Objective To explore the inhibitory effect of Xinhui tangerine peel polysaccharides on the mouse skin fibroblasts so as to understand the underlying molecular mechanism.Methods We separated and purified the components of tangerine peel polysaccharides from Xinhui tangerine peel.C57BL/6 mouse skin fibroblasts were isolated and cultured for the cellular experimental study.We set up a blank control group(normal culture)and low-,medium-and high-dose experimental groups(50,100 and 200 μg/mL tangerine peel polysaccharides).After 24 hours of treatment,cell survival rate was assessed by CCK-8 assay.The mRNA and protein expression levels of collagen type Ⅰ(Col1a1),collagen type Ⅲ(Col1a3),TGF-β1 and ACTA2 in fibroblasts were examined by RT-qPCR and Western blotting.Smad3 was examined by Western blotting.Results The cell survival rate in the blank control group,the medium-and high-dose experimental groups was 100％,(90.54±6.74)％,and(78.90±4.24)％,respectively.The relative expression level of Col1a1 protein was 1.13±0.15,0.57±0.16,and 0.48±0.05,respectively;the relative expression level of Col3a1 protein was 0.81±0.13,0.49±0.11 and 0.50±0.03;the relative expression level of TGF-β1 protein was 1.11±0.15,0.60±0.13,and 0.33±0.11;the relative expression level of p-Smad3/Smad3 proteins was 0.96±0.05,0.75±0.06 and 0.71±0.03.The mRNA expression level of Col1a1 was 1.01±0.17,0.58±0.11,and 0.52±0.12;the mRNA expression level of Col3a1 was 1.01±0.12,0.56±0.19,and 0.65±0.14;the expression level of ACTA2 mRNA was 1.01±0.13,0.24±0.04,and 0.22±0.07;the mRNA expression level of TGF-β1 was 1.00±0.09,0.50±0.10,and 0.49±0.15.The relative expression levels of p-Smad3/Smad3 proteins were 0.86±0.06,0.66±0.06,0.55±0.13,0.43±0.09,0.35±0.06,and 0.27±0.12,respectively,after time-related treatment with high-dose tangerine peel polysaccharides.The above indicators in medium-and high-dose tangerine peel polysaccharide groups showed statistically significant differences compared to those in the blank control group(P＜0.05).Conclusion Tangerine peel polysaccharides can inhibit the cell proliferation and the synthesis of keloid-related genes on fibroblasts by inhibiting TGF-β1/Smad3 signaling pathway.

Objective This study aims to develop an early in-hospital temperature management protocol for heat stroke patients and assess its effectiveness,providing guidance for rapid cooling and precise target temperature control.Methods The protocol was developed through a Delphi expert consultation combined with expert panel meetings.A multi-center,non-randomized,historical control study was conducted,utilizing convenience sampling to select heat stroke patients from the emergency departments of 7 tertiary hospitals in Zhejiang Province,China,between June and August 2024 as an experimental group.The protocol was implemented in this group,while the control group consisted of heat stroke patients treated between June and August 2022,prior to protocol implementation.Cooling rates,target temperature attainment rates,and clinical outcomes were compared between the 2 groups.Results The final protocol included 6 primary indicators,23 secondary indicators,and 56 tertiary indicators.After protocol implementation,the experimental group achieved a cooling rate of 0.08(0.05～0.09)℃/min within 0.5 hours,significantly higher than the control group,which had a rate of 0.04(0.02～0.06)℃/min(P＜0.001).The target temperature attainment rates at 0.5 hours and 2.0 hours were 55.93％and 98.31％,respectively,significantly higher than the rates of 15.87％and 61.11％in the control group(P＜0.001).The mechanical ventilation rate,hospitalization rate,ICU admission rate,and mortality rate in the experimental group were 25.42％,61.02％,44.07％,and 8.47％,respectively.Logistic regression analysis revealed that the early in-hospital temperature management protocol significantly reduced the risk of mechanical ventilation and hospitalization in heat stroke patients,with odds ratios(ORs)of 0.294 and 0.300,respectively(both P＜0.05).Conclusion The developed protocol for early in-hospital temperature management in heat stroke patients is scientific,systematic,and practical.It improves cooling rates and target temperature attainment,thereby enhancing the prognosis of heat stroke patients.

