ObjectiveTo investigate the therapeutic mechanism of Xuefu Zhuyutang （XFZYT） for metabolic-associated fatty liver disease （MAFLD） through integrated network pharmacology and animal experiments. MethodsNetwork pharmacology was utilized to predict the core components， key therapeutic targets， and signaling pathways of XFZYT in the treatment of MAFLD. For animal experiments， a rat model of MAFLD was established by feeding a high-cholesterol diet for 4 weeks. Intervention was then administered with low-dose （2 g·kg^-1） and high-dose （4 g·kg^-1） XFZYT for 2 weeks. Biochemical assays were performed to measure the serum levels of aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， total cholesterol （TC）， triglycerides （TG）， high-density lipoprotein （HDL）， and low-density lipoprotein （LDL）. In addition， the activities of superoxide dismutase （SOD） and catalase （CAT） and levels of malondialdehyde （MDA） and glutathione （GSH） in the serum were measured. The same way was adopted to measure the levels of TC and TG in the liver tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to quantify the serum levels of interleukin （IL）-6， IL-1β， and tumor necrosis factor-alpha （TNF-α）. Histopathological evaluations included hematoxylin and eosin （HE） staining for liver tissue morphology， Oil Red O staining for lipid deposition， and dihydroethidium （DHE） probe staining for reactive oxygen species （ROS） levels. Western blot analysis was conducted to assess the protein levels of AMP-activated protein kinase （AMPK）， phosphorylated （p）-AMPK， nuclear factor erythroid 2-related factor 2 （Nrf2）， heme oxygenase-1 （HO-1）， nuclear factor-kappa B （NF-κB）， and p-NF-κB in the liver tissue. Untargeted metabolomics analysis of the serum was performed by liquid chromatography-tandem mass spectrometry （LC-MS/MS）. ResultsNetwork pharmacology analysis predicted 155 potential targets of XFZYT for MAFLD treatment， with core targets including signal transducer and activator of transcription 3 （STAT3）， protein kinase B1 （Akt1）， TNF， and IL-6. Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment primarily implicated the AMPK signaling pathway. Animal experiments demonstrated that compared with the normal group， the model group exhibited dyslipidemia， hepatic function impairment， pronounced hepatic lipid deposition， and inflammatory manifestations， with elevated serum levels of AST， ALT， TC， TG， LDL， and MDA （P<0.05）， reduced HDL and GSH levels plus decreased SOD and CAT activities （P<0.05）， downregulated protein levels of Nrf2， HO-1， and p-AMPK （P<0.05）， and upregulated protein level of p-NF-κB （P<0.05） in the liver tissue. Compared with the model group， XFZYT intervention groups showed significant amelioration of dyslipidemia and hepatic function impairment， markedly reduced hepatic lipid deposition and inflammatory cell infiltration， decreased serum levels of AST， ALT， TC， TG， LDL， and MDA （P<0.05）， increased HDL and GSH levels plus enhanced SOD and CAT activities （P<0.05）， upregulated protein levels of Nrf2， HO-1， and p-AMPK （P<0.05）， and downregulated protein level of p-NF-κB （P<0.05）. Serum metabolomics revealed 511 differentially expressed metabolites （231 upregulated and 280 downregulated） between normal and model groups， while XFZYT groups versus model group showed 94 differential metabolites （51 upregulated and 43 downregulated）. Among them， 11 metabolites displayed the most significant alterations， with enriched pathways including glycerolipid metabolism， cholesterol metabolism， and insulin resistance， multiple of which demonstrated AMPK association. ConclusionXFZYT alleviates MAFLD by regulating the AMPK signaling pathway and associated metabolic networks.

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.

