Objective:To investigate the effect of asiaticoside on cognitive impairment in young epileptic rats by regulating SIRT1/AMPK signaling pathway.Methods:Young rats were randomly separated into Sham group,Model group,low-dose asiaticoside(20 mg/kg)group,high-dose asiaticoside(40 mg/kg)group and high-dose asiaticoside+EX527 group.The seizure situation of rats was observed;Morris water maze was applied to test spatial learning and memory abilities;ELISA was applied to detect levels of TNF-α,IL-10,IL-6,MDA,SOD and GSH-Px in rat hippocampal tissue;Nissl staining was applied to observe morphological changes of rat hippocampal tissue;TUNEL staining was applied to detect apoptosis of hippocampal neurons in rats;Western blot was applied to detect expressions of Cleaved-caspase-3,Bax,Bcl-2,SIRT1,p-AMPK and AMPK proteins in rat hippocampal tissue.Results:Compared with Sham group,Model group showed severe tissue damage in hippocampal CA1 region of rats,epilepsy score and seizure duration were obviously increased,incubation period was obviously prolonged,levels of TNF-α,IL-6,MDA,neuronal apoptosis rate,expressions of Cleaved-caspase-3 and Bax proteins in CA1 region of hippocampus were obviously increased,the retention time and number of platform crossings were obviously decreased,levels of IL-10,SOD,GSH-Px,protein expressions of Bcl-2,SIRT1,p-AMPK/AMPK in CA1 region of hippocampus were obviously reduced(P<0.05);compared with Model group,tissue damage in hippocampal CA1 region of rats in low-dose and high-dose asiaticoside groups was obviously reduced,the epilepsy score and seizure duration were obviously decreased,incubation period was obviously shortened,levels of TNF-α,IL-6,MDA,neuronal apoptosis rate,expressions of Cleaved-caspase-3 and Bax proteins in CA1 region of hippocampus were obviously reduced,the retention time and the number of platform crossings were obviously increased,levels of IL-10,SOD,GSH-Px,protein expressions of Bcl-2,SIRT1 and p-AMPK/AMPK in CA1 region of hippocampus were obviously increased(P<0.05);EX527 was able to partially reverse the improve-ment effect of asiaticoside on epileptic young rats.Conclusion:Asiaticoside can reduce inflammatory response,oxidative stress and hippocampal neuronal apoptosis in rats and reduce nerve damage by activating SIRT1/AMPK signaling pathway,thus improving cogni-tive function of young epileptic.

Objective:To systematically evaluate the impact of internet-based patient decision aid (PtDA) on decision-making for prenatal screening and diagnosis among pregnant women.Methods:Randomized controlled trials (RCTs) on the application of internet-based PtDA for prenatal screening and diagnosis among pregnant women were searched in PubMed, Embase, Web of Science, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Date, VIP, and China Biology Medicine disc. The search period was from inception to August 11, 2024. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Meta-analysis was performed using RevMan 5.4 software.Results:A total of 10 studies involving 3 838 pregnant women were included. The meta-analysis showed that internet-based PtDA significantly reduced decision conflict ( P<0.05), improved decision knowledge ( P<0.01), and decreased decision anxiety ( P<0.05) among pregnant women but had no significant impact on decision regret ( P>0.05) . Conclusions:Internet-based PtDA effectively reduce decision conflict and anxiety while improving decision knowledge during prenatal screening and diagnostic decision-making. Future studies should focus on developing culturally appropriate decision aids tailored to the Chinese context and explore the enhanced role of nurses in prenatal screening counseling.

