Objective: To investigate the mechanism by which icariin ( ICA) inhibits the invasion and metastasis of human triple-negative breast cancer ( TNBC) cells via downregulation of the transforming growth factor-β/ Smad ( TGF-β/ Smad) signaling pathway． Methods: TNBC cells ( MDA-MB-231 and MDA-MB-468) were cultured in vitro and divided into four groups: an experimental group treated with 15 μmol / L ICA; a model group treated with 10 μmol / L TGF-β receptor inhibitor LY2109761; a combination group ( LY2109761 + ICA) treated with both 15 μmol / L ICA and 10 μmol / L LY2109761; and a control group．Cell proliferation，migration，and invasion were as- sessed using CCK-8，colony formation，5-ethynyl-2 '-deoxyuridine ( EdU) ，wound healing，and Transwell assays． The expression levels of epithelial-mesenchymal transition ( EMT) -related proteins，as well as TGF-β1，Smad2， and phosphorylated Smad2 ( P-Smad2) were detected by immunofluorescence and Western blot． Results: CCK-8 results showed that cell proliferation decreased gradually with increasing concentrations of ICA ( P＜0. 05) ．Colony formation and EdU assays indicated significantly inhibited proliferation in the ICA-treated group compared to the control ( P＜0. 05) ．Wound healing and Transwell assays demonstrated reduced migration and invasion capabilities in the experimental group relative to the control ( P＜0. 05) ．Compared to the model group，the LY2109761 + ICA group exhibited further suppression of invasion ( P＜0. 05) ．Immunofluorescence revealed decreased Vimentin ex- pression in the experimental group ( P＜0. 05) ，with an even more pronounced reduction in the LY2109761 + ICA group ( P＜0. 01) ．Western blot analysis showed that the protein levels of N-cadherin，matrix metalloproteinase-9( MMP9) ，Vimentin，TGF-β1，Smad2，and P-Smad2 were downregulated in the experimental group compared to the control ( P＜0. 05) ．These proteins were further suppressed in the LY2109761 + ICA group compared to the model group ( P＜0. 05) ． Conclusion ICA inhibits TNBC cells proliferation，invasion，metastasis，and EMT by downregulating the TGF-β/ Smad signaling pathway．

Objective Based on the Hood Policy Tool perspective on China's DIP policy text mining,word frequen-cy analysis and clustering analysis of the policy content,to explore the actual policy in each pilot region,to further analyze the reasons,to provide a scientific and reference for the subsequent policy adjustment and implementation.Methods Policies were included in this study from platforms such as local healthcare protection bureaus,local health-care commissions,local people's government portals,and NVivo,from which policy documents with a high degree of relevance to DIP were selected.NVivo 20.0 software was used for text coding,word frequency analysis,and analysis based on Hood's policy tool dimensions and regional distribution dimensions to further explore DIP policy specifics.Results A total of 27 policies were included,covering all pilot provinces,with a total of 1,707 policy codes.Authoritative,fiscal,informational,and organizational policy instruments accounted for 54.9％,20.3％,16.9％,and 7.9％,respectively.The percentage of coded reference points in the East,Central,West,and Northeast regions were 23.0％,20.2％,44.5％,and 8.7％,respectively.Conclusion The use of DIP policy tools in the pilot regions focused on authoritative tools and less on organization tools.Among the authoritative policy tools,the sub-tools of mechanism building were mostly used,while the sub-tools of standards and norms were less used.The focus of the policy tools varies among the pilot regions,and the use of policy tools should be tailored to the local context.

