To evaluate the application value of the Peyton four-step teaching method in the standardized training of intestinal ultrasound and compare it with traditional teaching methods, so as to provide an optimized approach for clinical ultrasound training.

Objective To construct glucose oxidase（GOx）–loaded nanogels （GONGs）, optimize their formulation, and evaluate their capacity to inhibit the Warburg effect in glioma cells. Methods A responsive polymer （HAM） was synthesized and used to self-assemble GONGs, which were then characterized. Encapsulation efficiency and drug loading were determined using fluorescence spectrophotometry. Biocompatibility was tested by measuring cytotoxicity and hemolytic activity. Western blotting was used to evaluate the effects of GONGs on the expression of proteins associated with the Warburg phenotype and oxidative damage in glioma cells. Results GONGs prepared at a drug–to–polymer ratio of 1∶10 exhibited a particle size of 140.3 nm and a zeta potential of −27.2 mV. Compared with free GOx, GONGs markedly reduced cytotoxicity, increased the IC₅₀ in hUVEC cells from 2.150 nmol/L to 74.86 nmol/L, and significantly decreased hemolysis. At a GOx concentration of 2 nmol/L, GONGs effectively downregulated glycolysis-related proteins, such as HK2 and LDHA, and inhibited glutamine metabolism in glioma cells. Conclusion GONGs exhibited high GOx loading capacity, significantly reduced GOx-induced cytotoxicity, inhibited the Warburg effect in glioma cells and induced oxidative damage.

This paper summarizes Professor WANG Xixing's clinical experience in treating immune checkpoint inhibitor-related pneumonitis （CIP） based on the theory of "cough attributed to the five zang （脏） organs". Cough is a common predominant symptom of CIP. According to the theory of "cough attributed to the five zang organs"， drug toxicity triggers cancer toxin， leading to disharmony among the five zang organs， and then lung failing to diffuse and govern descent as the core pathogenesis. Therefore， treatment should focus on harmonizing the five zang organs to restore the normal function of lung qi to diffuse and govern descent. In clinical practice， CIP can be classified into four syndrome patterns， including lung yin depletion， deficiency of both the lung and the spleen with phlegm-dampness， liver fire harassing the lung， and lung-kidney yin deficiency. Correspondingly， Chaimai Jinluo Runfei Decoction （柴麦金络润肺汤） is used to nourish yin and moisten the lung； Qigui Peitu Huayin Decoction （芪桂培土化饮汤） is used to fortify the spleen and tonify the lung， resolve dampness and dispel phlegm； Chaidan Shuyu Runjin Decoction （柴丹疏郁润金汤） is used to drain liver and clear the lung； and Dimai Jinshui Xiangsheng Decoction （地脉金水相生汤） is used to nourish the kidney and moisten the lung.

Intravenous thrombolysis and mechanical thrombectomy are well-established reperfusion therapies for acute ischemic stroke,which can significantly improve clinical outcomes compared to conventional treatments.However,both strategies face the following challenges:although it is the first-line treatment,intravenous thrombolysis suffers from low recanalization rates and a narrow therapeutic time window(3-4.5 h),which limits its clinical benefit.Mechanical thrombectomy,while achieving over 80％recanalization,still results in disability or death in more than 50％of patients.Future efforts should focus on optimizing thrombolytic drugs by developing novel agents with higher fibrin specificity and safety profiles,thus expanding the population benefiting from thrombolysis.Moreover,reperfusion therapy based on the"tissue window"could be achieved with utilizing advanced imaging techniques to break the traditional time window limitation.The promotion of mobile stroke units could facilitate ultra-early reperfusion treatment.Additionally,optimization of post-thrombolysis antithrombotic strategies is essential to prevent neurological deterioration.For mechanical thrombectomy,it is crucial to enhance perioperative management and actively explore neuroprotective strategies for further improvement of outcomes.

Microbiota can be recognized by the human immune system,trigger specific immune responses,and play a significant role in the onset and progression of diseases through intricate regulatory mechanisms.The tumor microenvironment comprises the peritumoral extracellular matrix,immune cells,tumor-associated fibroblasts,and endothelial cells,among others.In this context,the tumor immune microenvironment,characterized by immune cells,significantly influences cancer progression and treatment.Notably,the tumor immune microenvironment is closely associated with the tumor microbiota.The presence of respiratory microbiota is correlated with the typing and staging of non-small cell lung cancer.This study investigated the mechanisms by which respiratory microbiota affect innate and adaptive immune cells within the tumor immune microenvironment and explored the role of respiratory microbiota in the immunotherapy of non-small cell lung cancer.The aim was to identify potential biomarkers that could enhance the diagnosis and treatment of non-small cell lung cancer.

