AIM:To explore the mechanism of ATP synthase mitochondrial F0 complex H+ transporting,sub-unit F6(ATP5J)in affecting the metastasis of hepatoma carcinoma cells by regulating mitochondrial function-mediated cy-toskeletal remodeling.METHODS:Hepatocellular carcinoma cells Li-7 were used to construct the ATP5J overexpression and knockdown models.JC-1 staining was used to detect the mitochondrial membrane potential in each group,reactive oxygen species(ROS)levels were examined by DCHF-DA,and mitochondrial ATP fluorescence probe was used to assess mito-chondrial function.Cytoskeletal remodeling was detected with a microfilament green fluorescent probe(Actin-Tracker Green-488).Transwell assay was used to assess cell invasion ability.The expression levels of ATP5J and translocase of outer mitochondrial membrane 20(TOMM20)were determined by Western blot.RESULTS:Overexpression of ATP5J up-regulated mitochondrial membrane potential and mitochondrial ATP fluorescence intensity,induced cytoskeletal re-modeling,promoted cell invasion and TOMM20 expression,and inhibited ROS production(P＜0.01).On the contrary,knockdown of ATP5J significantly decreased mitochondrial membrane potential and mitochondrial ATP fluorescence inten-sity,significantly decreased cell invasion ability and TOMM20 expression,promoted ROS production and blocked cyto-skeletal remodeling(P＜0.01).CONCLUSION:ATP5J regulates mitochondrial energy transformation in hepatocellular carcinoma cells,and affects metastasis of hepatoma carcinoma cells by regulating mitochondrial membrane potential and mitochondrial ATP production-mediated cytoskeletal remodeling through TOMM20.

Objective To design a safe,stable,flexible,and scalable information system for mobile medical forces to enhance the efficiency of command and casualty treatment during diversified medical rescue missions.Methods A mobile medical force information system was developed with a layered architecture based on both Browser/Server(B/S)and Client/Server(C/S)frameworks.In this system,the front-end presentation layer was developed with Vue.js architecture,the back-end application layer by SpringCloud and Mybatis frameworks,the data management layer was devised using MySQL and Redis databases to provide standard data interfaces for other systems.This system covered several functional modules including command,casualty triage and evacuation,minor injury treatment,severe injury rescue,emergency surgery,medical service,and logistical support,which could be flexibly configured according to different types of missions.Results Information about casualty treatment was recorded in detail,accessed and traced easily.The efficiency of information statistics was improved.Conclusion The developed system enhances the efficiency of decision-making and casualty management for mobile medical forces during varied medical rescue missions.

Purpose To observe the clinical and CT features of severe immune checkpoint inhibitor-related pneumonitis(CIP)in lung cancer patients.Materials and Methods A total of 174 patients with lung cancer who received immune checkpoint inhibitor(PD-1/PD-L1 inhibitors)in Xi'an International Medical Center Hospital from September 1,2019 to March 31,2022 were retrospectively collected.Clinical and imaging features of patients with severe CIP were analyzed.Results There were 23 patients who met the diagnostic criteria of severe CIP.Among them,22 were male patients,15 were younger(＜65 years old),17 had a history of underlying lung disease,16 had a history of chemoradiotherapy and other treatments,and 21 had a history of combined radiotherapy and chemoradiotherapy.The median time from the initiation of immune checkpoint inhibitor to CIP was 128(74,348)days.19 patients were non-small cell carcinoma.CIP occurred in 16 patients with right lung cancer,15 had tumor central airway invasion,14 had radiographic features of diffuse alveolar injury/acute interstitial pneumonia pattern,and 20 died during follow-up.Conclusion Severe CIP is likely to occur in male lung cancer patients with a history of basic medical history and radiotherapy and chemotherapy.The clinical manifestations are varied,and the main imaging features are diffuse alveolar injury/acute interstitial pneumonia pattern,and the prognosis is poor.

