Promoting the construction of a “Healthy China” is essential to building a great modern socialist country. Health workers in every era have their historical missions and they are the “benevolent doctors” of their own era. Therefore， clarifying the basic connotation and times requirements of “benevolent doctors” has become the first question to be answered in cultivating “benevolent doctors”. The basic connotation of “benevolent doctor” should reflect not only the comprehensive development of moral， intellectual， physical， aesthetic， and labor education in fostering virtue and nurturing talents， but also embody the people-centered development philosophy， promote social equity and justice， and reflect the strategic needs of building a “Healthy China.” Specifically in the practice of medical education， emphasizing both medical science spirit and medical humanities spirit has become an important path to cultivate “benevolent doctors” in the new era.

Aim To investigate the effect of Toddalia asiatica(TA)on bone destruction in rheumatoid ar-thritis(RA)and its possible mechanism by network pharmacology and in vitro experiments.Methods The active components and targets of TA against RA bone damage were analyzed by network pharmacology.Mo-lecular docking was performed by using AutoDock and PyMOL software pairs.MC3T3-e1 cells were cultured in vitro,and the effect of Toddalia asiatica alcohol ex-tract(TAAE)on cell viability was detected by CCK-8,and appropriate drug concentration and intervention time were screened.The osteoblast model was induced by osteogenic induction medium,and the osteogenic differentiation was detected by ALP staining,activity detection and alizarin red staining.The expression of pathway-related proteins Wnt3a and β-catenin was de-tected by Western blot,and the pathway inhibitor DKK-1 was used to further verify whether TAAE regulated osteoblast differentiation through the Wnt/β-catenin signaling pathway.Results A total of 158 anti-RA bone destruction targets and 56 core targets were se-lected.The enrichment of KEGG signaling pathway mainly included cancer pathway,phosphatidylinositol 3-kinase/protein kinase B signaling pathway and cAMP signaling pathway.The results of CCK-8 showed that 1 g·L-1 TAAE could significantly improve cell survival rate.The results of ALP staining and ALP activity de-tection showed that TAAE could significantly increase the staining positive rate and ALP activity of cells in-duced by osteogenic induction medium.Western blot showed that TAAE could increase the expression of Wnt3a and β-catenin.The expression of these proteins decreased after DKK-1 inhibitors were used.Conclu-sion TAAE can regulate osteoblast differentiation through Wnt/β-catenin signaling pathway to treat os-teodestruction in rheumatoid arthritis.

Aim To investigate the effect of discoidin domain receptor 1(DDR1)on high glucose induced endothelial cell dysfunction and the underlying mecha-nism.Methods Human umbilical vein endothelial cells(HUVECs)were cultured in vitro and divided in-to the control group and high glucose induction group(HG).HUVECs were treated with 33 mmol·L-1 D-glucose for 48 hours to construct endothelial dysfunc-tion.Pyroptosis was detected using propidium iodide staining(PI);lactate dehydrogenase(LDH)and IL-1β,IL-18 levels were determined using enzyme linked immunosorbent assay(ELISA);the expression of DDR1 and NF-κB/NLRP3 signaling pathway proteins and pyroptosis related proteinses were detected using Western blot.Subsequently,the experiment was divid-ed into the control group,HG group,HG+DDR1 NC group,and HG+DDR1 siRNA group.The effect of high glucose on the proliferation and migration of HU-VECs was observed after transfection with DDR1 siR-NA for 24 hours;ELISA was used to detect the endo-thelial nitric oxide synthase(eNOS),vascular cell ad-hesion molecule-1(VCAM-1),intercellular adhesion molecule-1(ICAM-1),as well as LDH,IL-1β,IL-18 levels;PI was employed to detect pyroptosis;Western blot was applied to detect DDR1 and NF-κB/NLRP3 signaling pathway proteins and pyroptosis related pro-teins.Results Compared with the control group,HG group decreased eNOS content,increased VCAM-1 and ICAM-1 contents,decreased cell viability and migration ability,and significantly increased the expressions of DDR1,p-NF-κB,NLRP3 and pyroptosis related pro-teins.The levels of LDH,IL-1β,IL-18 and the rate of pyroptosis significantly increased(P＜0.05).Com-pared with HG group,DDR1 siRNA could promote the secretion of eNOS,decrease the levels of VCAM-1,ICAM-1,LDH,IL-1β and IL-1 8,increase cell viability and migration ability,reduce the expression of p-NF-κB,NLRP3 and pyroptosis related proteins,and inhibit high glucose-induced pyroptosis of HUVECs(P＜0.05).Conclusions Gene silencing DDR1 can im-prove vascular endothelial cell dysfunction induced by high glucose,and the mechanism is related to the inhi-bition of NF-κB/NLRP3 signaling pathway mediated pyroptosis.

