Objective To elucidate the molecular mechanism by which exosomes (Exo) derived from cancer-associated fibroblasts (CAF) carrying HOX transcript antisense intergenic RNA (lncRNA HOTAIR) promote the metastasis of esophageal squamous cell carcinoma (ESCC). Methods CAFs were collected from tumor tissues, and non-cancer associated fibroblasts (NFs) were obtained from adjacent normal tissues at least 5 cm away from the tumor. Exosomes (CAFs-Exo and NFs-Exo) were isolated from conditioned media collected from CAFs or NFs. CAFs-Exo and NFs-Exo were incubated with human ESCC cell line TE-1 for 24 hours, and CCK-8 was used to determine the cell proliferation ability. Scratch test and Transwell test were performed to determine the cell migration and invasion ability. TE-1 cells were divided into the following two groups: NC group and KD group. The NC group and KD group were transfected with control siRNAs or siRNAs targeting HOTAIR respectively. The effects of HOTAIR knock-down on cell proliferation, migration, invasion and glycolysis were determined. Results CAFs-Exo promoted the proliferation of TE-1 cells more significantly than NFs-Exo. Compared with NFs-Exo group, the migration and invasion ability of TE-1 cells treated with CAFs-Exo were improved significantly. In addition, CAFs-Exo treatment inhibited the expression of E-cadherin and enhanced the expression of N-cadherin. The expression of HOTAIR in CAFs was significantly higher than that in NFs. Compared with NFs-Exo, the expression level of HOTAIR in CAFs-Exo increased significantly. Compared with NC group, the proliferation, migration and invasion of TE-1 cells in KD group decreased significantly. Compared with NC group, hexokinase 2 (HK2), extracellular acidification rate (ECAR) and ATP/ADP ratio of TE-1 cells in KD group decreased significantly. Conclusion HOTAIR, an exosome derived from CAFs, may be involved in metastasis and EMT by regulating glycolysis in ESCC cells.
Humans ; RNA, Long Noncoding/metabolism* ; Esophageal Neoplasms/metabolism* ; Cell Movement/genetics* ; Cell Proliferation/genetics* ; Cell Line, Tumor ; Esophageal Squamous Cell Carcinoma ; Exosomes/genetics* ; Neoplasm Metastasis ; Neoplasm Invasiveness ; Gene Expression Regulation, Neoplastic ; Glycolysis/genetics* ; Cancer-Associated Fibroblasts/metabolism* ; Carcinoma, Squamous Cell/metabolism* ; Cadherins/genetics*

As one of the core pathogenesis during treatment with traditional Chinese medicine，liver heat runs through different stages of liver disease. The interpretation of its meaning in different medicine categories（traditional Chinese medicine，Tibetan medicine，Mongolian medicine，Uygur medicine，Dai medicine，Yao medicine，etc.） is not unified， and the phenomena of the same name with different meanings，confusion， and misappropriation emerge. This seriously restricts the inheritance，innovation， and clinical application of traditional Chinese medicine and ethnomedicine. By tracing and analyzing liver heat， it is found that liver heat in traditional Chinese medicine is caused by disordered rest and diet， as well as internal injury due to emotional disorder， which leads to liver dysfunction， Qi stagnation， and heat turning to fire in the liver meridian. The liver heat in Tibetan medicine is caused by the accumulated heat of the liver nature and the evil heat in the liver， which stimulates the toxin of Chiba fever. The liver heat in Mongolian medicine derives from the abnormal diet and rest， making excessive Sheila accumulate in the liver and causing disease. The above etiologies are all related to diet， rest，exogenous evil，emotion，and so on， and the pathogenesis is related to the imbalance of Qi and the metabolic disorder of organs. The clinical symptoms are pain in the liver region，yellow eyes， bitter mouth， fever，digestion，and loss of appetite. The principle of treatment and compatibility of prescription are heat-based， with auxiliary detoxification. Other ethnomedicine， such as Uygur medicine， Dai medicine， Yao Medicine，Miao medicine， and She medicine do not have a clear discussion on liver heat，and their etiology， pathogenesis， treatment，and prescription are not systematic，mostly based on a single drug or proven prescriptions.Through the systematic tracing，mining，induction，analysis， and arrangement of the liver heat based on existing literature information database in China，this paper regarded syndrome as the outline and disease as the goal，clarified the similarities and differences of the pathogenesis of liver heat in traditional Chinese medicine，and determined the relationship between liver heat and liver disease and the status quo of syndrome and treatment.This review provides evidence and reference for clinical prevention and treatment，as well as drug development for liver disease.

