There is a substantial unmet need for treatments in the field of pediatric rare diseases, and investigator initiated trial(IIT) provide a critical pathway for testing and developing new drugs or treatment strategies. However, healthcare institutions, when conducting such research, must address compliance risks related to project approval, contract management, data protection, and conflict of interest management. This study aims to analyze the particularities and challenges of IIT in pediatric rare diseases, review relevant regulations and regulatory requirements, and provide healthcare institutions with a reference framework for compliance risk management to maximize the benefits of IIT. Based on literature review, analysis of laws and regulations, practical work experience, and frameworks from other institutions, we summarize the unique aspects of pediatric rare disease IIT in terms of participant characteristics, innovative technologies, and organizational structures.On this basis, targeted compliance management recommendations are proposed, which include establishing a risk rating and full-cycle risk monitoring mechanism, a consent and ethical review mechanism tailored to pediatric participants, a robust contract management mechanism, a comprehensive data security management mechanism, and a multidisciplinary team and multi-channel compensation mechanism. The study concludes that healthcare institutions, funders, and other collaborating entities should implement compliance management in line with the characteristics of IIT to ensure the safety and effectiveness of research and facilitate innovation and development in the treatment of pediatric rare diseases.

OBJECTIVES: To investigate the role of long noncoding RNA (lncRNA) HClnc1 in regulating proliferation, invasion, and migration of hepatocellular carcinoma (HCC) cells and the regulatory mechanism. METHODS: HClnc1 expression levels in liver cancer tissues were analyzed using data from the TCGA database. BrdU incorporation, plate cloning, and transwell assays were employed to examine the effects of HClnc1 silencing/overexpression and/or ODC1 silencing on proliferation, invasion, and migration of liver cancer cells. The effects of HClnc1 silencing on ODC1 protein and mRNA expression in the liver cancer cells were analyzed using qRT-PCR and Western blotting. The activity of ODC1 promoter was analyzed using a dual luciferase reporter gene assay. Pull-down experiment, mass spectrometry analysis, and chromatin immunoprecipitation (ChIP) assay were used for identification of HClnc1-binding proteins and their interactions. Protein interactions with the ODC1 promoter region and their binding efficiencies were investigated using RNA interference and ChIP analysis. RESULTS: HClnc1 was significantly overexpressed in HCC tissues. In liver cancer cells, HClnc1 silencing significantly inhibited cell proliferation, invasion, and migration, while HClnc1 overexpression promoted these behaviors. ODC1 silencing also suppressed malignant behaviors of liver cancer cells, and counteracted the effects of HClnc1 overexpression. Interference of HClnc1 obviously inhibited ODC1 promoter activity. RBBP5 and KAT2B proteins were identified to bind simultaneously with HClnc1. HClnc1 overexpression upregulated ODC1 protein expression, while interference of RBBP5 or KAT2B downregulated ODC1 protein expression and blocked HClnc1-induced upregulation of ODC1 protein. Both RBBP5 and KAT2B could directly bind to ODC1 promoter region; knocking out KAT2B or RBBP5 reduced the binding efficiency, while knocking out HClnc1 reduced the binding of both RBBP5 and KAT2B to ODC1 promoter region. CONCLUSIONS By targeting the RBBP5/KAT2B epigenetic modification complex, HClnc1 increases ODC1 promoter activity to enhance ODC1 transcription and promote the proliferation and migration of liver cancer cells.