Objective:To explore the effects of Silybin on pulmonary inflammatory injury and macrophage apoptosis in pulmo-nary tuberculosis(TB)rats,and its regulation on death receptor Fas and its ligand FasL.Methods:TB rat model was prepared by tail vein injection of Mycobacterium tuberculosis(Mtb).Rats were randomly separated into model group,Silybin group,Fas overexpres-sion recombinant protein(pcDNA-Fas)group,pcDNA-Fas negative control(pcDNA-NC)group and Silybin+pcDNA-Fas group,with 15 rats in each group,and another 15 rats were selected as normal control group.Acid-fast staining was used to measure infection of lung tissue;HE staining was performed to observe pathological changes of lung tissue;expressions of TNF-α and IL-6 in lung tissue were detected by ELISA;apoptosis rate of alveolar macrophages was detected by flow cytometry combined with Annexin V-FITC/PI staining;expression levels of Fas,FasL,caspase8,caspase3 and macrophage inflammatory protein-2(MIP-2)were detected by Western blot.Results:Compared with normal control group,expressions of inflammatory factors in lung tissue and apoptotic rate of alveolar macrophages were increased in model group,Mtb infection and caseous necrosis in lung tissue were severe,and Fas/FasL-mediated caspase8/3 apoptotic pathway was activated(P<0.05).Compared with model group,expressions of inflammatory factors in lung tissue and apoptosis rate of alveolar macrophages in Silybin group were reduced,Mtb infection and caseous necrosis in lung tissue were alleviated,and the activity of Fas/FasL-mediated caspase8/3 apoptosis pathway decreased(P<0.05).pcDNA-Fas was able to further activate Fas/FasL-mediated caspase8/3 apoptotic pathway,aggravate lung tissue Mtb infection and caseous necrosis,promote inflammatory damage in lung tissue and macrophage apoptosis,and weaken the anti-Fas/FasL activation,anti-inflammatory and anti-apoptotic effects of Silybin(P<0.05).Conclusion:Silybin may play an anti-Mtb infection,anti-apoptosis of lung tissue macro-phages and anti-inflammatory effects by inhibiting the Fas/FasL signaling pathway.

Endocrine disrupting chemicals (EDCs) are a class of chemical substances widely present in daily-life environment, and can enter human body through various pathways, posing a threat to reproductive development and health. Oxidative stress (OS) is one of the most important fundamental mechanisms underlying the reproductive toxicity of EDCs. Numerous studies have found that exposure to EDCs can increase the levels of reactive oxygen species (ROS) in human reproductive system and reduce the activity and quantity of multiple enzymatic antioxidants, leading to oxidative stress and inducing damage to the reproductive system at various levels such as DNA and cells. Many research results have shown that supplementing food-derived non-enzymatic antioxidants can reduce ROS levels and increase the activity of enzymatic antioxidants, thereby reduce OS levels, and further repair EDCs-induced reproductive damage. In addition, many food-derived antioxidants are important elements involved in reproductive physiological activities and have protective effects on reproductive health. This paper summarized the reproductive toxicity of EDCs, including damage to reproductive cells, interference with hormone action, and influence on reproductive-related epigenetic regulation, elaborated the relationship between OS and reproductive toxicity of EDCs, and further summarized the alleviating effects and related mechanisms of food-derived antioxidants such as vitamins, trace elements, and plant polyphenols and pigments against reproductive toxicity of EDCs, aiming to provide a theoretical and scientific basis for prevention and treatment against reproductive toxicity of EDCs.

Objective To investigate the clinical value of left ventricular global longitudinal strain (LVGLS) combined with the global register of acute coronary events (GRACE) score in predicting coronary microcirculation disorder (CMD) in patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (PCI). Methods A total of 90 patients with AMI were selected as the study objects (10 cases were lost in follow-up, 4 cases were screened for poor image quality), and 76 cases were finally included. Left ventricular myocardial contrast echocardiography (MCE) was performed in patients at 48 h after surgery. Patients were divided into non-CMD group (n=53) and CMD group (n=23) according to coronary microcirculation perfusion. Clinical data and echocardiographic data of the two groups were analyzed and compared. Multivariate Logistic regression analysis was used to screen the influencing factors of CMD occurrence, and receiver operating characteristic (ROC) curve was drawn to analyze its clinical predictive value. Results Of the 76 patients, 23(30.3%) cases had CMD. LVGLS and GRACE scores in the CMD group were higher than those in the non-CMD group, and the differences were statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that LVGLS and GRACE score were independent predictors of CMD in AMI patients after emergency PCI. The area under the curve of CMD predicted by LVGLS was 0.858 (95%CI, 0.769 to 0.948). LVGLS combined with GRACE predicted that the area under the curve for CMD was 0.891 (95%CI, 0.815 to 0.967). Conclusion LVGLS is an independent predictor for early assessment of CMD occurrence in AMI patients after emergency PCI, and its combination with GRACE score can improve the accuracy of predicting CMD occurrence.