Chlorobenzene contaminants (CBs) pose a threat to the eco-environment, and functional strains hold considerable potential for the remediation of CB-contaminated sites. To deeply explore the application potential of functional bacteria in the in-situ bioremediation of CBs, this study focused on the biodegradation characteristics and degradation kinetics of CB and 1, 2-dichlorobenzene (1, 2-DCB) in soil by the isolated strain Serratia marcescens TF-1. Additionally, an in-situ remediation trial was conducted with this strain at a chemical industrial site. Batch serum bottle experiments showed that the degradation rate of CB at the concentrations ranging from 20 to 200 mg/L by TF-1 was 0.22-0.66 mol/(g_cell·h), following the Haldane model, with the optimal concentration at 23.12 mg/L. The results from simulated soil degradation experiments indicated that the combined use of TF-1 and sodium succinate (SS) significantly enhanced the degradation of CBs, with the maximum degradation rate of CB reaching 0.104 d^-1 and a half-life of 6.66 d. For 1, 2-DCB, the maximum degradation rate constant was 0.068 7 d^-1, with a half-life of 10.087 d. The in-situ remediation results at the chemically contaminated site demonstrated that the introduction of bacterial inoculant and SS significantly improved the removal of CBs, achieving the removal rates of 84.2%-100% after 10 d. CB, 1, 4-dichlorobenzene (1, 4-DCB), and benzo[a]pyrene were completely removed. Microbial diversity analysis revealed that the in-situ remediation facilitated the colonization of TF-1 and the enrichment of indigenous nitrogen-fixing Azoarcus, which may have played a key role in the degradation process. This study provides a theoretical basis and practical experience for the in situ bioremediation of CBs-contaminated sites.
Chlorobenzenes/isolation & purification* ; Biodegradation, Environmental ; Soil Pollutants/isolation & purification* ; Serratia marcescens/metabolism* ; Industrial Waste ; Soil Microbiology

Objective:To investigate the liver-protective effect of Peipi Shugan Decoction (PSD) in rats with liver fibrosis through network pharmacology and experimental animal models.Methods:TCMSP was used to retrieve the active components of Peipi Shugan Decoction, GeneCards database was used to obtain the liver fibrosis related targets, and Venny 2.1 was used to obtain the intersection targets. A protein-protein interaction (PPI) network was constructed using the STRING 12.0 database, and Go function and KEGG pathway enrichment analysis were performed through David database. A total of 60 male Sprague-Dawley (SD) rats were divided into two groups: a blank control group ( n=10) and a model establishment group ( n=50) with random number table method. Liver fibrosis models were induced in the model group by intraperitoneal injection of a 40% CCl?- olive oil solution. After successful modeling, the rats were randomly assigned to the following groups ( n=10 per group): model group, colchicine group, and Peipi Shugan Decoction low-, medium-, and high-dosage groups. The colchicine group received colchicine suspension at 0.2 ml/kg via intragastric administration. Peipi Shugan Decoction low-, medium-, and high-dosage groups were administered the decoction at dosages of 2.81, 5.63, and 11.25 g/kg, respectively. The blank control and model groups received an equal volume of normal saline. All treatments were administered once daily for 8 consecutive weeks. HE staining and Masson staining were used to observe the morphological changes of liver tissue and the deposition of collagen fibers. he levels of GPT, GOT and ALP were detected by automatic biochemical analyzer. The expressions of JAK2/STAT1 signaling pathway related proteins, α - smooth muscle actin (α-SMA) and Collagen Ⅰ in rat liver were detected by Western blot. The expression of α-SMA protein in liver tissue was detected by immunohistochemistry. The number and ratio of CD4 + T cells and CD8 + T cells in liver tissue were analyzed by flow cytometry. The levels of IL-6, IL-1β and TNF-α in serum were detected by ELISA. Results:A total of 94 active components were screened out from Peipi Shugan Decoction; the prediction analysis results revealed that this compound formula shared 122 common targets with liver fibrosis diseases; The top five core targets with degree values in the PPI network are AKT1, TNF, IL-6, TP53, and IL-1β. GO enrichment analysis further indicated that Peipi Shugan Decoction mainly achieved anti-liver fibrosis effects by regulating JAK2/STAT1 signaling pathway and other mechanisms. Compared with the model group, the colchicine group and Peipi Shugan Decoction low-, medium-, and high-dosage groups exhibited decreased serum levels of GPT, GOT, ALP, IL-6, TNF-α, and IL-1β ( P<0.05), as well as reduced expression of α-SMA in liver tissue ( P<0.05). Peipi Shugan Decoction medium- and high-dosage groups showed increased protein expression of p-STAT1/STAT1 in liver tissue ( P<0.05), while Peipi Shugan Decoction high-dosage group demonstrated decreased α-SMA protein expression ( P<0.05). Additionally, Peipi Shugan Decoction medium- and high-dosage groups exhibited reduced expressions of CD4 + and CD8 + ( P<0.05). Conclusions:Peipi Shugan Decoction has the characteristics of multi-component, multi-target and multi-pathway in the treatment of liver fibrosis. Its mechanism is mainly related to activating the JAK2/STAT1 signaling pathway, inhibiting cellular inflammatory responses and hindering the activation of hepatic stellate cells (HSC).

