Objective To explore the regulation of the phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)-mediated inflammatory response in chronic obstructive pulmonary disease(COPD)by modified Shengxian Decoction through the lung-gut axis.Methods Thirty rats were divided into three groups:Control group,COPD group,and COPD+modified Shengxian Decoction(SXT)group,with 10 rats in each.The COPD model was established using passive smoking combined with intratracheal instillation of lipopolysaccharide(LPS).General symptoms and signs of the rats were monitored during the modeling and intervention periods.Hematoxylin and eosin(HE)staining and immunohistochemistry(IHC)were used to observe lung tissue structure.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of inflammatory cytokines interleukin-6(IL-6)and tumor necrosis factor-alpha(TNF-α)in lung tissues.Flow cytometry was used to detect the number of type Ⅱ innate lymphoid cells(nILC2)and type 2 innate lymphoid cells(iILC2)in lung and intestinal tissues.Illumina MiSeq sequencing technology was used to perform 16S rRNA gene sequencing on rat feces to analyze the gut microbiota structure.Gas chromatography-mass spectrometry(GC-MS)was used to determine the content of short-chain fatty acids(SCFAs)in rat feces.Western blotting was used to detect the expressions of related proteins in the PI3K/AKT pathway.Results Compared with the Control group,the COPD group showed significantly reduced lung function indicators,increased heart rate and decreased body mass,while the SXT group showed significant improvement in lung function and general signs(P＜0.05).HE staining showed that the COPD group had lung tissue damage filled with inflammatory cells,while the SXT group had significantly fewer inflammatory cells.IHC results showed that the SXT group had significantly reduced expression of caspase-3 protein(P＜0.05).ELISA results showed that the levels of IL-6 and TNF-α were significantly increased in the COPD group,while the SXT group showed significant improvement in inflammatory damage.The ratio of nILC2 to iILC2 in lung and intestinal tissues was significantly reduced in the COPD group,indicating a significant inflammatory response,while the SXT group showed significant improvement(P＜0.05).The levels of ILC2 cytokines IL-13 and IL-4 were significantly increased in the COPD group,while the SXT group had significantly reduced IL-13 and IL-4 levels.The relative abundance of lung and gut microbiota in the SXT group was significantly higher than that in the Control and COPD groups(P＜0.05).Beta diversity index analysis showed significant differences in species diversity among the three groups(P＜0.05).GC-MS detected six types of SCFAs in rat feces:acetic acid,propionic acid,isobutyric acid,butyric acid,isovaleric acid,and valeric acid.Their levels were lower in the COPD group than in the Control group,but the levels in the SXT group were higher than those in the COPD group.Western blotting results showed that the expressions of p-PI3K,PI3K,p-AKT,AKT,p-NF-κB,and NF-κB proteins were significantly reduced in the SXT group compared to the COPD group(P＜0.05).ELISA results showed that the SXT group had significantly downregulated expression levels of IL-1β and IL-10 compared to the COPD group(P＜0.05).Conclusion Modified Shengxian Decoction can alleviate COPD inflammation.It may mediate the inflammatory response in COPD by inhibiting iILC2 cell activity and expressions of related proteins in the PI3K/AKT signaling pathway through gut microbiota metabolism.