Objective To explore the influencing factors and prediction model construction of type 2 diabetes (T2DM) in women with gestational diabetes mellitus (GDM) within 2 years after delivery. Methods A total of 359 patients who diagnosed as GDM in prenatal examination and delivered in Suzhou Ninth Hospital Affiliated to Soochow University were selected for a 2-year follow-up. According to whether T2DM occurred during the follow-up period, the patients were divided into T2DM group and non-T2DM group. Univariate analysis was performed on data of the two groups, and multivariate Logistic regression analysis was performed to establish the prediction model. The goodness of fit test and receiver operating characteristic (ROC) curve were used to analyze and evaluate the effectiveness of the model. Results During the 2-year postpartum follow-up, 53 cases fell off, and 306 patients completed the follow-up. Among the 306 patients who completed the 2-year follow-up, 266 were not diagnosed with T2DM during the follow-up period (non-T2DM group), while 40 were diagnosed with T2DM (T2DM group). Statistically significant differences were observed between the T2DM andnon-T2DM groups in family history of diabetes, pre-pregnancy body mass index (BMI), 2-hour postprandial glucose level (OGTT-2hPG) for GDM diagnosis, the number of visits to prenatal classes during pregnancy, postpartum BMI, and postpartum visceral fat area (VFA) (P < 0.05). Multivariate Logistic regression analysis revealed that family history of diabetes, OGTT-2hPG, postpartum BMI, and postpartum VFA were influencing factors in the development of T2DM within 2 years postpartum among GDM patients (P < 0.05), while attending prenatal classes during pregnancy emerged as a protective factor (P < 0.05). The Hosmer-Lemeshow goodness-of-fit test indicated good fit of the prediction model (χ²=2.076, P=0.665). The area under the ROC curve for the model was 0.891 (95%CI, 0.828 to 0.954), with a cutoff value of 0.795 corresponding to the maximum Youden index, a sensitivity of 0.890 and a specificity of 0.847. Conclusion The risk prediction model based on OGT-2hPG index during pregnancy, the number of pregnant women attending school during pregnancy, family history of diabetes, postpartum BMI, VFA index has a certain predictive value for the risk of T2DM in GDM patients within 2 years after delivery.

Objective:To evaluate the clinical outcomes of additional surgery after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer.Methods:Sixty-nine patients with early gastric cancer who underwent ESD and were diagnosed as having non-curative resection by postoperative pathology at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2014 to December 2020 were included in the retrospective observation. Patients were divided into the additional surgery group ( n=12) and the follow-up group ( n=57). The differences in clinical and pathological data of the two groups, the surgical outcomes of the additional surgery group, three-year recurrence-free survival and tumor-specific survival of the two groups, and the independent risk factors affecting three-year recurrence-free survival in the follow-up group were analyzed. Results:Compared with the follow-up group, the rates of submucosal infiltration [66.7% (8/12) VS 21.1% (12/57), χ 2=7.927, P=0.005], vascular invasion [33.3% (4/12) VS 1.8% (1/57), P=0.003] and nerve invasion [16.7% (2/12) VS 0.0% (0/57), P=0.028] in the additional surgery group were significantly higher. In the additional surgery group, the interval between the additional surgery and ESD was 18.5 d (7-55 d), the surgical time was 286.4±85.9 min, and the number of dissected lymph nodes was 25.6±7.4. Four patients (33.3%) had residual tumor. Postoperative complications occurred in 4 patients (33.3%) (all were discharged after conservative treatment), and there was no perioperative death. One patient developed liver metastases 17 months after the surgery, and died 22 months after surgery due to liver metastases. One patient died 22 months after surgery due to non-tumor causes. The three-year recurrence-free survival and three-year tumor-specific survival in additional surgery group were 91.7% (11/12) and 91.7% (11/12), respectively, and those in the follow-up group were 87.7% (50/57) and 100.0% (57/57), respectively. Multivariate Cox regression analysis showed that tumor size ≥2 cm was an independent risk factor for three-year recurrence-free survival in the follow-up group ( P=0.037, HR=15.595, 95% CI: 1.181-205.952). Conclusion:Additional surgery and close follow-up are safe and feasible therapeutic strategies for early gastric cancer patients who underwent non-curative ESD. Clinicians should make reasonable choice based on the pathological results, patients' physical condition and surgery intention. But for patients with primary tumor size ≥2 cm, additional surgery is recommended.

Objective:To review the incidence and treatment status of perioperative anemia in patients with gastric cancer.Methods:The clinicopathological data of gastric cancer patients who underwent surgery at Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from Jan to Dec 2019 were collected. Univariate analysis and multivariate Logistic regression analysis were used to explore the risk factors of preoperative anemia in gastric cancer.Results:A total of 879 patients were included in this study. The incidence of preoperative anemia in patients with gastric cancer was 35.6%. The incidence of postoperative anemia was 63.5%. The proportion of patients with preoperative anemia receiving treatment was 17.3%, and the proportion of patients with postoperative anemia receiving treatment was 17.4%. Univariate analysis showed that age, nutritional risk screening 2002, T stage, M stage, tumor stage and lymph node metastasis were associated with preoperative anemia (all P<0.05). Multivariate Logistic regression analysis showed that age >60 years , nutritional risk screening 2002 ≥3, T 3-4 stage and M 1 stage were independent risk factors for preoperative anemia in patients with gastric cancer (all P<0.05). Conclusions:The incidence of perioperative anemia in patients with gastric cancer is high. At present, the proportion of patients with perioperative anemia receiving treatment is low. High nutritional risk, advanced age, late tumor T stage and distant metastasis are independent risk factors for preoperative anemia in patients with gastric cancer.