Background:Acute pancreatitis(AP)is a common disease of the digestive system,among which severe acute pancreatitis(SAP)has a high mortality rate.Finding more accurate and convenient methods for early recognition of SAP is one of the major challenges in clinical treatment.Aims:To explore the application value of the controlled attenuation parameter(CAP)of ultrasound elastography in predicting SAP.Methods:A retrospective cohort study was conducted involving 135 AP patients admitted to Jiading Branch of Shanghai General Hospital from February to October 2024.Patients were categorized into non-SAP and SAP groups according to the severity of the disease.Clinical data,local complications,laboratory indicators,and CAP were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for SAP.A SAP prediction model based on CAP was constructed according to the identified risk factors and the minimum Akaike information criterion(AIC).ROC curve and Bootstrap method were used to evaluate the efficacy of the prediction model and conduct internal validation,respectively.Results:There were statistically significant differences between the non-SAP group and SAP group in body mass index(BMI),incidence of hyperlipidemia,etiological composition,incidence of pleural and ascitic fluid,length of hospital stay,incidence of peripancreatic effusion,incidence of pancreatic necrosis,white blood cell count(WBC),D-dimer(D-D)level,blood glucose,triglyceride(TG),C-reactive protein(CRP),neutrophil count,procalcitonin(PCT),interleukin-6(IL-6),free triiodothyronine(FT3),and CAP(all P<0.05).Multivariate Logistic regression analysis showed that pancreatic necrosis(OR=13.39,95%CI:3.10-57.94,P<0.001)and CAP(OR=1.01,95%CI:1.01-1.02,P=0.038)were independent risk factors for SAP.The SAP prediction model based on CAP was formulated as:Logit(P)=-5.884+0.010×CAP+2.839×pancreatic necrosis+0.169×D-D+0.132×blood glucose+0.006×CRP.The model showed an area under the curve(AUC)of 0.834 for predicting SAP,which was superior to CAP alone(P<0.05).Internal validation indicated that the prediction model had high stability and accuracy(C-index=0.808).Conclusions:The prediction model constructed based on CAP has good clinical value for predicting SAP,providing a new perspective and tool for early identification and prognostic assessment of AP.

