Objective To explore the dominant views with positive results when performing echocardiography on common congenital heart disease (CHD) in children using the seven-step screening method for pediatric echocardiography. Methods The echocardiographic data of children with atrial septal defect, patent foramen ovale, ventricular septal defect, and patent ductus arteriosus were collected from September 2021 to February 2022. The disease type distribution, view distribution, and the dominant view distribution were analyzed. Dominant view referred to the view with a high ratio of positive result images per view to the total image in each disease. Results A total of 8 353 images of 1 633 children with common CHD were collected. There were 813 males and 820 females ageed 0-7 years, including 3 613 images in 701 patients with atrial septal defect, 1 178 images in 206 patients with patent foramen ovale, 2 857 images in 576 patients with ventricular septal defect, and 705 images in 150 patients with patent ductus arteriosus. The dominant views of atrial septal defect were subxiphoid 2-chamber view (92.96%), subxiphoid 4-chamber view (85.61%), parasternal 4-chamber view (62.07%), and parasternal short-axis view (38.50%). The dominant views of patent foramen ovale were subxiphoid 2-chamber view (82.69%) and subxiphoid 4-chamber view (65.41%). The dominant views of ventricular septal defect were parasternal 5-chamber view (79.73%), parasternal short-axis view (79.41%), parasternal 4-chamber view (58.18%), and parasternal long-axis view (51.11%). The dominant view of patent ductus arteriosus was parasternal short-axis view (98.80%). Conclusion The analysis of the lesion key areas of common CHD shows that there are 4 dominant views for atrial septal defect and ventricular septal defect, 2 for patent foramen ovale, and only 1 for patent ductus arteriosus. Clarifying the dominant views of common CHD is conducive to rapid and accurate diagnosis of diseases, clinical practice, teaching and scientific research.

Based on the theory of "cold qi generates turbidity" described in the Inner Canon of Yellow Emperor （《黄帝内经》）， together with the physiological characteristics of children， who are considered to have an inherent insufficiency of the lung， spleen， and kidney， and the clinical features of recurrent refractory nephrotic syndrome （RNS）， this article proposes that the pathogenesis of RNS in children is characterized by yang deficiency with internal cold， turbidity arising from cold， latent turbidity transforming into toxin， activation by newly contracted pathogens， and turbid toxins damaging the collaterals. The core pathogenesis is identified as yang deficiency， turbidity coagulation， and collateral damage. Accordingly， the general treatment principle is warming yang and eliminating turbidity， with coordination of three methods including warming yang to strengthen the body's foundation， promoting yang to relieve constraint， and raising yang while replenishing qi. Zhenwu Decoction （真武汤） is employed as the basic prescription with modification according to syndrome differentiation， to achieve an effect eliminating turbidity and arresting leakage， restoring kidney function by unblocking the collaterals， and consolidating recovery to prevent relapse.

OBJECTIVE To establish a high-performance liquid chromatography （HPLC） fingerprint and content determination method for Phellodendron chinensis ， and to evaluate its quality combined with chemometrics analysis.METHODS The HPLC fingerprints of 30 batches of P. chinensis were established by the Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine （2012 Edition）， and similarity evaluation and common peak identification were carried out.The contents of phellodendrine hydrochloride， magnoflorine， chlorogenic acid， 5- O -feruloylquinic acid， 4- O -feruloylquinic acid， 3- O -feruloylquinic acid， jatrorrhizine hydrochloride，and berberine hydrochloride were determined by the same HPLC method. Hierarchical cluster analysis （HCA）， principal component analysis （PCA）， and partial least squares-discriminant analysis （PLS-DA） were performed using the contents of the above eight components as variables.RESULTS A total of 16 common peaks were identified in the HPLC fingerprints of 30 batches of samples， and 8 common peaks were identified， including phellodendrine hydrochloride， magnoflorine， chlorogenic acid， 5- O -feruloylquinic acid， 4- O -feruloylquinic acid， 3- O -feruloylquinic acid， jatrorrhizine hydrochloride，and berberine hydrochloride. The similarity of 30 batches of samples ranged from 0.989 to 1.000. The results of content determination showed that the contents of eight components such as phellodendrine hydrochloride were 10.108-22.745，2.598-5.529，6.250-13.942，4.956-12.433，10.895-27.384，43.248-78.924， 0.428-1.154， 81.827-153.066 mg/g， respectively. The HCA results showed that 30 batches of samples were clustered into 3 categories：S1-S10 as one category， S11-S23 as one category，and S24-S30 as one category. The PCA results showed that the comprehensive scores of 10 batches of samples from the Sichuan production area （S1-S10） ranked among the top 10. The PLS-DA results showed that the variable importance in projection values of berberine hydrochloride， 3- O -feruloylquinic acid， chlorogenic acid and phellodendrine hydrochloride were greater than 1.CONCLUSIONS The HPLC fingerprint and content determination methods established in this study are stable and reliable. Chemometric analysis based on multi-component content data can be used for the quality evaluation of P. chinensis . Berberine hydrochloride， phellodendrine hydrochloride，and 3- O -feruloylquinic acid may be the differential markers affecting the overall quality of P. chinensis .

