transition to menopause shortly in peri-menopausal patients(OR=35.857,P<0.001).Among 104 cases with AMH tested before adjuvant chemotherapy,69 cases had AMH>0.1 ng/mL.Thirty-one out of the 69 cases were treated with ovarian function suppression(OFS)initially and 38 with SERM initially.Thirty-five cases with AMH≤0.1 ng/mL were all treated with SERM initially,with a higher rate of switching to AI(71.4%vs.23.7%,P<0.001)and a shorter SERM treatment duration(6.52 months vs.13.56 months,P=0.016)compared with the 38 cases(AMH>0.1 ng/mL)treated initially with SERM.After a median 30-month follow-up,no recurrence was observed in these thirty-five cases treated with SERM initially and AMH≤0.1 ng/mL,just like in OFS group.And they had a tendency of improved survival outcome compared with those treated with SERM initially and AMH>0.1 ng/mL(Log Rank P=0.076).Conclusion AMH could evaluate and predict menopause accurately,resulting in optimizing endocrine therapy for peri-menopausal patients effectively and safely.

Hereditary breast cancer refers to breast cancer with a genetic susceptibility gene.PTEN germline mutations are rare in breast cancer,but patients with PTEN mutations have a high risk of breast cancer.In 2021,A young patient with bilateral breast cancer was admitted to the Obstetrics and Gynecology Hospital,Fudan University.Due to bilateral multiple breast lumps,she underwent Vacuum-Assisted Breast Biopsy,which was pathologically confirmed as right ductal carcinoma in situ,left breast invasive carcinoma.The patient had multiple neoplasms in bilateral axillary region skin,neck skin and bilateral inguinal regiona skin,and the second-generation sequencing results of peripheral blood genes showed PTEN gene mutation.Combined with family history,the patient was diagnosed with Cowden syndrome(CS).Such patients should be paid attention to cancer risk management and family management,so as to attain early diagnosis and treatment.

Objective To develop a medical positive pressure protective suit for long-voyage aeromedical evacuation to realize protective isolation and drinking water and energy supply for medical personnel during long-voyage aeromedical evacuation of respiratory infectious disease patients.Methods The medical positive pressure protective suit had a one-piece structure,with its main part made of hydroentangled non-woven fabric,head and forebreast parts made of amorphous polyethylene terephthalate anti-fog material and wearing-and taking-off parts sealed with zipper and autohesion,which was equipped with a portable positive pressure air supply device,an airborne centralized positive pressure air supply device and a monitoring and warning device.The portable positive pressure air supply device was fixed in the back of the suit at the waist,the airborne device was made by modifying the commercially available positive pressure air supply fan,and the monitoring and warning device monitored the air supply volume of the fan,the battery power and the pressure inside the suit.Results The suit behaved well in protection,clean fresh air supply without time limitation and facilitating hydration and energy replenishment of medical personnel by forming three activity spaces.Conclusion The suit developed can continuously provide a clean and comfortable microenvironment,meeting the requirements of medical personnel for protection and hydration and energy replenishment during long-voyage aeromedical evacuation.[Chinese Medical Equipment Journal,2024,45(11):113-116]

With the development of molecular pharmacognosy, the advantages of DNA molecular markers in the identification of original plants of Chinese medicinal materials are becoming increasingly significant. To compensate for the limitations of existing markers in the quality supervision of Chinese medicinal materials, our team has independently designed a new molecular marker named DNA signature sequence(DSS). This marker is a nucleotide sequence that only appears in a specific taxonomic unit, with a length of 40 bp and high identification accuracy. This article aims to screen and verify the DSS markers that can accurately identify the original plants of the medicinal materials included in the volume one of the Chinese Pharmacopoeia, establish the operating procedure for developing standard nucleotide sequences, and lay a foundation for the widespread application of polymerase chain reaction in the quality supervision of traditional Chinese medicine. Firstly, the Chloroplast Genome Information Resource(CGIR) was searched for the chloroplast genome sequences of the test samples, species of the same genus, and common background species. IdenDSS was used to obtain the DSS tags and specific identification primers of the tested species. After DNA extraction, PCR amplification, sequencing, and sequence alignments, a total of 203 DSS markers of Chinese medicinal materials were obtained for validation. The above sequences were uploaded to the Traditional Chinese Medicine Molecular Identification Platform(www.herbsdna.com), and a standard DSS library was established for identifying the original plants of medicinal materials, serving as an important tool for quality supervision of Chinese materia medica. On this basis, an operating procedure for DSS development is formed, laying a foundation for further DSS screening and application based on more diverse genome sequences.
Plants, Medicinal/classification* ; DNA, Plant/genetics* ; Drugs, Chinese Herbal ; Pharmacopoeias as Topic ; Genetic Markers ; Medicine, Chinese Traditional