ObjectiveThis study aims to systematically analyze the blood-absorbed components and metabolic profiles of Xiebaisan（XBS） in normal and chronic bronchitis （CB） mice using ultra performance liquid chromatography-quadrupole-electrostatic field orbitrap high resolution mass spectrometry（UPLC-Q-Exactive Orbitrap MS）， while comparing differences between the two states. MethodsThirty female BABL/c mice were randomly divided into the normal group， the normal drug administration group， the CB group， the CB drug administration group and the dexamethasone group， with 6 mice in each group. The CB mouse model was established by inducing with ovalbumin （OVA）. The mice in the normal drug administration group and the CB drug administration group started to be gavaged with XBS（13.2 g·kg^-1） from the 21^st day， and the dexamethasone group mice were simultaneously gavaged with dexamethasone （0.5 mg·kg^-1） until the end of the 35^th day of the experiment. Subsequently， serum samples were collected and evaluated for their efficacy， based on the pharmacological evaluation indicators， to determine the efficacy of XBS in treating CB. Then the UPLC-Q-Exactive Orbitrap MS was employed to identify and analyze the chemical constituents， blood-absorbed components， and metabolites of XBS. Chemometric analysis was conducted to reveal metabolic profile differences under "dual states". Concurrently， Real-time PCR technology was utilized to detect the expression levels of key liver metabolic enzymes CYP2E1， CYP3A1， UGT1A1， and UGT1A6. ResultsA total of 28 prototype components and 158 metabolites （including 48 phase Ⅰ metabolites and 110 phase Ⅱ metabolites） of XBS were unambiguously identified in the serum of normal mice. Additionally， a comprehensive characterization was performed on a total of 32 prototype components and 178 metabolites （including 50 phase Ⅰ metabolites and 128 phase Ⅱ metabolites） of XBS in the serum of CB mice. Among them， 27 prototype components were detected in both states， including 12 flavonoids， 2 alkaloids， 3 triterpenes， 4 organic acids， 3 amides， 1 stilbene and 2 other compounds. The chemometrics analysis revealed no significant difference in the prototype components and metabolites of XBS between normal and CB mice； however， there was a significant increase in the in-vivo exposure of XBS in CB mice. Compared to normal mice， the levels of phase Ⅰ metabolites such as oxidation， reduction and methylation of blood components of XBS as well as phase Ⅱ metabolites of glucuronidation showed significant changes in CB mice. Real-time PCR further confirmed that these alterations were attributed to the upregulation of CYP2E1 （P<0.05）， CYP3A1 （P>0.05）， UGT1A1 （P<0.01） and UGT1A6 （P<0.01） enzymes expression in the liver of CB mice. ConclusionThis study elucidated the disparities in the levels of the blood-absorbed components and metabolic profiles of XBS in normal and CB mice， especially in oxidation， reduction， methylation in phase Ⅰ metabolism and glucoaldehyde acidification in phase Ⅱ metabolism. And there are related to the differences in the expression levels of phase Ⅰ and phase Ⅱ metabolic enzymes CYP2E1， CYP3A1， UGT1A1 and UGT1A6 in the liver.

Objective To explore the adverse event signals of children using macrolide drugs （azithromycin, clarithromycin, and erythromycin）, and provide reference for rational medicine use in clinical practice. Methods Data from children under 12 years old were extracted from the US FAERS database spanning from the first quarter of 2004 to the second quarter of 2023. The adverse drug reaction （ADR） signal mining for three macrolide antibiotics was conducted using the Reporting Odds Ratio （ROR） and Bayesian Confidence Propagation Neural Network （BCPNN） methods. Special emphasis was placed on analyzing and contrasting the differences in adverse events among the three drugs. Results A total of 1 615 reports for children under 12 years old were retrieved from the FAERS database, including 1 024 reports of azithromycin, 460 reports of clarithromycin, and 131 reports of erythromycin. Among azithromycin and erythromycin, there were more reports from boys than girls, while for clarithromycin, there were more reports from girls than boys. Oral administration was the most common route of administration for all three drugs. Regarding the outcome of adverse events reported, azithromycin and clarithromycin were primarily associated with other serious adverse events, whereas erythromycin was mainly associated with hospitalization and other serious adverse events. The number of adverse events reported decreased with increasing age, with a higher number of reports in the 0-3 age group. Using the ROR and BCPNN methods for signal detection, 86 signals were identified for azithromycin, 91 for clarithromycin, and 34 for erythromycin. These signals involved 22 System Organ Classes （SOCs）, with azithromycin mainly concentrated in skin and subcutaneous tissue disorders （n=21）, clarithromycin in gastrointestinal disorders （n=15）, and erythromycin in gastrointestinal disorders （n=8）. Twenty-four signals of moderate to high risk were detected, with 13 for azithromycin, 9 for clarithromycin, and 2 for erythromycin. Conclusion The adverse events induced by the three drugs with different risks in different systems. When clinically treating Mycoplasma pneumoniae pneumonia in children, the risk profiles of drugs in different systems should be considered, and personalized dosing should be implemented.

