In recent years, the deep integration of artificial intelligence (AI) into medical education has created new opportunities for teaching Biochemistry and Molecular Biology, while also offering innovative solutions to the pedagogical challenges associated with protein structure and function. Focusing on the case of anaplastic lymphoma kinase (ALK) gene mutations in non-small-cell lung cancer (NSCLC), this study integrates AI into case-based learning (CBL) to develop an AI-CBL hybrid teaching model. This model features an intelligent case-generation system that dynamically constructs ALK mutation scenarios using real-world clinical data, closely linking molecular biology concepts with clinical applications. It incorporates AI-powered protein structure prediction tools to accurately visualize the three-dimensional structures of both wild-type and mutant ALK proteins, dynamically simulating functional abnormalities resulting from conformational changes. Additionally, a virtual simulation platform replicates the ALK gene detection workflow, bridging theoretical knowledge with practical skills. As a result, a multidimensional teaching system is established—driven by clinical cases and integrating molecular structural analysis with experimental validation. Teaching outcomes indicate that the three-dimensional visualization, dynamic interactivity, and intelligent analytical capabilities provided by AI significantly enhance students’ understanding of molecular mechanisms, classroom engagement, and capacity for innovative research. This model establishes a coherent training pathway linking “fundamental theory-scientific research thinking-clinical practice”, offering an effective approach to addressing teaching challenges and advancing the intelligent transformation of medical education.

Objective To investigate the effect of esketamine on postoperative analgesia,stress response and serum tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)levels in children undergoing tonsillectomy(TE)combined with endoscopic-assisted transoral adenoidectomy(ETA).Methods 98 children with tonsil and adenoid hypertrophy from January 2023 to August 2023.They were divided into two groups randomly,with 49 cases in each group.Children in both groups received the same TE plus ETA treatment,and were given the same anesthesia induction and maintenance.The observation group was given 0.5 mg/kg of esketamine injection intravenously 20 min before the operation ended,while the control group same dose of normal saline intravenously.The operation and anesthesia recovery were observed in the two groups.The scores of the face,legs,activity,cry,consolability behavioral tool(FLACC)and pediatric anesthesia emergence delirium scale(PAED)were compared between the two groups immediately after extubation(T1),10 min after extubation(T2),20 min after extubation(T3),30 min after extubation(T4)and 60 min after extubation(T5).The stress response indicators and inflammatory reaction mediators were tested at the time entering the operating room(T0)and T5 time points.And the two groups were also compared in terms of adverse reactions.Results There were no significant differences in surgical duration,extubation time,wake-up time and length of postanesthesia care unit(PACU)stay between the two groups(P＞0.05).The FLACC and PAED scores at T1,T2,T3,T4 and T5 time points in observation group were lower than those of the control group,the differences were statistically significant(P＜0.05).The serum cortisol(Cor),angiotensin Ⅱ(Ang Ⅱ),tumor necrosis factor-α(TNF-α)and interleukin-iβ(IL-1β)levels of the two groups at T5 time point were higher than those at T0 time point,the differences were statistically significant(P＜0.05).At T5 time point,the levels of serum Cor,Ang Ⅱ,TNF-α and IL-1β in observation group were lower than those of the control group,the differences were statistically significant(P＜0.05).The incidence of adverse reactions in observation group was significantly lower than that in control group,the difference was statistically significant(8.16％and 24.49％,P＜0.05).Conclusion Application of esketamine in the operation of TE combined with ETA in children can achieve exert good sedative and analgesic outcomes,and effectively reduce the stress response and inflammatory reaction caused by surgical trauma in children.