Background:Acute pancreatitis(AP)is a common disease of the digestive system,among which severe acute pancreatitis(SAP)has a high mortality rate.Finding more accurate and convenient methods for early recognition of SAP is one of the major challenges in clinical treatment.Aims:To explore the application value of the controlled attenuation parameter(CAP)of ultrasound elastography in predicting SAP.Methods:A retrospective cohort study was conducted involving 135 AP patients admitted to Jiading Branch of Shanghai General Hospital from February to October 2024.Patients were categorized into non-SAP and SAP groups according to the severity of the disease.Clinical data,local complications,laboratory indicators,and CAP were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for SAP.A SAP prediction model based on CAP was constructed according to the identified risk factors and the minimum Akaike information criterion(AIC).ROC curve and Bootstrap method were used to evaluate the efficacy of the prediction model and conduct internal validation,respectively.Results:There were statistically significant differences between the non-SAP group and SAP group in body mass index(BMI),incidence of hyperlipidemia,etiological composition,incidence of pleural and ascitic fluid,length of hospital stay,incidence of peripancreatic effusion,incidence of pancreatic necrosis,white blood cell count(WBC),D-dimer(D-D)level,blood glucose,triglyceride(TG),C-reactive protein(CRP),neutrophil count,procalcitonin(PCT),interleukin-6(IL-6),free triiodothyronine(FT3),and CAP(all P<0.05).Multivariate Logistic regression analysis showed that pancreatic necrosis(OR=13.39,95%CI:3.10-57.94,P<0.001)and CAP(OR=1.01,95%CI:1.01-1.02,P=0.038)were independent risk factors for SAP.The SAP prediction model based on CAP was formulated as:Logit(P)=-5.884+0.010×CAP+2.839×pancreatic necrosis+0.169×D-D+0.132×blood glucose+0.006×CRP.The model showed an area under the curve(AUC)of 0.834 for predicting SAP,which was superior to CAP alone(P<0.05).Internal validation indicated that the prediction model had high stability and accuracy(C-index=0.808).Conclusions:The prediction model constructed based on CAP has good clinical value for predicting SAP,providing a new perspective and tool for early identification and prognostic assessment of AP.

Objective To construct a quality evaluation index system for non-medical technical services in public hospitals,aiming to provide a more scientific and feasible basis for evaluating patient service quality.Methods Based on literature research,the SERVQUAL theory was used to preliminarily formulate a comprehensive and full-cycle evaluation index for patient service quality.The final evaluation index system was determined through expert consultation,and the Analytic Hierarchy Process was used to determine the weights of the evaluation indices.Results The questionnaire response rates for the two rounds of expert consultation were both 100％.The authority coefficients of the experts were 0.82 and 0.80,respectively,indicating a high level of expert authority.The Kendall's W coefficient increased from 0.088 to 0.107 between the two rounds,and the difference was statistically significant (P<0.001),indicating good consistency of expert opinions.The consistency results of each judgment matrix were less than 0.1,passing the consistency test.The final evaluation index system consisted of six primary indicators (tangibility,reliability,responsiveness,assurance,empathy,and continuity) and 33 secondary indicators.Conclusion The selection of evaluation indicators revolves around the core service processes of outpatient,inpatient,and other hospital services,focusing on key elements at various critical junctures that influence patient experience.The evaluation indicators aim to guide hospitals to improve not only essential needs but also desired improvements in service quality,thus promoting the continuous enhancement of hospital services.

Objective To construct a quality evaluation index system for non-medical technical services in public hospitals,aiming to provide a more scientific and feasible basis for evaluating patient service quality.Methods Based on literature research,the SERVQUAL theory was used to preliminarily formulate a comprehensive and full-cycle evaluation index for patient service quality.The final evaluation index system was determined through expert consultation,and the Analytic Hierarchy Process was used to determine the weights of the evaluation indices.Results The questionnaire response rates for the two rounds of expert consultation were both 100％.The authority coefficients of the experts were 0.82 and 0.80,respectively,indicating a high level of expert authority.The Kendall's W coefficient increased from 0.088 to 0.107 between the two rounds,and the difference was statistically significant (P<0.001),indicating good consistency of expert opinions.The consistency results of each judgment matrix were less than 0.1,passing the consistency test.The final evaluation index system consisted of six primary indicators (tangibility,reliability,responsiveness,assurance,empathy,and continuity) and 33 secondary indicators.Conclusion The selection of evaluation indicators revolves around the core service processes of outpatient,inpatient,and other hospital services,focusing on key elements at various critical junctures that influence patient experience.The evaluation indicators aim to guide hospitals to improve not only essential needs but also desired improvements in service quality,thus promoting the continuous enhancement of hospital services.