Objective:To investigate the mechanism of ursolic acid regulating HMGB1/TLR4 pathway in reducing intestinal barrier injury in a rat model of ulcerative colitis(UC).Methods:Rats were randomly divided into control group,model group,glycyr-rhizic acid(HMGB1 inhibitor)group,ursolic acid group and glycyrrhizic acid+ursolic acid group,with 12 rats in each group.UC rat model was induced by tritrobenzene sulfonate enema.After drug administration,body weight and disease activity index(DAI)score were performed of rats in each group;pathological morphology of colonic mucosa was detected by HE staining,the thickness of mucosa and height of villi were compared;levels of catalase(CAT),superoxide dismutase(SOD),malondialdehyde(MDA)in colon tissue,levels of serum diamine oxidase(DAO),and intestinal fatty acid binding protein(I-FABP),TNF-α,IL-18,IL-6 were detected by kits;expression levels of tight junction proteins(Claudin-1,ZO-1,Occludin)and HMGB1/TLR4 pathway proteins(HMGB1,TLR4,MyD88)in colon tissues were detected by Western blotting.Expression levels of HMGB1,TLR4 and MyD88 in colonic tissue were detected by immunohistochemistry.Results:Compared with control group,colonic mucosal tissue of model group had severe pathological injury,the body weight,mucosal thickness,villus height,CAT,SOD,Claudin-1,ZO-1 and Occludin levels in colon tis-sue were significantly reduced,while DAI score,serum DAO,I-FABP,TNF-α,IL-18 and IL-6 levels,colon tissue MDA,HMGB1,TLR4 and MyD88 levels were significantly increased(P<0.05);compared with model group,pathological injury of colonic mucosal tissue of rats in ursolic acid group,glycyrrhizic acid group and glycyrrhizic acid+ursolic acid group were reduced,body weight,muco-sal thickness,villus height,colon tissue CAT,SOD,Claudin-1,ZO-1 and Occludin levels were significantly increased,while DAI score,serum DAO,I-FABP,TNF-α,IL-18 and IL-6 levels,colon tissue MDA,HMGB1,TLR4 and MyD88 levels were significantly reduced(P<0.05);combined intervention of glycyrrhizic acid and ursolic acid could enhance the influence of ursolic acid on the above indexes(P<0.05).Conclusion:Ursolic acid can inhibit inflammation,reduce the level of oxidative stress,reduce the colonic mucosal injury of UC rats,repair the intestinal mucosal barrier function,and improve the clinical symptoms of rats,which may be achieved by down-regulating the HMGB1/TLR4 pathway.

Objective To develop a core outcome set(COS)for clinical effectiveness trials of heart failure with preserved ejection fraction(HFpEF).Methods Outcome measures were collected through database literatures search,clinical experts questionnaire survey and semi-structured patients interview.Then,the outcome measures pool was constructed and domains were divided.Candidate outcome measures of COS were screened through two rounds of Delphi survey.Finally,a consensus meeting was held to determine COS and reach a consensus.Results A total of 317 outcome measures which could be divided into 6 domains were collected through literature research,questionnaire survey and semi-structured interview.15 candidate outcome measures of COS were screened through two rounds of Delphi survey.Finally,the consensus meeting reached consensus on a COS with 6 entries.Conclusion In this study,a COS for clinical effectiveness trials of HFpEF was developed,which is conducive to the standardization of efficacy evaluation.

Objective To investigate the risk factors of thrombus head shedding and bleeding during endoscopic treatment of patients with esophageal varices veins,and build a risk prediction model.Methods 209 cases of esophageal varices with thrombus head found by endoscopy from February 2009 to July 2024 were retrospectively analyzed,and divided into non-shedding group(n=186)and shedding group(n=23)according to whether thrombus head shedding bleeding occurred during endoscopic treatment.Clinical and endoscopic data of the two groups were compared.Statistically significant factors were included in multivariate Logistic regression analysis and their independent risk factors were explored.A nomogram risk prediction model was constructed by R software,and its prediction efficiency was evaluated.Results Multivariate Logistic regression analysis showed that red thrombus head((O＾R)=6.231,95%CI:1.748～22.208),thrombus head diameter≥3 mm((O＾R)=4.355,95%CI:1.341～14.144),conical thrombus head((O＾R)=8.555,95%CI:2.427～30.154),and the presence of hematoma in the stomach((O＾R)=7.079,95%CI:1.665～30.103)were risk factors for bleeding after thrombus head shedding during endoscopic diagnosis and treatment.A nomogram prediction model was constructed with a sensitivity of 0.870(95%CI:0.732～1.000)and a specificity of 0.887(95%CI:0.842～0.933).Conclusion The thrombus head being red,conical in shape,with a diameter of≥3 mm and the presence of hematoma in the stomach are independent risk factors for thrombus head shedding and bleeding during endoscopic diagnosis and treatment.Timely intervention should be made for the above factors to benefit patients.

