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.

Background Long working hours, as a common risk factor for occupational stress, is closely related to the occurrence of depressive symptoms. Understanding how long working hours affect occupational stress and depressive symptoms will inform occupational health interventions. Objective To quantify the impact of long working hours exposure on occupational stress and depressive symptoms among Internet industry employees, translate black-box outputs into actionable insights, and demonstrate the value of interpretable machine learning for early-warning occupational-health surveillance. Methods A dataset was derived from a cross-sectional survey involving 2866 internet industry employees in China. This survey was part of the project Risk Assessment Of Long Working Hour Exposure And Its Adverse Health Effects, conducted by the National Institute for Occupational Health and Poisoning Control, Chinese Center for Disease Control and Prevention, from 2021 to 2023. Working hours, occupational stress and depressive symptoms were quantified with a set of structured questionnaires including the Core Occupational Stress Scale and the Patient Health Questionnaire. Pairwise associations were screened by Mantel tests and variance-inflation factors. Key predictors identified through feature selection were fed into six machine-learning risk-prediction models. Visual interpretation was provided by feature importance, Shapley additive explanations (SHAP) and local interpretable model-agnostic explanations (LIME), while directed causal effects and intervention impacts of prolonged working hours exposure on occupational stress and depressive symptoms were dissected with causal explanation of features techniques. Results The positive rates of occupational stress and depressive symptoms among internet employees were 12.9% and 77.8% respectively. Twelve core features for occupational stress and nine for depressive symptoms were retained after selection. After these features were supplied to six predictive algorithms and evaluated on five metrics, the Light Gradient Boosting Machine (LGBM) achieved the highest accuracy—0.89 for occupational stress and 0.79 for depressive symptoms on the hold-out test set. The feature-importance rankings converged on fatigue accumulation and life satisfaction as dominant drivers for both outcomes, whereas weekly working hours and daily overtime emerged as the principal exposure-related predictors. The SHAP summary plots revealed that longer weekly hours and daily overtime systematically elevated the probability of occupational stress. The causal feature explanation further quantified that ascending one category in weekly working hours increased the probability of occupational stress by 7.04%. Conclusion Exposure to long working hours is associated with both occupational stress and depressive symptoms among internet industry employees. Interpretable machine-learning frameworks translate these associations into transparent, defensible drivers, enabling precise identification of the pivotal factors and their interplay. This evidence base equips occupational-health practitioners with actionable insights for designing targeted prevention and intervention strategies.

A case of secondary pulmonary infection in a patient with acute exacerbation of chronic obstructive pulmonary disease was admitted.The patient was initially giren piperacillin-tazobactam combined with levofloxacin for anti-infective treatment before the pathogen was identified.lafer,the HRZE anti-tuberculosis regimen was added,but the patient continued to experience high fever,yellow purulent sputum,and dyspnea.Subsequent,bronchoalveolar lavage fluid pathogen metagenomic sequencing revealed Nocardia terpenica.Clinical pharmacists,based on the patient's condition changes and in accordance with relevant guidelines and literature,suggested using various antimicrobial agents,including compound sulfamethoxazole tablets,linezolid glucose injection,amikacin injection combined with imipenem-cilastatin,to manage the patient's intolerance to sulfonamides and the bone marrow suppression induced by linezolid and to provide medication suggestions.The clinician adopted all the suggestions.Through the collaborative efforts of physicians and clinical pharmacists,the patient's condition improved,allowing for discharge with medication.Post-discharge,medication education and follow-up were conducted,leading to successful recovery.In this case,the clinical pharmacist reviewed domestic and international literature on Nocardia terpenica and the characteristics of antimicrobial drugs,and utilized their expertise to assist clinicians in treating rare infection cases,realizing their professional value.

