Esophageal cancer （EC） is a highly prevalent malignant tumor in China. The phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， as one of the key oncogenic pathways， can promote the cell cycle progression， proliferation， migration， and invasion， induce chemoresistance， and inhibit apoptosis and autophagy of EC cells. Traditional Chinese medicine （TCM）， with the advantages of targeting multiple points with multiple components to delay cancer progression， can target the PI3K/Akt signaling pathway for EC treatment. This article preliminarily discusses the molecular mechanism and role of the PI3K/Akt signaling pathway in EC and elaborates on the specific targets and efficacy of TCM in treating EC through intervention in the PI3K/Akt signaling pathway in the past five years. TCM materials and extracts inhibiting the PI3K/Akt signaling pathway in EC include Borneolum， spore powder of Ganoderma lucidum without spore coat， extract of Celastrus orbiculatus， root extract of Taraxacum， and Bruceae Fructus oil emulsion. TCM active ingredients exerting the effect include flavonoids， terpenoids， saponins， phenols， polysaccharides， alkaloids， and other compounds. TCM compound prescriptions with such effect include Qige San， Huqi San， Xuanfu Daizhetang， Tongyoutang and its decomposed prescriptions， Liujunzi Tang， and Xishenzhi Formula. In addition， TCM injections such as Compound Kushen Injection and Kang'ai injection also inhibit the PI3K/Akt signaling pathway in EC. This paper summarizes the role of the PI3K/Akt signaling pathway in EC and the TCM interventions， aiming to provide reference for the research and clinical application of new drugs for EC.

OBJECTIVES: To investigate the effect of Ching Shum Pills (CSP) for alleviating non-alcoholic fatty liver disease (NAFLD) and the underlying mechanism. METHODS: In a mouse model of NAFLD, the therapeutic effect of CSP was evaluated by measuring serum glucose, lipid profiles (TC, TG, LDL-C, HDL-C), and hepatic function markers. Network pharmacology was employed to identify active compounds in CSP and their targets using TCMSP, HERB, SwissTargetPrediction, GeneCards, OMIM, and DisGeNET. Protein-protein interaction (PPI) networks, Gene Ontology (GO), and KEGG pathway analyses were conducted. Molecular docking (AutoDock Vina) was used to assess the compound-target binding affinities. Quantitative real-time PCR (qRT-PCR) was used to validate the mRNA expressions of the core genes in the liver tissue of the mouse models. RESULTS: In the mouse model of NAFLD, treatment with CSP significantly reduced body weight gain and serum TG levels of the mice, and high-dose CSP treatment resulted in obvious reduction of ALT levels and hepatic fat accumulation. Network pharmacology analysis identified quercetin and 2-monolinolenin as the key bioactives in CSP, which target TNF, AKT1, IL6, TP53, and ALB. Docking simulations suggested strong binding between the two core compounds and their target proteins. The results of qRT-PCR showed that high-fat diet induced significant downregulation of Tp53, Cpt1, and Ppara expressions in mice, which was effectively reversed by CSP treatment. CONCLUSIONS CSP can improve lipid metabolism disorders in NAFLD mice through a regulatory mechanism involving multiple targets and pathways to reduce liver fat accumulation and protect liver function. The key components in CSP such as quercetin and linolenic acid monoacylglycerol may participate in the regulation of such metabolic processes as fatty acid oxidation by targeting TP53.
Animals ; Non-alcoholic Fatty Liver Disease/drug therapy* ; Mice ; Drugs, Chinese Herbal/pharmacology* ; Lipid Metabolism/drug effects* ; Molecular Docking Simulation ; Disease Models, Animal ; Liver/metabolism* ; Male ; Lipid Metabolism Disorders/drug therapy* ; PPAR alpha/metabolism* ; Mice, Inbred C57BL ; Network Pharmacology

Objective In order to strengthen the connotation construction of hospitals,promote high-quality develop-ment,improve the quality of medical services,improve operational efficiency,and explore and practice the performance manage-ment mode in combination with the characteristics of the hospital's own development.Methods Take a tertiary children's spe-cialty hospital in Wuxi as an example,optimize the internal performance appraisal management system of the hospital,and con-duct dynamic monitoring and management of the whole appraisal process.Results The sample hospital constructed a multifacet-ed performance management system,and the performance appraisal results of the national tertiary public hospital in 2022 were significantly improved,and the various appraisal indexes,such as the percentage of fourth-level surgery,the intensity of antimi-crobial drug use,the value of CMI,the satisfaction degree of the medical staff,and the satisfaction degree of the outpatients,were kept optimized.Conclusion The continuous optimization of the performance management model has improved the hospital's level of refined management,the efficiency of collaboration between departments,the efficiency of resource allocation,and the efficiency of economic operation,stimulated the work motivation of medical staff,and improved the quality of medical services.