Objective:To investigate the effect of asiaticoside on cognitive impairment in young epileptic rats by regulating SIRT1/AMPK signaling pathway.Methods:Young rats were randomly separated into Sham group,Model group,low-dose asiaticoside(20 mg/kg)group,high-dose asiaticoside(40 mg/kg)group and high-dose asiaticoside+EX527 group.The seizure situation of rats was observed;Morris water maze was applied to test spatial learning and memory abilities;ELISA was applied to detect levels of TNF-α,IL-10,IL-6,MDA,SOD and GSH-Px in rat hippocampal tissue;Nissl staining was applied to observe morphological changes of rat hippocampal tissue;TUNEL staining was applied to detect apoptosis of hippocampal neurons in rats;Western blot was applied to detect expressions of Cleaved-caspase-3,Bax,Bcl-2,SIRT1,p-AMPK and AMPK proteins in rat hippocampal tissue.Results:Compared with Sham group,Model group showed severe tissue damage in hippocampal CA1 region of rats,epilepsy score and seizure duration were obviously increased,incubation period was obviously prolonged,levels of TNF-α,IL-6,MDA,neuronal apoptosis rate,expressions of Cleaved-caspase-3 and Bax proteins in CA1 region of hippocampus were obviously increased,the retention time and number of platform crossings were obviously decreased,levels of IL-10,SOD,GSH-Px,protein expressions of Bcl-2,SIRT1,p-AMPK/AMPK in CA1 region of hippocampus were obviously reduced(P<0.05);compared with Model group,tissue damage in hippocampal CA1 region of rats in low-dose and high-dose asiaticoside groups was obviously reduced,the epilepsy score and seizure duration were obviously decreased,incubation period was obviously shortened,levels of TNF-α,IL-6,MDA,neuronal apoptosis rate,expressions of Cleaved-caspase-3 and Bax proteins in CA1 region of hippocampus were obviously reduced,the retention time and the number of platform crossings were obviously increased,levels of IL-10,SOD,GSH-Px,protein expressions of Bcl-2,SIRT1 and p-AMPK/AMPK in CA1 region of hippocampus were obviously increased(P<0.05);EX527 was able to partially reverse the improve-ment effect of asiaticoside on epileptic young rats.Conclusion:Asiaticoside can reduce inflammatory response,oxidative stress and hippocampal neuronal apoptosis in rats and reduce nerve damage by activating SIRT1/AMPK signaling pathway,thus improving cogni-tive function of young epileptic.

Objective:To systematically evaluate the impact of internet-based patient decision aid (PtDA) on decision-making for prenatal screening and diagnosis among pregnant women.Methods:Randomized controlled trials (RCTs) on the application of internet-based PtDA for prenatal screening and diagnosis among pregnant women were searched in PubMed, Embase, Web of Science, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Date, VIP, and China Biology Medicine disc. The search period was from inception to August 11, 2024. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Meta-analysis was performed using RevMan 5.4 software.Results:A total of 10 studies involving 3 838 pregnant women were included. The meta-analysis showed that internet-based PtDA significantly reduced decision conflict ( P<0.05), improved decision knowledge ( P<0.01), and decreased decision anxiety ( P<0.05) among pregnant women but had no significant impact on decision regret ( P>0.05) . Conclusions:Internet-based PtDA effectively reduce decision conflict and anxiety while improving decision knowledge during prenatal screening and diagnostic decision-making. Future studies should focus on developing culturally appropriate decision aids tailored to the Chinese context and explore the enhanced role of nurses in prenatal screening counseling.

