BACKGROUND:Duhuo Jisheng Decoction is a classic prescription for the treatment of rheumatoid arthritis,but its specific mechanism is not clear.Extracellular vesicles have the powerful function of inter-cell communication and signal transmission,and may be the signal carrier for the Decoction.OBJECTIVE:To explore the effects of serum extracellular vesicles treated with Duhuo Jisheng Decoction on the proliferation,migration,invasion,and apoptosis of rheumatoid arthritis fibroblast-like synovial cells.METHODS:The rheumatoid arthritis fibroblast-like synovial cell model was established by co-culturing with tumor necrosis factor-α in vitro.The experiment was divided into five groups:normal group,model group,serum treated with Duhuo Jisheng Decoction group,extracellular vesicles treated with Duhuo Jisheng Decoction group,and extracellular vesicles treated with normal saline group.The optimal concentration and time of drug-containing serum and extracellular vesicles were screened by CCK-8 assay.Expression of inflammatory cytokines in the supernatants of cells in each group was detected by ELISA.The migration ability of rheumatoid arthritis fibroblast-like synovial cells was detected by scratch assay.The invasive ability of cells was measured by Transwell Invasion assay.Hoechst staining was adoped to detect cell apoptosis.The expression levels of apoptosis-related genes and proteins were detected by qRT-PCR and western blot assay.RESULTS AND CONCLUSION:(1)The optimal volume fraction of serum treated with Duhuo Jisheng Decoction was 10%and optimal mass concentration of extracellular vesicles treated with Duhuo Jisheng Decoction was 10 ng/mL;the optimal time for the interaction between the two was 24 hours.(2)Compared with the model group,serum treated with Duhuo Jisheng Decoction,extracellular vesicles treated with Duhuo Jisheng Decoction,and extracellular vesicles treated with normal saline could suppress the expression of inflammatory factors of rheumatoid arthritis fibroblast-like synovial cells(P<0.05),scratch healing(P<0.05),migration and invasion(P<0.05).Moreover,the inhibition of extracellular vesicles treated with Duhuo Jisheng Decoction was more significant(P<0.05).(3)Drug-containing serum and extracellular vesicles treated with Duhuo Jisheng Decoction promoted the apoptosis of rheumatoid arthritis fibroblast-like synovial cells.(4)Compared with the model group,serum treated with Duhuo Jisheng Decoction,extracellular vesicles treated with Duhuo Jisheng Decoction,and extracellular vesicles treated with normal saline could increase the expression of proapoptotic factors Caspase-3,Caspase-9,and Bax(P<0.05)and decrease the expression of antiapoptotic factor Bcl-2(P<0.05).Moreover,extracellular vesicles treated with Duhuo Jisheng Decoction had a more significant regulatory effect on apoptosis-related factors.Above findings indicate that extracellular vesicles treated with Duhuo Jisheng Decoction can inhibit the excessive proliferation,migration,and invasion of rheumatoid arthritis fibroblast-like synovial cells and promote their apoptosis.

Objective To study the death status of pancreatic cancer among residents in Xuhui district, Shanghai, from 1992 to 2021, and analyze its trends of change, so as to provide evidence for the prevention and treatment of pancreatic cancer. Methods Based on the database of Shanghai death registration system from 1992 to 2021, the crude mortality rate, standardized mortality rate, age-specific mortality rate and other indicators of pancreatic cancer among registered residents in Xuhui district were calculated. The Joinpoint software was used to analyze the trends of average annual percent change (AAPC) of pancreatic cancer mortality rate, and the age-period-cohort model was used to analyze the age effect, period effect and birth cohort effect pairs significant changes in pancreatic cancer mortality. Results In 2021, the mortality rate of pancreatic cancer in Xuhui district, Shanghai, ranked fourth among malignant tumors, and the winning rate and world standard rate of the whole population, males and females were 8.34/100 000 (8.81/100 000, 7.98/100 000) and 7.28/100 000 (7.69/100 000, 6.96/100 000), respectively, with males higher than females. AAPC of crude mortality rate and the standardized (6) mortality rate were higher in males than that in females. The age-specific mortality rate increased with the increase of age, and the highest mortality rate was found in 60-84 years old group. The age-period-cohort model showed that from 1992 to 2021, the annual net shift of pancreatic cancer mortality among the whole population, male and female residents in Xuhui district, Shanghai, was 1.22%, 1.58%, 1.15% (P=0.20, 0.19, 0.45) respectively, and the time trend was not significant. From the perspective of age effect, the risk of death from pancreatic cancer in the whole population and with age deviation in males had an obvious trend with increasing age (P<0.05), while the age effect in females had no obvious trend. From the perspective of period effect, no period deviation was significant in the whole population, males and females (P>0.05). In terms of cohort effects, there were significant differences in the whole population and the male cohort deviations(P<0.05). No significant cohort effect was observed in the female population. Conclusions The mortality rate of pancreatic cancer among registered residents in Xuhui district, Shanghai from 1992 to 2021, was on the rise, especially in the 60-84 years old group and male. The prevention and control of pancreatic cancer needs to develop effective epidemic prevention measures for corresponding populations.

