Objective To elucidate the changes in the gut microbiota and molecular mechanism of huaier in enhancing the efficacy of oxaliplatin (OXA) chemotherapy in gastric cancer (GC). Methods The effects of huaier on the gut microbiota structure and intestinal barrier function in MKN45-bearing mice were analyzed by using 16S rRNA sequencing, RT-qPCR, and IHC. UPLC-MS and network pharmacology, as well as in vivo experimental approaches, were employed to investigate the key bioactive constituents of huaier systematically and elucidate the underlying mechanisms by which huaier exerts therapeutic effects against GC. The expression of the PI3K/AKT/SREBP pathway was detected in cancer cells and tissues via Western blot analysis. The safety profile of huaier combined with OXA was verified through serum biochemistry and HE-stained tissue section analyses. Results Huaier inhibited the PI3K/AKT/SREBP pathway by increasing the abundance of Akkermansia muciniphila, reduced lipid droplet deposition, and ultimately enhanced the sensitivity to OXA in the treatment of GC. Conclusion This study demonstrates the value of huaier in gastric cancer treatment by enhancing chemosensitivity and provides novel insights into its systemic therapeutic effects through molecular mechanisms and gut microbiota modulation.

Objective:To investigate the clinical efficacy of three-connections and four-screwings technique in the treatment of high double column acetabular fractures through a single ilioinguinal approach.Methods:A retrospective study was conducted to analyze the data of 42 patients who had been treated for high double column acetabular fractures from June 2017 to June 2020 at Trauma Ward 2, Department of Orthopedics and Traumatology, The First Hospital of Traditional Chinese Medicine of Changde. There were 19 males and 23 females with an age of (42.7±25.6) years. 29 injuries were due to a traffic accident, 12 ones to fall from a height, and one to fall. The time from injury to operation was (4.5±2.1) days. All the patients were treated by the three-connections and four-screwings technique through a single ilioinguinal approach. Briefly, the anterior column was connected and secured to the main bone using 3 routes, and the posterior column was attached and fixated to the anterior column reset using 2 or 3 of the 4 screwings. The operation time, intraoperative blood loss, fracture reduction quality, fracture healing time, hip function at the last follow-up and complications during the follow-up were recorded.Results:For this cohort, the operation time was (150.0±30.5) min, and intraoperative blood loss (300.0±50.0) mL. According to the Matta scale for postoperative acetabular fracture reduction, 34 cases were excellent, 6 cases good, and 2 cases acceptable, with an excellent and good rate of 95.2% (40/42). After operation one patient had fat liquefaction and wound exudation which responded to drainage and dressing change. The 42 patients were followed up for (15.0±3.4) months. All fractures healed after (11.0±2.0) months. By the modified Merle d'Aubigné & Postel scoring system, the hip function was evaluated at the last follow-up as excellent in 33 cases, as good in 6 cases, and as fair in 3 cases, yielding an excellent and good rate of 92.9% (39/42).Conclusions:In the treatment of high double column acetabular fractures, the three-connections and four-screwings technique through a single ilioinguinal approach can lead to fine reduction and rigid fixation by lag screw compression and neutralization plate protection. Consequently, early functional exercises can be performed to secure good therapeutic outcomes for the patients.