Objective:To explore the effect and mechanism of Chlorfortunone A(ChlA) in the treatment of diabetic nephropathy(DN) in mice.Methods:The DN model mice were assigned to DN, low-dose ChlA(ChlAL) and high-dose ChlA(ChlAH), and the normal control groups(Ctrl). Kidney tissue was analyzed via HE and Masson staining, and urine albumin, fasting blood glucose and kidney weight were measured. Collagen1 and α-SMA proteins were detected in renal tissues. The level of GSH-px, SOD, CAT, and TGF-β were detected. The TGF-β/Smad2 pathway in kidney tissue was detected. The mechanism was verified by setting the high glucose+ ChlA+ TGF-β group in MPC-5 cells. The proliferation of the cells and DCFDA staining were detected.Results:Compared to the Ctrl group, the DN group had significantly higher UACR and kidney weight( P<0.001). High-dose ChlA reduced UACR and kidney weight( P<0.05), with no effect on blood glucose( P>0.05). Masson staining showed reduced fibrosis with ChlA treatment. Collagen I and α-SMA expressions were significantly higher in DN( P<0.001) and decreased with ChlA treatment( P<0.05). GSH-px, SOD, and CAT levels were lower in DN( P<0.001), while TGF-β was elevated( P<0.001); ChlA increased antioxidant enzymes and decreased TGF-β( P<0.05). The TGF-β/Smad2 pathway was upregulated in DN( P<0.001) and inhibited by ChlA( P<0.001). In vitro, ChlA reduced cell proliferation( P<0.05) and increased ROS levels( P<0.001). Conclusions:ChlA alleviates kidney injury and fibrosis in DN mice, reduces oxidative stress, which may be related to the inhibition of the TGF-β/Smad2 pathway.

Objective:To observe the clinical effect of comprehensive reconstruction of grades Ⅰ-Ⅱ thumb and finger defects with hallux osteo-onychocutaneous flaps of great toe.Methods:This is a retrospective study. From June 2020 to December 2023, comprehensive reconstruction surgery for Grade Ⅰ-Ⅱ digital defect were performed with hallux osteo-onychocutaneous flaps of great toe for 3 thumbs and 7 fingers in 9 patients in the Department of Hand and Microsurgery of Baoji Third Hospital. Causes of digital injury were: 4 of machine crush, 3 of electric saw cut, 1 of door crush, and 1 of electrical burn. There were 6 grade I digital defects (beyond the nail root) and 4 grade Ⅱ defects (last segment of digit). The defects of the digits were reconstructed by taking references of the shape and structure of the contralateral normal thumbs and fingers. Then the hallux osteo-onychocutaneous flaps of great toe were designed and harvested accordingly from the left and right great toes. Donor sites were covered by skin grafting or local dressing change. One patient was treated in emergency surgery, 6 in sub-emergency surgery and 2 in elective surgery. Integrated perioperative patient management was provided to all of the patients. Postoperative follow-ups were conducted through the visit of outpatient clinic, telephone calls or WeChat interviews. Flap survival, appearance and sensation recovery were evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:Vascular insufficiency of 1 digit occurred in surgery, and relieved by local treatment with lidocaine and warm saline. All 10 digits successfully survived, and all donor sites healed spontaneously. The postoperative follow-up period was 10 to 30 months, with an average of 18 months. One transferred nail was found in poor appearance (not flat), the rest of the reconstructed digits were good in appearance and function. The nail, finger print and fine sensation (TPD 5~8 mm), as well as digital flexion, extension, grasping and opposition of the reconstructed digits were all good. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, at the last follow-up visit, 5 digits were in excellent, 4 in good and 1 in fair.Conclusion:The comprehensive reconstruction of grades Ⅰ-Ⅱ digital defects with hallux osteo-onychocutaneous flap of great toe is an ideal surgical technique that can reconstruct the nail, finger print and sensation of a digit, with good postoperative function as well as an aesthetic and realistic appearance.