Objective To explore the inhibitory effect of Xinhui tangerine peel polysaccharides on the mouse skin fibroblasts so as to understand the underlying molecular mechanism.Methods We separated and purified the components of tangerine peel polysaccharides from Xinhui tangerine peel.C57BL/6 mouse skin fibroblasts were isolated and cultured for the cellular experimental study.We set up a blank control group(normal culture)and low-,medium-and high-dose experimental groups(50,100 and 200 μg/mL tangerine peel polysaccharides).After 24 hours of treatment,cell survival rate was assessed by CCK-8 assay.The mRNA and protein expression levels of collagen type Ⅰ(Col1a1),collagen type Ⅲ(Col1a3),TGF-β1 and ACTA2 in fibroblasts were examined by RT-qPCR and Western blotting.Smad3 was examined by Western blotting.Results The cell survival rate in the blank control group,the medium-and high-dose experimental groups was 100％,(90.54±6.74)％,and(78.90±4.24)％,respectively.The relative expression level of Col1a1 protein was 1.13±0.15,0.57±0.16,and 0.48±0.05,respectively;the relative expression level of Col3a1 protein was 0.81±0.13,0.49±0.11 and 0.50±0.03;the relative expression level of TGF-β1 protein was 1.11±0.15,0.60±0.13,and 0.33±0.11;the relative expression level of p-Smad3/Smad3 proteins was 0.96±0.05,0.75±0.06 and 0.71±0.03.The mRNA expression level of Col1a1 was 1.01±0.17,0.58±0.11,and 0.52±0.12;the mRNA expression level of Col3a1 was 1.01±0.12,0.56±0.19,and 0.65±0.14;the expression level of ACTA2 mRNA was 1.01±0.13,0.24±0.04,and 0.22±0.07;the mRNA expression level of TGF-β1 was 1.00±0.09,0.50±0.10,and 0.49±0.15.The relative expression levels of p-Smad3/Smad3 proteins were 0.86±0.06,0.66±0.06,0.55±0.13,0.43±0.09,0.35±0.06,and 0.27±0.12,respectively,after time-related treatment with high-dose tangerine peel polysaccharides.The above indicators in medium-and high-dose tangerine peel polysaccharide groups showed statistically significant differences compared to those in the blank control group(P＜0.05).Conclusion Tangerine peel polysaccharides can inhibit the cell proliferation and the synthesis of keloid-related genes on fibroblasts by inhibiting TGF-β1/Smad3 signaling pathway.

Objective This study aims to develop an early in-hospital temperature management protocol for heat stroke patients and assess its effectiveness,providing guidance for rapid cooling and precise target temperature control.Methods The protocol was developed through a Delphi expert consultation combined with expert panel meetings.A multi-center,non-randomized,historical control study was conducted,utilizing convenience sampling to select heat stroke patients from the emergency departments of 7 tertiary hospitals in Zhejiang Province,China,between June and August 2024 as an experimental group.The protocol was implemented in this group,while the control group consisted of heat stroke patients treated between June and August 2022,prior to protocol implementation.Cooling rates,target temperature attainment rates,and clinical outcomes were compared between the 2 groups.Results The final protocol included 6 primary indicators,23 secondary indicators,and 56 tertiary indicators.After protocol implementation,the experimental group achieved a cooling rate of 0.08(0.05～0.09)℃/min within 0.5 hours,significantly higher than the control group,which had a rate of 0.04(0.02～0.06)℃/min(P＜0.001).The target temperature attainment rates at 0.5 hours and 2.0 hours were 55.93％and 98.31％,respectively,significantly higher than the rates of 15.87％and 61.11％in the control group(P＜0.001).The mechanical ventilation rate,hospitalization rate,ICU admission rate,and mortality rate in the experimental group were 25.42％,61.02％,44.07％,and 8.47％,respectively.Logistic regression analysis revealed that the early in-hospital temperature management protocol significantly reduced the risk of mechanical ventilation and hospitalization in heat stroke patients,with odds ratios(ORs)of 0.294 and 0.300,respectively(both P＜0.05).Conclusion The developed protocol for early in-hospital temperature management in heat stroke patients is scientific,systematic,and practical.It improves cooling rates and target temperature attainment,thereby enhancing the prognosis of heat stroke patients.

