Traditional Chinese medicine （TCM）， through its multi-target and systematic regulatory effects， has demonstrated unique advantages in the treatment of gastric precancerous lesions （GPL）. At present， TCM theoretical research on GPL is mainly reflected in three aspects， the integration of macroscopic syndrome differentiation， the inflammation-carcinoma transformation mechanism， as well as the systematization and scientization of theoretical inheritance from famous TCM practitioners. High-quality evidence-based research findings serve as the foundation for clinical practice guidelines on GPL， and TCM has gained international academic recognition in the field of GPL prevention and treatment. Research on TCM mechanisms has yielded a series of important outcomes in the aspects of signaling pathways， gene expression regulation， cellular epigenetics， histone modification， and intestinal microecology. It is proposed that future research on GPL should focus on four key directions， establishing multi-omics data， exploring targeted intervention strategies on key regulatory nodes， advancing the standardization process of integrated traditional Chinese and western medicine prevention and treatment technologies， and constructing stratified screening and intervention platforms. The in-depth integration of TCM microcosmic mechanism of action with its macroscopic syndrome differentiation and treatment system， coupled with interdisciplinary research， will provide valuable references for the clinical treatment and scientific research of GPL.

Notum, a negative feedback regulator of the Wnt signaling, has emerged as a promising target for treating glucocorticoid-induced osteoporosis (GIOP). This study showcases an efficient strategy for discovering the anti-Notum constituents from herbal medicines (HMs) as novel anti-GIOP agents. Firstly, a rapid-responding near-infrared fluorogenic substrate for Notum was rationally engineered for high-throughput identifying the anti-Notum HMs. The results showed that Bu-Gu-Zhi (BGZ), a known anti-osteoporosis herb, potently inhibited Notum in a competitive-inhibition manner. To uncover the key anti-Notum constituents in BGZ, an efficient strategy was adapted via integrating biochemical, phytochemical, computational, and pharmacological assays. Among all identified BGZ constituents, three furanocoumarins were validated as strong Notum inhibitors, while 5-methoxypsoralen (5-MP) showed the most potent anti-Notum activity and favorable safety profiles. Mechanistically, 5-MP acted as a competitive inhibitor of Notum via creating strong hydrophobic interactions with Trp128 and Phe268 in the catalytic cavity of Notum. Cellular assays showed that 5-MP remarkably promoted osteoblast differentiation and activated Wnt signaling in dexamethasone (DXMS)-challenged MC3T3-E1 osteoblasts. In dexamethasone-induced osteoporotic mice, 5-MP strongly elevated bone mineral density (BMD) and improved cancellous and cortical bone thickness. Collectively, this study constructs a high-efficient platform for discovering key anti-Notum constituents from HMs, while 5-MP emerges as a promising anti-GIOP agent.

Acute respiratory distress syndrome(ARDS)is a common clinical syndrome in intensive care unit(ICU)with high morbidity and mortality.Recently,the new global definition of ARDS has redefined the diagnosis of ARDS,which is divided into non-intubated ARDS,intubated ARDS and ARDS with limited resources.Hypoxia is the main clinical manifestation of ARDS,and respiratory support therapy is the first-line treatment for ARDS.With respect to non-intubated ARDS,current guidelines do not provide a clear preference between high flow nasal cannula(HFNC)and non-invasive mechanical ventilation(NIV).In order to improve clinical managmet of non-intubated ARDS,we review the role of HFNC and NIV in non-intubated ARDS in this paper.

Acute respiratory distress syndrome(ARDS)is a common clinical syndrome in intensive care unit(ICU)with high morbidity and mortality.Recently,the new global definition of ARDS has redefined the diagnosis of ARDS,which is divided into non-intubated ARDS,intubated ARDS and ARDS with limited resources.Hypoxia is the main clinical manifestation of ARDS,and respiratory support therapy is the first-line treatment for ARDS.With respect to non-intubated ARDS,current guidelines do not provide a clear preference between high flow nasal cannula(HFNC)and non-invasive mechanical ventilation(NIV).In order to improve clinical managmet of non-intubated ARDS,we review the role of HFNC and NIV in non-intubated ARDS in this paper.