Objective To analyze the significance of serum glucagon-like peptide-1(GLP-1)expression in patients with type 2 diabetes mellitus(T2DM)and its predictive value for diabetic retinopathy(DR).Methods A total of 160 T2DM patients admitted to our hospital from January 2020 to January 2022 were enrolled in this study and divided into DR group(n=68)and T2DM group(n=92)according to whether they had DR.Another 80 healthy physical examination subjects were selected as normal control(NC)group from our physical examination center during the same period.Serum GLP-1 levels were detected and compared among all the groups.Serum GLP-1 levels were compared among patients with different stages of DR.The correlation between serum GLP-1 and other indexes was evaluated by Pearson analysis.The influencing factors for DR were analyzed by Logistic regression analysis.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)was generated,and the predictive efficacy of serum GLP-1 on DR was analyzed.Results Serum GLP-1 in NC,T2DM and DR groups decreased in turn(P<0.05).Serum GLP-1 in subgroups Ⅱ,Ⅲ,Ⅳ and Ⅴ decreased in turn(P<0.05).Pearson analysis showed that serum GLP-1 was negatively correlated with systolic blood pressure(SBP),diastolic blood pressure(DBP),2 h postprandial blood glucose(2 hPG),low density lipoprotein cholesterol(LDL-C),tumor necrosis factor-α(TNF-α)(r=-0.359,-0.314,-0.361,-0.308,-0.429,P<0.05),positively correlated with fasting C-peptide(FC-P)(r=0.382,P<0.05).Logistic regression analusis showed that DM duration,SBP,DBP,2 hPG,LDL-C,TNF-α and FC-P were the influencing factors for DR.The AUC of GLP-1 was 0.091 in predicting DR,and the sensitivity and specificity were 93.76%and 90.23%when the optimal cut-off value was 1.95 pmol/L.Conclusions Serum GLP-1 expression is low in T2DM patients,and serum GLP-1 is correlated with SBP,DBP,2 hPG,LDL-C,TNF-α and FC-P to a certain extent,which has high sensitivity and specificity in predicting the occurrence of DR.Abnormal low expression of serum GLP-1,metabolic disorders of blood glucose and lipids,hypertension,inflammation and other factors are involved in the progression of the disease,all of which are influencing factors for inducing DR,and should attract clinical attention.

Objective To analyze the significance of serum glucagon-like peptide-1(GLP-1)expression in patients with type 2 diabetes mellitus(T2DM)and its predictive value for diabetic retinopathy(DR).Methods A total of 160 T2DM patients admitted to our hospital from January 2020 to January 2022 were enrolled in this study and divided into DR group(n=68)and T2DM group(n=92)according to whether they had DR.Another 80 healthy physical examination subjects were selected as normal control(NC)group from our physical examination center during the same period.Serum GLP-1 levels were detected and compared among all the groups.Serum GLP-1 levels were compared among patients with different stages of DR.The correlation between serum GLP-1 and other indexes was evaluated by Pearson analysis.The influencing factors for DR were analyzed by Logistic regression analysis.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)was generated,and the predictive efficacy of serum GLP-1 on DR was analyzed.Results Serum GLP-1 in NC,T2DM and DR groups decreased in turn(P<0.05).Serum GLP-1 in subgroups Ⅱ,Ⅲ,Ⅳ and Ⅴ decreased in turn(P<0.05).Pearson analysis showed that serum GLP-1 was negatively correlated with systolic blood pressure(SBP),diastolic blood pressure(DBP),2 h postprandial blood glucose(2 hPG),low density lipoprotein cholesterol(LDL-C),tumor necrosis factor-α(TNF-α)(r=-0.359,-0.314,-0.361,-0.308,-0.429,P<0.05),positively correlated with fasting C-peptide(FC-P)(r=0.382,P<0.05).Logistic regression analusis showed that DM duration,SBP,DBP,2 hPG,LDL-C,TNF-α and FC-P were the influencing factors for DR.The AUC of GLP-1 was 0.091 in predicting DR,and the sensitivity and specificity were 93.76%and 90.23%when the optimal cut-off value was 1.95 pmol/L.Conclusions Serum GLP-1 expression is low in T2DM patients,and serum GLP-1 is correlated with SBP,DBP,2 hPG,LDL-C,TNF-α and FC-P to a certain extent,which has high sensitivity and specificity in predicting the occurrence of DR.Abnormal low expression of serum GLP-1,metabolic disorders of blood glucose and lipids,hypertension,inflammation and other factors are involved in the progression of the disease,all of which are influencing factors for inducing DR,and should attract clinical attention.