Objective:To analyze the epidemiological characteristics and economic burden of palmoplantar pustulosis (PPP) in China.Methods:A population-based retrospective study was conducted using the data from China′s Urban Basic Medical Insurance data from January 1, 2012, to December 31, 2016. International Classification of Diseases code and diagnoses in Chinese for PPP were used to identify cases and estimate the prevalence, incidence, and cost. Subgroup analyses were performed according to age and sex, and sensitivity analyses were conducted to evaluate the robustness of the results. Age-adjusted prevalence rates were calculated based on the 2010 national census data.Results:The crude prevalence and incidence rate of PPP in 2016 were 2.730/100 000 (95% CI: 2.218/100 000-3.242/100 000) and 1.556/100 000 (95% CI: 1.154/100 000-1.958/100 000), and the prevalence rate of females (2.910/100 000) was higher than that of males (2.490/100 000, χ2=97.48, P=0.001). The incidence rate of females (1.745/100 000) was also higher than that of males (1.418/100 000, χ2=85.02, P=0.001). The age peak of incidence and prevalence of patients with PPP was in the 30-39-year age group and a small peak existed in the 0-3-year age group among people under 20 years old. From 2012 to 2016, the average number of visits was (2.44±0.04) per patient, and the total per-capita cost per year was (982.40±39.19) yuan. Conclusion:In 2016, the prevalence and incidence rate of PPP in China were higher in females than in males, and the highest age peak was in the 30-39-year age group.

ObjectiveTo investigate the application value of liver/spleen CT value （CT_L/S）， controlled attenuation parameter （CAP）， and magnetic resonance imaging-proton density fat fraction （MRI-PDFF） in chronic hepatitis B （CHB） patients with hepatic steatosis. MethodsA retrospective analysis was performed for the clinical data of 213 CHB patients who underwent liver CT， CAP， and MRI-PDFF examinations in Affiliated Hospital of Yan’an University from October 2018 to December 2022. According to MRI-PDFF， the 213 patients were divided into CHB group with 111 patients （MRI-PDFF<5%） and CHB+hepatic steatosis group with 102 patients （MRI-PDFF≥5%）， among whom there were 69 patients with mild hepatic steatosis and 33 patients with moderate to severe hepatic steatosis. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The Bland-Altman plot was used to evaluate the consistency in MRI-PDFF measurement between two physicians. The Spearman’s correlation coefficient was used to analyze the correlation between CT_L/S and MRI-PDFF and between CAP and MRI-PDFF. The receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to investigate the value of CT_L/S and CAP in the diagnosis of different degrees of hepatic steatosis， and the DeLong test was used to compare the AUCs of the two radiological examinations. ResultsMRI-PDFF had relatively high repeatability and stability in CHB patients. There is a significant negative correlation between CT_L/S and MRI-PDFF （r=-0.800， P<0.001） and a significant positive correlation between CAP and MRI-PDFF （r=0.692， P<0.001）. Both CT_L/S and CAP had a relatively high accuracy in the diagnosis of hepatic steatosis in CHB patients， with an AUC of 0.951 and 0.902， respectively， and CT_L/S had a better accuracy than CAP （P<0.05）. In the diagnosis of mild and moderate-to-severe hepatic steatosis， CT_L/S had an AUC of 0.921 and 0.895， respectively， and CAP had an AUC of 0.859 and 0.825， respectively， suggesting that CT_L/S had a slightly higher diagnostic efficiency than CAP. ConclusionMRI-PDFF has high repeatability and stability in CHB patients， and CT_L/S and CAP have a high diagnostic value for different degrees of hepatic steatosis in CHB patients.