Objective To construct a diagnostic model for the phlegm-dampness obstruction syndrome in patients with coronary heart disease stable angina pectoris(CSAP);To provide a reference for clinical syndrome differentiation.Methods Totally 305 patients'clinical data were collected from the Department of Cardiology,Dongying Hospital Affiliated to Shandong University of Traditional Chinese Medicine,from May 2022 to January 2024.The least absolute shrinkage and selection operator(LASSO)was used to select features,and multiple models were constructed and compared using machine learning(ML)algorithms.The optimal ML model was selected for training,validation,and testing.Finally,the operational logic of the optimal model was explained using Shapley Additive Explanations(SHAP),and two typical examples were provided to help users understand the model's operational logic.Results LASSO regression identified chest pain,body mass index(BMI),limb heaviness,drinking history,age,triglycerides(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)as features included in the model.After comparing multiple models,the Gaussian Naive Bayes(GNB)model demonstrated the best performance.The final constructed GNB model achieved an average AUC of 0.938(95%CI:0.903-0.972)in the training set,an average AUC of 0.927(95%CI:0.851-0.992)in the validation set,and an AUC of 0.856(95%CI:0.751-0.961)in the test set.The learning curve showed that the error between the training and validation sets in the model converged as the number of training samples increased.The calibration curve showed that the model had good consistency in predicting the probability of observed phlegm-dampness obstruction syndrome patients.The clinical decision curve(DCA)showed that the model could provide clinical benefits for patients at a decision threshold below 0.7.The features ranked by SHAP importance in order were chest pain,BMI,LDL-C,TG,limb heaviness,TC,drinking history and age.Conclusion The diagnostic model for CSAP phlegm-dampness obstruction syndrome constructed in this study can assist physicians in the syndrome differentiation of patients,thereby enabling the formulation of integrated clinical treatment plans combining traditional Chinese and Western medicine,and aiding patients in achieving better clinical therapeutic outcomes.

Objective:To explore the effects of glycosylated nanoparticles on early radiation responses including the generation of reactive oxygen species (ROS), the polarization of pulmonary macrophages, and secretion of inflammatory cytokines in mice lung tissues.Methods:Twenty mice were randomly divided into control group, drug administration group, irradiation group and irradiation + drug administration group. The irradiation group and irradiation + drug administration group were subjected to whole lung irradiation with X-rays. The antioxidant ability of glycosylated nanoparticles was characterized using ROS indicator (CM-H 2DCFDA). The M2 polarization of pulmonary macrophages was detected by flow cytometry and PCR. The mRNA and protein expression levels of inflammatory cytokines were investigated by PCR and ELISA assay, respectively. Results:Compared with the irradiation group, the intensity of ROS fluorescence signals was significantly lower ( t=15.76, P < 0.05), the proportion of M2-type macrophages was significantly higher ( t=2.89, P < 0.05), the expression level of arginase 1 (ARG-1) gene was elevated, and the expression levels of tumour necrosis factor α (TNF-α), interleukin 1β (IL-1β) and interleukin 6 (IL-6) inflammatory factors were significantly reduced ( t=3.32, 2.90, 2.85, 4.55, 2.88, P < 0.05) in the lung tissues of irradiation + treatment group. Conclusions:Glycosylated nanoparticles can effectively scavenge ROS, trigger polarization of M2 macrophage, dampen inflammatory responses, and thus potentially alleviate radiation-induced lung injury.

Objective: To investigate whether the transplantation of umbilical cord mesenchymal stem cells (UC-MSCs) can alleviate radiation-induced pulmonary fibrosis (RIPF) and attenuate intrapulmonary cellular senescence in mice with RIPF. Methods: The C57BL/6 mice were unilaterally irradiated with 17 Gy in the right lung to construct RIPF models. UC- MSCs were injected into the caudal vein at 3 months after radiation, and samples were taken at 6 months. The survival rate of mice was recorded, and the lung organ ratio was calculated. Lung structure and collagen deposition were observed by hem- atoxylin-eosin  staining  and  Masson  staining.  The  expression  of  senescence  secretion-associated  phenotype  (SASP)  was measured by quantitative real-time polymerase chain reaction. Intrapulmonary cellular senescence was assessed by β-Gal im- munohistochemistry. The expression of key proteins in the P53-P21 and P16 pathways was measured by Western blot. P21 expression in the lung was measured by tissue immunofluorescence. Results: Compared with the untreated group, RIPF mice treated with UC-MSCs showed an improved survivalrate, reduced collagen deposition, and an improvement incollapse and thickening of alveolar structure. Increased β-Gal-positive senescent cells and high expression of SASP (IL-6, IL-8, IL- 1β) in the lung of RIPF mice were all reduced after UC-MSC treatment. The abnormally increased levels of P53, p-P53, P21 and P16 proteins in RIPF mice were reduced by UC-MSC treatment. Conclusion UC-MSCs may reduce cellular senes- cence in fibrotic lungs and alleviate RIPF by inhibiting P53-P21 and P16 pathways, which is expected to be used for the treatment of radiation-induced lung injury.

