Bacillus is a class of spore-producing Gram-positive bacteria that produce a variety of antimicrobial substances with different structures and functions. The application of the antimicrobial substances produced by Bacillus can effectively inhibit the activity of harmful bacteria and fungi and promote the sustainable development of green agriculture. The antimicrobial substances produced by Bacillus mainly include proteins, lipopeptides, polyketones, and polypeptides. This paper reviews the synthesis gene clusters, synthesis pathways, structures, and mechanisms of various antimicrobial substances produced by Bacillus and discusses the challenges in the industrial application of these antimicrobial substances. Furthermore, this paper clarifies the future research and development focuses and prospects the application prospects, and provides comprehensive theoretical support for the in-depth research and wide application of the antimicrobial substances produced by Bacillus.
Bacillus/genetics* ; Anti-Infective Agents/metabolism* ; Bacterial Proteins/genetics* ; Antimicrobial Peptides/biosynthesis* ; Lipopeptides/biosynthesis*

Objective:To investigate the clinical features of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) manifested as epileptic seizures.Methods:Clinical data of a family with CADASIL manifested as epileptic seizures admitted to Department of Neurology, Tengzhou Central People's Hospital in December 2018 were collected. Literature on CADASIL manifested as epileptic seizures was collected from databases of CNKI, Wanfang, VIP and PubMed published from database establishment to July 31, 2024. Clinical, imaging and genetic test results of these 48 patients were analyzed.Results:The proband presented with recurrent generalized tonic-clonic seizure, and had history of cerebral infarction and cognitive impairment. His mother had a similar history. Multiple lacunar infarction and extensive white matter lesion (involving the temporal pole, external capsule and superior frontal gyrus) and intracranial artery stenosis (ICAS) was noted at the proband. His son had no clinical symptom, but had multiple white matter lesion, without temporal pole involvement or ICAS. The proband and his son had the same pathogenic heterozygous missense mutation site C.505 C>T(P. Arg169Cys) at NOTCH3 gene. Among these 48 patients, 25 (52.1%) had stroke and 33 (68.8%) had cognitive impairment. All patients showed white matter lesion on imaging, including 19 (39.6%) with temporal pole involvement, 21 (43.8%) with external capsule involvement, 38 (79.2%) with multiple lacunar infarction, and 2 (4.2%) with ICAS. Conclusion:ICAS is rare in patients with CADASIL manifested as epileptic seizures; cognitive impairment and stroke are often accompanied; extensive white matter lesion is the clue for diagnosis.

Cultivating intern's doctor-patient communication skills is crucial for fostering a patient-centered approach in medical practice.This process helps to overcome information gaps,cognitive and ideological barriers,and trust between doctors and patients,thereby laying a strong foundation for the interns' future careers.Clinical internships encompass several stages where doctor-patient communication is emphasized:during the preparation phase,while collecting medical history,throughout the treatment process,and before and after surgical procedures.Key strategies for developing these skills include clearly defining es-sential communication components,engaging in diverse communication practice activities,leveraging the guidance of instructors,and enhancing assessment,and evaluation mechanisms for communication skills.

Objective To prepare a stable rat model of chronic liver failure to provide a tool for basic research.Methods Sixty-six SPF SD rats were divided into a normal group(n=18)and a modeling group(n=48).Rats in the modeling group received an intraperitoneal injection of 50％CCl4 olive oil solution(1.5 mL/kg,twice a week).Multidimensional assessment was performed at 8,16,and 24 weeks,respectively,including ultrasonic examination of liver morphology,hardness,portal vein diameter,and ascites,and collection of serum,plasma,and liver tissue to detect liver function,coagulation function,and blood ammonia levels.Liver tissue injury and fibrosis were observed by hematoxylin-eosin(HE)and Masson staining.Cognitive function was assessed using the water maze test.Survival were recorded simultaneously.Results Rats in the model group showed decreased activity and appetite,yellow urine,and increased abdominal circumference compared with the normal group.Ultrasound showed enhanced liver parenchyma echo in the model group that thickened with time,secondary ascites formation,portal vein dilation,and portal hypertension.Water maze and blood ammonia tests confirmed cognitive decline(memory and orientation loss)and hepatic encephalopathy in the model group.Gross observation showed that the liver in the model group was atrophied and appeared rough and uneven.HE staining showed hepatocyte swelling,steatosis,and necrosis,and Masson staining confirmed fibrosis progression with pseudolobule formation.The liver function indexes AST,ALT,TBIL and blood ammonia continued to increase,and coagulation dysfunction(prolonged PT and increased INR)gradually increased with the modeling process.Conclusions Intraperitoneal injection of 50％CCl4 olive oil solution(1.5 mL/kg,every week)for 24 weeks can stably simulate persistent chronic liver injury in rats and lead to the typical pathological changes and complications of chronic liver failure,based on the decompensation stage of cirrhosis.This model replicates the pathological evolution of human hepatitis from liver fibrosis → liver cirrhosis compensation → decompensation → chronic liver failure,providing a reliable modeling reference for the study of the mechanism of chronic liver failure.