Activation of nuclear factor erythroid 2-related factor 2(Nrf2)by Kelch-like ECH-associated protein 1(Keap1)alkylation plays a central role in anti-inflammatory therapy.However,activators of Nrf2 through alkylation of Keap1-Kelch domain have not been identified.Deoxynyboquinone(DNQ)is a natural small molecule discovered from marine actinomycetes.The current study was designed to investigate the anti-inflammatory effects and molecular mechanisms of DNQ via alkylation of Keap1.DNQ exhibited signif-icant anti-inflammatory properties both in vitro and in vivo.The pharmacophore responsible for the anti-inflammatory properties of DNQ was determined to be the α,β-unsaturated amides moieties by a chemical reaction between DNQ and N-acetylcysteine.DNQ exerted anti-inflammatory effects through activation of Nrf2/ARE pathway.Keap1 was demonstrated to be the direct target of DNQ and bound with DNQ through conjugate addition reaction involving alkylation.The specific alkylation site of DNQ on Keap1 for Nrf2 activation was elucidated with a synthesized probe in conjunction with liquid chromatography-tandem mass spectrometry.DNQ triggered the ubiquitination and subsequent degra-dation of Keap1 by alkylation of the cysteine residue 489(Cys489)on Keap1-Kelch domain,ultimately enabling the activation of Nrf2.Our findings revealed that DNQ exhibited potent anti-inflammatory capacity through α,β-unsaturated amides moieties active group which specifically activated Nrf2 signal pathway via alkylation/ubiquitination of Keap1-Kelch domain,suggesting the potential values of targeting Cys489 on Keap1-Kelch domain by DNQ-like small molecules in inflammatory therapies.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Aim To explore the effects of Lycium berry seed oil on Nrf2/ARE pathway and oxidative damage in testis of subacute aging rats. Methods Fifty out of 60 male SD rats, aged 8 weeks, were subcutaneously injected with 125 mg • kg"D-galactosidase in the neck for 8 weeks to establish a subacute senescent rat model. The presence of senescent cells was observed using P-galactosidase ((3-gal), while testicular morphology was examined using HE staining. Serum levels of testosterone (testosterone, T), follicle-stimulating hormone ( follicle stimulating hormone, FSH ) , luteinizing hormone ( luteinizing hormone, LH ) , superoxide dis-mutase ( superoxide dismutase, SOD ) , glutathione ( glutathione, GSH) and malondialdehyde ( malondial-dehyde, MDA) were measured through ELISA, and the expressions of factors related to aging, oxidative damage, and the Nrf2/ARE pathway were assessed via immunohistochemical analysis and Western blotting. Results After successfully identifying the model, the morphology of the testis was improved and the intervention of Lycium seed oil led to a down-regulation in the expression of [3-gal and -yH2AX. The serum levels of SOD, GSH, T, and FSH increased while MDA and LH decreased (P 0. 05) . Additionally, there was an up-regulated expression of Nrf2, GCLC, NQOl, and SOD2 proteins in testicular tissue ( P 0. 05 ) and nuclear expression of Nrf2 in sertoli cells. Conclusion Lycium barbarum seed oil may reduce oxidative damage in testes of subacute senescent rats by activating the Nrf2/ARE signaling pathway.

The early response of plant auxin gene family Aux/IAA (auxin/indole-3-acetic acid) and its interaction with auxin response factor (ARF) are important pattern to regulate plant growth and development. This work identified 28 StoIAA and 24 StoARF members based on the whole genome data of the medicinal plant Senna tora L., which were classified into 10 and 8 subfamilies, respectively. Phylogenetic tree and collinearity analysis showed that S. tora has close evolutionary relationship with the IAA and ARF homologous genes of Glycine max, Medicago truncatula, and the segment duplication events dominate the expansion of StoIAA and StoARF. Gene structure analysis showed that the vast majority of StoIAA and StoARF contain characteristic conserved domain. Transcriptome data showed that StoIAAs and StoARFs were expressed in leaves, roots and seeds, some members had tissue specific expression. The StoIAA and StoARF promoter region most contain functional elements related to stress response, growth and development, hormone induction and secondary metabolism. In addition, gene expression analysis showed that many StoIAAs and StoARFs can quickly respond to drought and salt stress and exhibited same expression patterns under both stress condition. The yeast two-hybrid experiment confirmed that StoARF8 and StoARF10 exhibit varying degrees of interaction with multiple StoIAA proteins, respectively. The above results provide a basis for further biological functional analysis of the Aux/IAA and ARF gene family of S. tora.

[摘 要] 目的：探究桃叶珊瑚苷（AU）调控RhoA/ROCK信号通路对胃癌MGC803细胞上皮间质转化（EMT）进程和血管生成拟态（VM）形成的影响。方法：常规培养人胃癌MGC803细胞，将其随机分为对照组、AU-L组（20 μmol/L AU）、AU-M组（40 μmol/L AU）、AU-H组（80 μmol/L AU）、AU-H+RhoA激活剂水仙环素（Nar）组（AU-H+Nar组，80 μmol/L AU+30 μmol/L Nar）。采用CCK-8法、Transwell实验、细胞划痕实验分别检测不同浓度AU对细胞增殖、迁移和侵袭的影响，三维细胞培养法观察不同浓度AU对细胞体外VM管腔结构形成的影响，WB法检测AU对各组细胞RhoA、ROCK、VM与EMT相关蛋白表达的影响。结果：与对照组相比，AU-M组、AU-H组MGC803细胞增殖率（48、72 h时）、细胞迁移率、细胞侵袭数目、VM管腔结构数，以及RhoA、ROCK1、N-cadherin、vimentin、VE-cadherin的蛋白表达均显著降低（均P<0.05），E-cadherin表达显著升高（P<0.05）；同时，使用Nar处理显著减弱了AU对MGC803细胞EMT和VM形成的抑制作用（均P<0.05）。结论：AU通过下调RhoA/ROCK信号通路抑制胃癌MGC803细胞的增殖、迁移、侵袭、EMT和VM形成过程。