Plague,caused by Yersinia pestis,is a zoonotic disease that infects both humans and animals.Y.pestis not only encodes various virulence factors that can disrupt host immune signaling but also can modify its lipopolysaccharide(LPS)struc-ture,thereby evading host immune surveillance and potently suppressing the host's immune response,in an important molecu-lar mechanism underlying its high pathogenicity.The LPS of Y.pestis lacks an O antigen,and its lipid A structure possesses a unique temperature transition regulatory mechanism.At different temperatures,Y.pestis forms lipid A with different numbers of acyl side chains,which plays a pivotal role in the evasion of host innate immune recognition and clearance.Here,we present a comprehensive review of research progress in the biosynthetic regulation,structural variation,and immune escape mechanism of Y.pestis LPS,to provide a reference for the study of the molecular mechanisms of pathogens using LPS structural modifica-tions to elude host innate immune defenses.

Objective:To investigate the prognostic value of lymphocyte-to-monocyte ratio(LMR)and CD163+tumor-associated macrophages(TAM)in patients with diffuse large B cell lymphoma(DLBCL).Methods:Peripheral blood and lymph node tissues were collected from 63 newly diagnosed DLBCL patients.LMR was calculated by the number of lymphocytes and monocytes in peripheral blood from the result of blood routine examination.The level of CD163+TAM in lymph nodes was detected by immunohistochemistry.The cut-off values of LMR and CD163+TAM were determined by ROC curves,and the prognostic value of LMR and CD163+TAM in DLBCL patients was analyzed.Results:The LMR level of 63 newly diagnosed DLBCL patients was 3.69±1.71,and the median value of CD163+TAM was 26/HPF.The number of CD163+TAM was negatively correlated with LMR(r=-0.58)and positively correlated with monocyte count(r=0.46).The cut-off values of LMR and CD163+TAM determined by ROC curve were 2.95 and 29/HPF,respectively,and based on this,the patients were divided into low LMR group and high LMR group,as well as low CD163+TAM group and high CD163+TAM group.The proportion of patients with clinical stage Ⅲ-Ⅳ,IPI score 3-5 and bone marrow infiltration in the low LMR group were higher than those in the high LMR group(P＜0.05).The proportion of patients with clinical stage Ⅲ-Ⅳ,IPI score 3-5,elevated LDH level and bone marrow infiltration in the high CD163+TAM group were higher than those in the low CD163+TAM group(P＜0.05).There was a positive correlation between LMR and OS(r=0.43)and a negative correlation between CD163+TAM and OS(r=-0.65).DLBCL patients with low LMR and high CD163+TAM had shorter OS(P＜0.05).Conclusion:Low LMR and high CD163+TAM can be used as biological markers for poor prognosis of DLBCL patients.

Objective To investigate the predictive value of Cys C and AT Ⅲ for CIAKI in elderly hypertensive patients with AMI after PCI.Methods A total of 911 elderly hypertensive patients with AMI undergoing emergency PCI in the Affiliated Hospital of Xuzhou Medical University from January 2019 to May 2023 were consecutively enrolled,and then randomly divided into a training group(731 cases)and a validation group(180 cases)in a ratio of 8∶2.According to the diagnostic criteria of CIAKI defined by the European Society of Urogenital Radiology,the patients of the training group were further divided into CIAKI subgroup(n=91)and non-CIAKI sub-group(n=640).The basic clinical data were compared between the CIAKI and non-CIAKI sub-groups and between the training and validation groups.Multivariate logistic regression analysis was used.ROC curve was drawn to analyze the predictive value of Cys C,ATⅢ and their combina-tion for CIAKI.Results Fasting blood glucose,TG,Cys C,and diuretics were independent risk factors(OR=1.116,95％CI:1.009-1.235;OR=1.786,95％CI:1.363-2.339;OR=13.360,95％CI:4.462-39.999;OR=10.606,95％CI:4.110-27.370),while LVEF and AT Ⅲ were protective factors(OR=0.932,95％CI:0.897-0.968;OR=0.949,95％CI:0.929-0.969)for CIAKI in eld-erly hypertensive patients after emergency PCI.The AUC value of Cys C and AT Ⅲ combined to-gether in predicting CIAKI after emergency PCI was 0.818(95％CI:0.773-0.863,P＜0.01),which was better than either of them alone.When Cys C level ≥1.10 mg/L,the risk of CIAKI was increased with the increment of the level;when AT Ⅲ ≥69％,the risk of CIAKI was decreased with the increase of AT Ⅲ level.Conclusion High Cys C level and low AT Ⅲ level are independ-ent risk factors for CIAKI,and their combination can improve the accuracy of predicting CIAKI after emergency PCI in elderly patients with hypertensive AMI.