BACKGROUND:Duhuo Jisheng Decoction is a classic prescription for the treatment of rheumatoid arthritis,but its specific mechanism is not clear.Extracellular vesicles have the powerful function of inter-cell communication and signal transmission,and may be the signal carrier for the Decoction.OBJECTIVE:To explore the effects of serum extracellular vesicles treated with Duhuo Jisheng Decoction on the proliferation,migration,invasion,and apoptosis of rheumatoid arthritis fibroblast-like synovial cells.METHODS:The rheumatoid arthritis fibroblast-like synovial cell model was established by co-culturing with tumor necrosis factor-α in vitro.The experiment was divided into five groups:normal group,model group,serum treated with Duhuo Jisheng Decoction group,extracellular vesicles treated with Duhuo Jisheng Decoction group,and extracellular vesicles treated with normal saline group.The optimal concentration and time of drug-containing serum and extracellular vesicles were screened by CCK-8 assay.Expression of inflammatory cytokines in the supernatants of cells in each group was detected by ELISA.The migration ability of rheumatoid arthritis fibroblast-like synovial cells was detected by scratch assay.The invasive ability of cells was measured by Transwell Invasion assay.Hoechst staining was adoped to detect cell apoptosis.The expression levels of apoptosis-related genes and proteins were detected by qRT-PCR and western blot assay.RESULTS AND CONCLUSION:(1)The optimal volume fraction of serum treated with Duhuo Jisheng Decoction was 10%and optimal mass concentration of extracellular vesicles treated with Duhuo Jisheng Decoction was 10 ng/mL;the optimal time for the interaction between the two was 24 hours.(2)Compared with the model group,serum treated with Duhuo Jisheng Decoction,extracellular vesicles treated with Duhuo Jisheng Decoction,and extracellular vesicles treated with normal saline could suppress the expression of inflammatory factors of rheumatoid arthritis fibroblast-like synovial cells(P<0.05),scratch healing(P<0.05),migration and invasion(P<0.05).Moreover,the inhibition of extracellular vesicles treated with Duhuo Jisheng Decoction was more significant(P<0.05).(3)Drug-containing serum and extracellular vesicles treated with Duhuo Jisheng Decoction promoted the apoptosis of rheumatoid arthritis fibroblast-like synovial cells.(4)Compared with the model group,serum treated with Duhuo Jisheng Decoction,extracellular vesicles treated with Duhuo Jisheng Decoction,and extracellular vesicles treated with normal saline could increase the expression of proapoptotic factors Caspase-3,Caspase-9,and Bax(P<0.05)and decrease the expression of antiapoptotic factor Bcl-2(P<0.05).Moreover,extracellular vesicles treated with Duhuo Jisheng Decoction had a more significant regulatory effect on apoptosis-related factors.Above findings indicate that extracellular vesicles treated with Duhuo Jisheng Decoction can inhibit the excessive proliferation,migration,and invasion of rheumatoid arthritis fibroblast-like synovial cells and promote their apoptosis.