Objective To identify S-palmitoylation sites on angiotensin-converting enzyme 2(ACE2),the cellular receptor for severe acute respiratory syndrome corona virus(SARS-CoV)and SARS-CoV-2,and to investigate the functional relevance of these modifications in regulating ACE2 localization and activity.Methods An optimized multi-site mutagenesis strategy was performed by simultaneously substitution of all eight cysteine(Cys)residuesin ACE2 by serine to create a non-palmitoylatable mutant(8CS).Then individual cysteine residues were re-introduced one by one.Palmitoylation level of mutants was evaluated using a bioorthogonal click chemistry method to identify palmitoylation-competent residues.Immune-fluorescence staining and extra-cellular vesicle isolation assays were then used to evaluate the impact of specific palmitoylation sites on ACE2 sub-cellular localization.Results An efficient strategy for multi-site palmitoylation site mapping was optimized and successfully identified three critical palmitoylation sites on ACE2:Cys141,Cys344 and Cys498.Functional analyses showed that palmi-toylation of these sites significantly promotes the enrichment of ACE2 in extra-cellular vesicles.Conclusions S-palmitoylation at Cys141,Cys344 and Cys498 is essential for the trafficking of ACE2 to extra-cellular vesicles,which suggests a potential regulatory mechanism of its impact on viral receptor presentation and ACE2-associated signaling pathways.

Objective:To investigate the temporal expression of Growth Differentiation Factor-15 (GDF15) in the serum of patients with Acute Coronary Syndrome (ACS) and explore the clinical significance of GDF15 in protecting cardiomyocytes in ACS.Methods:A retrospective study was conducted on 289 ACS patients admitted to the emergency departments from February to October 2023. Data on gender, age, troponin T (TnT), creatine kinase isoenzyme (CK-MB), GDF15, and B-type natriuretic peptide (BNP) within 30 minutes of admission were recorded. Differences in these indicators among different groups were compared. Receiver Operating Characteristic (ROC) curves were plotted to evaluate the diagnostic value of GDF15, TnT, and BNP for ACS. Among the patients, 15 exhibited a temporal expression pattern of GDF15, and their blood samples were re-measured using a GDF15 fluorescent quantitative immunochromatographic assay kit. Fifteen patients without temporal expression were randomly selected as controls, and their samples were also re-measured to exclude detection errors. Fifteen patients with temporal expression were included in the temporal expression group, and 15 without temporal expression were included in the non-temporal expression group. Laboratory indicators such as fasting blood glucose, glycated hemoglobin, triglycerides, creatinine, and uric acid were compared between the groups. Additionally, patient age, gender, body mass index (BMI), coronary angiography results, echocardiography, Gensini score, left ventricular ejection fraction (LVEF), and GRACE risk score were recorded to assess their correlation with GDF15 temporal expression. Statistical analysis was performed using SPSS 27 software, with continuous data expressed as mean ± standard deviation (Mean ± SD) and compared using t-tests and χ2 tests. Results:The overall trend in ACS patients showed a higher proportion of males than females (73.36% vs. 26.64%). The oldest group was the Unstable Angina (UA) group, with a mean age of (63.98 ± 15.19) years, while the youngest group was the non-ACS chest pain group, with a mean age of (54.29 ± 16.39) years. A higher proportion of patients in the UA, ST-segment elevation myocardial infarction (STEMI), and non-ST-segment elevation myocardial infarction (NSTEMI) groups had a history of smoking. The combination of GDF15 and TnT showed high diagnostic value for ACS, with an area under the ROC curve (AUC) of 0.843, consistent with previous studies. Among all ACS patients, 15 exhibited a temporal expression pattern of GDF15, where GDF15 levels peaked at 4 hours, gradually decreased, and peaked again at 24 hours. Patients in the temporal expression group had higher LVEF and left ventricular end-systolic diameter compared to the non-temporal expression group. The Gensini score was lower in the temporal expression group, and the GRACE risk score was significantly lower in the temporal expression group (00.7±14.72) compared to the non-temporal expression group (116.1±23.46), with a statistically significant difference ( P = 0.0115). There were no significant differences in general characteristics (age, gender, BMI) or clinical biochemical indicators (fasting blood glucose, glycated hemoglobin, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, creatinine, uric acid) between the temporal and non-temporal expression groups ( P > 0.05). Conclusions:GDF15 demonstrates significant diagnostic and prognostic predictive value in ACS. Patients with temporally dynamic expression of serum GDF15 exhibit milder myocardial injury and a lower probability of mortality. These findings provide novel therapeutic targets and research directions for further exploring the role of GDF15 in ACS management.