Objective To explore the predictive value of serum homo sapiens microRNA(hsa-miR)-30c-5p expression in patients with type 2 diabetes mellitus(T2DM)for microvascular complications.Methods A total of 205 T2DM patients admitted to Bazhong Central Hospital from May 2021 to September 2022 were selected as the diabetes group,and the diabetes group was further divided into diabetes with combined group(n=124)and non combined group(n=81)according to the microvascular complications of the patients.In addition,205 healthy people who underwent physical examination during the same period were selected as the control group.The expression of hsa-miR-30c-5p in serum was detected by reverse transcription-polymerase chain reaction(RT-PCR)and compared.The factors affecting microvascular complications were analyzed using multivariate logistic regression analysis,and receiver operating characteristic(ROC)curves were plotted to predict the value of serum hsa-miR-30c-5p expression in predicting microvascular complications in T2DM patients.Results The expression of serum hsa-miR-30c-5p in the combined group(0.58±0.06)and the non-combined group(0.72±0.08)were lower than that in the control group(0.89±0.21),and the differences were significant(t=16.038,7.079,all P=0.001).The combined group was lower than the non-combined group,and the difference was significant(t=14.289,P=0.001).The course of diabetes[(OR(95％CI):3.873(2.976～4.770)],uric acid[(OR(95％CI):2.125(1.211～3.040)]and glycosylated hemoglobin[(OR(95％CI):2.680(1.745～3.616)]were independent risk factors for microvascular complications in T2DM patients(all P＜0.05),while the time within the target range of glucose[(OR(95％CI):0.491(0.135～0.846)]and serum hsa-miR-30c-5p[(OR(95％CI):0.532(2.976～4.770)]were protective factors for microvascular complications in T2DM patients(all P＜0.05).The sensitivity,specificity and area under the curve(95％CI)of serum hsa-mir-30c-5p expression in predicting microvascular complications in T2DM patients were 81.45％,85.19％and 0.802(0.741～0.854),respectively.Conclusion The expression of serum hsa-miR-30c-5p in patients with T2DM is abnormally reduced,and serum hsa-miR-30c-5p is a protective factor for microvascular complications in patients with T2DM.It may have a certain predictive value for microvascular complications in patients with T2DM.

Objective To explore the health-related quality of life(HRQOL)among patients with multidrug-resistant and rifampin-resistant pulmonary tuberculosis(MDR/RR-PTB)and analyze its influencing factors.Methods Data was collected from 50 MDR/RR-PTB patients registered for treatment management in the"Tuberculosis Management Information System"in Bazhong City from 2021 to 2024 as resistance group.Fifty pulmonary tuberculosis patients sensitive to anti-tuberculosis drug treatment registered in the system during the same period were selected as control group.A cross-sectional survey method was employed using the quality of life instruments for chronic disease pulmonary tuberculosis(QLICD-PT)to measure and compare the HRQOL between two groups.Multiple linear regression analysis was used to analyze factors affecting the HRQOL of MDR/RR-PTB patients.Results Except for physiological function,there were statistically significant difference between MDR/RR-PTB group and control group in terms of total quality of life score,psychological function,social function,and specific modules(P＜0.05).Univariate analysis showed that there were statistically significant differences in the total quality of life scores among patients with different genders,medical insurance statuses,monthly family income situations,presence or absence of comorbidities,lymphocyte count,albumin,C-reactive protein,and body mass index(P＜0.05).Multiple linear regression analysis revealed that(P＜0.05)there was significant difference for the partial regression coefficient tests of patient's medical insurance and monthly family income situations(P＜0.05).Conclusion The HRQOL of MDR/RR-PTB patients is lower than that of pulmonary tuberculosis patients sensitive to anti-tuberculosis drugs.The patient's health insurance and monthly family income are potential factors affecting the HRQOL of MDR/RR-PTB patients.

Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death, and most patients with HCC are diagnosed at an advanced stage. Before 2017, tyrosine kinase inhibitors were the main drugs for the treatment of advanced hepatocellular carcinoma. With the emergence of immune checkpoint inhibitors (ICIs), immunotherapy has gradually brought new hope to such patients. At present, the combination of ICIs and other systemic or local treatments has become a potential strategy for the treatment of advanced hepatocellular carcinoma, and some of these combinations have been included in large-scale clinical trials. The main challenges of immunotherapy for advanced hepatocellular carcinoma include the exploration of predictive biomarkers, management of immune-related adverse events, and exploration of effective combination regimens. This article provides the latest research progress on the single or combined use of ICIs and other immunotherapy for hepatocellular carcinoma and discusses the limitations of current research and clinical application and the future development direction.

In recent years, the problem of bacterial resistance has become more and more serious, which has brought troubles to global public health and medical care. The time and money required to develop new antibiotics is even greater than before. Bacteriophage is a kind of virus that can specifically infect bacteria, fungi, actinomycetes and other microorganisms. Relying on host bacteria to replicate in large numbers, rich species, low research and development cost, the value of anti-infection therapy is very considerable. It is a new generation of biological antimicrobial agents with great potential. This paper briefly describes the sterilization mechanism, progress of research on anti-infection aspect and clinical application of phage, in order to provide reference for phage anti-infection treatment and clinical application.