BACKGROUND: The effects of acupuncture have varied in different randomized controlled trials (RCTs), and there are many factors that influence treatment effect of acupuncture in different outcomes, with conflicting results. OBJECTIVE: To identify factors and their impact on the treatment effect of acupuncture in different outcomes. METHODS: Acupuncture RCTs were searched from 7 databases including Medline (PubMed), Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc between January 1st, 2015 and December 31st, 2019. Eligible studies must compare acupuncture to no acupuncture, sham acupuncture, or waiting lists, and report at least 1 patient-important outcome. A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables, even those excluded from the multivariable model due to collinearities. We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences (SMDs), categorising them as small (<0.2), moderate (0.2-0.4), or large (>0.4) effects. RESULTS: The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables. High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude, the difference of adjusted SMDs 0.46, 95% confidence interval (CI) 0.07 to 0.84; P=0.02]. The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables. Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture (0.30, 95% CI 0.06 to 0.53; P=0.01). The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables. Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects, compared to non-penetrating acupuncture and fixed regimen, respectively (0.40, 95% CI 0 to 0.80; P=0.05; 0.29, 95% CI 0.06 to 0.53; P=0.01). CONCLUSIONS High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms. Penetrating acupuncture demonstrated greater effect in relieving non-painful symptoms. Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes. Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.
Humans ; Randomized Controlled Trials as Topic ; Acupuncture Therapy/methods* ; Pain ; Pain Management ; China

Objective:To investigate the clinical efficacy of femoral component revision surgery in addressing polyethylene sleeve wear in rotating hinge knee joints.Methods:A retrospective analysis was conducted on 21 patients who underwent treatment for polyethylene sleeve wear in rotating hinge knee joints at the Department of Orthopaedics, the Fourth Medical Center, PLA General Hospital, spanning from August 2008 to April 2023. There were 8 males and 13 females with a median age of 63(38, 76) years. Among them, 11 cases involved the left side, and 10 cases involved the right side. The average body mass index (BMI) was 25.0(22.5, 31.0) kg/m 2, and all cases underwent unilateral knee joint revision. The time interval from receiving the hinge knee joint prosthesis to revision was 10.5(6.0, 17.0) years, with 18 cases undergoing primary revision and 3 cases undergoing revision for the second time. Revision surgery of the femoral component sleeve was performed in all patients due to polyethylene sleeve wear. Visual analogue scale (VAS), range of motion (ROM) of the knee joint, changes in hip-knee-ankle angle (HKA), and Knee Society score (KSS) were collected and recorded to assess the surgical outcomes. Results:All patients were followed up for a median duration of 12.5(11.7, 13.4) months. Preoperatively, the VAS score was 5(3, 7) points, which significantly decreased to 0(0, 1) points at the last follow-up ( Z=5.721, P<0.001). At the last follow-up, the KSS scores decreased from 41.19±13.65 points preoperatively to 79.81±7.80 points, indicating a statistically significant difference ( t=12.560, P<0.001). HKA increased from 174.65°±5.20° preoperatively to 178.71°±2.79°, with a statistically significant difference ( t=5.533, P<0.001). Knee joint ROM increased from 69.05°±34.37° preoperatively to 110.00°±10.12°, also demonstrating a significant improvement ( t=5.960, P<0.001). Notably, patients exhibited knee joint stability with no passive flexion or extension laxity. Conclusion:Femoral component sleeve revision surgery effectively addresses polyethylene sleeve wear in rotating hinge knee joint prostheses, thereby mitigating the substantial loss of bone and soft tissue associated with overall revision procedures. The early postoperative clinical outcomes are promising and indicative of the efficacy of this surgical intervention.

Objective To observe the efficacy and safety of Morinda officinalis oligosaccharides in the continuation treatment of mild and moderate depression.Methods An open,single-arm,multi-center design was adopted in our study.Adult patients with mild and moderate depression who had received acute treatment of Morinda officinalis oligosaccharides were enrolled and continue to receive Morinda officinalis oligosaccharides capsules for 24 weeks,the dose remained unchanged during continuation treatment.The remission rate,recurrence rate,recurrence time,and the change from baseline to endpoint of Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Clinical Global Impression-Severity(CGI-S)and Arizona Sexual Experience Scale(ASEX)were evaluated.The incidence of treatment-related adverse events was reported.Results The scores of HAMD-17 at baseline and after treatment were 6.60±1.87 and 5.85±4.18,scores of HAMA were 6.36±3.02 and 4.93±3.09,scores of CGI-S were 1.49±0.56 and 1.29±0.81,scores of ASEX were 15.92±4.72 and 15.57±5.26,with significant difference(P＜0.05).After continuation treatment,the remission rate was 54.59％(202 cases/370 cases),and the recurrence rate was 6.49％(24 cases/370 cases),the recurrence time was(64.67±42.47)days.The incidence of treatment-related adverse events was 15.35％(64 cases/417 cases).Conclusion Morinda officinalis oligosaccharides capsules can be effectively used for the continuation treatment of mild and moderate depression,and are well tolerated and safe.