Objective:To investigate the effect of quality improvement (QI) project on delayed cord clamping (DCC) implementation in very preterm infants.Methods:This study retrospectively collected the clinical data and assessed the QI indices of very preterm infants born in the Women and Children's Hospital of Chongqing Medical University and transferred to the Neonatology Department from January 2017 to January 2021. The indices for QI assessment included three types: (1) process indices: the implementation rate and timing of DCC; (2) outcome indices: hemoglobin level and hematocrit, etc; (3) balancing indices: the proportion of neonates requiring endotracheal intubation in the delivery room and chest compressions, Apgar score body temperature, and blood pH value on admission, etc. There were four phases for the implementation of QI, the pre-QI period (January to December of 2017), the QI period (January to December of 2018), the post-QI period (January to December of 2019), and the sustained-QI period (January 2020 to January 2021). The QI project was performed since August 2018. Control charts or statistical tests were used for statistical analysis.Results:(1) Process indices: After the implementation of the QI project, the practice of DCC increased from 0 to 82.2%, and the timing of umbilical cord clamping was from 0 s to a delay of 47.1 s. (2) Outcome indices: The levels of hemoglobin in the QI period, the post-QI period, and the sustained-QI period were significantly higher than those in the pre-QI period [(202.22±28.84), (210.10±33.52), (210.52±32.27) g/L vs. (187.94±35.29) g/L; F=8.61, P<0.001]. The hematocrit values in the post-QI period and the sustained-QI period were significantly higher than those in the pre-QI period [(58.99±8.71) %, (60.18±8.06)% vs. (55.41±9.17)%; χ2=5.13, P=0.002]. The other indices showed no statistical differences in different phases. (3) Balancing indices: The proportions of neonates receiving endotracheal intubation in the delivery room in the post-QI period and the sustained-QI period were significantly lower than those in the pre-QI period [16.0% (19/119), 13.2% (25/191) vs. 42.3% (30/71); χ2=29.08, P<0.001]. The body temperature on admission increased gradually through the four periods [pre-QI period: 35.3 ℃ (34.5-36.1 ℃); QI period: 36.0 ℃ (34.0-37.7 ℃); post-QI period: 36.0 ℃ (35.6-37.4 ℃); sustained-QI period: 37.0 ℃ (35.9-38.1 ℃); H=277.88, P<0.001]. The blood pH value on admission in the sustained-QI period [7.32 (6.85-7.50)] was significantly higher than those in the other three periods [7.26 (7.07-7.46), 7.26 (7.04-7.43), and 7.25 (6.91-7.49); H=34.46, P<0.001]. Conclusion:The interventions in this QI project significantly increase the practice of DCC and enable a longer DCC in very preterm infants.

Objective:On the basis of post evaluation,the hospital pharmacy posts are scientifically classified and stratified,and the performance evaluation standard of pharmacy posts is constructed.Methods:The hospital pharmacy posts are classified and stratified by factor comparison method and the post value coefficient is determined.Delphi method and analytic hierarchy process are used to construct the performance evaluation index system of pharmaceutical posts and determine the performance evaluation standards.Results:Pharmacy posts in hospitals are divided into 5 categories,including clinical pharmacists,research pharmacists,static pharmacists,dispensing pharmacists and purchasing pharmacists.The indexes and weights of pharmaceutical post performance evaluation are determined from 4 dimensions:service,process,quality and cost,and the evaluation standard of pharmaceutical post performance oriented to rational drug use is established.Conclusion:The construction of pharmaceutical performance evaluation system meets the requirements of the reform of public hospitals for the transformation and development of pharmaceutical services,which is conducive to enhancing the enthusiasm of pharmaceutical personnel and improving the efficiency and benefit of pharmaceutical services.