OBJECTIVE：To study the protective effect of timosaponin BⅡ（TB-Ⅱ）on blood vessels and explore its possible mechanism. METHODS ：Using aquaculture water as blank control ，the effects of 100，200 and 400 μg/mL TB-Ⅱ treatment for 48 h on the situation of subintestinal veins （SIVs）in normal zebrafish embryos 24 h after fertilization （24 hpf）were investigated. PTK787（0.06 μg/mL），a tyrosine kinase inhibitor ，was used to induce the model of zebrafish intestinal vascular injury ；using combing with 0.1％ dimethyl sulfoxide but no PTK 787 as blank control ，combing with PTK 787 but no drug as model control ，the effects treatment of 100，200 and 400 μg/mL TB-Ⅱ for 48 h on the SIVs of zebrafish model with vascular injury were investigated. Relative expressions of fam-like tyrosine kinase 1（Flt-1），kinase insert domain containing receptor （Kdr），kinase insert domain containing receptor l （Kdr-l），vascular endothelial growth factor A （VEGF-A），tumor necrosis factor α（TNF-α）and interleukin 6 （IL-6）mRNA were detected by RT-PCR. RESULTS ：100 μg/mL TB-Ⅱ could significantly increase the sprouting vessel of normal zebrafish SIVs sprouting vessel number （P＜0.05），and 200 μg/mL TB-Ⅱ could significantly increase SIVs number of normal zebrafish （P＜0.05）. Compared with blank control ， SIVs treatment （P＜0.01），and the relative expressions of Flt-l ， Kdr，Kdr-l，VEGF-A，TNF-α and IL-6 mRNA were alse decreased significantly （P＜0.05 or P＜0.01）. After treated 化。E-mail：pn333@163.com with different concentrations of TB- Ⅱ ，SIVs number of vascular injury model zebrafish increase d to different extents ；relative expressions of Flt-l ，Kdr，Kdr-l，VEGF-A，TNF-α and IL-6 mRNA were increased to different extents. There was no significant difference in SIVs number and the expression of Flt-l ，TNF-α mRNA in zebrafish treated with 100 μg/mL TB-Ⅱ and the expression of TNF-α mRNA in zebrafish treated with 400 μg/mL TB-Ⅱ， but there was statistical significance in other indexes （P＜0.05 or P＜0.01）. CONCLUSIONS ：TB-Ⅱ has a certain function of promoting angiogenesis and repairing damaged blood vessels ，and its mechanism is related to the up-regulation of vascular endothelial growth factor receptor and pro-inflammatory cytokine expression.

Objective:To investigate the effect of situational simulation drill in nurses training on prevention and treatment of venous thromboembolism (VTE).Methods:Totally 120 nurses in 1-3 years from a tertiary general hospital were selected to participate in the training for prevention and treatment of venous thromboembolism. They were divided into intervention group and control group according to the number of single and double packet ward. A total of 62 nurses in the single wards were selected as the intervention group, and a total of 58 nurses in the double wards were selected as the control group. The control group and the intervention group were trained on the prevention and treatment of venous thromboembolism by traditional teaching method and scenario simulation drill, and the effect was evaluated by Kirkpatrick Model.Results:After training, intervention group training object theory examination score, operation assessment score, clinical nursing work assessment score, and nurses ability to scale score (83.79±6.85), (87.00±4.57), (7.90±0.62), (79.03±8.24) respectively, were higher than the control group (80.67±7.90), (84.02±4.70), (7.21±0.72), (70.86±11.59), the score comparison difference was statistically significant ( t values were -3.660-5.670, P < 0.05); The satisfaction of the training object to the teaching plan, teaching content and teaching form in the intervention group was 88.71% (55/62), 87.10% (54/62) and 87.10% (54/62), which were all higher than the control group 74.14% (43/58), 72.41% (42/58) and 68.97% (40/58), with statistically significant differences ( χ2 values were 4.250, 4.038, 5.804, P<0.05). Conclusion:The application of situational simulation drill in the nursing training of prevention and treatment of VTE is helpful to improve the theoretical skills and clinical work ability of nurses in the prevention and treatment of VTE, and to increase the satisfaction of nurses with the training.