Objective To explore the efficacy of progressive exercise training based on the modified Medical Research Council dyspnea scale (mMRC) grading in respiratory rehabilitation for patients with chronic obstructive pulmonary disease (COPD) at a primary healthcare setting. Methods A total of 106 patients with COPD admitted to Zhuanqiao Community Health Service Center in Shanghai from Aug.1, 2022 to Jul. 30, 2024 were selected as research subjects. They were randomly divided into a study group and a control group in a 1∶1 ratio, with 53 patients in each group. The control group received conventional treatment, while the study group received conventional treatment combined with progressive exercise training. After 4 weeks of continuous treatment, the changes in the 6-minute walk test (6MWT), COPD assessment test (CAT) score, mMRC grading, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading and pulmonary function were compared between the two groups. Results Patients in both groups showed improvements in 6MWT distance, CAT score, mMRC grading, GOLD grading, and pulmonary function compared to baseline (P＜0.05). Moreover, the study group had better improvements in 6MWT distance, CAT score, mMRC grading, GOLD grading, and pulmonary function than the control group (P＜0.05). Conclusions Conventional treatment combined with progressive exercise training based on mMRC grading can enhance the effect of respiratory rehabilitation in patients with COPD, particularly in improving pulmonary function and exercise tolerance.

Objective:To investigate the safety and efficacy of laparoscopic fundoplication in the treatment of gastroesophageal reflux related cough (GERC).Methods:Clinical data of 138 GERC patients undergoing laparoscopic fundoplication at our center from Jan 2013 to Dec 2017 were analyzed and patients were followed up until Dec 2022.Results:A total of 138 patients underwent surgery successfully.The median follow-up time was 51 (7-130) months.There were no mortality,nor major complications. In 138 GERC patients, GERC was cured in 85 patients,the cure rate of fundoplication was 61.6%, and altogether 112 patients reported effective, the effective rate was 81.2%. Multivariate regression analysis showed that normal esophageal peristalsis was independent predictors of good efficacy of fundoplication[ OR=3.810(1.373,10.573), P=0.01]. Conclusions:Laparoscopic fundoplication has long term efficacy for refractory GERC. Esophageal motility is an important dynamic characteristic that affects the postoperative efficacy of GERC.

ObjectiveTo establish a quality evaluation method for Zhuye Shigao granules（Zhuye Shigaotang） based on fingerprint and determination of index components， and to investigate the therapeutic effect of Zhuye Shigao granules on mice with cold-dampness pestilence attacking lung syndrome. MethodsThe fingerprint of Zhuye Shigao granules was established by high performance liquid chromatography（HPLC）， and the methods for determination of total calcium， orientin， isoorientin， ginsenosides Rg₁， Re and Rb₁ and other 2 index components were established. Fifty ICR mice were randomly divided into the blank group， model group， Zhuye Shigao granules low， medium and high dose groups（9.3， 18.6， 37.2 g·kg^-1·d^-1）， with 10 mice in each group. In addition to the blank group， the model mice with cold-dampness pestilence attacking lung syndrome was prepared by nasal drip of lipopolysaccharide combined with cold-dampness environment. Each administration group was given the corresponding liquid by gavage according to the dose， while the blank group and model group were given the same volume of normal saline by gavage. Then， the body temperature and organ index of mice in each group were measured， hematoxylin-eosin（HE） staining was used to investigate the lung tissue injury of mice in each group， and enzyme-linked immunosorbent assay（ELISA） was used to detect the changes of tumor necrosis factor-α（TNF-α）， interleukin（IL）-lβ， IL-6， IL-10 levels in serum and lung tissue， as well as immunoglobulin（Ig）A and IgM levels in serum. ResultsThe fingerprint similarity of 10 batches of Zhuye Shigao granules was>0.950， and 20 common peaks were calibrated. Seven of them were identified， including peak 11（isoorientin）， peak 12（orientin）， peak 14（apioside liquiritin）， peak 15（liquiritin）， peak 17（apioside isoliquiritin）， peak 19（isoliquiritin） and peak 20（liquiritigenin）. The results of quantitative analysis showed that the content range of each index component in 10 batches of Zhuye Shigao granules was as follows：Total calcium of 9.978-11.294 mg·g^-1， isoorientin of 0.033-0.041 mg·g^-1， orientin of 0.046-0.055 mg·g^-1， ginsenoside Rg₁+ginsenoside Re of 0.748-0.762 mg·g^-1， ginsenoside Rb₁ of 0.151-0.197 mg·g^-1， liquiritin of 1.106-1.366 mg·g^-1， glycyrrhizic acid of 0.904-1.182 mg·g^-1_. Compared with the blank group， the body temperature of mice in the model group was significantly increased， the organ indexes of liver， lung and spleen were significantly decreased， the organ index of thymus was significantly increased， HE staining of lung tissue showed infiltration of inflammatory cells， a small amount of serous exudation was observed in the alveoli， and lung tissue was damaged. After the intervention of Zhuye Shigao granules， the pathological changes were improved compared with the model group. The expression levels of IL-1β， IL-6 and TNF-α were significantly increased， the expression level of IL-10 was significantly decreased in serum and lung tissue. The levels of IgA and IgM in serum were significantly decreased（P<0.01）. Compared with the model group， the body temperature， the organ indexes and immune factor levels in serum and lung tissue of mice in the Zhuye Shigao granules medium and high dose groups were significantly reduced（P<0.05， P<0.01）. ConclusionIn this study， the quality evaluation of Zhuye Shigao granules was carried out based on fingerprint combined with determination of index components， and the fingerprint of four herbs（Lophatheri Herba， Ophiopogonis Radix， Pinelliae Rhizoma and Glycyrrhizae Radix et Rhizoma） in this formula and the determination of 8 index components were established. The therapeutic effect of Zhuye Shigao granules on mice with cold-dampness pestilence attacking lung syndrome may be related to inhibiting inflammatory response and mediating immune regulation.