Objective:To investigate the clinicopathological features, diagnosis and differential diagnosis of adrenal cortical carcinoma (ACC) in children.Methods:Twenty-five children with ACC diagnosed in the Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China from March 2014 to August 2022 were retrospectively analyzed. The related literature was reviewed.Results:A total of 25 children with ACC were collected, including 11 males and 14 females, with a male to female ratio of 1.0∶1.3. The patient ages ranged from 8 months to 14 years (median, 4 years). Eighteen cases with clinical data had functional tumors (18/22, 81.8%) presenting with virilization or precocious puberty (15/18), symptoms related to hypercortisolism (8/18) or endocrine symptoms mixed with both (5/18), while 3 cases (3/22, 13.6%) had unknown clinical data. The clinical manifestations of four patients with nonfunctional tumors were an abdominal mass and/or abdominal pain, walking instability and others. Grossly, the average maximum diameter of the tumor was 9.4 cm. Most of the tumors were nodular and partially encapsuled. The cut surfaces were gray or gray brown, soft with hemorrhage. Histologically, the tumor cells were diffusely distributed, separated by a vascular-rich network. The tumor cells were large, with distinct nucleoli, abundant eosinophilic or clear cytoplasm, and round or oval nuclei. The mitotic index was high, and atypical mitoses were common. Necrosis, calcification, capsule invasion or/and venous invasion were present. In some cases, the tumor invaded the surrounding soft tissues or kidneys. Immunohistochemically, the tumor cells were diffusely positive for syn and SF1 and focally positive for α-inhibin, Melan A and Calretinin, but negative for CgA. Ki-67 proliferation index ranged from 2%-90%. TP53 gene status was examined in 7 cases, in which mutations were detected in 4 cases. Follow-up data was obtained in 21 patients, among whom 18 received chemotherapy and 3 received radiotherapy. Distant metastasis occurred in 13 patients. Median progression-free survival (PFS) was 11.2 months and median overall survival (OS) was 54.7 months. Patients aged less than 5 years had a better prognosis for OS ( P<0.05) than the older ones (≥5 years), but a similar PFS ( P>0.05). Male patients and Ki-67 proliferation index <15% had a better prognosis tendency for OS, but there was no statistically significant difference ( P>0.05). Conclusions:ACC in children is a rare, often functional tumor associated with Li-Fraumeni genetic syndrome and has a poor prognosis. Diagnosis and differential diagnosis require a combination of morphological, phenotypic and clinical analysis.

Objective:To carry out a scoping review on the development process, main forms, main contents and outcome indicators of decision aids for thyroid cancer patients, providing a theoretical basis for future research in China.Methods:The Arksey and O'Malley's methodological framework was used to analyze the literature. Electronic retrieval was conducted in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biomedical Database, and the search period was from database establishment to August 21, 2023.Results:A total of 11 articles were included. The forms of decision aids included paper decision support manuals, web-based decision support tools, conversation support tools and so on. The main content was to provide disease knowledge and the advantages and disadvantages of various treatment plans, help patients clarify their values, understand patient preferences, and assist doctors and patients make decisions. Outcome indicators involved treatment choice, medical knowledge, decision conflict, decision regret, decision satisfaction, anxiety and so on.Conclusions:The application of decision aids has a positive effect in thyroid cancer patients. Future research should encourage many people to participate in decision-making in order to improve the quality of decision-making for thyroid cancer patients.

Objective To design and construct a syndrome differentiation knowledge graph that integrates TCM facial color diagnosis information;To explore the hidden relationships between the knowledge.Methods The literature data came from ancient classics,textbooks,as well as standard literature related to inspection included in the CNKI,VIP and Wanfang Data from the establishment of the databases to December 31,2022.The clinical data was sourced from 30 elderly individuals who underwent TCM health examinations at the Community Health Service Center in Jiading Industrial Zone,Shanghai in September 2022.Facial image acquisition was performed using TFDA-1 digital tongue and facial diagnostic instrument.By following the steps of knowledge extraction,knowledge fusion and quality assessment to construct a graph,and with the assistance of TCM experts for interpretation,using Access 2019 to integrate qualitative textual data and quantitative objective image digital information,a syndrome differentiation knowledge graph integrating TCM facial diagnosis was designed and completed in the Neo4j graph database.In addition,a method was designed to shift facial diagnosis knowledge from qualitative to quantitative.Results There were a total of 194 nodes under 8 entity term types and 12 entity term labels,as well as 361 relationships under 13 semantic relationships in knowledge graph.The Neo4j graph database provided a visualized TCM facial color diagnosis and differentiation,which could be queried and fed back using Cypher language.Conclusion The knowledge graph constructed based on the theory of TCM facial color diagnosis visually shows the complex correlation between facial color diagnosis and syndrome differentiation diagnosis,with a knowledge representation model that forms qualitative data of image features → semantic relationships → syndrome differentiation diagnosis forms.