Objective:To identify risk factors for infections by multidrug-resistant organisms(MDRO)in elderly patients admitted to the intensive care unit(ICU)based on an retrospective analysis of data from the Medical Information Mart for Intensive Care-Ⅳ v2.0(MIMIC-Ⅳ v2.0).Methods:Structured query language was used to extract basic information, disease severity scores, laboratory test results, medications, medical procedures, and outcome events of elderly patients from MIMIC-Ⅳ v2.0.Patients were divided into a non-MDRO group and an MDRO group based on whether they had MDRO infections.Univariate analysis was performed according to the type of variables.For significant variables identified from univariate analysis, logistic regression was used to calculate the odds ratio and the 95% confidence interval for MDRO infections.The Kaplan-Meier method was used to draw survival curves.The log-rank test was used to analyze the 28-day survival rate.Results:A total of 31 237 cases were enrolled, including 26 032 with non-MDRO infections and 5 205 with MDRO infections.The MDRO infection rate was 16.7%.MDRO were most frequently found in urine cultures, and the most common bacteria belonged to the genus Enterobacter.Multivariate logistic regression analysis showed that age( P=0.006), being male( P<0.001), coronary artery disease( P<0.001), brain disease( P=0.042), hemoglobin( P<0.001), albumin( P<0.001), and mechanical ventilation( P<0.001)were protective factors against MDRO infections.Diabetes( P<0.001), COPD( P<0.001), chronic kidney disease( P<0.001), white blood cell( P=0.001), SAPS Ⅱ( P<0.001), previous use of antibiotics( P<0.001), use of proton pump inhibitors( P<0.001), glucocorticoids( P<0.001), immunosuppressants( P<0.001)and sedatives( P<0.001), and continuous renal replacement therapy(CRRT)( P=0.015)were risk factors for MDRO infections.The 28-day mortality rates of the non-MDRO and MDRO groups were 16.3% and 19.1%, respectively.The log-rank test showed that the difference between two groups was statistically significant( P<0.001). Conclusions:The mortality rate among patients with MDRO infections is higher than among those with non-MDRO infections.Previous use of antibiotics, use of proton pump inhibitors, glucocorticoids, immunosuppressants and sedatives, mechanical ventilation, and CRRT are risk factors for MDRO infections.

AIM To identify the in vivo metabolites of Cynanchum auriculatum Royle ex Wight extract in functional dyspepsia rats by UHPLC Q-Exactive Plus Orbitrap HRMS.METHODS The rat models for functional dyspepsia were established.The analysis was performed on a 40℃ thermostatic Hypersil GOLD C18 column(2.1 mm×100 mm,1.9 μm),with the mobile phase comprising of water(containing 0.1％formic acid)-acetonitrile(containing 0.1％formic acid)flowing at 0.3 mL/min in a gradient elution manner,and electrospray ionization source was adopted in positive and negative ion scanning.RESULTS Total 4 prototypes(baishouwubenzophenone,deacylmetaplexigenin,qingyangshengenin,syringic)and 110 metabolites were identified,12 of which were common metabolites in feces and urine,56 of which were unique metabolites in urine,42 of which were unique metabolites in feces.The metabolic pathway of prototypes contained phase Ⅰ metabolism(reduction,oxidization,etc.),phase Ⅱ metabolism(sulfonation,glucuronidation,etc.)and phase Ⅰ,Ⅱ composite reactions.CONCLUSION This effective and comprehensive method can lay the theoretical foundation for further discovery of potential active metabolites in C.auriculatum.

This case report described the sucussful treatment of a male infant born at 21 weeks and 4 days through assisted reproductive technology. After prenatal consultation and with the strong desire of the parents, active resuscitation and treatment were performed. The infant received 52 days of mechanical ventilation and was extubated to non-invasive ventilation at a corrected gestational age of 28 weeks and 6 days. During hospitalization, no vasoactive drugs were used, and necrotizing enterocolitis did not occur. The gastric tube was removed at a corrected gestational age of 37 weeks and 4 days. At a corrected gestational age of 40 weeks, cranial MRI showed no abnormalities. The infant was discharged at a corrected gestational age of 42 weeks after 143 days of treatment, without the need for any respiratory support. Follow-up until a corrected age of 6 months showed good growth and development.

As the improvement of patient experience and medical experience has become the key goal of medical model reform,patient experience has gradually guided the development direction of future medical treatment and dominated the model of patient management.Patient journey mapping,as a patient-centered tool for visualizing patient experience,has been widely used in patient management in recent years.It will introduce the definition,construction method,application progress,problems,and prospects of patient journey mapping in the field of patient management at home and abroad to encourage more medical staff to use patient journey mapping to gain insight into patient needs,optimize patient experience and gather strength in patient management.