Objective In order to understand the current status and influencing factors of perioperative pulmonary rehabilitation knowledge,attitude,and practice among Chinese thoracic surgery nurses,and to provide references for managers to take targeted measures to improve their pulmonary rehabilitation knowledge,attitude,and practice level.Methods From August to October 2023,a convenience sampling method and cross-sectional descriptive survey were used to anonymously survey 1 167 thoracic surgery nurses from tertiary-level A cancer specialty hospitals and tertiary-level A general hospitals in 24 provinces through the Wenjuanxing platform.A general information questionnaire and a knowledge,attitude and practice questionnaire for lung cancer perioperative pulmonary rehabilitation nurses were used,including knowledge dimension(14 items),belief dimension(6 items),and behavior dimension(14 items),totaling 34 items.Univariate analysis and linear regression multivariate analysis were used to determine the influencing factors of the knowledge,attitude and practice level of thoracic surgery nurses in perioperative pulmonary rehabilitation.Results 1 089 nurses completed the investigation.The total standard score and the dimension scores on knowledge,attitude,and behavior of the perioperative pulmonary rehabilitation questionnaire for thoracic surgery nurses were(80.45±11.84)(73.72±14.68)(89.61±11.38)and(83.46±14.48),respectively.The nature of the hospital,whether there is an administrative position,whether the department carries out ERAS,and whether they have received pulmonary rehabilitation training are the influencing factors of the perioperative pulmonary rehabilitation knowledge,attitude,and practice level of thoracic surgery nurses(P＜0.05).Conclusion The knowledge,attitude,and practice of perioperative lung rehabilitation among thoracic surgery nurses are generally at a moderate level.However,their knowledge of perioperative lung rehabilitation is relatively insufficient,and there are many influencing factors.Managers should strengthen pulmonary rehabilitation training for thoracic surgery nurses,improve their knowledge reserves and evidence conversion capabilities,and coordinate cross-integration among multidisciplinary teams to improve their knowledge,attitude and practice in perioperative pulmonary rehabilitation.

In recent years, the bacteriophage Φ29 (Phi29) DNA polymerase has garnered increasing attention due to its high-fidelity amplification capacity at constant temperatures. To advance the industrial application of this type of isothermal polymerases, this study mined and characterized new enzymes from the microbial metagenome based on the known Phi29 DNA polymerase sequence. The results revealed that a new enzyme, Php29 DNA polymerase, was identified in the microbial metagenome with plants as the hosts. This enzyme exhibited higher strand displacement activity, with a 59.5% similarity to bacteriophage Φ29. Experimental validation demonstrated that the enzyme had 3'→5' exonuclease activity, and its amplification products can serve as substrates for further catalytic reactions. The discovery and validation of Php29 DNA polymerase gives insights into the future industrial application of isothermal polymerases.
DNA-Directed DNA Polymerase/metabolism* ; Bacillus Phages/genetics* ; Metagenome

Environmental Microbiology, as a compulsory foundational course for the major of environmental and ecological engineering. Its knowledge system not only lays a profound theoretical foundation but also evinces a close-knit nexus to practical applications in environmental protection and ecological restoration. This course thus serves as an outstanding platform facilitating both teaching reforms and practical innovations of professional courses. With Environmental Microbiology as a paradigmatic illustration, this paper concentrates on addressing issues like archaic course contents and enervating teaching approaches, with the aspiration of augmenting students' professional acuities, practical dexterities, and innovation and entrepreneurial aptitudes. In light of the aforesaid aim, we initiated an all-encompassing probe into the teaching reform and practicable paradigms from the perspective of amalgamating professional education with innovation-steered stratagems. Across multiple fronts, comprehensive reformative undertakings were implemented, subsuming the optimization and reconfiguration of course contents, the exploration of sundry teaching methodologies, and the scientific erection of an evaluation system. Ultimately, a nascent teaching model dubbed "three-dimensional, six-loop and five-collaborative" was formed. This series of comprehensive and innovative reform measures has not only substantially augmented the profundity and extensiveness of professional knowledge, permeating into the core of disciplinary essence, but also remarkably bolstered students' practical operational capabilities and innovative thinking patterns, thereby catalyzing their transformation into well-rounded individuals with a competitive edge. By virtue of these efforts, a solid foundation has been firmly laid for the teaching reform of Environmental Microbiology and the cultivation of high-caliber environmental professionals in the contemporary era, heralding a new chapter in the development of environmental education.
Environmental Microbiology ; Teaching ; Education, Professional/methods* ; Curriculum