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

Objective:To analyze the failure patterns and survival after stereotactic body radiotherapy (SBRT) in patients with T 1-2N 0M 0 non-small cell lung carcinoma (NSCLC). Methods:Clinical data of early-stage NSCLC patients who received SBRT at Zhejiang Cancer Hospital from January 2012 to September 2018 were retrospectively analyzed. The primary observed endpoint was the pattern of disease progression, which was divided into intra-field recurrence, regional lymph node recurrence and distant metastasis. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox's model.Results:A total of 147 patients with 156 lesions were included. The median follow-up time was 44.0 months (16.5-95.5 months). A total of 57 patients (38.8%) progressed: 14 patients (24.5%) had recurrence with the 1-, 3-, and 5-year local recurrence rates of 2.0%, 10.9%, and 14.3%, respectively; 36 patients (63.2%) had Distant metastasis with the 1-, 3- and 5-year distant metastasis rates of 12.2%, 22.4% and 28.6%, respectively; and 7 patients (12.3%) had recurrence complicated with distant metastasis. The 3-, 5- and 7-year OS rates were 80.5%, 64.2% and 49.9% for all patients, respectively. The median OS was 78.4 months. The 3-, 5- and 7-year PFS rates were 64.8%,49.5% and 41.5%, with a median PFS of 57.9 months (95% CI: 42.3-73.5 months). Univariate and multivariate analyses showed that biologically equivalent dose and age were the factors affecting the efficacy of SBRT (both P<0.05). Conclusion:Distant metastasis is the main failure pattern in patients with T 1-2N 0M 0 NSCLC after SBRT. High-risk population should be selected for further systematic treatment to improve the efficacy.

Objective:To understand the current status of perioperative analgesics use and management in China.Methods:A questionnaire was self-designed with the content consisting of 4 dimensions (the basic information of the respondents, perioperative analgesics management, medical behaviors in perioperative analgesia, and understanding of analgesics-related knowledge) and 55 questions (8, 10, 22, and 15 questions under 4 dimensions, respectively). The questionnaire was sent through Wechat by the members of Chinese Pharmacological Society Professional Committee of Drug-induced Diseases and Anesthesiology Branch of the Chinese Medical Association. Anesthesiologists, surgeons/nurses and clinical pharmacists volunteered to participate in the survey and submitted in anonymous form directly. The investigation period was from August 1 to 31, 2020.Results:A total of 204 effective questionnaires were received from 45 hospitals in 19 provinces and cities, including 43 tertiary hospitals (95.6%) and 2 secondary hospitals (4.4%). Among the 204 respondents, 46 were surgeons (22.5%), 80 were anesthesiologists (39.2%), 32 were clinical pharmacists (15.7%), and 46 were surgical nurses (22.5%). Of the 45 hospitals where the respondents work, 35 (77.8%) had established regular communication mechanisms for perioperative pain management, and 22 (48.9%) arranged clinical pharmacist to assist the work of the physician in the clinical division. Among the 204 respondents, 76.5% (156 respondents) received knowledge training on analgesics once or twice a year; 60.3% (123 respondents) had found irrational use of perioperative analgesics in their daily work, and the top 3 problems were about drug selection [74.0% (91/123)], usage and dosage [69.1% (85/123)], and drug interactions [46.3% (57/123)]; 37.3% (76 respondents) had found the problem of irrational use of the analgesia pump, and the top 3 problems were about the usage and dosage [69.7% (53/76)], drug selection [67.1% (51/76)], and contraindications [36.8% (28/76)]. Only 13.7% (28/204) of the respondents had a score of ≥120 points (full score of 150 points) in the survey for understanding of knowledge about analgesics. There was 53.9% (110/204) of the respondents with a score of <90 points, including 50.0% (23/46) of the surgeons, 43.8% (35/80) of the anesthesiologists, 46.9% (15/32) of the clinical pharmacists, and 80.4% (37/46) of the surgical nurses. Only 4 of the 15 questions had a correct answer fill rate of >50%.Conclusion:Most of the hospitals surveyed have established relevant mechanisms for perioperative pain management, but there are still problems of irrational use of perioperative analgesics and analgesia pumps. About half of the surgeons, anesthesiologists, clinical pharmacists, and most of the surgical nurses have little understanding of knowledge about analgesics.