Objective To investigate the effect of diosgenin on the proliferation and apoptosis of breast cancer cells and its potential molecular mechanism. Methods The breast cancer cell line MCF-7 was treated with low, medium, and high doses of diosgenin, and cell proliferation was detected through the MMT method. Flow cytometry was used to detect cell apoptosis. Nuclear-cytoplasmic-protein separation method was applied to detect the subcellular localization of death associated protein (DAXX). qRT-PCR and Western blot were used to detect the expressions of DAXX and c-Jun N-terminal kinase pathway (JNK)-related proteins. Results Diosgenin considerably inhibited the proliferation of MCF-7 cells and promoted cell apoptosis in a concentration-dependent manner. Diosgenin can promote the movement of DAXX from nucleus into the cytoplasm. Diosgenin upregulated the expression of cell surface death receptor (Fas), increased the phosphorylation levels of JNK and mitogen activated protein kinase (p38), and activated the JNK/p38 signaling pathway with concentration dependence. Conclusion Diosgenin inhibits the proliferation and promotes the apoptosis of the breast cancer cell line MCF-7, whose mechanism may be related to the regulation of DAXX subcellular localization and the activation of JNK/p38 signaling pathway.

The visual crowding effect refers to the phenomenon that the observers' ability to identify the target object significantly decreases when it is flanked by surrounding objects.A variety of ophthalmic diseases,including amblyopia,strabismus,glaucoma,macular degeneration and nystagmus,involve structural or functional abnormalities in different parts of the visual system.These abnormalities will exacerbate the visual crowding effect,thereby impairing the ability in multi-line visual identification,reading and other daily visual activities of patients.Since intervention on visual crowding can im-prove patients' ability to process complex visual information,optimize the use of residual vision and improve prognosis,it is of great clinical value to develop targeted intervention methods.This article systematically reviews the characteristics of visual crowding in patients with oculopathy and its impact on functional vision,and summarizes the current intervention strategies,in order to provide theoretical basis and practical guidance for future clinical practice.

Objective To investigate the efficacy of continuous suture and parachute continuous suture in forearm autologous arteriovenous endovascular fistula surgery,and to analyse their effects on postoperative fistula patency rate and complications.Methods 209 patients with end-stage renal disease(ESRD)admitted to our hospital from January,2020 to January,2024 were selected as observation objects,and they were divided into group A(simple intermittent suture,n=50),group B[simple continuous(two-point)suture,n=63]and group C(parachute continuous suture,n=96)The postoperative vascular anastomosis time,operation time,blood flow,vascular patency rate,thrombosis rate,complication rate and quality of life score of each group were compared.Results In group C,the vascular anastomosis time and overall operation time were the shortest,and the blood flow was less(P<0.05),but there was no significant difference in vascular patency rate,thrombosis rate and complication rate(P>0.05).In group C,the level of serum inflammatory factors decreased the most and the qual-ity of life improved the most significantly(P<0.05).Conclusions Continuous suture and parachute suture can shorten the operation time,reduce the level of serum factors and improve the quality of life.The best scheme should be selected according to the individual differences of patients.

Objective:To investigate the feasibility of transcatheter edge-to-edge repair (TEER) using a short-clip strategy for patients with moderate-to-severe or greater degenerative mitral regurgitation caused by commissural prolapse.Methods:This retrospective study included patients with severe mitral regurgitation secondary to commissural prolapse who underwent TEER at the Second Affiliated Hospital of Zhejiang University School of Medicine between September 2022 and July 2024. Preoperative clinical and imaging data, intraoperative details, procedural outcomes, and 1-month postoperative follow-up results were collected.Results:A total of 19 patients were enrolled, aged (74.1±6.1) years, including 12 males. Among them, 10 patients had external commissural prolapse, and 9 patients had internal commissural prolapse. Preoperatively, all patients exhibited severe mitral regurgitation (4+), with an effective regurgitant orifice area of (0.55±0.17) cm2, left atrial volume of (104.77±36.57) ml, left ventricular end-diastolic volume of (102.29±32.47) ml, left ventricular end-diastolic dimension of (5.34±0.59) mm, and prolapse width of (1.18±0.34) cm. All procedures utilized short clips (NTR or NTW clips) to target the prolapsed commissural region and were completed successfully without intraoperative complications. At 1-month follow-up, no mortality, stroke, single-leaflet device attachment, myocardial infarction, or unplanned mitral reintervention occurred. Mitral regurgitation severity improved to ≤2+ in all patients, with left atrial volume of (74.49±33.83) ml, left ventricular end-diastolic volume of (85.90±18.05) ml, and left ventricular end-diastolic dimension of (4.93±0.37) mm (all P<0.05). Conclusion:The short-clip strategy, focusing on precise clip placement at the commissural interface, is feasible and effective for TEER in patients with severe mitral regurgitation due to commissural prolapse.