BACKGROUND:Our previous studies found that decreased expression of connexin 43 and its Ser368 phosphorylation after myocardial hypothermic ischemia-reperfusion was closely associated with decreased cardiac conduction velocity and reperfusion arrhythmia.OBJECTIVE:To observe the effect of changes in membrane-type matrix metalloproteinase 2,matrix metalloproteinase 2 and collagen type Ⅳ on the expression of connexin 43 and its Ser368 phosphorylation and electrical conduction in the myocardial extracellular matrix after hypothermic ischemia-reperfusion.METHODS:Sixteen Langendorff extracorporeal cardiac perfusion models were successfully established from SD rats and randomly divided into a control group(n=8)and a hypothermic ischemia-reperfusion group(n=8).The control group was balanced perfused with 37 ℃ Krebs-Henseleit solution for 15 minutes and then continued to be perfused with 37 ℃ Krebs-Henseleit solution for 90 minutes.The hypothermic ischemia-reperfusion group was balanced perfused with 37 ℃ Krebs-Henseleit solution for 15 minutes,and then the heart was arrested for 60 minutes by injection of 4 ℃ Thomas solution.During the cardiac arrest,the periphery was protected by 4 ℃ Krebs-Henseleit solution.Half-volume 4 ℃ Thomas solution was reperfused 30 minutes after the arrest.After stopping the arrest,the heart was reperfused with 37 ℃ Krebs-Henseleit solution for 30 minutes.The occurrence of arrhythmias,rebeating time,and the duration of arrhythmias were recorded from the immediate time point to the end of the reperfusion period.Conduction velocity,absolute inhomogeneity,and inhomogeneity index were measured using the Mapping Lab multi-channel electrophysiological mapping system at the time of balanced perfusion for 15 minutes(T1),reperfusion for 15 minutes/continuous perfusion for 90 minutes(T2),and reperfusion for 30 minutes/continuous perfusion for 105 minutes(T3).The relative expression levels of membrane-type matrix metalloproteinase 2,matrix metalloproteinase 2,collagen type Ⅳ,connexin 43,and its Ser368 phosphorylation in ventricular tissue were detected by western blot assay.RESULTS AND CONCLUSION:(1)No arrhythmia occurred in the control group.There were six cases of arrhythmia in the hypothermic ischemia-reperfusion group during reperfusion.Rebeating time and duration of arrhythmias were(25.38+12.02)and(158.67±67.68)seconds,respectively.(2)The conduction sochronal diagrams at T1,T2,and T3 in the control group were uniform and regular in direction,and the conduction velocity at T2 and T3 was not different from that at T1(P＞0.05).The conduction isochronal diagrams at T2 and T3 in the hypothermic ischemia-reperfusion group were uneven and irregular in direction,and the conduction velocity was slower than that at T1(P＜0.01).The conduction velocity at T2 and T3 in the hypothermic ischemia-reperfusion group was slower than that in the control group(P＜0.01).Conduction dispersion was greater in the hypothermic ischemia-reperfusion group than that in the control group at T2 and T3(P＜0.05).(3)Compared with the control group,the protein expressions of membrane-type matrix metalloproteinase 2 and matrix metalloproteinase 2 in the hypothermic ischemia-reperfusion group were increased(P＜0.05 or P＜0.01),and the protein expression levels of type Ⅳ collagen,connexin 43 and its Ser368 phosphorylation were decreased(P＜0.05 or P＜0.01).(4)The results indicate that after hypothermic ischemia-reperfusion,myocardial extracellular matrix remodeling may mediate the downregulation of myocardial connexin 43 and its Ser368 phosphorylation,slowed conduction velocity and increased conduction dispersion,thereby increasing the risk of arrhythmia.

