Ursodeoxycholic acid (UDCA) is a naturally occurring, low-toxicity, and hydrophilic bile acid (BA) in the human body that is converted by intestinal flora using primary BA. Solute carrier family 7 member 11 (SLC7A11) functions to uptake extracellular cystine in exchange for glutamate, and is highly expressed in a variety of human cancers. Retroperitoneal liposarcoma (RLPS) refers to liposarcoma originating from the retroperitoneal area. Lipidomics analysis revealed that UDCA was one of the most significantly downregulated metabolites in sera of RLPS patients compared with healthy subjects. The augmentation of UDCA concentration (≥25 μg/mL) demonstrated a suppressive effect on the proliferation of liposarcoma cells. [¹⁵N₂]-cystine and [¹³C₅]-glutamine isotope tracing revealed that UDCA impairs cystine uptake and glutathione (GSH) synthesis. Mechanistically, UDCA binds to the cystine transporter SLC7A11 to inhibit cystine uptake and impair GSH de novo synthesis, leading to reactive oxygen species (ROS) accumulation and mitochondrial oxidative damage. Furthermore, UDCA can promote the anti-cancer effects of ferroptosis inducers (Erastin, RSL3), the murine double minute 2 (MDM2) inhibitors (Nutlin 3a, RG7112), cyclin dependent kinase 4 (CDK4) inhibitor (Abemaciclib), and glutaminase inhibitor (CB839). Together, UDCA functions as a cystine exchange factor that binds to SLC7A11 for antitumor activity, and SLC7A11 is not only a new transporter for BA but also a clinically applicable target for UDCA. More importantly, in combination with other antitumor chemotherapy or physiotherapy treatments, UDCA may provide effective and promising treatment strategies for RLPS or other types of tumors in a ROS-dependent manner.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

BACKGROUND:Ossification of the ligamentum flavum was previously considered to be rare in the population.As research has progressed,its incidence rate is increasing gradually,which has aroused the interest of a large number of researchers. OBJECTIVE:To visualize and analyze the research results on ossification of the ligamentum flavum from the Web of Science Core Collection since 1999 using bibliometric methods,and to review the research history of ossification of the ligamentum flavum,highlighting important literature,summarizing research hotspots,and providing ideas for researchers to find research directions. METHODS:Using the Web of Science Core Collection as the data source,relevant papers on ossification of the ligamentum flavum were searched and screened.VOSviewer 1.6.19 and CiteSpace 6.2.R6 were used to conduct the visual analysis of annual publication volume,research countries,institutions,citations,journals,authors,and keywords. RESULTS AND CONCLUSION:(1)A total of 347 papers were included.Since 1999,the number of published papers has increased in a spiral pattern.China's research started later than Japan's,but the number of publications has come up later,with Peking University being the institution with the most publications,and Prof.Chen Zhongqiang from Peking University being the scholar with the most publications.(2)Five of the 10 most frequently cited publications were related to the surgical treatment of the disease.(3)Excluding keywords directly related to the research topic and synthetically analyzing frequencies and betweenness centralities of key words,terms such as"thoracic myelopathy,""dural ossification,""minimally invasive surgery,"and"ossification of the posterior longitudinal ligament"occupied a central position in this field.(4)Keywords clustering analysis showed that clinical manifestations and surgical treatment of ossification of the ligamentum flavum accounted for a large proportion of study.(5)The timeline and burst analysis of keywords revealed that"minimally invasive surgery"appeared as a keyword around 2015,with the highest burst strength and the latest burst start time,and began to receive extensive attention from researchers in 2019.The burst of the keyword"dural ossification"has not yet ended.(6)Surgical treatment for ossification of the ligamentum flavum has been at the forefront of research.Development and research of minimally invasive surgery and research on dural ossification secondary to ossification of the ligamentum flavum are both current research hotspots and possible future research trends.