Humans ; Cell Proliferation ; RNA, Long Noncoding/genetics* ; Cell Movement ; Liver Neoplasms/metabolism* ; Cell Line, Tumor ; Carcinoma, Hepatocellular/genetics* ; Promoter Regions, Genetic ; Gene Expression Regulation, Neoplastic

Objective To evaluate the effectiveness and safety of Su Fei He Ji combined with anlotinib hydrochloride in the treatment of refractory advanced non-small cell lung cancer(NSCLC)patients presenting with phlegm stasis obstructing lung type.Methods Thirty-nine patients with advanced NSCLC were randomly assigned to either a control group(19 patients)or an experimental group(20 patients).The control group received treatment with anlotinib alone,while the experimental group received an additional oral administration of Su Fei He Ji.A comparative analysis was conducted between the two groups based on various parameters including short-term objective therapeutic efficacy,progression-free survival,TCM syndrome scores,KPS scores,weight changes,related tumor markers,incidence of adverse reactions,and variations in plasma concentrations of anlotinib.Results Following treatment,the objective response rate was 5%and the disease control rate was 85%in the experimental group,while the control group showed an objective response rate of 0%and a disease control rate of 78.95%.No statistically significant difference was observed in short-term objective efficacy between the two groups(P>0.05).Notably,the experimental group exhibited a significant improvement compared to the control group in various aspects,including TCM syndrome scores and KPS scores(P<0.05).Conversely,no significant differences were observed in weight changes or the reduction levels of other tumor markers(CEA,SCC,CA125,CA199,CYFRA21-1)(P>0.05).Moreover,the incidence of fatigue was notably lower in the experimental group(P<0.05),while no statistical difference was evident in the occurrence of other adverse reactions,such as hypertension,rash,and bleeding,between the two groups(P>0.05).It is important to highlight that there was no statistically significant variance in plasma concentrations between the groups(P>0.05),and no significant correlation was identified between plasma concentrations and the incidence of adverse reactions(P>0.05).Conclusion The combination of Su Fei He Ji and anlotinib hydrochloride effectively improves clinical symptoms and quality of life,and reduces adverse reactions in advanced NSCLC patients.This is achieved without affecting the plasma concentrations of anlotinib.

This article systematically analyzes the historical evolution of the name， origin， quality evaluation， harvesting， processing and other aspects of Picrorhizae Rhizoma by referring to the medical books， prescription books， and other documents of the past dynasties， combined with relevant modern research materials， in order to provide a basis for the development and utilization of famous classical formulas containing this medicinal herb. The research results indicate that Picrorhizae Rhizoma was first recorded in New Revised Materia Medica from the Tang dynasty. Throughout history， Huhuanglian has been used as its official name， and there are also aliases such as Gehu Luze， Jiahuanglian and Hulian. The main source of past dynasties is the the rhizomes of Picrorhiza kurrooa and P. scrophulariiflora. In ancient times， Picrorhizae Rhizoma was mainly imported by foreign traders via Guangzhou and other regions， and also produced in China， mainly in Xizang. In ancient times， it was harvested and dried in early August of the lunar calendar， while in modern times， it is mostly harvested from July to September， with the best quality being those with thick and crispy rhizomes without impurities， and bitter taste. Throughout history， Picrorhizae Rhizoma was collected， washed， sliced， and dried before being used as a raw material for medicine， it has a bitter and cold taste， mainly used to treat bone steaming， hot flashes， infantile chancre fever， and dysentery. There is no significant difference in taste and efficacy between ancient and modern times. Based on the research results， it is recommended that the rhizomes of P. scrophulariiflora in the 2020 edition of Chinese Pharmacopoeia， or the rhizomes of P. kurrooa， can be used in famous classical formulas containing this medicinal herb， which can be processed according to the processing requirements marked by the original formula. For those without clear processing requirements， the dried raw products are used as medicine.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