Objective:To analyze the epidemiological characteristics and economic burden of palmoplantar pustulosis (PPP) in China.Methods:A population-based retrospective study was conducted using the data from China′s Urban Basic Medical Insurance data from January 1, 2012, to December 31, 2016. International Classification of Diseases code and diagnoses in Chinese for PPP were used to identify cases and estimate the prevalence, incidence, and cost. Subgroup analyses were performed according to age and sex, and sensitivity analyses were conducted to evaluate the robustness of the results. Age-adjusted prevalence rates were calculated based on the 2010 national census data.Results:The crude prevalence and incidence rate of PPP in 2016 were 2.730/100 000 (95% CI: 2.218/100 000-3.242/100 000) and 1.556/100 000 (95% CI: 1.154/100 000-1.958/100 000), and the prevalence rate of females (2.910/100 000) was higher than that of males (2.490/100 000, χ2=97.48, P=0.001). The incidence rate of females (1.745/100 000) was also higher than that of males (1.418/100 000, χ2=85.02, P=0.001). The age peak of incidence and prevalence of patients with PPP was in the 30-39-year age group and a small peak existed in the 0-3-year age group among people under 20 years old. From 2012 to 2016, the average number of visits was (2.44±0.04) per patient, and the total per-capita cost per year was (982.40±39.19) yuan. Conclusion:In 2016, the prevalence and incidence rate of PPP in China were higher in females than in males, and the highest age peak was in the 30-39-year age group.

Background::The incidence and mortality of colorectal cancer (CRC) in China are increasing in recent years. The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent, screen, and diagnose CRC at an early stage. With the development of endoscopic and surgical techniques, the choice of treatment for early CRC is also worth further discussion, and accordingly, a standard follow-up program after treatment needs to be established.Methods::This clinical practice guideline (CPG) was developed following the recommended process of the World Health Organization, adopting Grading of Recommendations Assessment, Development and Evaluation (GRADE) in assessing evidence quality, and using the Evidence to Decision framework to formulate clinical recommendations, thereby minimizing bias and increasing transparency of the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline’s completeness and transparency.Results::This CPG comprises 46 recommendations concerning prevention, screening, diagnosis, treatment, and surveillance of CRC. In these recommendations, we have indicated protective and risk factors for CRC and made recommendations for chemoprevention. We proposed a suitable screening program for CRC based on the Chinese context. We also provided normative statements for the diagnosis, treatment, and surveillance of CRC based on existing clinical evidence and guidelines.Conclusions::The 46 recommendations in this CPG are formed with consideration for stakeholders’ values and preferences, feasibility, and acceptability. Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.

[Objective] To investigate the role of miR-199a-3p on mouse skin scar fibroblasts and the potential target of miR-199a-3p. [Methods] A mouse skin keloid model was established. The mRNA levels of miR-199a-3p, Smad1 and keloid related genes in keloid tissues and normal skin tissues were detected by Real-time quantitative PCR. C57BL/6 mouse skin fibroblasts were isolated and cultured for the cellular experimental study. miR-199a-3p mimic and Smad1 siRNA matter were transiently transfected into mouse skin fibroblasts by liposome reagent. the interaction between miR-199a-3p and the 3′-UTR of Smad1 was confirmed by the dual luciferase reporter assay. The expressions of Smad1 and keloid-related genes at mRNA and protein levels after transfection of miR-199a-3p mimic were determined. The expressions of Smad1 and keloid-related genes at protein level after transfection of miR-199a-3p mimic and Smad1 siRNA were determined by Western blot assay. [Results] Compared with normal skin tissues, the expressions of Smad1 (t=-4.403, P=0.010) and keloid related genes, Col1a1(t=-3.334, P=0.016), Col3a1(t=-5.927, P=0.001) and ACTA2(t=-3.673, P=0.010), were significantly increased in keloid tissues, while miR-199a-3p (t=7.059, P<0.001) expression was significantly decreased. Over-expression of miR-199a-3p could significantly decrease the expressions of keloid-related genes, Col1a1 (t=5.514, P=0.005), Col3a1 (t=5.132, P=0.014) and ACTA2 (t=4.136, P=0.026), in mouse skin fibroblasts. Moreover, the dual luciferase reporter assay revealed that miR-199a-3p could interact with the 3′-UTR of Smad1. miR-199a-3p was observed to inhibit Smad1 at mRNA expression level (t=3.556, P=0.024), and at the post-transcriptional level (t=3.781, P=0.019). Meanwhile, miR-199a-3p mimic, in parallel to Smad1 siRNA, decreased the expressions of keloid-related genes, Col1a1 (F=18.804; P=0.003, 0.022), Col3a1 (F=33.212; P=0.001, 0.001) and α-SMA (F=10.181; P=0.020, 0.028), and decreased the proliferation of skin fibroblasts (F=18.622; P=<0.001, <0.001). [Conclusion] miR-199a-3p inhibits the formation of keloid by targeting Smad1.

