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 To optimize the extraction process for Bletillae Rhizoma,and to evaluate its anti-oxidant,tyrosinase inhibitory activities.METHODS With ultrasound time,ethanol concentration and solid-liquid ratio as influencing factors,the total extraction content of gastrodin,protocatechualdehyde,p-hydroxybenzaldehyde,1,4-bis[4-(gluconoxy)benzyl]-2-isobutylmalate-2-glucoside,1,4-bis[4-(gluconoxy)benzyl]-2-isobutylmalate,yam Ⅲ,dihydropinosin and 3'-O-methylyam Ⅲ as an evaluation index,the extraction process was optimized by Box-Behnken response surface method.Subsequently,the extract's scavenging effects on DPPH,ABTS+free radicals,and inhibitory ability on tyrosinase were determined.RESULTS The optimal conditions were determined to be 49 min for ultrasound time,55％for ethanol concentration,1∶30 for solid-liquid ratio,and 2 times for extraction frequency,the total extraction content was 13.18 mg/g.The extract demonstrated the IC50 of 10.12,314.07 and 1.70 μg/g on DPPH,ABTS+free radicals and tyrosinase,respectively.CONCLUSION This simple,reliable and stable method can be used for the extraction for Bletillae Rhizoma with strong anti-oxidant,tyrosinase inhibitory activities.

Objective To evaluate the effect of bundle intervention on reducing catheter-associated urinary tract in-fection(CAUTI).Methods Hospitalized patients with urinary catheterization in a tertiary first-class hospital were subjected to targeted monitoring of a baseline survey from January to December 2022(pre-intervention).The main causes were found out,and bundle intervention measures were developed and implemented through plan-do-check-act(PDCA)tools from January to March 2023(intervention period).The data from April to December 2023(post-intervention)were collected,difference in catheter use rate and incidence of CAUTI before and after intervention were compared.Results The implementation rate of correctly hanging urine collection bags after intervention was 97.00％,the implementation rate of timely emptying urine collection bags was 91.72％,awareness rate of hand hy-giene among patient's family members was 79.13％,implementation rate of urinary catheter clamping during trans-portation was 74.79％,and daily evaluation implementation rate was 87.68％,which were higher than the pre-in-tervention rates of 85.63％,80.47％,62.75％,60.00％,and 79.93％,respectively.The incidence of CAUTI de-creased from 1.23‰ before intervention to 0.57‰ after intervention,the use rate of urinary catheter decreased from 5.53％before intervention to 5.37％after intervention.Differences of the above indicators were all statistically sig-nificant(all P＜0.05).Conclusion Through targeted monitoring on CAUTI and PDCA quality tools,the weak links in healthcare-associated infection control are identified,more targeted prevention and control measures are for-mulated,the implementation of bundle intervention measures can reduce the incidence of CAUTI.

Objective To evaluate the effect of bundle intervention on reducing catheter-associated urinary tract in-fection(CAUTI).Methods Hospitalized patients with urinary catheterization in a tertiary first-class hospital were subjected to targeted monitoring of a baseline survey from January to December 2022(pre-intervention).The main causes were found out,and bundle intervention measures were developed and implemented through plan-do-check-act(PDCA)tools from January to March 2023(intervention period).The data from April to December 2023(post-intervention)were collected,difference in catheter use rate and incidence of CAUTI before and after intervention were compared.Results The implementation rate of correctly hanging urine collection bags after intervention was 97.00％,the implementation rate of timely emptying urine collection bags was 91.72％,awareness rate of hand hy-giene among patient's family members was 79.13％,implementation rate of urinary catheter clamping during trans-portation was 74.79％,and daily evaluation implementation rate was 87.68％,which were higher than the pre-in-tervention rates of 85.63％,80.47％,62.75％,60.00％,and 79.93％,respectively.The incidence of CAUTI de-creased from 1.23‰ before intervention to 0.57‰ after intervention,the use rate of urinary catheter decreased from 5.53％before intervention to 5.37％after intervention.Differences of the above indicators were all statistically sig-nificant(all P＜0.05).Conclusion Through targeted monitoring on CAUTI and PDCA quality tools,the weak links in healthcare-associated infection control are identified,more targeted prevention and control measures are for-mulated,the implementation of bundle intervention measures can reduce the incidence of CAUTI.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

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.