Objective:To analyze the risk factors of non-suicidal self-injury behavior (NSSI) in women of childbearing age with depression, and construct a nomogram prediction model.Methods:Adopting cross-sectional research method and retrospective cohort study design, a total of 278 female patients of childbearing age with depression admitted to Shaoxing Seventh People′s Hospital from January 2022 to July 2024 were selected as the modeling group by convenience sampling method, and were divided into the NSSI group and the non-NSSI group according to whether the patients had NSSI. Another 104 cases of female depression patients of childbearing age admitted to hospital during the same period were selected as the verification group. The influencing factors were screened by multi-factor Logistic regression analysis, and the nomogram prediction model was constructed by R software "rms" package.Results:In the modeling group, there were 98 cases in the NSSI group with an age of (32.58 ± 6.96) years, and 180 cases in the non-NSSI group with an age of (32.73 ± 7.08) years. In the verification group, there were 36 cases in the NSSI group with an age of (32.92 ± 7.76) years, and 68 cases in the non-NSSI group with an age of (33.18 ± 7.59) years. Multi-factor Logistic regression analysis showed that depression degree ( OR=4.834, 95% CI 2.089-11.185), family relationships ( OR=5.121, 95% CI 1.987-13.197), sleep disorders ( OR=2.302, 95% CI 1.203-4.408), childhood trauma ( OR=2.332, 95% CI 1.235-4.402), impulsivity ( OR=2.227, 95% CI 1.168-4.248), and Defeat Scale score ( OR=1.144, 95% CI 1.085-1.206) were influence factors for NSSI in female depression patients of childbearing age (all P<0.05). The C-index of the prediction model constructed based on this was 0.847 (0.800-0.895), and the calibration curve was close to the ideal curve. The results of the decision curve showed that the predictive model provided a higher clinical net benefit. Conclusions:The nomogram prediction model based on depression degree, family relationship, sleep disorder, childhood trauma, impulsivity and Defeat Scale score provides important strategic guidance for predicting and evaluating the occurrence of NSSI in women of childbearing age with depression and clinical nursing intervention.

Objective To translate self-care in spinal cord injuries inventory(SC-SCII)into Chinese and evaluate its reliability and validity,therefore to provide medical staff with a tool for evaluation of self-care behaviour of patients.Methods Brislin translation model was adopted for forward translation,back-translation,cultural adaptation and pilot testing in the development of Chinese version of SC-SCII.Convenience sampling was used to recruit 207 patients with spinal cord injury(SCI)from three Tier-IIIA hospitals in Xi'an between January 2024 and March 2025 for the purpose of assessing the reliability and validity of the translated inventory.Results A total of 202 patients completed the study.The finalised Chinese version of SC-SCII encompassed 4 dimensions with a total of 35 items,with the same structure as the original SC-SCII.Scale-level content validity index was 0.948,and the item-level content validity indices ranged from 0.912 to 1.000.Four common factors were extracted by exploratory factor analysis:self-care maintenance(12 items),self-care monitoring(8 items),self-care management(8 items)and self-care self-efficacy(7 items),cumulatively accounting for 61.402%of the total variance.The overall Cronbach's α coefficient was 0.820 and the Cronbach's α coefficients of the four dimensions were 0.935,0.905,0.921 and 0.892,respectively.The split-half reliability was 0.798,and the two-week retest reliability was 0.875.No statistically significant difference was observed between the original and sinicised scales(paired t-test,P>0.05),indicating a high cross-time stability of the sinicised scale.Conclusion The Chinese version of SC-SCII demonstrates a good reliability and validity,making it a suitable tool in evaluation of self-care abilities in SCI patients.