Objective:To investigate the nutritional risk status of children in PICU and analyze its influencing factors.Methods:From July 2021 to February 2023,all children aged 1 to 18 years admitted to PICU of Beijing Children's Hospital were investigated by using the pediatric Yorkhill Malnutrition Scoring tool(PYMS)and the clinical data questionnaire.Results:A total of 492 children in PICU were enrolled.The first nutritional risk screening results showed that there were 32 cases of no/low nutritional risk(6.5%),76 cases of medium risk(15.4%),and 384 cases of high risk(78.1%).The incidence of medium/high nutritional risk was as high as 93.5%.The PYMS score of nutritional risk in PICU was(2.61±1.42).The results of multiple linear regression analysis showed that weight,fever time before admission,white blood cells,body mass index,primary diagnosis,father's education,and diet before illness were the main influencing factors of nutritional risk of children in PICU(P<0.05).Conclusion:Children in PICU are in a state of high nutritional risk.It is suggested that children in PICU should carry out nutritional screening in a standardized manner,identify children with high nutritional risk and its influencing factors early.To actively conduct nutritional assessment and nutritional intervention could improve the clinical outcome of children in PICU.

Objective To evaluate the application of flipped classroom(FC)approach in endocrine system integrated course for students from 4+4 clinical medicine pilot class at Peking Union Medical College(PUMC).Methods The study included the students of 4+4 clinical medicine pilot class grades 2019-2023 in PUMC.The students of grades 2019-2021(n=77)served as the control receiving traditional teaching method,while the students of grades 2022 and 2023(n=76)were selected as the experimental group,which were taught by FC approach.The selected teaching content is thyroid theme.The scoring rates of thyroid related questions in the final exam were as-sessed and a questionnaire survey was conducted to evaluate teaching satisfaction and effectiveness.Results The scoring rates of experimental group were significantly higher as compared to that of control group(P＜0.05).Over 90％of the students in the experimental group strongly satisfied or satisfied with the teaching content arrangement,design form,classroom atmosphere,teacher-student interaction of FC and expressed willingness to continue with this methodology.In addition,over 90％of the students strongly agreed or agreed that FC stimulated learning inter-est,improved self-learning ability,strengthened the connection between theory and clinical practice,inspired clini-cal reasoning,enhanced the abilities to analyze and solve problems,and cultivated communication and teamwork skills.Conclusions The application of FC approach in endocrine system integrated course achieved excellent teaching outcomes with high satisfaction of the students.

Ursodeoxycholic acid(UDCA)is a naturally occurring,low-toxicity,and hydrophilic bile acid(BA)in the human body that is converted by intestinal flora using primary BA.Solute carrier family 7 member 11(SLC7A11)functions to uptake extracellular cystine in exchange for glutamate,and is highly expressed in a variety of human cancers.Retroperitoneal liposarcoma(RLPS)refers to liposarcoma originating from the retroperitoneal area.Lipidomics analysis revealed that UDCA was one of the most significantly down-regulated metabolites in sera of RIPS patients compared with healthy subjects.The augmentation of UDCA concentration(≥25 μg/mL)demonstrated a suppressive effect on the proliferation of liposarcoma cells.[15N2]-cystine and[13Cs]-glutamine isotope tracing revealed that UDCA impairs cystine uptake and glutathione(GSH)synthesis.Mechanistically,UDCA binds to the cystine transporter SLC7A11 to inhibit cystine uptake and impair GSH de novo synthesis,leading to reactive oxygen species(ROS)accumulation and mitochondrial oxidative damage.Furthermore,UDCA can promote the anti-cancer effects of ferroptosis inducers(Erastin,RSL3),the murine double minute 2(MDM2)inhibitors(Nutlin 3a,RG7112),cyclin dependent kinase 4(CDK4)inhibitor(Abemaciclib),and glutaminase inhibitor(CB839).Together,UDCA functions as a cystine exchange factor that binds to SLC7A11 for antitumor activity,and SLC7A11 is not only a new transporter for BA but also a clinically applicable target for UDCA.More importantly,in combination with other antitumor chemotherapy or physiotherapy treatments,UDCA may provide effective and promising treatment strategies for RLPS or other types of tumors in a ROS-dependent manner.