Objective To develop an ultra-sensitive nanoparticle contrast agent for magnetic resonance angiography(MRA),to establish a highly sensitive imaging method for complicated vascular structures,and to provide imaging evidence for precision diagnosis,treatment,prognosis,and individualized treatment of ischemic stroke.Methods A dual-modality MRA contrast agent was prepared through ligand exchange of ultra-small NaGdF4 nanocrystals synthesized via a high temperature method,with biocompatible polyethylene glycol(PEG-dp)ligands.The basic structure,morphology,size distribution,and relaxation rate of the NaGdF4 nano contrast agent were characterized using transmission electron microscopy(TEM),a particle size potential analyzer,and a 7.0 T small-animal MRI scanner.A total of 6 healthy male SPF-grade BALB/c mice were selected and randomly divided into two groups,a NaGdF4 group and a Gd-DTPA group.The mice in the two groups were injected with NaGdF4 nanoparticle contrast agent or clinical Gd-DTPA contrast agent(0.1 mmol Gd3+/kg)via the tail vein.MRA images were obtained using a 7.0 T small animal magnetic resonance imaging system before and after the injection.A total of 6 healthy male SPF-grade Sprague Dawley(SD)rats were selected to establish a right middle cerebral artery occlusion(rMCAO)model to simulate ischemic stroke.The rats were injected with NaGdF4 nano-contrast agent(0.1 mmol Gd3+/kg)via the tail vein.Before and after the injection,brain MRI images of the rats were obtained using a 7.0 T small animal magnetic resonance imaging system.The in vitro and in vivo biological safety of the nano contrast agent was verified through cytotoxicity and hemolysis experiments and HE staining.Results Uniform spherical oil-phase NaGdF4 nanocrystals with an average particle size of approximately(4.43±0.46)nm were successfully prepared.After ligand exchange,biocompatible water-phase nanocrystals were obtained with a hydrodynamic size of 16.1 nm and a surface potential of-1.9 mV.The relaxation performance of this nanocrystal contrast agent was significantly superior to that of the clinical contrast agent Gd-DTPA.The longitudinal molar relaxivity rate(r1)of the NaGdF4 nano contrast agent was 8.84 mM-1s-1,while the transverse molar relaxivity rate(r2)was 27.36 mM-1s-1,which were 1.96 times(4.52 mM-1s-1)and 3.37 times(8.13 mM-1s-1)those of Gd-DTPA,respectively.It also demonstrated excellent biocompatibility.NaGdF4-enhanced MRA achieved high-resolution vascular imaging and effectively enabled the differentiation of the ischemic area,infarct core,and ischemic penumbra in an animal model of ischemic stroke.Conclusion The multi-parameter MRA based on NaGdF4 nanoparticles provides critical imaging evidence for the clinical diagnosis and prognosis of ischemic stroke.

Sugarcane (Saccharum spp.) is an important sugar crop. Biotic and abiotic stresses such as diseases, cold, and drought are major factors limiting sugarcane production. β-1,3-glucanase (EC 3.2.1.39), a member of the pathogenesis-related protein family, plays an essential role not only in the plant defenses against pathogens but also in plant growth, development, and abiotic stress responses. To systematically investigate the sugarcane β-1,3-glucanase gene family, 132 glycoside hydrolase (GH) 17 family members were identified in the genomes of the sugarcane wild species Saccharum spontaneum 'Np-X', the tropical species S. officinarum 'LA-Purple', and the Saccharum spp. hybrid cultivar 'R570'. The results of the phylogenetic analysis categorized them into four subfamilies, of which subfamily Ⅳ had the largest proportion of members (102). The members of the sugarcane GH17 gene family contained five conserved motifs and 0-16 introns. The majority of the GH17 genes exhibited a genome-wide replication pattern, with 89.50% originating from S. spontaneum 'Np-X' and S. officinarum 'LA-Purple', while 58.10% of them in the Saccharum spp. hybrid cultivar 'R570' belonged to the discrete replication type. Four major classes of cis-acting elements were identified in the promoters, including the elements related to plant growth, development, and tissue-specific expression (14.21%), light-responsive elements (38.24%), biotic or abiotic stress-responsive elements (9.18%), and hormone-responsive elements (38.37%), which suggested that this gene family was involved in plant growth, development, hormone responses, and stress responses. Transcriptome and quantitative real-time PCR (RT-qPCR) analyses showed that the sugarcane GH17 genes exhibited tissue-specific expression and were differentially expressed under low temperature, drought, and hormone treatments, as well as during the interactions between different sugarcane genotypes and Sporisorium scitamineum, suggesting their potential roles in plant defenses. In addition, some SsGlu genes (SsGlu5, SsGlu20, SsGlu21, SsGlu25, SsGlu28, and SsGlu39) were expected to serve as candidate stress-related genes. This study lays a foundation for further revealing the molecular mechanisms of the stress resistance of sugarcane via β-1,3-glucanase genes.