The visual crowding effect refers to the phenomenon that the observers' ability to identify the target object significantly decreases when it is flanked by surrounding objects.A variety of ophthalmic diseases,including amblyopia,strabismus,glaucoma,macular degeneration and nystagmus,involve structural or functional abnormalities in different parts of the visual system.These abnormalities will exacerbate the visual crowding effect,thereby impairing the ability in multi-line visual identification,reading and other daily visual activities of patients.Since intervention on visual crowding can im-prove patients' ability to process complex visual information,optimize the use of residual vision and improve prognosis,it is of great clinical value to develop targeted intervention methods.This article systematically reviews the characteristics of visual crowding in patients with oculopathy and its impact on functional vision,and summarizes the current intervention strategies,in order to provide theoretical basis and practical guidance for future clinical practice.

Objective To investigate the efficacy of continuous suture and parachute continuous suture in forearm autologous arteriovenous endovascular fistula surgery,and to analyse their effects on postoperative fistula patency rate and complications.Methods 209 patients with end-stage renal disease(ESRD)admitted to our hospital from January,2020 to January,2024 were selected as observation objects,and they were divided into group A(simple intermittent suture,n=50),group B[simple continuous(two-point)suture,n=63]and group C(parachute continuous suture,n=96)The postoperative vascular anastomosis time,operation time,blood flow,vascular patency rate,thrombosis rate,complication rate and quality of life score of each group were compared.Results In group C,the vascular anastomosis time and overall operation time were the shortest,and the blood flow was less(P<0.05),but there was no significant difference in vascular patency rate,thrombosis rate and complication rate(P>0.05).In group C,the level of serum inflammatory factors decreased the most and the qual-ity of life improved the most significantly(P<0.05).Conclusions Continuous suture and parachute suture can shorten the operation time,reduce the level of serum factors and improve the quality of life.The best scheme should be selected according to the individual differences of patients.

Objective:To investigate the feasibility of transcatheter edge-to-edge repair (TEER) using a short-clip strategy for patients with moderate-to-severe or greater degenerative mitral regurgitation caused by commissural prolapse.Methods:This retrospective study included patients with severe mitral regurgitation secondary to commissural prolapse who underwent TEER at the Second Affiliated Hospital of Zhejiang University School of Medicine between September 2022 and July 2024. Preoperative clinical and imaging data, intraoperative details, procedural outcomes, and 1-month postoperative follow-up results were collected.Results:A total of 19 patients were enrolled, aged (74.1±6.1) years, including 12 males. Among them, 10 patients had external commissural prolapse, and 9 patients had internal commissural prolapse. Preoperatively, all patients exhibited severe mitral regurgitation (4+), with an effective regurgitant orifice area of (0.55±0.17) cm2, left atrial volume of (104.77±36.57) ml, left ventricular end-diastolic volume of (102.29±32.47) ml, left ventricular end-diastolic dimension of (5.34±0.59) mm, and prolapse width of (1.18±0.34) cm. All procedures utilized short clips (NTR or NTW clips) to target the prolapsed commissural region and were completed successfully without intraoperative complications. At 1-month follow-up, no mortality, stroke, single-leaflet device attachment, myocardial infarction, or unplanned mitral reintervention occurred. Mitral regurgitation severity improved to ≤2+ in all patients, with left atrial volume of (74.49±33.83) ml, left ventricular end-diastolic volume of (85.90±18.05) ml, and left ventricular end-diastolic dimension of (4.93±0.37) mm (all P<0.05). Conclusion:The short-clip strategy, focusing on precise clip placement at the commissural interface, is feasible and effective for TEER in patients with severe mitral regurgitation due to commissural prolapse.