Autoimmune hepatitis （AIH） is a chronic inflammatory liver disease mediated by T lymphocytes， and it can progress to liver cirrhosis or even liver failure without timely intervention. As a natural flavonoid compound， naringenin （NAR） shows a potential value in the prevention and treatment of AIH through multiple mechanisms such as remodeling immune homeostasis， targeted inhibition of inflammatory pathways， antioxidation， regulating hepatocyte metabolism and apoptosis， improving mitochondrial function， and regulating intestinal flora. However， the clinical translation and application of NAR is limited by issues such as low bioavailability and insufficient efficiency of liver-targeted delivery. This article systematically reviews the mechanism of action of NAR in the prevention and treatment of AIH， explores the potential signaling pathways involved in this process， and analyzes existing challenges in its translation and application and future research directions， so as to provide a reference for further research on NAR and its application in the prevention and treatment of AIH.

Objective To investigate the existing nuclear radiation health emergency response capacity of local health systems at nuclear power plant sites in Guangdong Province. Methods The health administrative departments of all nuclear power plants sites in Guangdong Province, along with radiation health protection institutions, designated nuclear radiation treatment hospitals, and township health centers, were selected as the study subjects using the purposive sampling method. A series of standardized questionnaires on the capacities for nuclear radiation health emergency response, developed uniformly by the National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, were adopted to separately investigate the capacities for nuclear radiation health emergency response in the study subjects. Results There were 13 health administration departments, 15 radiological health protection institutions, 18 designated hospitals for nuclear radiation medical response, and 18 township health centers located in the nuclear power plants sites in Guangdong Province. Among the 13 health administration departments, the Health Commission of Guangdong Province met all 15 criteria for nuclear radiation health emergency response capacities. All six prefecture-level health administrative departments possessed more than 10 capacities for nuclear radiation health emergency response, while only one of the six county-level departments had more than 10 such capacities. Among radiation health protection institutions, the provincial-level institution possessed all 18 capacity for nuclear radiation health emergency response; of the six prefectural-level institutions, only four had more than 10 capacities; none of the eight county-level institutions or 18 township health centers possessed more than 10 capacities. Among designated nuclear radiation treatment hospitals, provincial-level institution met all 32 capacities for nuclear radiation health emergency response; of the eight prefecture‑level hospitals, only four meet more than ten such capacities; and of the nine county‑level hospitals and 18 township health centers, none possess more than 10 capacities. Conclusion Provincial- and prefectural-level nuclear radiation emergency capacity in Guangdong Province is adequate, whereas county-level and township health centers have obvious weaknesses in organizational structure, personnel training, equipment reserves, funding, and technical reserves; emergency response capacity needs urgent enhancement.

Pancreatic ductal adenocarcinoma （PDAC） has an extremely poor prognosis， and resistance to gemcitabine is one of the key reasons for treatment failure， with an underlying mechanism closely associated with lipid metabolic reprogramming in tumor cells. This article aims to systematically elaborate on the multidimensional drug resistance network constructed by such reprogramming and the feasibility of targeted intervention. Lipid metabolic reprogramming comprehensively remodels the metabolic homeostasis of PDAC cells by enhancing lipid uptake， de novo synthesis， storage， and oxidative catabolism in a synergistic manner. This process alters membrane lipid composition to impede drug influx and promote efflux， thereby reducing intracellular drug concentration. Meanwhile， it activates pathways involving sterol regulatory element-binding protein and peroxisome proliferator-activated receptor δ， couples lipid synthesis with cell survival， stemness， and anti-apoptotic capacity， and synergizes with autophagy to provide survival support through “lipophagy”. In addition， it reshapes the tumor microenvironment through “lipid hijacking” and the secretion of immunosuppressive mediators. Based on the above mechanisms， targeting key lipid metabolic enzymes （such as fatty acid synthase， stearoyl-CoA desaturase， carnitine palmitoyltransferase 1） or their upstream regulators has shown certain potential in reversing such drug resistance in preclinical studies. Although clinical translation faces the challenges such as systemic toxicity， metabolic redundancy in tumors， and patient heterogeneity， the development of biomarkers， intelligent drug delivery systems， and combined therapies may provide new ideas for overcoming drug resistance.