Objective To construct a critical care humanistic nursing curriculum under the perspective"great ideological and political education",and evaluate its effects in the training of intensive care unit(ICU)standardized training nurses.Methods A research team was established and organized by department of nursing of Zhongshan Hospital,Fudan University,which consisting of 6 critical care nursing managers and specialists,including 1 chief nurse,3 head nurses,1 master's graduate,and 1 doctoral graduate.The team was responsible for literature review,questionnaire design,expert recruitment,survey distribution and collection,data integration,and analysis.A preliminary questionnaire was developed through literature reviews on critical care humanistic nursing,brainstorming sessions,and clinical surveys.A two-round Delphi method was conducted to finalize the humanistic nursing training curriculum.Ideological and political elements,such as political identity,patriotism,moral cultivation,legal awareness,scientific spirit and professional quality were integrated into the program.From July 2023 to June 2024,newly enrolled ICU standardized training nurses at Zhongshan Hospital,Fudan University participated in the training.Training outcomes were assessed via theoretical examinations and pre-and post-training evaluations of humanistic competency.Results A total of 10 experts participated in the consultation,resulting in a training course consisting of two primaryl indicators and 11 secondary indicators.A total of 60 nurses participated in the training,achieving an average post-training theoretical score of 84.92±7.73.Significant improvements were observed across all dimensions of humanistic competency post-training compared to pre-training(humanistic care practice competency:33.95±4.50 vs.30.82±4.10,communication skills:20.27±2.68 vs.18.98±2.98,self-management:10.07±1.91 vs.9.20±2.02,ethical and legal competence:10.38±1.61 vs.9.68±2.02,psychological adaptability:14.20±2.31 vs.13.03±2.19,and total humanistic practice competency score:88.87±7.65 vs.81.71±8.55),with all differences statistically significant(all P<0.05).Conclusion The critical care humanistic nursing curriculum under the perspective of"great ideological and political education"can effectively improve the humanistic quality of nurses and enhance their ICU practical skills,so as to provide reference for the training of nurses in intensive care.

Objective:To investigate the effect of ginsenoside octanoate(Rh2-O)on inducing immunogenic cell death in hepa-tocellular carcinoma cells and its molecular mechanism.Methods:Effects of ginsenoside caprylate(Rh2-O)and autophagy inhibitor 3-MA on the activity of hepatocellular carcinoma cells were detected by CCK-8 assay.The effect of Rh2-O on CRT membrane eversion in Hepa1-6 cells were detected by immunofluorescence assay.Rh2-O treated mouse hepatocellular carcinoma cells were used to pre-pare a tumor vaccine for in vivo vaccination experiments in mice.Extracellular ATP levels were detected in real-time.The expression of autophagy-related genes and proteins were measured by real-time fluorescence PCR and Western blot,and the mitochondrial morphol-ogy and co-localization with autophagy proteins were observed by laser confocal microscopy.Results:Rh2-O showed strong cytotoxicity to Hepa1-6 cells[cell viability:(58.54±3.56)%]at a concentration of 150 μmol/L,and a large amount of CRT was observed on the surface of the cell membrane.The tumor emergence rate was 36.36%in the vaccinated group and 100%in the control group.The tumor vaccine prepared by Rh2-O effectively protected mice from the same type of tumor attack;Rh2-O induced an increase in the level of cellular secreted ATP(P<0.05),the mRNA of autophagy-related genes ATG3,p62,LC3 expression levels and autophagy-associated proteins LC3A and LC3B expression levels were increased(P<0.05),and co-localization of mitochondria with autophagy proteins was significantly increased(P<0.05).In addition,Rh2-O action on 3-MA pretreated hepatocellular carcinoma cells resulted in a signifi-cant decrease in extracellular ATP levels(P<0.001).Conclusion:Rh2-O may induce immunogenic cell death by inducing autophagy in hepatocellular carcinoma cells.