Objective To investigate the value of liver/muscle ratio (LMR) on susceptibility-weighted imaging (SWI) and serum markers in the diagnosis of the severity of chronic hepatitis B liver fibrosis after grouping based on alanine aminotransferase (ALT) level. Methods A retrospective analysis was performed for 255 patients with chronic hepatitis B who attended Affiliated Hospital of Yan'an University from October 2018 to September 2021, and the patients were divided into severe liver fibrosis group (SLF group) and non-severe liver fibrosis group (non-SLF group). The SLF group was defined as liver stiffness measurement (LSM) > 9.0 kPa and ALT level within the normal range or LSM > 12.0 kPa and ALT level greater than 1-5 times of the upper limit of normal. LMR was calculated by measuring the mean SWI value of the liver (SWI liver ) and the signal intensity of the erector spinae. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two group; the chi-square test was used for comparison of categorical data between two groups. The binary logistic regression analysis was used to investigate the influencing factors for SLF. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of LMR and its combination with serum markers, and the DeLong test was used to compare the difference in the area under the ROC curve (AUC). Results Compared with the non-SLF group, the SLF group had significantly higher ALT ( Z =-3.569, P < 0.001), aspartate aminotransferase (AST) ( Z =-5.495, P < 0.001), hyaluronic acid (HA) ( Z =-6.746, P < 0.001), laminin (LN) ( Z =-5.459, P < 0.001), type Ⅳ collagen (Ⅳ-C)( Z =-8.470, P < 0.001), type Ⅲ procollagen (PCⅢ) ( Z =-6.326, P < 0.001), aspartate aminotransferase-to-platelet ratio index ( Z =-9.004, P < 0.001), and FIB-4 ( Z =-8.357, P < 0.001) and significantly lower prothrombin time activity (PTA) ( t =10.088, P < 0.001), platelet count ( t =9.163, P < 0.001), SWI liver ( t =2.347, P =0.02), and LMR×10 ( Z =-4.447, P < 0.001). PTA, HA, Ⅳ-C, and LMR×10 were independent influencing factors for SLF. LMR×10 had an AUC of 0.675 (95% confidence interval [ CI ]: 0.614-0.732) in the diagnosis of SLF, which was significantly higher than that of SWI liver (AUC=0.594, 95% CI : 0.531-0.655) ( Z =3.984, P < 0.001). PTA+HA+Ⅳ-C+LMR×10 and PTA+HA+Ⅳ-C had an AUC of 0.937 (95% CI : 0.896-0.966) and 0.905 (95% CI : 0.858-0.941), respectively, suggesting that PTA+HA+Ⅳ-C+LMR×10 had a better diagnostic performance than PTA+HA+Ⅳ-C ( Z =2.228, P =0.026). Conclusion LMR and serum markers can accurately distinguish SLF after grouping based on ALT level. LMR is a quantitative and objective imaging indicator and is better than SWI liver , and it can also improve the diagnostic performance of serum markers for SLF in clinical practice.