Objective:To design a device for exercise to frozen shoulder,and explore its application effect.Methods:The main body of the device for exercise to frozen shoulder adopted stainless steel,which included horizontal frame and adjustable vertical column.It is suitable to the functional rehabilitation of the shoulder in patients with frozen shoulder or postoperative joint adhesions on shoulder.Fifty patients with frozen shoulder who admitted to Zunyi Hospital of Traditional Chinese Medicine between July 2019 and December 2022 were selected.They were randomly divided into observation group(n=25)and control group(n=25)by using a random number table.Both groups received injection therapy via anterior glenohumeral joint cavity.The observation group underwent treatment using the device for exercise to frozen shoulder,while the control group received conventionally functional exercises for shoulder.The Visual Analog Scale(VAS)scores,Shoulder Pain and Disability Index(SPADI)scores,and the range of motion(ROM)of shoulder were compared between the two groups at different periods before and after treatment.Results:VAS and SPADI scores in the observation group were significantly lower than those in the control group at the 2nd week,the 2nd month,and the 6th month post-treatment(t=3.368,3.597,4.363,t=2.301,3.553,3.513,P<0.05).Flexion and abduction ROM of shoulder in the observation group were significantly higher than those in the control group at the 2nd week,the 2nd month,and the 6th month post-treatment(t=3.116,2.909,3.687,t=2.299,2.171,2.413,P<0.05).External rotation ROM of shoulder in the observation group was significantly higher than that in the control group at the 2nd month and the 6th month post-treatment(t=2.501,3.576,P<0.05).Furthermore,there were significant differences in the VAS and SPADI scores of observation group among before treatment and after 2 weeks,2 months,and 6 months of treatment(F=8.021,6.108,P<0.05).Similarly,there were significant differences in flexion,abduction and external rotation ROM of shoulder in the observation group among before treatment and after 2 weeks,2 months,and 6 months of treatment(F=8.412,10.261,4.085,P<0.05).Conclusion:The self-designed device for exercise is safe and effective in short-term adjunctive treatment to frozen shoulder,which is one kind of alternative tool that is contribute to rehabilitation of frozen shoulder.

Objective:To explore the training experiences of palliative care nurses participating in a prognosis disclosure workshop based on Kolb's experiential learning model, and to provide references for future educational programs in palliative care nursing.Methods:Using purposive sampling, 11 nurses were recruited who had participated in the "Palliative Care Competency Training Program for Nurses" in Shanghai between March and May 2025 and selected the Third Affiliated Hospital of Naval Medical University as their clinical training site. Semi-structured interviews were conducted, and data were analyzed using Colaizzi's seven-step method.Results:A total of three major themes emerged: a sense of benefit from enhanced competencies; complex emotional experiences; recommendations for course optimisation.Conclusions:Workshops based on Kolb's experiential learning model offer positive value in palliative care education. They effectively improve core competencies such as communication and empathy. However, the emotional experiences of nurses must also be considered, and multifaceted optimizations to the training design are recommended to further enhance training outcomes.

Objective To develop a predictive model for postoperative mortality risk in patients with acute aortic dissection(AAD)using the Extreme Gradient Boosting(XGBoost)algorithm combined with Shapley Additive Explanation(SHAP),and to establish a prediction website to serve as a diagnostic and therapeutic support platform for clinicians and patients.Methods A retrospective cohort study design was adopted.Data from 782 AAD patients who underwent surgical treatment at the Fourth Hospital of Hebei Medical University from January 2013 to December 2023 were collected,including basic information and initial serum biomarker test results.Patients were randomly divided into training and test sets at a 7:3 ratio.An external validation set consisting of 313 AAD patients admitted to the Second Hospital of Hebei Medical University from January 2020 to December 2023 was also established for further model validation.Variables were screened using LASSO regression,and an XGBoost machine learning model was constructed and interpreted using SHAP.The predictive performance of the model was evaluated using receiver operating characteristic(ROC)curve analysis.Using the Shiny package,the XGBoost model was deployed to shinyapps.io to create a prediction website for postoperative mortality risk in AAD patients.One patient was selected by simple random sampling from the test set and the external validation set respectively for the prediction example on the Shiny webpage.Results The XGBoost model demonstrated high predictive performance for postoperative mortality in AAD patients,with area under the ROC curve(AUC)values of 0.928(95%CI 0.901-0.956)in the training set,0.919(95%CI 0.891-0.949)in the test set,and 0.941(95%CI 0.915-0.967)in the external validation set.SHAP values indicated the following order of variable importance in the model(from highest to lowest):"lactate dehydrogenase""blood chlorine""multiple organ injury""carbon dioxide combining power""prothrombin time""α-hydroxybutyric acid""creatine kinase isoenzyme""Stanford classification""combined use of bedside blood purification""gender""acute kidney injury""gastrointestinal bleeding""brain injury"and"shock".A risk prediction website for adverse postoperative outcomes in AAD patients was developed using XGBoost-SHAP method(https://dun-dunxiaolu.shinyapps.io/document/)and validated with examples.One randomly selected patient from each of the test and external validation sets was applied:the predicted mortality risk value for patient 1(who died postoperatively)was 0.9539,and that for patient 2(who survived postoperatively)was 0.0206.Conclusions The XGBoost-SHAP model demonstrates high accuracy in predicting postoperative mortality risk for AAD patients.The online prediction tool established based on this model enhances the identification efficiency of high-risk postoperative mortality patients.