With the increasing emphasis on the bio-psycho-social medical model, significant progress has been made in patient-reported outcomes. Now, through a comprehensive analysis and synthesis of literature within the field, this study explores the advancements in the application of patient-reported outcomes in clinical research on lymphoma. The intention is to provide valuable references for future related studies.

Periodontitis is a chronic inflammatory and immune reactive disease induced by the subgingival biofilm.The therapeutic effect for susceptible patients is often unsatisfactory due to excessive inflammatory response and oxidative stress.Sinensetin(Sin)is a nature polymethoxylated flavonoid with anti-inflammatory and antioxidant activities.Our study aimed to explore the beneficial effect of Sin on periodontitis and the specific molecular mechanisms.We found that Sin attenuated oxidative stress and inflammatory levels of periodontal ligament cells(PDLCs)under inflammatory conditions.Administered Sin to rats with ligation-induced periodontitis models exhibited a protective effect against periodontitis in vivo.By molecular docking,we identified Bach1 as a strong binding target of Sin,and this binding was further verified by cellular thermal displacement assay and immunofluorescence assays.Chromatin immunoprecipitation-quantitative polymerase chain reaction results also revealed that Sin obstructed the binding of Bach1 to the HMOX1 promoter,subsequently upregulating the expression of the key antioxidant factor HO-1.Further functional experiments with Bach1 knocked down and overexpressed verified Bach1 as a key target for Sin to exert its antioxidant effects.Additionally,we demonstrated that Sin prompted the reduction of Bach1 by potentiating the ubiquitination degradation of Bach1,thereby inducing HO-1 expression and inhibiting oxidative stress.Overall,Sin could be a promising drug candidate for the treatment of periodontitis by targeting binding to Bach1.

Bipolar disorder is a chronic mental disorder with a high rate of relapse, disability and suicide. Safe, effective and rapid onset non-invasive neuromodulation therapy technology is becoming a research hotspot in the treatment of bipolar disorder. In this paper, the latest clinical research progress of the main techniques in this field is summarized and reviewed, and its future prospects is also forecasted.

Bipolar disorder is a chronic mental disorder with a high rate of relapse, disability and suicide. Safe, effective and rapid onset non-invasive neuromodulation therapy technology is becoming a research hotspot in the treatment of bipolar disorder. In this paper, the latest clinical research progress of the main techniques in this field is summarized and reviewed, and its future prospects is also forecasted.

For the transportation process of rescuing wounded personnel on naval vessels, a new type of shoulder type exoskeleton stretcher for individual soldier was designed in this paper. The three-dimensional model of the shoulder type exoskeleton stretcher for individual soldier was constructed using three dimensional modeling software. Finite element analysis technique was employed to conduct statics simulation, modal analysis, and transient dynamics analysis on the designed exoskeleton stretcher. The results show that the maximum stress of the exoskeleton stretcher for walking on flat ground is 265.55 MPa, which is lower than the allowable strength of the fabrication material. Furthermore, the overall deformation of the structure is small. Modal analysis reveals that the natural frequency range of the exoskeleton stretcher under different gait conditions is 1.96 Hz to 28.70 Hz, which differs significantly from the swing frequency of 1 Hz during walking. This indicates that the designed structure can effectively avoid resonance. The transient dynamics analysis results show that the maximum deformation and stress of exoskeleton stretcher remain within the safety range, which meets the expected performance requirements. In summary, the shoulder type exoskeleton stretcher for individual soldier designed in this study can solve the problem of requiring more than 2 people to carry for the existing stretcher, especially suitable for narrow spaces of naval vessels. The research results of this paper can provide a new solution for the rescue of wounded personnel on naval vessels.
Humans ; Stretchers ; Military Personnel ; Shoulder ; Exoskeleton Device ; Walking ; Gait ; Biomechanical Phenomena