BACKGROUND:Rev-erbα is involved in the regulation of inflammation,but pharmacological activation of Rev-erbα increases the risk for cardiovascular diseases.To reduce the relevant risk,an exploration on SR9009,a Rev-erbα agonist,combined with other drugs to relieve inflammation in skeletal myoblasts was conducted,laying the theoretical foundation for the treatment of inflammation-associated skeletal muscle atrophy. OBJECTIVE:To investigate the relationship of SR9009,indolepropionic acid and nuclear factor-κB signaling pathways in lipopolysaccharide-induced C2C12 myoblasts. METHODS:(1)C2C12 myoblasts were induced to differentiate in the presence of lipopolysaccharide(1 μg/mL).RNA-seq and KEGG pathway analysis were used to study signaling pathways.(2)C2C12 myoblast viability was assessed using the cell counting kit-8 assay to determine optimal concentrations of indolepropionic acid.Subsequently,cells were categorized into control group,lipopolysaccharide(1 μg/mL)group,SR9009(10 μmol/L)+lipopolysaccharide group,indolepropionic acid(80μmol/L)+lipopolysaccharide group,and SR9009+indolepropionic acid+lipopolysaccharide group.ELISA was employed to measure protein expression levels of interleukin-6 in the cultured supernatant.Real-time quantitative PCR were employed to measure mRNA expression levels of interleukin-6,tumor necrosis factor α,TLR4 and CD14.Western blot assay were employed to measure protein expression levels of NF-κB p65 and p-NF-κB p65.(3)After Rev-erbα was knocked down by siRNA,knockdown efficiency was assessed by RT-qPCR.And mRNA levels of interleukin-6 and tumor necrosis factor α were also measured. RESULTS AND CONCLUSION:Compared with the blank control group,lipopolysaccharide time-dependently inhibited myofibroblast fusion to form myotubes,the mRNA expression levels of interleukin-6 and tumor necrosis factor α were elevated,and the level of interleukin-6 in the cell supernatant was significantly increased.The results of KEGG pathway showed that the nuclear factor-κB signaling pathway was activated by lipopolysaccharide.Indolepropionic acid exhibited significant suppression of C2C12 myoblasts viability when its concentration exceeded 80 μmol/L.Indolepropionic acid and SR9009 inhibited the activation of NF-κB signaling pathway,thereby played an anti-inflammatory role,and suppressed the mRNA expression levels of interleukin-6,tumor necrosis factor α,TLR4 and CD14.Compared with the lipopolysaccharide group,the ratio of p-NF-κB p65/NF-κB p65 protein expression were downregulated.SR9009 combined with indolepropionic acid notably reduced lipopolysaccharide-induced inflammation,further downregulated the mRNA expression levels of interleukin-6,tumor necrosis factor α,TLR4 and CD14.The ratio of p-NF-κB p65/NF-κB p65 protein expression was significantly lower than that in the SR9009+lipopolysaccharide group or indolepropionic acid+lipopolysaccharide group.Rev-erbα increases time-dependently with lipopolysaccharide induction.The knockdown efficiency of Rev-erbα by siRNA reached over 58%,and lipopolysaccharide was added after Rev-erbα was successfully knocked down.Compared with the lipopolysaccharide group,the mRNA expression levels of interleukin-6 and tumor necrosis factor α were significantly up-regulated.These results conclude that Rev-erbα may act as a promising pharmacological target to reduce inflammation.SR9009 targeted activation of Rev-erbα combined with indolepropionic acid significantly inhibits the nuclear factor-κB signaling pathway and attenuates the inflammatory response of C2C12 myofibroblasts.Moreover,the combined anti-inflammatory effect is superior to that of the intervention alone.

Objective:To explore the correlation between serum ferritin (SF) and risk of lean non-alcoholic fatty liver disease (NAFLD), so as to provide the basis for the prevention and treatment of lean NAFLD.Methods:A total of 7 187 people without NAFLD at baseline who took at least 2 physical examinations in the Health Management Center of the Second Hospital of Dalian Medical University from January 2014 to December 2023 and met the selection criteria were selected as the research subjects, and all the subjects had no NAFLD at baseline. Subjects were divided into four groups according to baseline SF quartiles: 1 797 cases in the first quartile ( Q1) group, 1 797 cases in the second quartile ( Q2) group, 1 797 cases in the third quartile ( Q3) group, and 1 796 cases in the fourth quartile ( Q4) group. The incidence of lean NAFLD in each group were observed. Kaplan-Meier curve was plotted to calculate the cumulative incidence of lean NAFLD which compared by log-rank test. Cox proportional hazard regression model was used to analyze the correlation between SF and new-onset lean NAFLD, Q1, Q2, Q3 and Q4 of SF were taken as continuous variables into the model for trend test.The stability of the results was verified by two item sensitivity analyses. Time-dependent receiver operating characteristic curve (ROC) was plotted to evaluate the predictive value of SF for the onset of lean NAFLD. Results:The cumulative follow-up were 25 076 person-years. There were 230 new cases of lean NAFLD, and the incidence density was 9.172/1 000 person-years. The incidence densities of lean NAFLD in Q1, Q2, Q3 and Q4 groups were 6.915/1 000 person-years, 8.552/1 000 person-years, 9.641/1 000 person-years, 12.003/1 000 person-years, respectively. Kaplan-Meier curve indicated that the incidence of lean NAFLD was increased with the increment of SF, and the difference was statistically significant (log-rank test, χ2=9.92, P=0.019). Cox proportional hazard regression model results showed that the risk of developing lean NAFLD in Q4 group increased by 72.8% ( HR=1.728, 95% confidence interval (95% CI): 1.059 to 2.820) compared with Q1 group. Trend analysis revealed that the risk of lean NAFLD increased by 18.9% for each one-quartile increase of SF( HR=1.189, 95% CI: 1.012 to 1.396). Two sensitivity analyses indicated that the risk of NAFLD in Q4 group was 1.795 times ( HR=1.795, 95% CI: 1.083 to 2.975) or 1.654 times ( HR=1.654, 95% CI: 1.022 to 2.678) higher than that in Q1 group. The area under the curve (95% CI) of SF for predicting the incidence of lean NAFLD at 2-, 3-, 7- and 8-year follow-up based on time-dependent ROC were 0.645 (0.593 to 0.698), 0.652 (0.603 to 0.700), 0.605 (0.539 to 0.672) and 0.716 (0.597 to 0.836), respectively. Conclusion:SF is an independent risk factor for lean NAFLD and has predictive value for the new-onset of lean NAFLD.