Objective:To investigate whether transplantation of gingival mesenchymal stem cells (GMSCs) can inhibit radiation-induced senescence of alveolar epithelial cells type Ⅱ (AECⅡ) and its role in the prevention of radiation-induced pulmonary fibrosis (RIPF).Methods:Mouse type Ⅱ alveolar epithelial cells (MLE12) were irradiated with 6 Gy X-rays and then co-cultured with GMSCs. The extent of cellular senescence of MLE12 cells was assessed by cell morphology, β-Gal staining, and senescence secretion-associated phenotype (SASP) assay. RIPF model was constructed by unilaterally irradiating the right chest of C57BL/6 mice with 17 Gy X-rays. GMSCs were transplanted 1 d after irradiation. At 180 d after irradiation, the pulmonary organ ratio, HE staining, and Masson staining were used to assess intra-pulmonary structure and interstitial collagen deposition in the lung. β-Gal immunohistochemistry and immunofluorescence co-localization with AECⅡ were measured to assess the degree of cellular senescence in the lung. The SASP expression changes in lung tissue were detected by qRT-PCR. The protein expressions in P53-P21 and P16 pathways were detected by Western blot assay. P21 expression in AECⅡ was detected by immunofluorescence co-localization assay.Results:GMSCs effectively inhibited radiation-induced senescence of MLE12 cells, reduced the ratio of radiation-elevated β-Gal positive cells by 11.8% ( t=6.72, P<0.05), and decreased the expressions of SASP (IL-6, IL-8, IL-1β) ( t=28.43, 28.43, 4.82, P<0.05). GMSCs transplantation improved the survival rate of irradiated mice, prevented radiation-induced alveolar structural collapse thickening and collagen deposition, reduced the number of senescent cells in the irradiated lung tissues by 23.9% ( t=21.83, P<0.05), and inhibited the expressions of SASP ( t=8.86, 20.63, P<0.05). GMSCs also inhibited the expression of P53-P21, P16-related proteins in MLE12 cells and lung tissues of mice after irradiation. Conclusions:GMSCs inhibit senescence-related P53-P21 and P16 pathways, prevent radiation-induced AECⅡ senescence, as well as the development of RIPF.

OBJEC TIVE To provide reference for clinical comprehensive evaluation of pediatric drugs in China. METHODS Taking pediatric anti-allergic drugs as an example ，the clinical comprehensive evaluation methods of pediatric drugs in medical institutions were explored from the aspects of theme selection ，evaluation content and dimension ，evaluation index ，evaluation method and evaluation result report. RESULTS & CONCLUSIONS During the clinical comprehensive evaluation of pediatric drugs，under the guidance of relevant national guidelines for clinical comprehensive evaluation ，the evaluation topics could be selected according to the three principles of importance ，relevance and evaluability ，and then an appropriate evaluation index system could be developed around the six dimensions of safety ， effectiveness， economy， suitability，accessibility and innovativeness；qualitative and quantitative data integration analysis of the drugs to be evaluated were performed. In the evaluation ， it is necessary to focus on children ’s clinical basic drug use practice and decision-making needs ，normatively，scientifically and reasonably define the core index set and standard data set required by different dimensions of evidence ，standardize the collection and use of real-world data ，and effectively combine other types of evidence to truly play its advantageous role in the clinical comprehensive evaluation of pediatric drugs in China.