Locally advanced non-small cell lung cancer (NSCLC) is a highly heterogeneous disease. For patients with driver gene-negative, unresectable NSCLC, traditional treatment primarily involves concurrent chemoradiotherapy. With the advent of the immunotherapy era, integrated treatment strategies combining concurrent chemoradiotherapy with immunotherapy have significantly improved therapeutic outcomes and substantially extended survival periods. This article summarizes the interaction mechanisms and clinical research progress of radiotherapy, chemotherapy, and immune checkpoint inhibitors in the treatment of NSCLC. This review also provides perspectives on the development of therapies in the future and predictive biomarkers, serving as a reference for treatment options for patients with unresectable locally advanced NSCLC.

Brain metastases are the most common intracranial tumors, and their incidence is increasing with the improvement of systemic treatments and survival rates. Optimal treatment usually requires a multidisciplinary approach, including radiotherapy, surgical resection, chemotherapy, targeted therapy, and immunotherapy. Stereotactic radiotherapy, compared to whole-brain radiotherapy, offers improved local control rates and reduced risk of neurocognitive impairment, and has become a new standard option for the treatment of brain metastases. Additionally, the widespread use of targeted and immune therapies in brain metastases has significantly improved the survival of some patients. This article reviews and integrates recent literature on the treatment of brain metastases and analyzes the role of stereotactic radiotherapy in comprehensive treatment, aiming to provide a reference for the selection of clinical treatment plans.

Objective To explore the change trajectory of self-acceptance of patients with permanent urostomy,in order to provide basis for self-acceptance intervention practice of patients.Methods 168 patients with abdominal wall stoma with urinary diversion from June 2021 to June 2023 in Fudan University Cancer Hospital were selected as the survey subjects by convenience sampling.We used a general information questionnaire,SAQ,PTGI,SSRS,and COST-PROM.Baseline surveys were conducted a week after surgery(T0),and follow-up surveys were conducted at 1 month(T1),3 months(T2),and 6 months(T3)after discharge.The mixed model of latent variable growth was used to analyze the change trajectory of self-acceptance of patients with permanent urinary stoma,and the core predictors of each subtype were explored through the decision tree model.Results The number of patients who participated in the 4 surveys was 168,168,165 and 163,respectively,and the final questionnaire recovery rate was 97.02％(163/168).The self-acceptance scores of patients with permanent urostomy were(35.72±8.63)(36.81±9.23)(39.88±8.95)and(43.17±9.56)points,respectively.The 3 subgroups of self-acceptance changes were identified,including low self-acceptance slow rising group(49.08％),medium self-acceptance first falling then rising group(30.06％),and medium self-acceptance fast rising group(20.86％)(P＜0.001).The decision tree model showed that education level,age,post-traumatic growth,social support,and economic burden could all predict the change track subtype of self-acceptance of patients with permanent urostomy,and the importance of post-traumatic growth was 100％.Conclusion The self-acceptance of patients with permanent urostomy is generally on the rise,and there is a population heterogeneity development track.Posttraumatic growth is the core predictor.It is important to identify the slow increase group of low self-acceptance according to the predictive indicators,and construct an intervention program focusing on improving the post-traumatic growth of patients with permanent urinary stoma to improve their self-acceptance level.

Objective:To evaluate the left atrial function in patients with hypertrophic cardiomyopathy（HCM）combined with heart failure with preserved ejection fraction（HFpEF）using four-dimensional automated left atrial quantification（4D Auto LAQ）technology，and to investigate the independent factors affecting patients with HCM combined with HFpEF.Methods:One hundred HCM patients with left ventricular ejection fraction（LVEF）≥ 50% who were admitted to the First Affiliated Hospital of Zhengzhou University from September 2023 to March 2025 were prospectively selected. There were 50 cases in the HFpEF group and 50 cases in the non-HF group. The clinical data and conventional ultrasound parameters of HCM patients were collected. The 4D Auto LAQ technology was applied to obtain the four-dimensional volume and strain parameters of the left atrium，including the minimum left atrial volume（LAVmin），the maximum left atrial volume（LAVmax），the maximum left atrial volume index（LAVImax），the pre-atrial contraction volume（LAVpreA），the left atrial emptying volume（LAEV），the left atrial ejection fraction（LAEF），the longitudinal and circumferential strains in the left atrial reservoir period（LASr，LASr-c），the longitudinal and circumferential strains in the left atrial conduit period（LAScd，LAScd-c），the longitudinal and circumferential strains in the left atrial contraction period（LASct，LASct-c），and the minimum left atrial volume index（LAVImin）. The differences in the above parameters between the two groups were compared. Univariate and multivariate Logistic regression analyses were used to analyze the independent influencing factors in HCM patients with HFpEF. The intraclass correlation coefficient was used to test the repeatability of the 4D Auto LAQ parameters.Results:Compared with the non-HF group，LAVmin，LAVmax，LAVpreA，LAVImin，and LAVImax increased，while LAEF，LASr，LAScd，LASct，LASr-c，LAScd-c，and LASct-c decreased in the HFpEF group（all P<0.05）. Multivariate Logistic regression analysis showed that LASr was the strongest independent influencing factor in patients with HCM combined with HFpEF（ OR=0.255， P=0.003）. The consistency test showed that the intraclass correlation coefficients of each parameters of 4D Auto LAQ were all>0.7，the consistency was good. Conclusions:4D Auto LAQ technology can be used to evaluate left atrial function in patients with HCM combined with HFpEF，and LASr is the strongest independent influence factor in patients with HCM combined with HFpEF.