Objective:To investigate the relationship between positive rate and titer of hepatitis B surface antibody (anti-HBs) and CD4 + T lymphocyte count level in human immunodeficiency virus (HIV) infected patients after hepatitis B virus (HBV) exposure. Methods:A total of 4 893 HIV-infected patients were admitted to Zhongnan Hospital of Wuhan University from January 2010 to December 2018. The demographic data, HIV-related diagnosis, treatment information, CD4 + T lymphocyte count and serum markers of HBV infection of HIV infected patients were retrospectively analyzed. The patients were grouped according to the CD4 + T lymphocyte count and serum markers of HBV infection, and the differences of anti-HBs positive rate and HBV exposure rate in patients with different CD4 + T lymphocyte counts were compared.The differences of CD4 + T lymphocyte count in patients with different titer of anti-HBs were compared. Statistical analysis was performed using chi-square test, analysis of variance or t test. Results:Patients with HIV infection were divided into CD4 + T lymphocyte count<200/μL group (3 293 cases), 200-500/μL group (1 200 cases) and CD4 + T lymphocyte count>500/μL group (400 cases). The HBV exposure rates in the three groups were 78.0%(2 569/3 293), 77.0%(924/1 200) and 76.2%(305/400), respectively. The anti-HBs positive rates were 38.2%(1 258/3 293), 53.8%(645/1 200) and 62.5%(250/400), respectively. The anti-HBs titers were (120.00±36.45) IU/L, (148.00±26.40) IU/L and (212.00±92.08) IU/L, respectively. The exposure rates of HBV in the three groups were similar ( χ2=0.992, P=0.609), but the positive rates and titers of anti-HBs were significantly different ( χ2=146.779 and F=45.362, respectively, both P<0.01). When the patients were grouped by anti-HBs titer, 2 740 cases were divided into anti-HBs negative group (<10 IU/L), 1 220 cases in low anti-HBs group (10-99 IU/L), 693 cases in medium anti-HBs group (100-499 IU/L) and 240 cases in high anti-HBs group (≥500 IU/L). The CD4 + T lymphocyte count levels of the four groups were (150.00±8.42)/μL, (185.00±7.08)/μL, (243.00±12.07)/μL and (308.00±22.60)/μL, respectively. The overall CD4 + T lymphocyte count levels among the four groups were significantly different ( F=68.479, P<0.01). Among the 90 HIV infected patients who received anti-retroviral therapy (ART), the anti-HBs titer increased from (91.96±21.87) IU/L to (200.76±56.43) IU/L after treatment, and the anti-HBs level before and after treatment was significantly different ( t=-2.542, P=0.035). Among 208 patients with negative HBV markers, no patients had hepatitis B surface antigen switched to positive when monitored for an interval time of (26.2±5.3) months. Conclusions:The risk of HBV exposure in patients with HIV infection is not significantly related to the disease stage, but the positive rate and titer of anti-HBs are significantly positively correlated with CD4 + T lymphocyte count level. The monitoring of anti-HBs and the serum markers of HBV infection in the same individual is conducive to the in-depth understanding of the protective effect of anti-HBs and the scientific evaluation of the risk of infection after HBV exposure.

Objective To investigate the MRI manifestations of secondary toxoplasmosis encephalitis in HIV patients and summarize the characteristics of MRI changes.Methods MRI images of 3 5 HIV patients with secondary toxoplasmosis encephalitis were analyzed retrospectively.Results Of 35 patients,27 showed multiple lesions and 8 showed single lesion.Lesions mainly involved the brain gray matter j unction or basal ganglia.MRI showed lamellar,nodular or round lesions,which showed low signal on T1WI,and slightly higher and unevenly high signal on T2WI.Irregular liquid signal or nodular slightly lower signal was showed on T2WI in 14 cases,and short T1signal was showed in 15 cases.Circular lesions could be seen"cattle eye"in 18 cases.For 11 cases of enhanced scan of a single lesion,a ring enhancement was displayed,and coexistence of patchy,nodular and annular enhancement were showed in multiple lesions,in which parts of the multi-circular enhancemens were clustered.Conclusion MRI manifestations of HIV patients with secondary toxoplasmosis encephalitis show primarily multiple lesions on the gray matter j unction or basal ganglia.The lesions show high signal on T1WI and"cattle eye"on T2WI,and existence of flaky,nodular and ring enhanced lesion or clustered enhancement are showed on enhanced imaging,which is of a certain specificity.