Saccharum/physiology* ; Stress, Physiological/genetics* ; Glucan 1,3-beta-Glucosidase/metabolism* ; Multigene Family ; Phylogeny ; Gene Expression Regulation, Plant ; Plant Proteins/genetics*

AIM:The aim of this study was to explore the effects of Yiqi-Yangyin-Quyu prescription(YP)on skeletal muscle injury and related metabolic disorders in mice with Sj?gren syndrome(SS),and to clarify the role of hy-droxyacyl-CoA dehydrogenase trifunctional multienzyme complex subunit beta(Hadhb)in mediating the effect of YP on skeletal muscle in SS.METHODS:The SS mice underwent YP treatment for 8 weeks.The morphological changes of the submandibular gland and muscle tissue were examined using hematoxylin-eosin staining.The mitochondrial status in mus-cle tissue was assessed through transmission electron microscopy.Additionally,combined transcriptome and proteome se-quencing was conducted on skeletal muscle samples.The omics sequencing results were validated by RT-qPCR.Immuno-fluorescence was used to confirm the levels of key proteins involved in the P53/peroxisome proliferator-activated receptor gamma(PPARG)signaling pathway.Immunohistochemistry and Western blot were employed to determine the levels of Hadhb key targets.RESULTS:Combined transcriptome and proteome analysis identified 1 523 differentially expressed genes(DEGs)and 182 differentially expressed proteins(DEPs)between the muscle tissue of SS mice(model group)and that of control animals(ICR group),12 of which showed co-differential expression at both transcriptomic and proteomic levels.Compared with model group,1 232 genes and 432 proteins were found to be differentially expressed in the muscle tissue of the mice in YP group.Among these,23 exhibited co-differential expression at both mRNA and protein levels.Gene Ontology(GO)analysis showed that the DEGs and DEPs between ICR and model groups were mainly involved in ener-gy metabolism and fatty acid oxidation,while the DEGs and DEPs between YP and model groups were primarily associated with sarcomere tissue and actin structure.Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis indi-cated that the DEGs and DEPs between ICR and model groups and between model and YP groups were enriched in the com-plement and coagulation cascade and lipid and pyruvate metabolism.The RT-qPCR validation results were consistent with those of the transcriptome analysis.Furthermore,the protein expression of the tumor suppressor P53 was significantly de-creased in YP group compared with model group,whereas that of PPARG was significantly increased.Western blot analy-sis showed that compared with ICR group,Hadhb protein expression was significantly decreased in model group,whereas the opposite trend was detected in YP group.CONCLUSION:The SS-related skeletal muscle damage is closely related to amino acid metabolism disorder and fatty acid degradation.Treatment with YP modulates innate immune defenses,lipid metabolism and energy metabolism in SS,and Hadhb is the key target of YP in SS-related skeletal muscle.