AIM:The aim of our study is to investigate the metabolic profile differences during cervical lesion progression and evaluate their potential clinical value in assisting the diagnosis of cervical cancer(CC).METHODS:Ul-tra-high-performance liquid chromatography coupled with high-resolution mass spectrometry(UHPLC-HRMS)was em-ployed to conduct non-targeted metabolomic analysis of cervical swab samples from 43 CC patients,34 high-grade squa-mous intraepithelial lesion(HSIL)patients,and 43 healthy controls.Based on the distinct features among the three groups,principal component analysis(PCA)was used to identify the metabolic differences among CC,HSIL and healthy groups.MetaboAnalyst 5.0 was then employed to perform KEGG pathway enrichment analysis on the differential metabo-lites.Finally,random forest machine learning algorithm was used to construct classification prediction models for distin-guishing CC from healthy,HSIL from healthy,and CC from HSIL.The performance of these models was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS:A total of 1 543 metabolites were identified across the healthy,HSIL and CC groups after filtration,with 407 metabolites differing between the groups.The study found that metabolite PGE2 was present in all three groups,with its expression levels progressively increasing with the progression of cervical lesions.Differential metabolite enrichment analysis demonstrated that CC is associated with specific cancer-relat-ed metabolic pathways,including the tricarboxylic acid cycle,tyrosine metabolism,tryptophan metabolism,and the pen-tose phosphate pathways.Additionally,the study developed three prediction models based on metabolic products for diag-nosing HSIL and CC:the full model,the simplified model,and the PGE2 model.The results indicated that metabolites ex-hibited strong diagnostic efficiency.Both the full model and the simplified model effectively distinguished CC from HSIL,CC from healthy,and HSIL from healthy.The AUC values for the full model were 0.90,0.92 and 0.84,respectively,while those for the simplified model were 0.81,0.95 and 0.85,respectively.Furthermore,the PEG2 model achieved AUC values of 0.74 and 0.80 for distinguishing CC from healthy and HSIL from healthy,respectively.CONCLUSION:The metabolic profiles of cervical cancer exhibit significant differences during the progression of cervical cancer,and these metabolites hold potential clinical value as biomarkers for cervical lesions.

AIM:The aim of our study is to investigate the metabolic profile differences during cervical lesion progression and evaluate their potential clinical value in assisting the diagnosis of cervical cancer(CC).METHODS:Ul-tra-high-performance liquid chromatography coupled with high-resolution mass spectrometry(UHPLC-HRMS)was em-ployed to conduct non-targeted metabolomic analysis of cervical swab samples from 43 CC patients,34 high-grade squa-mous intraepithelial lesion(HSIL)patients,and 43 healthy controls.Based on the distinct features among the three groups,principal component analysis(PCA)was used to identify the metabolic differences among CC,HSIL and healthy groups.MetaboAnalyst 5.0 was then employed to perform KEGG pathway enrichment analysis on the differential metabo-lites.Finally,random forest machine learning algorithm was used to construct classification prediction models for distin-guishing CC from healthy,HSIL from healthy,and CC from HSIL.The performance of these models was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS:A total of 1 543 metabolites were identified across the healthy,HSIL and CC groups after filtration,with 407 metabolites differing between the groups.The study found that metabolite PGE2 was present in all three groups,with its expression levels progressively increasing with the progression of cervical lesions.Differential metabolite enrichment analysis demonstrated that CC is associated with specific cancer-relat-ed metabolic pathways,including the tricarboxylic acid cycle,tyrosine metabolism,tryptophan metabolism,and the pen-tose phosphate pathways.Additionally,the study developed three prediction models based on metabolic products for diag-nosing HSIL and CC:the full model,the simplified model,and the PGE2 model.The results indicated that metabolites ex-hibited strong diagnostic efficiency.Both the full model and the simplified model effectively distinguished CC from HSIL,CC from healthy,and HSIL from healthy.The AUC values for the full model were 0.90,0.92 and 0.84,respectively,while those for the simplified model were 0.81,0.95 and 0.85,respectively.Furthermore,the PEG2 model achieved AUC values of 0.74 and 0.80 for distinguishing CC from healthy and HSIL from healthy,respectively.CONCLUSION:The metabolic profiles of cervical cancer exhibit significant differences during the progression of cervical cancer,and these metabolites hold potential clinical value as biomarkers for cervical lesions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.