Objective To investigate the situation of sexual transmitted diseases (STD) prevalence among human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS ) patients and to analyze its impact on HIV transmission between couples .Methods Under voluntary counseling and testing ,1871 clinically confirmed HIV/AIDS patients underwent common STD testing , with synchronous test of HIV infection on their couples .Continuous variables were compared using t-test , and categorical variables were compared using variance analysis .Chi-square test was used for comparison between groups .Results Among 1871 HIV/AIDS patients ,571 patients (30 .5％ ) were co-infected with STD .The HIV transmission rates between couples in STD co-infection group and non-STD co-infection group were 49 .2％ (281/571) and 23 .6％ (307/1300) ,respectively ,which was statistically different (χ2 =120 .6 ,P<0 .01) .Among the 571 HIV/STD co-infection patients ,HIV transmission rates between couples with genital herpes ,condyloma acuminatum ,gonorrhoea or nongonococcal urethritis and syphilis were 84 .2％ (80/95) ,72 .2％ (78/108) ,45 .0％ (27/60) and 31 .2％ (96/308) ,respectively .There was statistically significant among multiple groups comparisons (χ2 =110 .0 , P<0 .01) .Among the comparison between two groups , there were statistically significant differences between genital herpes group and condyloma acuminatum group (χ2 =4 .210 ,P=0 .040) ,between pointed condyloma group and gonorrhoea or nongonococcal urethritis group (χ2 =12 .196 , P< 0 .01) ,between gonorrhoea or nongonococcal urethritis group and syphilis group (χ2 = 4 .317 , P=0 .038) .Conclusions STD co-infection rate is high among HIV/AIDS patients .STD can facilitate the HIV transmission between couples ,and different STD has different impact on the transmission .

Objective Galangin is a natural flavonoid with antineoplastic activity .SIRT1 is an important member of Sirtuin family which parcitipate in many physiological process .The aim of this study was to investigate the effect of SIRT 1 on HepG2 cell apop-tosis induced by galangin . Methods HepG2 cells were pre-treated with SIRT1 inhibitor EX-527 for 2 hours, and then galangin for 24 hours.DMSO solvent control group, EX-527 treatment group, galangin treatment group and EX-527 and galangin co-treatment group were established.Hoechst 33342 staining, flow cytometry and western blot were performed to detect the apoptosis of HepG2 cells.After regu-lating the expression of SIRT1 in HepG2 cells with RNA interference and transfection of exogenous genes , these cells were treated with ga-langin for 24 hours.Negative control group , vector control group , SIRT1 knock down group , blank control group , blank vector group ,and SIRT1 upregulation group were established .Western blot and Flow cytometry were performed to detect the apoptosis of HepG 2 cells. Results The apoptosis rate and the gray level ratio of shear band of PARP 1 and GAPDH that of galangin group [(11.62± 0.55) %, 0.89±0.01]and EX-527+galangin group[(25.75±0.61) %, 1.15±0.06] were all increased(P<0.01),when these were compared with DMSO solvent control group [(2.49±0.22) %, 0.06±0.00];and those in EX-527+galangin group were also markedly increased compared with galangin group (P<0.01).The result of western bolt was that the gray level ratio of PARP 1 and GAPDH of SIRT1 knocked down group(0.06±0.01) was markedly decreased compared with vector control group (1.11±0.05)and without adenovi-rus infection group (1.10±0.04)(P<0.01).The apoptosis rate and the gray level ratio of shear band of PARP 1 and GAPDH that of SIRT1 knocked down group were markedly increased compared with vector control group and without adenovirus infection group ( P<0.01).The gray level ratio of PARP1 and GAPDH of SIRT1 up-regulated group (1.63±0.04) was markedly increased compared with blank control group (0.89±0.02) and without plasmid transfection group (0.87±0.03) (P<0.01).The apoptosis rate and the gray lev-el ratio of shear band of PARP 1 and GAPDH that of SIRT1 up-regulated group were markedly decreased compared with blank control group and without plasmid transfection group (P<0.01). Conclusion SIRT1 inhibited galangin-induced apoptosis in HepG2 cells.