Objective To evaluate the effectiveness and safety of Su Fei He Ji combined with anlotinib hydrochloride in the treatment of refractory advanced non-small cell lung cancer(NSCLC)patients presenting with phlegm stasis obstructing lung type.Methods Thirty-nine patients with advanced NSCLC were randomly assigned to either a control group(19 patients)or an experimental group(20 patients).The control group received treatment with anlotinib alone,while the experimental group received an additional oral administration of Su Fei He Ji.A comparative analysis was conducted between the two groups based on various parameters including short-term objective therapeutic efficacy,progression-free survival,TCM syndrome scores,KPS scores,weight changes,related tumor markers,incidence of adverse reactions,and variations in plasma concentrations of anlotinib.Results Following treatment,the objective response rate was 5%and the disease control rate was 85%in the experimental group,while the control group showed an objective response rate of 0%and a disease control rate of 78.95%.No statistically significant difference was observed in short-term objective efficacy between the two groups(P>0.05).Notably,the experimental group exhibited a significant improvement compared to the control group in various aspects,including TCM syndrome scores and KPS scores(P<0.05).Conversely,no significant differences were observed in weight changes or the reduction levels of other tumor markers(CEA,SCC,CA125,CA199,CYFRA21-1)(P>0.05).Moreover,the incidence of fatigue was notably lower in the experimental group(P<0.05),while no statistical difference was evident in the occurrence of other adverse reactions,such as hypertension,rash,and bleeding,between the two groups(P>0.05).It is important to highlight that there was no statistically significant variance in plasma concentrations between the groups(P>0.05),and no significant correlation was identified between plasma concentrations and the incidence of adverse reactions(P>0.05).Conclusion The combination of Su Fei He Ji and anlotinib hydrochloride effectively improves clinical symptoms and quality of life,and reduces adverse reactions in advanced NSCLC patients.This is achieved without affecting the plasma concentrations of anlotinib.

Objective:To screen out the disinfection procedure and disinfectant suitable for the actual production of specific pathogen free(SPF)chicken embryo eggs,so as to ensure the disinfection effect of specific pathogen free(SPF)chicken embryo eggs in vaccine production.Methods:This study compares the microbial counting methods of soaking,swabbing with cotton swabs and pouring after thin-film filtration for SPF chicken embryo eggs in a GMP production workshop,and selects the most suitable method for SPF chicken embryo egg microbial counting.Experi-mental groups A,B,and C use self-prepared concentrations of 1∶50 sporicidal agent dilution solution,1∶128 alka-line phenol salt dilution solution,and ready-to-use compound quaternary ammonium disinfectant(sterile),respec-tively,and follow the actual disinfection procedures in the workshop to disinfect and sample the surfaces of SPF chicken embryo eggs entering different cleanliness grades,while using sterile water instead of disinfectant as the control group.The average bactericidal rate is calculated by recording the number of colonies and monitoring the viability of chicken embryo cells using microbial culture,and the disinfection effect of the three disinfectants on SPF chicken embryo eggs is evaluated.Results:The comparison of the results from the three methods shows that the method of sampling SPF chicken embryo eggs by immersion and then counting the microbial colonies through membrane filtration is superior to the other two methods.The final cleaning rate of the control group,which used sterilized injection water to clean the SPF chicken embryo eggs,was 91.67％to 96.97％,while the final steriliza-tion rate of the experimental group,which used the above three disinfectants to disinfect the SPF chicken embryo eggs,was 100.00％.By comparing the cell counts of the experimental group and the control group,it was found that the live cell density of the control group was(6.03-6.25)× 105 cells·mL-1,and that of the experimental groups A-C was(6.08-6.17)× 105 cells·mL-1,(5.99-6.25)× 105 cells·mL-1,and(5.87-6.21)× 105 cells·mL-1 respectively;the cell viability of the control group was 90.33％to 91.35％,and that of the experi-mental groups A-C was 88.25％to 92.12％,89.45％to 93.59％,and 88.02％to 92.89％respectively.Through statistical analysis,it was found that the P values of all experimental groups compared with the control group were greater than 0.05,indicating no statistically significant difference.Conclusion:By comparing the dis-infection effects,cell density and cell viability of the three disinfectants and comprehensively considering factors such as cost and risk of the three disinfectants,1∶50 sporicide dilution,1∶128 alkaline phenolate dilution and ready-to-use compound quaternary ammonium salt disinfectant(sterile)can all be used for the daily surface disin-fection of SPF chicken embryo eggs in the production workshop.The selection of an appropriate disinfectant should be based on specific application scenarios and requirements.