Objective:To explore the diagnostic value of the nomogram constructed based on multi-modal ultrasound features combined with inflammatory complex indicators for benign and malignant nodules in breast imaging reporting and data system (BI-RADS) .Methods:102 female patients with breast BI-RADS type 4 nodules who were treated in Northwest Women’s and Children’s Hospital from Jan. 2021 to Mar. 2024 were included as study objects, and benign and malignant nodules were determined according to postoperative pathological examination results. Conventional ultrasound, shear-wave elastography and contrax-ultrasound were performed in each breast BI-RADS patient with Class 4 nodules using Mindray resona7 ultrasonic diagnostic instrument within 1 week before surgery to record the ultrasonic characteristics. According to the results of laboratory examination, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (NLR), PLR, the systemic immune inflammation index (SII), and the systemic inflammatory response index (SIRI) were calculated and recorded.Results:There were 42 cases of malignant nodules and 60 cases of benign nodules. Compared with the benign group, there were significant differences in nodule boundary, internal echo, Alder blood flow grading, hard ring sign, area expansion after enhancement, peripheral radial enhancement and perfusion defect in the malignant group ( χ2 value was 5.83, 9.31, 5.20, 10.25, 6.99, 7.24, 4.90, P < 0.05). Compared with the benign group, NLR and SIRI in the malignant group were significantly increased, with statistical difference (t-value 3.13 and 4.33, P < 0.05). The results of multi-factor Logistics regression analysis show that breast BI-RADS were characterized by blurred nodule boundary (X1), Alder blood flow grade 2-3 (X3), hard ring sign (X4), enlarged area after enhancement (X5), peripheral radial enhancement (X6), NLR≥2.29 (X8), SIRI≥0.91 (X9) were independent risk factors for malignant nodules ( P < 0.05). Based on these factors, the Logistics regression model was established as Logit (P) = -3.217 + 0.291X1 + 1.051X3 + 0.354X4 + 0.360X5 + 0.524X6 + 0.513X8 + 0.726X9. The results of calibration curve and clinical decision curve evaluation showed that the model had good accuracy and high predictive value. ROC curve analysis results showed that the area under the curve of the nomogram model for predicting benign and malignant nodules of category 4 breast BI-RADS was 0.925 (0.877-0.974), the sensitivity was 88.6%, and the specificity was 86.1%. Conclusion:The nomogram model constructed by multi-modal ultrasound combined with inflammatory complex index NLR and SIRI has certain application value in the differential diagnosis of benign and malignant breast BI-RADS 4 nodules.

Objective:To explore the diagnostic value of the nomogram constructed based on multi-modal ultrasound features combined with inflammatory complex indicators for benign and malignant nodules in breast imaging reporting and data system (BI-RADS) .Methods:102 female patients with breast BI-RADS type 4 nodules who were treated in Northwest Women’s and Children’s Hospital from Jan. 2021 to Mar. 2024 were included as study objects, and benign and malignant nodules were determined according to postoperative pathological examination results. Conventional ultrasound, shear-wave elastography and contrax-ultrasound were performed in each breast BI-RADS patient with Class 4 nodules using Mindray resona7 ultrasonic diagnostic instrument within 1 week before surgery to record the ultrasonic characteristics. According to the results of laboratory examination, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (NLR), PLR, the systemic immune inflammation index (SII), and the systemic inflammatory response index (SIRI) were calculated and recorded.Results:There were 42 cases of malignant nodules and 60 cases of benign nodules. Compared with the benign group, there were significant differences in nodule boundary, internal echo, Alder blood flow grading, hard ring sign, area expansion after enhancement, peripheral radial enhancement and perfusion defect in the malignant group ( χ2 value was 5.83, 9.31, 5.20, 10.25, 6.99, 7.24, 4.90, P < 0.05). Compared with the benign group, NLR and SIRI in the malignant group were significantly increased, with statistical difference (t-value 3.13 and 4.33, P < 0.05). The results of multi-factor Logistics regression analysis show that breast BI-RADS were characterized by blurred nodule boundary (X1), Alder blood flow grade 2-3 (X3), hard ring sign (X4), enlarged area after enhancement (X5), peripheral radial enhancement (X6), NLR≥2.29 (X8), SIRI≥0.91 (X9) were independent risk factors for malignant nodules ( P < 0.05). Based on these factors, the Logistics regression model was established as Logit (P) = -3.217 + 0.291X1 + 1.051X3 + 0.354X4 + 0.360X5 + 0.524X6 + 0.513X8 + 0.726X9. The results of calibration curve and clinical decision curve evaluation showed that the model had good accuracy and high predictive value. ROC curve analysis results showed that the area under the curve of the nomogram model for predicting benign and malignant nodules of category 4 breast BI-RADS was 0.925 (0.877-0.974), the sensitivity was 88.6%, and the specificity was 86.1%. Conclusion:The nomogram model constructed by multi-modal ultrasound combined with inflammatory complex index NLR and SIRI has certain application value in the differential diagnosis of benign and malignant breast BI-RADS 4 nodules.