Objective:To evaluate the clinical efficacy of an integrated traditional Chinese and Western medication regimen on depression in the elderly.Methods:Sixty elderly patients with depression were randomly divided into two groups.The integrated traditional Chinese and Western medicine group was treated with an in-house preparation composed of traditional Chinese medicine ingredients plus Escitalopram oxalate for 4 weeks, and the control group was treated with Escitalopram oxalate for 4 weeks.The clinical efficacy was assessed by the Hamilton depression(HAMD)scale.Adverse drug reactions were assessed by the treatment emergent symptoms scale(TESS).Results:After 4 weeks of treatment, HAMD scores in both groups were decreased compared with those before treatment, with a greater reduction in HAMD scores in the integrated traditional Chinese and Western medicine group than in the control group(0.71±4.36 vs. 0.52±3.45, t=2.54, P=0.03). TESS scores were lower in the integrated traditional Chinese and Western medicine group than in the control group after 4 weeks of treatment(8.42±5.30 vs.16.01±7.02, t=3.25, P=0.02). Conclusions:Compared with Western medicine therapy alone, the integrated traditional Chinese and Western medication regimen has better efficacy and fewer adverse drug reactions for the treatment of depression in the elderly.

Objective:To investigate the preliminary clinical and radiographic outcomes of percutaneous endoscopic lumbar discectomy (PELD) combined with oblique lateral interbody fusion (OLIF) for the degenerative lumbar spondylolisthesis, lumbar spine instability or lumbar spinal stenosis with ruptured disc herniation.Methods:Data of 11 patients with degenerative lumbar spondylolisthesis, lumbar spine instability or lumbar spinal stenosis with ruptured disc herniation who had undergone PELD combined with OLIF between March 2017 to July 2018 in our spine surgery center were retrospectively analyzed. There were 5 males and 6 females with an average age of 61.2±6.8 years old. All the patients were diagnosed with degenerative lumbar diseases including lumbar spondylolisthesis (7 cases), lumbar spinal stenosis (3 cases) and segmental instability (1 case). The patients were treated with PELD combined with OLIF. The visual analogue scale (VAS) scores of low back pain and lower limb pain and the Oswestry disability index (ODI) of lumbar function, spinal canal anteroposterior diameter, intervertebral disc height, vertical diameter of intervertebral foramen, segmental angle and the whole lumbar lordotic angle were collected.Results:All patients received PELD with local anesthesia before OLIF with general anesthesia. The mean operation time was 52.3±13.2 min and the mean blood loss was 10.9±4.7 ml for PELD. The mean operation time was 56.8±18.0 min and the mean blood loss was 65.5±24.6 ml for OLIF. All patients were followed up for an average of 11.2 months. At the latest follow-up, the mean VAS score for back pain was 1.3±0.8, the mean VAS score for leg pain 1.1±0.5, the mean ODI 14.6%±5.3%, thus all of those were improved significantly compared to those of pre-operation ( t=10.37, 16.49, 8.73; P< 0.05). The radiographic results showed the mean pre-operative intervertebral disc height, vertical diameter of intervertebral foramen, spinal canal anteroposterior diameter, segmental angle, and lumbar lordosis angle was 7.1±1.2 mm, 15.3±2.2 mm, 6.2±1.3 mm, 10.2°±3.5°, 16.2°±6.2°, and thus all of those were increased significantly to the latest follow-up 11.5±1.8 mm, 19.2±2.6 mm, 10.4±2.5 mm, 19.3°±7.8°, 27.4°±8.3°, respectively ( t=5.83, 4.21, 6.59, 10.32, 7.65; P< 0.05). One of the patients had weakness of flexor hip strength and one had a transient paresthesia immediately post-operation. All symptoms were relieved within 1 month. Another one case had cage subsidence and encountered serious back pain after 1 month, and alleviated after percutaneous pedicle screw fixation. Conclusion:PELD combined with OLIF can overcome the limitations of OLIF with indirect decompression effects, resulting in successful direct neural decompression without posterior decompressive procedures and providing a satisfactory outcome for the patients with degenerative lumbar diseases with ruptured disc herniation.