Objective:To investigate the related factors of cognitive impairment in middle-aged and old-aged patients with type 2 diabetes mellitus(T2DM).Methods:A total of 970 patients with T2DM(585 middle-aged group and 385 old-aged group)were selected from residents of a large community in Beijing from September to December 2018.The Mini-Mental State Examination(MMSE)was used to assess the cognitive func-tion.Multivariate logistic regression was used to analyze the related factors.Results:The detection rates of cognitive impairment were 12.0％and 13.5％in middle-aged and old-aged patients with T2DM,respectively.Among mid-dle-aged patients with T2DM,work(OR=0.22,95％CI:0.03-0.77)and education at the junior college or un-dergraduate level and above(OR=0.18,95％CI:0.04-0.55)were protective factors for cognitive impair-ment.Myocardial infarction(OR=4.13,95％CI:1.26-13.63)was a risk factor for cognitive impairment.Among old-aged patients with T2DM,drinking tea 1-2 times a week(OR=0.11,95％CI:0.01-0.58)and education at the junior college or undergraduate level and above(OR=0.19,95％CI:0.05-0.54)were protective factors for cognitive impairment.Stroke(OR=3.64,95％CI:1.55-8.39)and good sleep self-assessment(OR=2.75,95％CI:1.13-7.35)were risk factors for cognitive impairment.Conclusion:Cognitive impairment in middle-aged pa-tients with T2DM is related to work,education level and myocardial infarction,and cognitive impairment in old-aged patients with T2DM is related to lifestyle,education level and stroke.

BACKGROUND:Stage Ⅱ Kümmell's disease has traditionally been treated with percutaneous kyphoplasty,but this approach is associated with a high incidence of complications such as poor postoperative pain relief,suboptimal cement dispersion,and adjacent vertebral fractures.Studies have shown that cement augmentation of the injured vertebra combined with posterior spinal canal decompression and short-segment fixation has a good effect on the treatment of Kümmell's disease with neurological symptoms.OBJECTIVE:To compare the outcomes of cement-augmented short-segment percutaneous pedicle screw fixation with those of percutaneous kyphoplasty for the treatment of stage Ⅱ Kümmell's disease.METHODS:From January 2020 to January 2023,a total of 49 patients with stage Ⅱ Kümmell's disease from Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine were included in this study,with 15 males and 34 females.According to the treatment method,the patients were divided into the trial group(n=23)and the control group(n=26).The patients in the trial group received cement-augmented short-segment percutaneous pedicle screw fixation,and the patients in the control group received percutaneous kyphoplasty.The postoperative complications were recorded,and the spinal Cobb angle and the ratio of the anterior edge height of the injured vertebra were compared between the two groups at 1,6,12 weeks,6,and 12 months after surgery.The Oswestry disability index and lumbar visual analog score were compared at 1 week and 12 months after surgery.RESULTS AND CONCLUSION:(1)All patients in the two groups were followed up for more than 12 months after surgery.Five patients in the control group had adjacent vertebral fractures,three patients had severe kyphosis,and one patient in the trial group had postoperative incision complications.(2)Compared with preoperative data,the spinal Cobb angle and the ratio of the anterior edge height of the injured vertebra in both groups were significantly improved after surgery(P＜0.05).The spinal Cobb angle of the trial group was lower than that of the control group at 1,6,12 weeks,6,and 12 months after surgery(P＜0.05),and the ratio of the anterior edge height of the injured vertebra in the trial group was higher than that of the control group at 1,6,12 weeks,6,and 12 months after surgery(P＜0.05).(3)Compared with preoperative data,the Oswestry disability index and lumbar visual analog scale score of the two groups were significantly improved after surgery(P＜0.05).The Oswestry disability index and lumbar visual analog scale score of the trial group were lower than those of the control group at 1 week and 12 months after surgery(P＜0.05).(4)The results show that compared with percutaneous kyphoplasty,cement-augmented short-segment percutaneous pedicle screw fixation for stage Ⅱ Kümmell's disease can better restore the height of the affected vertebra,maintain the shape of the affected vertebra,improve spinal function,and alleviate lumbar pain.