Radiopharmaceuticals operate by combining radionuclides with carriers. The radiation energy emitted by radionuclides is utilized to selectively irradiate diseased tissues while minimizing damage to healthy tissues. In comparison to external beam radiation therapy, radionuclide drugs demonstrate research potential due to their biological targeting capabilities and reduced normal tissue toxicity. This article reviews the applications and research progress of radiopharmaceuticals in cancer treatment. Several key radionuclides are examined, including ²²³Ra, ⁹⁰Y, Lutetium-177 (¹⁷⁷Lu), ²¹²Pb, and Actinium-225 (²²⁵Ac). It also explores the current development trends of radiopharmaceuticals, encompassing the introduction of novel radionuclides, advancements in imaging technologies, integrated diagnosis and treatment approaches, and equipment-medication combinations. We review the progress in the development of new treatments, such as neutron capture therapy, proton therapy, and heavy ion therapy. Furthermore, we examine the challenges and breakthroughs associated with the clinical translation of radiopharmaceuticals and provide recommendations for the research and development of novel radionuclide drugs.
Humans ; Radiopharmaceuticals/therapeutic use* ; Neoplasms/radiotherapy* ; Radioisotopes/therapeutic use* ; Animals

Carbon ion radiotherapy(CIRT)is an advanced radiotherapy method with unique physical and biological properties.It increases the dose to the tumor target area while providing better protection to normal tissues.CIRT can be used for hypoxic tumors resistant to photon radiotherapy.It also has the potential superiority of inducing immune responses and can produce the"abscopal effect"when com-bined with different immunotherapies.Radioimmunotherapy can not only ablate tumors at the irradiated site but also partially control dis-tant metastases at the unirradiated site.However,the underlying mechanism has not been fully elucidated.Due to the protection of the tu-mor microenvironment,tumors can sometimes be difficult to completely clear through CIRT-mediated anti-tumor immunity;this can also in-dicate functional limitations of some immune organs after CIRT.Therefore,this study reviewed the impact of CIRT on both innate and adapt-ive immune responses.It also examined the relationship between different radiation doses/fractions and immune protein expression,as well as compared the differences in imaging techniques between carbon ion radiotherapy and traditional radiotherapy.We have also proposed future directions to enhance the superiority of CIRT.This study aimed to provide a strong theoretical basis for improving the efficacy of CIRT and its combination therapy,ultimately benefiting more patients with cancer.

Objective To observe the correlations of image manifestations of organ damage and clinical characteristics of heat stroke.Methods Totally 46 patients with heat stroke were retrospectively enrolled.Based on the presence or absence of image manifestations of heat stroke related organ damage on head MRI and chest-abdominal CT and combined with sequential organ failure assessment(SOFA),the patients were divided into organ damage positive group(positive A,images showed clear manifeatations of organ damage and the corresponding SOFA≥2)and organ damage negative group(negative B,images showed no obvious organ damage or the corresponding SOFA＜2).Clinical data,laboratory indicators and treatment outcomes were compared between groups.Univariate and multivariate logistic analyses were used to explore the correlations of image manifestations of organ damage and clinical characteristics of heat stroke.Results Among 46 cases,26 were classified as positive group A and 20 as negative group.There were significant differences of patients' age,gender,Glasgow coma scale(GCS)and heart rate at admission,thrombin time,D-dimer,lactate dehydrogenase,partial pressure of carbon dioxide,lactic acid,myoglobin,platelet count(PLC),interleukin-6 and serum creatinine before treatment,as well as time of hospital stay and post-treatment outcomes between groups(all P＜0.05).GCS score,PLC levels and time of hospital stay of heat stroke patients were all correlated with image manifeations of organ damage(OR=0.592,0.729,1.532,all P＜0.05),among which GCS score and time of hospital stay were independently associated with image manifeations of organ damage(OR=0.607,1.448,both P＜0.05).Conclusion Image manifeations of organ damage was correlated with GCS score and time of hospital stay in patients with heat stroke.