Objective To observe the impact factors of obesity(Ob)complicated with type 2 diabetes mellitus(T2DM).Methods Twenty Ob patients complicated with T2DM(group A)and 47 simple Ob patients(group B)were retrospectively enrolled.The blood glucose related indicators,including fasting blood glucose(FBG),fasting insulin(FINS)and glycosylated hemoglobin(HbA1c),homeostasis model assessment of insulin resistance(HOMA-IR),as well as fat quantitative parameters measured with dual-energy X-ray absorptiometry,CT or MRI were compared between groups,their correlations were analyzed,and the impact factors of Ob complicated with T2DM were explored.Results FBG,HbA1c and HOMA-IR in group A were all higher,while the total body fat mass percentage(TFM%)and leg fat mass percentage(LFM%)in group A were both lower than those in group B(all P＜0.05).Proton density fat fraction(PDFF)of liver and lumbar bone marrow in group A were both higher than those in group B(both P＜0.05).TFM%and LFM%in all 67 Ob patients were negatively correlated with FBG or HbA1c,while TFM%and Android region fat mass percentage(Android FM%)were both negatively correlated with HOMA-IR(r=-0.447—-0.263,all P＜0.05).For all 67 Ob patients,the area of visceral adipose tissue(VAT)was positively correlated with HOMA-IR(r=0.339,P=0.006),liver PDFF was positively correlated with FBG,HbA1c and HOMA-IR,and PDFF of lumbar bone marrow was positively correlated with FBG(r=0.323-0.599,all P＜0.05).Elevated LFM%was a protective factor,while elevated PDFF of liver and pancreas were both risk factors of Ob complicated with T2DM(all P＜0.05).Conclusion LFM%and liver PDFF were both impact factors of Ob complicated with T2DM.

Objective To investigate the effect of Ching Shum Pills(CSP)for alleviating non-alcoholic fatty liver disease(NAFLD)and the underlying mechanism.Methods In a mouse model of NAFLD,the therapeutic effect of CSP was evaluated by measuring serum glucose,lipid profiles(TC,TG,LDL-C,HDL-C),and hepatic function markers.Network pharmacology was employed to identify active compounds in CSP and their targets using TCMSP,HERB,SwissTargetPrediction,GeneCards,OMIM,and DisGeNET.Protein-protein interaction(PPI)networks,Gene Ontology(GO),and KEGG pathway analyses were conducted.Molecular docking(AutoDock Vina)was used to assess the compound-target binding affinities.Quantitative real-time PCR(qRT-PCR)was used to validate the mRNA expressions of the core genes in the liver tissue of the mouse models.Results In the mouse model of NAFLD,treatment with CSP significantly reduced body weight gain and serum TG levels of the mice,and high-dose CSP treatment resulted in obvious reduction of ALT levels and hepatic fat accumulation.Network pharmacology analysis identified quercetin and 2-monolinolenin as the key bioactives in CSP,which target TNF,AKT1,IL6,TP53,and ALB.Docking simulations suggested strong binding between the two core compounds and their target proteins.The results of qRT-PCR showed that high-fat diet induced significant downregulation of Tp53,Cpt1,and Ppara expressions in mice,which was effectively reversed by CSP treatment.Conclusion CSP can improve lipid metabolism disorders in NAFLD mice through a regulatory mechanism involving multiple targets and pathways to reduce liver fat accumulation and protect liver function.The key components in CSP such as quercetin and linolenic acid monoacylglycerol may participate in the regulation of such metabolic processes as fatty acid oxidation by targeting TP53.