Objective To explore the effects of modified prone ventilation combined with bronchoscopic alveolar lavage on respiratory mechanics and hemodynamics in children with Acute Respiratory Distress Syndrome(ARDS),as well as to evaluate the clinical treatment efficacy.Methods A total of 96 ARDS children receiving mechanical ventilation treatment in the emergency intensive care unit of Kunming Children's Hospital from January 2021 to December 2023 were selected and randomly assigned into three groups:Group A(prone ventilation group,n=32),Group B(modified prone ventilation group,n=32),and Group C(modified prone ventilation combined with bronchoscopic alveolar lavage group,n=32).The changes in the following parameters before and after treatment among the three groups were compared:oxygenation indicators:arterial oxygen partial pressure(PaO2),arterial oxygenation index(PaO2/FiO2);respiratory mechanics indicators:lung compliance,mean airway pressure,plateau airway pressure,and total airway resistance;hemodynamic indicators:cardiac output,cardiac index,systemic vascular resistance index,and mean arterial pressure;clinical efficacy indicators time to disappearance of rales,mechanical ventilation duration,and length of hospital stay;and incidence of complications:arrhythmia,airway obstruction,pressure injuries,total incidence of catheter dislodgment,and gastric content reflux.Results The oxygenation indicators in Group C after treatment were superior to those in Groups A and B(P<0.05).The respiratory mechanics indicators in Group C after treatment were also better than those in Groups A and B(P<0.05).In terms of hemodynamics,there were no statistically significant differences in cardiac output,cardiac index,and mean arterial pressure among Groups A,B,and C after treatment(P>0.05).However,the SVRI in Group C was better than that in Groups A and B(P<0.05).Curative effect for Group C were also better than those for Groups A and B(P<0.05).The incidence of complications in Group C showed no significant difference compared to Groups A and B(P>0.05).Conclusion The modified prone ventilation combined with bronchoscopic alveolar lavage treatment scheme demonstrates better therapeutic effects compared to traditional treatment methods,significantly improving oxygenation and respiratory mechanics indicators as well as the systemic vascular resistance index in children,and is worthy of clinical promotion.