Objective To explore the application effect of"5E"teaching mode combined with deep learning charac-teristics in residential training teaching of general subjects.Methods From July to December 2024,the"5E"teaching mode combined with the characteristics of deep learning was implemented in 30 general practitioners being trained in three standardized training bases of residents in Qiqihar City,and the scores of self-learning ability and critical thinking ability of students before and after the implementation of teaching were tested by paired t-test.Re-sults After teaching,the scores of self-learning ability and critical thinking ability of the general training students were higher than those before teaching,and the differences were statistically significant(P＜0.05).Conclusion"5E"teaching mode can improve the learning effect and clinical practice ability of general training students.

Intricate and complex interactions between tumor cells and tumor microenvironment(TME)are essential driving factors in tumor development and metastasis.In recent years,modulation of TME to reverse tumor progression has garnered significant attention as a therapeutic strategy.For precise and targeted tumor treatment,there is an urgent need for accurate and effective TME tar-get molecules and relevant prediction model.Fibronectin,a protein with multiple domains in extracellular matrix(ECM),plays a cru-cial role in physiological and pathological processes.Particularly,Fibronectin extra domain B(FN-EDB)in fibronectin is pivotal in regulating interaction between ECM and cells.During active tissue remodeling processes,especially in angiogenesis,FN-EDB expres-sion tends to increase.Studies have indicated that FN-EDB is involved in regulating various key aspects of tumorigenesis,including promoting tumor cell invasion and metastasis,influencing development of immune evasion mechanisms,enhancing tumor angiogene-sis,and contributing to development of chemoresistance.Therefore,targeting FN-EDB as a potential therapeutic target for cancer treat-ment and developing relevant therapeutic drugs hold significant importance and promising clinical prospects.This article reviews roles of FN-EDB in TME in recent years and research progress on tumor immunotherapy targeting this molecule,with aim of providing new insights and strategies for cancer treatment.

Objective To explore the application effect of"5E"teaching mode combined with deep learning charac-teristics in residential training teaching of general subjects.Methods From July to December 2024,the"5E"teaching mode combined with the characteristics of deep learning was implemented in 30 general practitioners being trained in three standardized training bases of residents in Qiqihar City,and the scores of self-learning ability and critical thinking ability of students before and after the implementation of teaching were tested by paired t-test.Re-sults After teaching,the scores of self-learning ability and critical thinking ability of the general training students were higher than those before teaching,and the differences were statistically significant(P＜0.05).Conclusion"5E"teaching mode can improve the learning effect and clinical practice ability of general training students.