Objective To develop a deep learning method for small sample multi-omics data using attention mechanism and Meta-learning for the establishment of autism diagnosis model.Methods MLAN(Meta-learning based attentive network)consisting of the omics feature pre-reduction module,the multi-omics data fusion and feature learning module,and the parameter optimization module was designed.Firstly,differential expression analysis was performed on high-dimensional multi-omics data to preliminarily screen out unimportant features.Secondly,a multi-channel attention mechanism was used to learn the importances of every set of omics data and to realize data fusion,and a two-layer fully connected network was constructed to further extract latent features and realize the diagnosis task.Finally,the Meta-learning algorithm Reptile was used to optimize the initial parameters of the above model to obtain the optimal parameters.A total of 58 children's saliva samples were collected,including 21 children diagnosed with autism,12 children with social disorders,and 25 healthy controls,and the protein and metabolomics data were detected by mass spectrometry.All data were randomly divided into training set and test set by 4∶1,and the training set was divided into training data and validation data in the same way for model training and validation.The test set was used for the final evaluation of the model effect.Five baseline models and three ablated models were constructed and evaluated along with MLAN based on metrics including multi-classification accuracy,F1-macro and F1-weighted scores.Results The constructed multi-classification autism diagnosis model MLAN achieved multi-classification accuracy,F1-macro and F1-weighted scores of 0.850±0.066,0.817±0.103 and 0.834±0.087.The values of all three indicators were better than those of baseline models and the ablated models.Conclusion The proposed MLAN can effectively deal with heterogeneous multi-omics data with small samples and achieve good results,which is expected to provide assistance for the clinical diagnosis of autism.

Objective To develop a deep learning method for small sample multi-omics data using attention mechanism and Meta-learning for the establishment of autism diagnosis model.Methods MLAN(Meta-learning based attentive network)consisting of the omics feature pre-reduction module,the multi-omics data fusion and feature learning module,and the parameter optimization module was designed.Firstly,differential expression analysis was performed on high-dimensional multi-omics data to preliminarily screen out unimportant features.Secondly,a multi-channel attention mechanism was used to learn the importances of every set of omics data and to realize data fusion,and a two-layer fully connected network was constructed to further extract latent features and realize the diagnosis task.Finally,the Meta-learning algorithm Reptile was used to optimize the initial parameters of the above model to obtain the optimal parameters.A total of 58 children's saliva samples were collected,including 21 children diagnosed with autism,12 children with social disorders,and 25 healthy controls,and the protein and metabolomics data were detected by mass spectrometry.All data were randomly divided into training set and test set by 4∶1,and the training set was divided into training data and validation data in the same way for model training and validation.The test set was used for the final evaluation of the model effect.Five baseline models and three ablated models were constructed and evaluated along with MLAN based on metrics including multi-classification accuracy,F1-macro and F1-weighted scores.Results The constructed multi-classification autism diagnosis model MLAN achieved multi-classification accuracy,F1-macro and F1-weighted scores of 0.850±0.066,0.817±0.103 and 0.834±0.087.The values of all three indicators were better than those of baseline models and the ablated models.Conclusion The proposed MLAN can effectively deal with heterogeneous multi-omics data with small samples and achieve good results,which is expected to provide assistance for the clinical diagnosis of autism.

AIM To optimize the extraction process for Bletillae Rhizoma,and to evaluate its anti-oxidant,tyrosinase inhibitory activities.METHODS With ultrasound time,ethanol concentration and solid-liquid ratio as influencing factors,the total extraction content of gastrodin,protocatechualdehyde,p-hydroxybenzaldehyde,1,4-bis[4-(gluconoxy)benzyl]-2-isobutylmalate-2-glucoside,1,4-bis[4-(gluconoxy)benzyl]-2-isobutylmalate,yam Ⅲ,dihydropinosin and 3'-O-methylyam Ⅲ as an evaluation index,the extraction process was optimized by Box-Behnken response surface method.Subsequently,the extract's scavenging effects on DPPH,ABTS+free radicals,and inhibitory ability on tyrosinase were determined.RESULTS The optimal conditions were determined to be 49 min for ultrasound time,55％for ethanol concentration,1∶30 for solid-liquid ratio,and 2 times for extraction frequency,the total extraction content was 13.18 mg/g.The extract demonstrated the IC50 of 10.12,314.07 and 1.70 μg/g on DPPH,ABTS+free radicals and tyrosinase,respectively.CONCLUSION This simple,reliable and stable method can be used for the extraction for Bletillae Rhizoma with strong anti-oxidant,tyrosinase inhibitory activities.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.