Objective:To explore the relationships between sarcopenia and the clinical efficacy and prognosis of elderly patients with esophageal cancer who were treated by radical radiotherapy.Methods:The clinicopathological data of 134 elderly patients with esophageal cancer who received radical radiotherapy in Department of Radiotherapy, Affiliated Hospital of Yangzhou University from January 2013 to December 2018 were retrospectively analyzed. The muscle cross-sectional area at the level of the third lumbar vertebra was measured by using computed tomography (CT) images. These patients were divided into sarcopenia group ( n=56) and non-sarcopenia group ( n=78) according to the skeletal muscle index before radiotherapy. The efficacy and incidence of adverse reactions of the two groups were compared. Kaplan-Meier method was used to plot the survival curve, and Cox regression model was used to analyze prognostic factors. Results:There was a significant difference in the objective response rate between the sarcopenia and non-sarcopenia group at 1 month after radiotherapy [53.57% (30/56) vs. 71.79% (56/78) , χ2=4.71, P=0.030]. There was no significant difference in the disease control rate between the two groups [94.64% (53/56) vs. 91.03% (71/78) , χ2=0.21, P=0.651]. There was a significant difference in the total incidence of adverse reactions between the sarcopenia and non-sarcopenia group [67.86% (38/56) vs. 47.44% (37/78) , χ2=5.52, P=0.019]. By the end of the follow-up, the 1-, 3- and 5-year overall survival (OS) rates of 134 elderly patients with esophageal cancer who received radical radiotherapy were 91.0%, 73.1% and 55.2% respectively. The median OS of patients in the sarcopenia and non-sarcopenia group were 14 months and 26 months respectively, with a statistically significant difference ( χ2=9.84, P=0.002) . The median progression-free survival (PFS) of the two groups were 7 months and 18 months respectively, with a statistically significant difference ( χ2=9.91, P=0.002) . Univariate analysis showed that cT stage ( HR=2.45, 95% CI: 1.26-4.74, P=0.008) , cN stage ( HR=1.63, 95% CI: 1.06-2.50, P=0.027) , cTNM stage ( HR=2.04, 95% CI: 1.28-3.27, P=0.003) , body mass index (BMI) ( HR=2.23, 95% CI: 1.01-4.90, P=0.046) , pre-radiotherapy sarcopenia ( HR=2.45, 95% CI: 1.27-4.72, P=0.007) and chemotherapy ( HR=0.30, 95% CI: 0.11-0.83, P=0.020) were prognostic factors for OS; cT stage ( HR=2.27, 95% CI: 1.18-4.39, P=0.015) , cN stage ( HR=1.61, 95% CI: 1.04-2.47, P=0.030) , cTNM stage ( HR=1.90, 95% CI: 1.19-3.02, P=0.007) , BMI ( HR=1.98, 95% CI: 1.06-3.79, P=0.032) , pre-radiotherapy sarcopenia ( HR=1.79, 95% CI: 1.06-3.04, P=0.031) and adverse reactions ( HR=0.60, 95% CI: 0.38-0.97, P=0.037) were prognostic factors for PFS. Multivariate analysis showed that pre-radiotherapy sarcopenia ( HR=1.91, 95% CI: 1.22-3.00, P=0.005) was an independent prognostic factor for OS; BMI ( HR=1.80, 95% CI: 1.03-3.15, P=0.039) and pre-radiotherapy sarcopenia ( HR=2.00, 95% CI: 1.27-3.14, P=0.003) were independent prognostic factors for PFS. Conclusion:Sarcopenia before radiotherapy can be a useful predictor for prognosis in elderly patients with esophageal cancer who received radical radiotherapy, and patients with sarcopenia benefit less from treatment.