AIM To investigate effects of petroleum ether fraction from Derris eriocarpa How on glucose and lipid metabolism in a mouse model of metabolic syndrome(MS).METHODS KM mice were fed a high-fat diet and administered streptozotocin intraperitoneally to establish MS models.The MS mice were then randomly assigned to the model group,the metformin hydrochloride group,the lovastatin group,the ursolic acid group,and the high-,medium-and low-dose D.eriocarpa petroleum ether fraction groups,with 10 mice in each group.Ten additional mice maitained on a normal diet served as the normal control group.After 4 weeks of intragastric administration,glucose and lipid metabolism indicators were measured.Hepatic pathological changes were assessed using HE staining and oil red O staining.Liver tissue mRNA expressions of ATF3,PEPCK,FXR,CYP7A1,HNF4ɑ,CYP8B1 and SRB1 were quantified by RT-qPCR.Hepatic protein expressions of ATF3,HNF4ɑ,PEPCK,FXR and CYP7A1 was analyzed by Western blot in MS mice.RESULTS Compared to the model group,the high-dose D.eriocarpa petroleum ether fraction group exhibited significant glucose tolerance improvement(reduced OGTT-AUC,P＜0.01);favorable serum lipid modulation in terms of increased HDL-C levels(P＜0.01)and decreased TG,TC,LDL-C(P＜0.01);reduced renal biomarkers(BUN,SCR)and hepatotoxic indicators of TBA,AST and ALT activities(P＜0.01);alleviated hepatic lipid accumulation and histopathological damage;downregulated mRNA and protein expressions of ATF3,HNF4ɑ and PEPCK,as well as CYP8B1 mRNA expression(P＜0.01);and upregulated mRNA and protein expressions of FXR and CYP7A1,along with SRB1 mRNA expression(P＜0.01).CONCLUSION D.eriocarpa petroleum ether fraction ameliorates glucose and lipid metabolism dysregulation in MS mice by modulating the ATF3/HNF4ɑ/CYP7A1 signaling pathway,consequently eliciting hypoglycemic,hypolipidemic,hepatoprotective and nephroprotective effects.

Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.

Objective To investigate the efficacy of ferro-based magnetic starch-loaded gel beads,composed of MgFe2O4 and cassava starch,in the treatment of colorectal cancer.Methods Sixteen SPF-grade 6-week-old male Balb/c mice were randomly assigned to four groups(n=4 per group):control,CMCS SA@MgFe2O4,doxorubicin,and CMCS SA@MgFe2O4@Dox.Mice in each group received normal saline,CMCS SA@MgFe2O4,doxorubicin,or CMCS SA@MgFe2O4@Dox on days 4,6,8,10,12,and 14 post-implantation of colorectal tumor cells(HCT116).Tumor volume changes were monitored following treatment.TUNEL staining was performed to assess tumor tissue apoptosis.Immunohistochemistry was used to evaluate the expression levels of Ki67 and Caspase-3 in tumor tissues.Western blot was employed to determine the protein expression levels of Caspase-3,Bcl-2,and Bax.Results Mice in the Control and CMCS SA@MgFe2O4 groups exhibited the largest tumour volumes,with intact major organ structures,tightly arranged cells,normal nuclear morphology,and no significant inflammatory cell aggregation.In contrast,mice in the Dox group displayed shrunken tumour tissues,disorganized cardiac muscle fibres,enlarged interstitial spaces in splenic tissues,and inflammatory cell infiltration in liver,lung,and kidney tissues.Mice in the CMCS SA@MgFe2O4@Dox group showed minimal tumour tissue,well-aligned cardiac muscle fibres,and reduced inflammatory responses in the remaining organs.Compared to the Control group,mice in both the Dox and CMCS SA@MgFe2O4@Dox groups demonstrated significantly decreased tumour volume and final weight(P<0.05),in-creased interstitial inflammatory cell aggregation,decreased collagen fibres,and enhanced apoptosis.Additionally,there was a significant decrease in Ki67 expression(P<0.05)and an increase in Caspase-3 expression(P<0.05).The expression of Bcl-2 protein was also significantly reduced(P<0.05),while the expression of Caspase-3 and Bax proteins was significantly increased(P<0.05).Compared to the Dox group,mice in the CMCS SA@MgFe2O4@Dox group exhibited significantly smaller tumour volume and final weight(P<0.01),more pronounced tissue necrosis,further reduction in collagen fibres,and a greater increase in apoptosis.There was also a more significant decrease in Ki67 expression(P<0.05)and a more substantial increase in Caspase-3 expression(P<0.05).Furthermore,the expression of Bcl-2 protein was further decreased,while the expression of Caspase-3 and Bax proteins was further increased(P<0.05).Conclusion The iron-based magnetic starch drug delivery system has no therapeutic effect on tumor cells,but the combination with adriamycin can significantly increase the therapeutic effect of adriamycin and reduce its side effects.

Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.