Objective The aim of this study was to analyze the incidence and mortality of esophageal cancer and its trend in Lianyungang city from 2008 to 2019.Methods The data of esophageal cancer in all cancer registry areas in Lianyungang city were col-lected and sorted out,and the quality control reached the standards.The incidence,mortality,age-standardized rate of Chinese population(ASRC),age-standardized rate of World population(ASRW),cumulative rate at 0-74 years old,truncation rate of 35-64 years old,and composition ranking were calculated.The Joinpoint4.7.0.0software was used to analyze the average annual percentage change(AAPC)of the age-standardized incidence and mortality of esophageal cancer by the standard population(ASIRC and ASMRC).Results From 2008 to 2019,the incidence of esophageal cancer in Lianyungang city was 25.90/100,000,ASIRC was 17.95/100,000,ASIRW was 17.91/100,000,ranking the third in the incidence spectrum of malignant tumors.The mortality was 20.55/100,000,ASMRC was 13.86/100,000,and ASMRW was 13.71/100,000,ranking the third in the malignant tumor mortality spectrum.The incidence,mortali-ty,ASIRC and ASMRC of esophageal cancer were higher in men than those in women,and higher in rural areas than those in urban are-as.From 2008 to 2019,the change trend of incidence and mortality of esophageal cancer in Lianyungang city was the same,showing a downward trend.The AAPC of the ASIRC was-6.19%(95%CI:-7.08%-5.30%,P<0.001),and the AAPC of the ASMRC was-4.03%(95%CI:-5.81%-2.22%,P<0.001).Among them,the ASIRC and ASMRC of esophageal cancer in urban and rural areas showed a downward trend(P<0.05).Among them,the ASIRC and ASMRC of esophageal cancer in urban women decreased the most,with an average annual decline of-7.99%(95%CI:-10.86%-5.03%,P<0.001)and-9.19%(95%CI:-12.35%-5.93%,P<0.001).Conclusion The incidence and mortality of esophageal cancer in Lianyungang city have shown a downward trend,a rural areas and male populations are the key prevention and control populations for esophageal cancer.

Objective To investigate the predictive value of derived neutrophil lymphocyte ratio(dNLR)and non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio(NHHR)for in-hospital outcomes of acute myocardial infarction(AMI)patients after PCI.Methods A total of 206 AMI patients undergoing PCI in our department from January 2021 to December 2023 were recruited,and according to their outcomes after PCI,they were divided into a good prognosis group(174 cases)and a poor prognosis group(32 cases).The clinical data were collected,and the dNLR and NHHR values were calculated.ROC curve was plotted to evaluate the predictive value of dNLR,NHHR and their combination for in-hospital outcomes of AMI pa-tients after PCI.Multivariate logistic regression analysis was applied to identify the influencing factors for in-hospital outcomes of AMI patients after PCI.Results The poor prognosis group had significantly higher Gensini score,larger proportions of NYHA Classes Ⅲ+Ⅳ and multi-vessel lesions,and elevated dNLR and NHHR,and lower LVEF value than the good prognosis group(P＜0.05,P＜0.01).The AUC value of dNLR,NHHR and their combination in predicting in-hospital outcomes of AMI patients after PCI was 0.758(95％CI:0.713-0.808),0.812(95％CI:0.767-0.857)and 0.914(95％CI:0.869-0.964),respectively.Multivariate logistic regression analysis showed that LVEF(OR=2.519,95％CI:1.249-5.082,P=0.010),multi-vessel lesions(OR=2.323,95％CI:1.358-3.975,P=0.002),dNLR(OR=3.031,95％CI:1.793-5.126,P=0.001),and NHHR(OR=3.480,95％CI:1.873-6.465,P=0.001)were influencing factors for in-hospital outcomes in AMI patients after PCI(P＜0.05).Conclusion High dNLR and NHHR values are closely associated with poor outcomes in AMI patients after PCI,and their combination may be an indicator to predict the outcomes after PCI.