Objective:To analyze the incidence, mortality, survival patterns, and distribution characteristics of modifiable risk factors for colorectal cancer in selected global regions.Methods:Secondary analysis was conducted using data from the GLOBOCAN database and previous literature. We described the number of cases and age-standardized rates (ASRs) of incidence and mortality for colorectal cancer in China, the United States, the United Kingdom, and globally in 2022 and 2020, with gender-stratified analysis. ASRs were calculated using Segi's world standard population. Temporal trends in 5-year net survival rates were compared across three periods (2000-2004, 2005-2009, 2010-2014) among countries. Regional distribution differences in colorectal cancer deaths attributable to modifiable risk factors by gender were assessed in China.Results:In 2022, global colorectal cancer incidence and mortality were estimated at 1.926 million new cases and 904 000 deaths. China accounted for 27% of both global incidence (517 000 cases) and mortality (240 000 deaths). China's age-standardized incidence rate (20.1 per 100 000) was lower than those of the United States (27.0 per 100 000) and the UK (30.9 per 100 000). However, China's mortality rate (8.6 per 100 000) exceeded that of the US (7.9 per 100 000) but was lower than the UK (11.8 per 100 000). Compared to 2020, China demonstrated significant mortality reductions in 2022: males declined from 14.8 to 10.9 per 100 000, females from 9.4 to 6.5 per 100 000. Five-year net survival rates in China improved across periods for colon cancer (51.4%, 55.6%, 57.6%) and rectal cancer (49.5%, 52.5%, 56.9%), yet remained consistently lower than US and UK rates. Modifiable risk factors contributed to 45.1% of male and 41.4% of female colorectal cancer deaths in China, with marked regional disparities.Conclusions:China exhibits higher colorectal cancer incidence and mortality than global averages, with survival gaps persisting compared to developed nations. Regionally tailored comprehensive prevention strategies are essential to reduce disease burden through risk factor modification and optimized clinical management.

Malignant tumors (commonly referred to as cancer) represent a major global public health challenge and contribute significantly to the worldwide disease burden. Early screening plays a critical role in improving detection rates, enabling timely intervention, and enhancing patient survival rates. However, current cancer screening guidelines primarily focus on site-specific screening, which may not fully address the need for comprehensive early detection. A scientifically rational, multi-cancer screening approach offers several advantages: it optimizes the use of biological samples, reduces time costs for participants, enhances the efficiency and comprehensiveness of screening, and minimizes overall expenses. Such an approach also facilitates the rational allocation of healthcare resources, ultimately helping to reduce the societal burden of cancer. To address this need, the Cancer Epidemiology Committee of the Chinese Anti-Cancer Association has developed the Expert Consensus on Combined Screening for Common Cancers in China. This consensus integrates multidisciplinary expertise and synthesizes the latest domestic and international researches on cancer screening, early detection, and treatment for prevalent malignancies. Drawing upon China's unique demographic and healthcare context, as well as practical screening experiences, the consensus provides evidence-based recommendations on target populations, screening technologies, and procedural workflows for multi-cancer screening. These guidelines align with the principles and methodologies established by the World Health Organization (WHO), aiming to enhance the effectiveness of combined cancer screening in China, improve early detection rates, and provide a scientific foundation for national cancer prevention and control strategies.