Intricate and complex interactions between tumor cells and tumor microenvironment(TME)are essential driving factors in tumor development and metastasis.In recent years,modulation of TME to reverse tumor progression has garnered significant attention as a therapeutic strategy.For precise and targeted tumor treatment,there is an urgent need for accurate and effective TME tar-get molecules and relevant prediction model.Fibronectin,a protein with multiple domains in extracellular matrix(ECM),plays a cru-cial role in physiological and pathological processes.Particularly,Fibronectin extra domain B(FN-EDB)in fibronectin is pivotal in regulating interaction between ECM and cells.During active tissue remodeling processes,especially in angiogenesis,FN-EDB expres-sion tends to increase.Studies have indicated that FN-EDB is involved in regulating various key aspects of tumorigenesis,including promoting tumor cell invasion and metastasis,influencing development of immune evasion mechanisms,enhancing tumor angiogene-sis,and contributing to development of chemoresistance.Therefore,targeting FN-EDB as a potential therapeutic target for cancer treat-ment and developing relevant therapeutic drugs hold significant importance and promising clinical prospects.This article reviews roles of FN-EDB in TME in recent years and research progress on tumor immunotherapy targeting this molecule,with aim of providing new insights and strategies for cancer treatment.

Objective:To investigate the safety and efficacy of laparoscopic fundoplication in the treatment of gastroesophageal reflux related cough (GERC).Methods:Clinical data of 138 GERC patients undergoing laparoscopic fundoplication at our center from Jan 2013 to Dec 2017 were analyzed and patients were followed up until Dec 2022.Results:A total of 138 patients underwent surgery successfully.The median follow-up time was 51 (7-130) months.There were no mortality,nor major complications. In 138 GERC patients, GERC was cured in 85 patients,the cure rate of fundoplication was 61.6%, and altogether 112 patients reported effective, the effective rate was 81.2%. Multivariate regression analysis showed that normal esophageal peristalsis was independent predictors of good efficacy of fundoplication[ OR=3.810(1.373,10.573), P=0.01]. Conclusions:Laparoscopic fundoplication has long term efficacy for refractory GERC. Esophageal motility is an important dynamic characteristic that affects the postoperative efficacy of GERC.

OBJECTIVE To optimize the management model of drugs used in investigator-initiated trial(IIT).METHODS With benchmarking analysis,based on the practical work experience of a tertiary specialized hospital in the field of IIT drug management in Shanghai,a thorough review was conducted,involving relevant laws,regulations,and academic literature to establish benchmark criteria and the evaluation standards.Starting from the initiation of IIT projects,a detailed comparative analysis of key processes was carried out,such as the receipt,storage,distribution,use and recycling of drugs for trial.The deficiencies in the current management of IIT drugs were reviewed in detail and a series of optimization suggestions were put forward.RESULTS It was found that the authorized records of drug management were missing,the training before project implementation was insufficient,and the records of receipt and acceptance of IIT drugs were incomplete.In light of these existing problems,improvement measures were put forward,including strengthening the training of drug administrators and stipulating that only drug administrators with pharmacist qualifications be eligible to inspect and accept drugs,etc.The related systems were improved,and 17 key points of quality control for the management of IIT drugs were developed.CONCLUSIONS A preliminary IIT drug management system for medical institutions has been established,which helps to improve the institutional framework of medical institutions in this field.

Objective:To establish an in vivo infection model of West Nile virus (WNV) pseudovirus and evaluate the neutralizing activity of antibody WNV-XH1.Methods:A stable cell line that can package the WNV pseudovirus was established in the early stage to prepare the pseudovirus supernatant. The supernatant was concentrated and infected BHK21 cells to detect the titer of the pseudovirus. After intraperitoneal injection of the pseudovirus into C57BL/J mice, bioluminescence imaging was performed to observe the infection status of the pseudovirus in the mice. After simultaneous infection, blood was collected and ELISA was used to detect NS1 levels in mouse serum. The in vivo functional activity of antibody WNV-XH1 was evaluated using the established mouse infection model.Results:Fluorescence was detected in C57BL/J mice infected with WNV pseudovirus, and the NS1 levels in the peripheral blood serum of mice infected with pseudovirus were significantly higher than those of non infected mice (1.453±0.09vs0.305±0.018). After intravenous administration of WNV-XH1 antibody before the attack, the fluorescence signal in the mice decreased and the serum NS1 level decreased (0.384±0.015).Conclusions:A successful in vivo infection model of WNV pseudovirus was established, and it was confirmed that the antibody WNV-XH1 had a protective effect against WNV pseudovirus infection in vivo.