Objective To observe the impact factors of obesity(Ob)complicated with type 2 diabetes mellitus(T2DM).Methods Twenty Ob patients complicated with T2DM(group A)and 47 simple Ob patients(group B)were retrospectively enrolled.The blood glucose related indicators,including fasting blood glucose(FBG),fasting insulin(FINS)and glycosylated hemoglobin(HbA1c),homeostasis model assessment of insulin resistance(HOMA-IR),as well as fat quantitative parameters measured with dual-energy X-ray absorptiometry,CT or MRI were compared between groups,their correlations were analyzed,and the impact factors of Ob complicated with T2DM were explored.Results FBG,HbA1c and HOMA-IR in group A were all higher,while the total body fat mass percentage(TFM%)and leg fat mass percentage(LFM%)in group A were both lower than those in group B(all P＜0.05).Proton density fat fraction(PDFF)of liver and lumbar bone marrow in group A were both higher than those in group B(both P＜0.05).TFM%and LFM%in all 67 Ob patients were negatively correlated with FBG or HbA1c,while TFM%and Android region fat mass percentage(Android FM%)were both negatively correlated with HOMA-IR(r=-0.447—-0.263,all P＜0.05).For all 67 Ob patients,the area of visceral adipose tissue(VAT)was positively correlated with HOMA-IR(r=0.339,P=0.006),liver PDFF was positively correlated with FBG,HbA1c and HOMA-IR,and PDFF of lumbar bone marrow was positively correlated with FBG(r=0.323-0.599,all P＜0.05).Elevated LFM%was a protective factor,while elevated PDFF of liver and pancreas were both risk factors of Ob complicated with T2DM(all P＜0.05).Conclusion LFM%and liver PDFF were both impact factors of Ob complicated with T2DM.

Objective In order to strengthen the connotation construction of hospitals,promote high-quality develop-ment,improve the quality of medical services,improve operational efficiency,and explore and practice the performance manage-ment mode in combination with the characteristics of the hospital's own development.Methods Take a tertiary children's spe-cialty hospital in Wuxi as an example,optimize the internal performance appraisal management system of the hospital,and con-duct dynamic monitoring and management of the whole appraisal process.Results The sample hospital constructed a multifacet-ed performance management system,and the performance appraisal results of the national tertiary public hospital in 2022 were significantly improved,and the various appraisal indexes,such as the percentage of fourth-level surgery,the intensity of antimi-crobial drug use,the value of CMI,the satisfaction degree of the medical staff,and the satisfaction degree of the outpatients,were kept optimized.Conclusion The continuous optimization of the performance management model has improved the hospital's level of refined management,the efficiency of collaboration between departments,the efficiency of resource allocation,and the efficiency of economic operation,stimulated the work motivation of medical staff,and improved the quality of medical services.

Objective: To explore whether Lycium barbarum polysaccharide (LBP) can reduce the apoptosis of retinal photoreceptor cells in retinitis pigmentosa (RP) mice by inhibiting nuclear factor-kappa B (NF-κB)/NOD-like receptor thermal protein domain-associated protein 3 (NLRP3) signaling pathway. Methods: (i) In vitro experiments, mouse retinal ganglion cells (661W cells) were divided into normal, model, LBP low-dose (LBP-L, 40 mg/L), LBP middle-dose (LBP-M, 80 mg/L), LBP high-dose (LBP-H, 160 mg/L), and positive drug control (NLRP3 inhibitor, 160 mg/L) groups. And the 661W cells were exposed to varying concentrations of H2O2 ranging from 50 to 400 μmol/L to determine the optimal concentration for inducing apoptosis (200 μmol/L). Then the cell viability was assessed using Cell Counting Kit-8 (CCK-8), while the apoptosis rate was detected by flow cytometry; the expression of NLRP3 was detected by immunofluorescence; and the expression of apoptosis markers was detected by enzyme-linked immunosorbent assay (ELISA) and Western blot (WB). (ii) In vivo assays were carried out with the use of C57/BL6 and Rd10 mice. The animal experimental groups were divided into normal, model, LBP-L, LBP-M, LBP-H, and NLRP3 inhibitor groups, in which the normal group was C57/BL6 mice and the other groups were Rd10 mice. Ten mice were included in each group, and the corresponding drugs were administered intragastrically for a duration of four weeks. NF-κB/NLRP3 pathway and the expression of apoptosis markers were observed by electroretinogram, histopathological examination, and WB to assess the effects of LBP on retinal photoreceptor cell apoptosis. Results: (i) In vitro experiments, compared with the normal group, the apoptosis rate of 661W cells in model group was significantly increased (P < 0.01), and the expression levels of key proteins of NF-κB/NLRP pathway, such as NLRP3, NF-κB, p-NF-κB, and pro-apoptotic protein caspase-3, were up-regulated (P < 0.01). The rate of Bax/Bcl-2 was increased (P < 0.01), and the concentrations of interleukin (IL)-1β and tumor necrosis factor (TNF)-α were significantly increased (P < 0.01). Compared with the model group, high dose of LBP decreased the apoptosis rate of 661W cells (P < 0.01), and down-regulated the expression levelsof the key proteins of NF-κB/NLRP3 pathway, including NF-κB, NLRP3, p-NF-κB, and caspase-3 (P < 0.01). The rate of Bax/Bcl-2 was decreased (P < 0.01), and the concentrations of IL-1β and TNF-α were decreased (P < 0.01). (ii) In vivo experiments, high dose of LBP significantly increased morphological changes in the outer nuclear layer (ONL) thickness of Rd10 mice, as well as functional changes in the amplitudes of the a-wave and b-wave (P < 0.01), which also down-regulated the expression levels of NF-κB (P < 0.05), NLRP3, p-NF-κB, and caspase-3 (P < 0.01), reduced the Bax/Bcl-2 rate (P < 0.01), and decreased the concentrations of IL-1β (P < 0.01) and TNF-α (P < 0.05). Conclusion LBP could improve both retinal morphology and function, providing protection to photoreceptors from apoptosis through the inhibition of the NF-κB/NLRP3 pathway.