Palliative care not only embodies modern life perspectives, but also encompasses significant traditional Chinese cultural elements.The primary objective of palliative care is to alleviate patient suffering, preserve their dignity, and facilitate a peaceful passing.Traditional Chinese medicine, known for its simplicity, accessibility, affordability, and efficacy in disease prevention and treatment, adopts a holistic approach to address systemic pain through personalized treatment based on symptom differentiation.This approach aims to enhance the quality of life for terminally ill patients.To equip palliative care providers with essential clinical skills in traditional Chinese medicine, the National Center of Gerontology and Beijing Palliative Care Guidance Center collaborated with experts and scholars to develop guidelines focusing on common end-of-life symptoms.Through extensive deliberation, expert evaluation, and revisions, this guidance document was crafted as a valuable resource for palliative care practitioners, traditional Chinese medicine clinicians, and researchers in the field.

Objective: To understand the allocation of health staff and clinics in primary and secondary schools in Guangdong Province, so as to provide a reference for school health construction. Methods: In December 2020, a total of 17 205 primary and secondary schools in 21 cities in Guangdong Province were investigated by combining document verification and on site surveys. The allocation of health staff and clinics in different cities and types of schools was analyzed using SPSS 25.0 software. Results: The proportion of schools in Guangdong Province that met the national standard for school health staff ratio was 37.7%. Among different types of schools, the lowest ratio was found in nine year schools (33.1%), while the highest was in twelve year schools (61.3%). Among the 17 205 schools in the province, 12.6% had clinics with an area of >40 m 2, and 6.9% with occupational licenses for medical institutions. The proportion of full time health staff was 39.1%. Among all school health staffs, the proportions of permanent staff, temporary staff, and appointed staff were 47.5%, 29.0% and 23.6%, respectively. The rate of school health staff with professional qualifications was 44.9%, while 48.3% had graduated from medical related majors, and 20.9% held a bachelor s degree or higher as their first degree. There were differences among various types of schools, with primary schools having the lowest health staff configuration and professional level (24.0% and 35.7%, respectively). Conclusions There are still issues of insufficient staff and low professional level in health staff and establishment of clinics in primary and secondary schools in Guangdong Province, and the allocation is uneven across different types of schools. The allocation of clinics in the province is still in urgent need of improvement.

This article reported a case of fetal giant hepatic hemangioma with cardiomegaly managed with intrauterine treatment. At 23 weeks of gestation, the patient was referred to Guangdong Women and Children Hospital due to abnormal abdominal echogenicity of the fetus, which was suspected to be a hepatic hemangioma or a hepatic arteriovenous fistula. The prenatal ultrasound at 26 weeks of gestation revealed an enlarged fetal hepatic hemangioma of 45 mm×35 mm×42 mm and an enlarged heart (cardiothoracic area ratio of 0.50). So, with the patient's informed consent, the fetus was treated with intrauterine administration of propranolol and dexamethasone and closely monitored by ultrasound. The volume of the lump still increased at the beginning of the medication, but started to shrink in the 7th week. Besides, the fetal cardiac load was reduced and the condition was controlled. The patient delivered at 37 weeks of gestation. The baby received a CT examination on the fourth day after birth which revealed an abdominal mass of 40 mm×30 mm×44 mm requiring no treatment, and no abnormalities were reported during a one-year follow-up.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Bibenzyls, a kind of important plant polyphenols, have attracted growing attention for their broad and remarkable pharmacological activities. However, due to the low abundance in nature, uncontrollable and environmentally unfriendly chemical synthesis processes, these compounds are not readily accessible. Herein, one high-yield bibenzyl backbone-producing Escherichia coli strain was constructed by using a highly active and substrate-promiscuous bibenzyl synthase identified from Dendrobium officinale in combination with starter and extender biosynthetic enzymes. Three types of efficiently post-modifying modular strains were engineered by employing methyltransferases, prenyltransferase, and glycosyltransferase with high activity and substrate tolerance together with their corresponding donor biosynthetic modules. Structurally different bibenzyl derivatives were tandemly and/or divergently synthesized by co-culture engineering in various combination modes. Especially, a prenylated bibenzyl derivative ( 12) was found to be an antioxidant that exhibited potent neuroprotective activity in the cellular and rat models of ischemia stroke. RNA-seq, quantitative RT-PCR, and Western-blot analysis demonstrated that 12 could up-regulate the expression level of an apoptosis-inducing factor, mitochondria associated 3 (Aifm3), suggesting that Aifm3 might be a new target in ischemic stroke therapy. This study provides a flexible plug-and-play strategy for the easy-to-implement synthesis of structurally diverse bibenzyls through a modular co-culture engineering pipeline for drug discovery.