Objective:To evaluate the efficacy and safety of endoscopic variceal ligation (EVL) of esophageal varices combined with endoscopic variceal intensive ligation (EVIL) of gastric varices for gastroesophageal variceal bleeding with liver cirrhosis under non-emergency settings.Methods:Data of 643 consecutive patients with gastroesophageal variceal bleeding due to liver cirrhosis admitted to the Department of Gastroenterology, Henan Provincial People's Hospital from January 2017 to March 2023 were included in the retrospective study. A total of 192 patients were included after excluding 451 patients. One hundred and forty-nine patients who underwent EVL of esophageal varices combined with EVIL of gastric varices were enrolled into the EVIL group, while 43 patients who underwent EVL of esophageal varices combined with endoscopic tissue adhesive injection (ETAI) of gastric varices were enrolled into the ETAI group. The endoscopic treatment success rate, esophageal variceal ligations number, operation time of endoscopic treatment, hospitalization time, rebleeding rate, mortality and the incidence of adverse events were compared between the two groups.Results:Compared with the ETAI group, the EVIL group exhibited significantly higher endoscopic treatment success rate [100.0% (149/149) VS 95.3% (41/43), P=0.049], slightly greater esophageal variceal ligations number [8 (6, 11) rings VS 7 (6, 9) rings, Z=-1.29, P=0.196], shorter operation time of endoscopic treatment [27.0 (20.5, 34.0) min VS 36.0 (21.0, 51.0) min, Z=-2.30, P=0.021], and significantly shorter hospitalization time [10 (7, 13) d VS 13 (9, 15) d, Z=-3.02, P=0.003]. The rebleeding rate within 24, 72, 120 hours after the operation, early, delayed and total rebleeding in the EVIL group were 0.0% (0/149), 0.0% (0/149), 0.7% (1/149), 2.0% (3/149), 12.8% (19/149) and 14.8% (22/149) respectively, and 4.7% (2/43) ( P=0.049), 9.3% (4/43) ( P=0.002), 9.3% (4/43) ( χ2=6.69, P=0.010), 4.7% (2/43) ( χ2=0.17, P=0.679), 30.2% (13/43) ( χ2=7.34, P=0.007) and 44.2% (19/43) ( χ2=17.20, P<0.001) in the ETAI group, respectively. No death related to rebleeding occurred within 6 weeks after the operation in 2 groups. The mortality related to rebleeding within 1 year after the operation and during the follow-up period in the EVIL group were 1.3% (2/149) and 3.4% (5/149) respectively, and 0.0% (0/43) ( P=1.000) and 2.3% (1/43) ( χ2=0.02, P=0.876) in the ETAI group, respectively. The incidences of fever, chest pain, nausea or vomiting in the EVIL group were 12.1% (18/149), 14.1% (21/149) and 13.4% (20/149) respectively, and 11.6% (5/43) ( χ2=0.01, P=0.936), 16.3% (7/43) ( χ2=0.13, P=0.721) and 18.6% (8/43) ( χ2=0.72, P=0.396) in the ETAI group, respectively. Two patients (1.3%) in the EVIL group had gastric variceal ring loss. Ectopic embolism occurred in 1 patient (2.3%) in the ETAI group. Conclusion:For patients with gastroesophageal variceal bleeding due to liver cirrhosis who are suitable for non-emergency endoscopic treatment, EVL of esophageal varices combined with EVIL of gastric varices is also safe, and more effective than EVL of esophageal varices combined with ETAI of gastric varices. This approach offers improved treatment success rate, reduced operation and hospitalization time, lower rebleeding rates, and decreased rebleeding-related mortality.