Objective The number of confirmed and suspected cases of the COVID-19 in Hubei province is still increasing. However, the estimations of the basic reproduction number of COVID-19 varied greatly across studies. The objectives of this study are 1) to estimate the basic reproduction number ( R 0 ) of COVID-19 reflecting the infectiousness of the virus and 2) to assess the effectiveness of a range of controlling intervention. Method The reported number of daily confirmed cases from January 17 to February 8, 2020 in Hubei province were collected and used for model fit. Four methods, the exponential growth (EG), maximum likelihood estimation (ML), sequential Bayesian method (SB) and time dependent reproduction numbers (TD), were applied to estimate the R 0 . Result Among the four methods, the EG method fitted the data best. The estimated R 0 was 3.49 (95% CI : 3.42-3.58) by using EG method. The R 0 was estimated to be 2.95 (95% CI : 2.86-3.03) after taking control measures. Conclusion In the early stage of the epidemic, it is appropriate to estimate R 0 using the EG method. Meanwhile, timely and effective control measures were warranted to further reduce the spread of COVID-19.

Objective To investigate the relationship of preoperative level of serum anterior gradient 2 (AGR2)with clinicopathological features and prognosis of patients with prostate cancer. Methods The serum levels of AGR2 were detected by ELISA in 72 patients with prostate cancer, 30 patients with benign prostatic hyperplasia (BPH) and 20 healthy controls. The receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of clinical diagnosis, and to analyze the diagnostic value of serum AGR2 in prostate cancer. Kaplan-Meier method was used to plot the survival curve. Log-rank test was used to analyze the difference of survival time between the two groups. The effect of AGR2 on the prognosis of prostate cancer patients was analyzed by Cox regression. Results The level of serum AGR2 in prostate cancer group was obviously higher than those in BPH group and health control group (t=4.441, t=5.285, both P<0.01).Serum AGR2 level was correlated with Gleason score,tumor stage, lymph node metastasis and preoperative PSA level (F=11.343, F=9.613, t=3.882, t=7.514, all P<0.01). The area under the ROC curve(AUC) of AGR2 was 0.803(95%CI 0.726-0.880,P=0.000), when the cut-off value was 17.25 ng/ml, the sensitivity rate was 63.9%, specificity rate was 80.0%. Kaplan-Meier survival analysis showed that the survival rate in low AGR2 expression group was significantly higher than that in high AGR2 expression group (χ 2=5.565, P=0.018). Cox regression analysis showed that AGR2 was an independent risk factor for prostate cancer patients (HR=5.412, 95%CI 1.143-25.624, P=0.033). Conclusions The elevated level of serum AGR2 is related with tumor progression in prostate cancer. It may be a potential marker for predicting prognosis of patients with prostate cancer.