Objective:To assess the current situation, advantages, and difficulties of standardized management in Investigator-Initiated Clinical Trials (IIT).Methods:This article summarized the requirements and policies for clinical research management, the development of clinical research domestically and internationally, the achievements and advantages of clinical research management development in China, and the main problems and difficulties with the standardized IIT management in China, and compiled the experiences and models of several medical institutions in IIT management.Results:While China has a large number of clinical medical publications and is ranked high in the world, the quality of the publications needs to be further improved. Domestic management requirements for IIT were gradually improving, providing a basis for medical institutions to implement standardized management throughout the lifecycle of IIT, and achieve certain progress. However, there were still challenges in the departmental divisions, the unification of management standards, whole-process management and quality control, the scientific review, high-risk project management, and registration.Conclusions:Drawing on the excellent experience of domestic medical institutions, measures including identifying a primary responsible department, establishing unified supervision and inspection standards, and implementing a whole life cycle management may help overcome the challenges in IIT management and improve the quality and efficiency of IIT management.

Traditional Chinese medicine （TCM）， as an invaluable scientific legacy and cultural patrimony of China， encapsulates the cumulative wisdom of millennia from the Chinese civilization. The deeply rooted medical theories and extensive empirical practices of TCM hold an indispensible central role within China's healthcare framework. Facing the challenges of modern medicine and health needs， it is particularly urgent to explore the mechanisms of Chinese medicines. Post-translational modification （PTM）， as a core mechanism to regulate the complex and diverse protein functions， is a bridge between environmental stimuli and physiological responses. Different PTMs can interact with each other to form a complex regulatory network， which is in line with the multi-component and multi-target action of Chinese medicines. In recent years， protein modification omics has emerged as a powerful means to probe into PTMs， and studies have employed protein modification omics to investigate the mechanisms of Chinese medicines. However， the research in this field is still in the initial stage. This article summarizes the basic theory of PTM and the basic research process of protein modification omics， reviews the application status of protein modification omics in the research on the mechanisms of Chinese medicines， and analyzes the existing research limitations. This study aims to explore an innovative research paradigm for analyzing the mechanisms of Chinese medicines from the perspective of PTM and provide a theoretical basis and practical guidance for understanding the mechanisms of Chinese medicines in the future.

Objective To evaluate the surgical treatments of refractory sclerosing peritonitis related peritoneal dialysis.Methods Clinical data of 15 patients with refractory sclerosing peritonitis related to peritoneal dialysis treated in the General Surgery Department of the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army from June 30,2014 to May 30,2018.Among them,5 cases underwent"open abdomen peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",4 cases underwent"laparoscopic peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",3 cases underwent"laparoscopic peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",2 cases underwent"open abdomen peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",and 1 case underwent"laparoscopic examination combined with laparotomy exploration and removal of lower abdominal catheter+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter".Age,gender,clinical symptoms,abdominal CT examination,peripheral blood routine,blood biochemistry,blood C-reactive protein(CRP),white blood cells,biochemistry,and aetiology of peritoneal dialysis fluid were collected and followed up,and the therapeutic effect was evaluated.Results 15 patients were transferred to the Department of Surgery after ineffective treatment in the Department of Internal Medicine.Preoperatively(after 5 days of antibiotic treatment)compared to before antibiotic treatment,there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Laparoscopic exploration or laparotomy exploration was performed,during which the peritoneal dialysis catheter was removed and the abdominal infection focus was cleared.A pelvic cavity washout drainage tube was left in place postoperatively.Fourteen patients had a good recovery after surgery,with effective control of peritonitis symptoms and no complications such as intestinal obstruction or enterocutaneous fistula.After the removal of the peritoneal dialysis catheter,all patients switched to hemodialysis.A comparison of inflammatory markers before and after surgery showed a significant decrease after surgery.Three days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Seven days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there was a significant decrease in blood WBC[(7.43±2.65)× 109/L VS(10.17±5.24)× 109/L],blood NEUT％[(88.23±9.02)％VS(85.07±11.57)％],and CRP[(152.88±113.01)mg/L VS(114.49±92.97)mg/L](P＜0.05);the peritoneal fluid WBC at 7 days postoperatively showed no significant change compared to before surgery(after 5 days of antibiotic treatment)(P＞0.05).The cases were followed up for at least 22 months,and 13 patients did not experience peritonitis or intestinal obstruction again.One patient died 39 days after surgery due to multiple organ failure,and one patient died from other causes after a 2-year follow-up.Conclusion For refractory sclerosing peritonitis related peritoneal dialysis that is ineffective in medical conservative treatment,On the basis of reasonable and effective antibiotics to control infection,surgical intervention should be actively carried out and surgical methods such as surgery should be used to control the progress of peritonitis,reduce mortality and improve the cure rate.