Cultivating intern's doctor-patient communication skills is crucial for fostering a patient-centered approach in medical practice.This process helps to overcome information gaps,cognitive and ideological barriers,and trust between doctors and patients,thereby laying a strong foundation for the interns' future careers.Clinical internships encompass several stages where doctor-patient communication is emphasized:during the preparation phase,while collecting medical history,throughout the treatment process,and before and after surgical procedures.Key strategies for developing these skills include clearly defining es-sential communication components,engaging in diverse communication practice activities,leveraging the guidance of instructors,and enhancing assessment,and evaluation mechanisms for communication skills.

Objective To prepare a stable rat model of chronic liver failure to provide a tool for basic research.Methods Sixty-six SPF SD rats were divided into a normal group(n=18)and a modeling group(n=48).Rats in the modeling group received an intraperitoneal injection of 50％CCl4 olive oil solution(1.5 mL/kg,twice a week).Multidimensional assessment was performed at 8,16,and 24 weeks,respectively,including ultrasonic examination of liver morphology,hardness,portal vein diameter,and ascites,and collection of serum,plasma,and liver tissue to detect liver function,coagulation function,and blood ammonia levels.Liver tissue injury and fibrosis were observed by hematoxylin-eosin(HE)and Masson staining.Cognitive function was assessed using the water maze test.Survival were recorded simultaneously.Results Rats in the model group showed decreased activity and appetite,yellow urine,and increased abdominal circumference compared with the normal group.Ultrasound showed enhanced liver parenchyma echo in the model group that thickened with time,secondary ascites formation,portal vein dilation,and portal hypertension.Water maze and blood ammonia tests confirmed cognitive decline(memory and orientation loss)and hepatic encephalopathy in the model group.Gross observation showed that the liver in the model group was atrophied and appeared rough and uneven.HE staining showed hepatocyte swelling,steatosis,and necrosis,and Masson staining confirmed fibrosis progression with pseudolobule formation.The liver function indexes AST,ALT,TBIL and blood ammonia continued to increase,and coagulation dysfunction(prolonged PT and increased INR)gradually increased with the modeling process.Conclusions Intraperitoneal injection of 50％CCl4 olive oil solution(1.5 mL/kg,every week)for 24 weeks can stably simulate persistent chronic liver injury in rats and lead to the typical pathological changes and complications of chronic liver failure,based on the decompensation stage of cirrhosis.This model replicates the pathological evolution of human hepatitis from liver fibrosis → liver cirrhosis compensation → decompensation → chronic liver failure,providing a reliable modeling reference for the study of the mechanism of chronic liver failure.

Objective:To investigate the clinical features of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) manifested as epileptic seizures.Methods:Clinical data of a family with CADASIL manifested as epileptic seizures admitted to Department of Neurology, Tengzhou Central People's Hospital in December 2018 were collected. Literature on CADASIL manifested as epileptic seizures was collected from databases of CNKI, Wanfang, VIP and PubMed published from database establishment to July 31, 2024. Clinical, imaging and genetic test results of these 48 patients were analyzed.Results:The proband presented with recurrent generalized tonic-clonic seizure, and had history of cerebral infarction and cognitive impairment. His mother had a similar history. Multiple lacunar infarction and extensive white matter lesion (involving the temporal pole, external capsule and superior frontal gyrus) and intracranial artery stenosis (ICAS) was noted at the proband. His son had no clinical symptom, but had multiple white matter lesion, without temporal pole involvement or ICAS. The proband and his son had the same pathogenic heterozygous missense mutation site C.505 C>T(P. Arg169Cys) at NOTCH3 gene. Among these 48 patients, 25 (52.1%) had stroke and 33 (68.8%) had cognitive impairment. All patients showed white matter lesion on imaging, including 19 (39.6%) with temporal pole involvement, 21 (43.8%) with external capsule involvement, 38 (79.2%) with multiple lacunar infarction, and 2 (4.2%) with ICAS. Conclusion:ICAS is rare in patients with CADASIL manifested as epileptic seizures; cognitive impairment and stroke are often accompanied; extensive white matter lesion is the clue for diagnosis.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Cancer immunotherapy has great potential and is expected to become the mainstream method of cancer treatment.In the current application of cancer immunotherapy,immune checkpoint inhibitors(ICIs)have achieved remarkable results.The cur-rently widely used ICIs in clinical practice include inhibitors targeting cytotoxic T lymphocyte-associated antigen-4(CTLA-4),pro-grammed death-1(PD-1)and programmed death-ligand 1(PD-L1).In addition,new immunotherapies such as oncolytic viruses and chimeric antigen receptor T cells are gradually entering the clinical practice,and combination therapy related to ICIs has shown unique advantages.This article will focus on the current application status of ICIs,oncolytic viruses,and chimeric antigen receptor T cell ther-apies in solid tumors either their individual or combined forms.