BACKGROUND:Neuregulin 1 has been shown to be characterized in cell proliferation,differentiation,and vascular growth.Human amniotic mesenchymal stem cells are important seed cells in the field of tissue engineering,and have been shown to be involved in tissue repair and regeneration. OBJECTIVE:To construct human amniotic mesenchymal stem cells overexpressing neuregulin 1 and investigate their proliferation and migration abilities,as well as their effects on wound healing. METHODS:(1)Human amniotic mesenchymal stem cells were in vitro isolated and cultured and identified.(2)A lentivirus overexpressing neuregulin 1 was constructed.Human amniotic mesenchymal stem cells were divided into empty group,neuregulin 1 group,and control group,and transfected with empty lentivirus and lentivirus overexpressing neuregulin 1,or not transfected,respectively.(3)Edu assay was used to detect the proliferation ability of the cells of each group,and Transwell assay was used to detect the migration ability of the cells.(4)The C57 BL/6 mouse trauma models were constructed and randomly divided into control group,empty group,neuregulin 1 group,with 8 mice in each group.Human amniotic mesenchymal stem cells transfected with empty lentivirus or lentivirus overexpressing neuregulin-1 were uniformly injected with 1 mL at multiple local wound sites.The control group was injected with an equal amount of saline.(5)The healing of the trauma was observed at 1,7,and 14 days after model establishment.Histological changes of the healing of the trauma were observed by hematoxylin-eosin staining.The expression of CD31 on the trauma was observed by immunohistochemistry. RESULTS AND CONCLUSION:(1)Human amniotic mesenchymal stem cells overexpressing neuregulin-1 were successfully constructed.The mRNA and protein expression of intracellular neuregulin 1 was significantly up-regulated compared with the empty group(P<0.05).(2)The overexpression of neuregulin 1 promoted the migratory ability(P<0.01)and proliferative ability of human amniotic mesenchymal stem cells(P<0.05).(3)Human amniotic mesenchymal stem cells overexpressing neuregulin 1 promoted wound healing in mice(P<0.05)and wound angiogenesis(P<0.05).The results showed that overexpression of neuregulin 1 resulted in an increase in the proliferative and migratory capacities of human amniotic mesenchymal stem cells,significantly promoting wound healing and angiogenesis.

During the treatment of non-small cell lung cancer ( NSCLC) , many patients have developed drug resistance due to the use of targeted EGFR inhibitors. The main reasons for drug resistance are EGFR site mutations and bypass activation. Activation of ALK pathway is one of the major types of bypass activation. A recent authoritative study indicates that ALK is closely related to immunotherapy. This article reviews the treatment of ALK in tumors from three aspects: the structure and physiological function of ALK, the small molecule inhibitor of ALK, the biological function of ALK and its related treatment methods for NSCLC, and prospects future directions for better application of ALK in the treatment of NSCLC.

【Objective】 To evaluate the therapeutic effect of probiotics on core symptoms in patients with autism spectrum disorder (ASD), in order to provide theoretical basis for the treatment and intervention of ASD. 【Method】 Articles published from January 2000 to May 2023 on the effect of probiotics on core symptoms in ASD children were retrieved from 7 databases, including Chinese Biomedical Literature Service System (SinoMed), Wanfang Data Knowledge Service Platform, VIP Citation Database, and China National Knowledge Infrastructure (CNKI), PubMed, Embase, and Web of Science.Meta-analysis was performed using RevMan 5.4.Effect size, combine heterogeneity test sensitivity analysis and subgroup analysis were calculated. 【Result】 Totally 10 studies with 343 patients were included in this Meta-analysis.Meta-analysis showed that there was statistically significant difference in ASD core symptom score between the intervention group and the control group (SMD=-0.34, 95%CI: -0.55 - -0.12, P<0.05).Subgroup analysis showed that the efficacy of the trial conducted in Asian populations was not significant (SMD=-0.32, 95%CI: -0.63 - 0.00, P=0.05).In Caucasian populations, the therapeutic effect was significant (SMD=-0.35, 95%CI: -0.65 - -0.06, P<0.05).Grouped by age, it was found that the efficacy was not significant in trials involving adults (SMD=-0.12, 95%CI: - 0.57 - 0.33, P=0.61), but significant in trials involving only minors (SMD=-0.40, 95%CI: -0.65 - -0.16, P<0.05).According to the treatment course grouping, the intervention for less than 3 months (SMD=-0.35, 95%CI: -0.66 - -0.03, P<0.05) and more than 3 months (SMD=-0.33, 95%CI: -0.62 - -0.03, P<0.05) showed significant therapeutic efficacy.Grouped by bacterial strains, the efficacy of a single microbial community was not significant (SMD=-0.16, 95%CI: -0.46 - 0.15, P>0.05), while the efficacy of a composite microbial community was significant (SMD=-0.51, 95%CI: -0.81 - -0.21, P<0.05). 【Conclusions】 Probiotic therapy is effective in improving the core symptoms of ASD patients, but is influenced by factors such as race, age and probiotic strain. Composite microbiota has better efficacy in Caucasian and underage populations.

Idiopathic pulmonary fibrosis (IPF) is a terminal disease of the lung. Its pathogenesis mechanism and pathogenesis evolution are very complex, which is closely related to epithelial-mesenchymal transformation (EMT). Under the guidance of the theory of "deficient-qi induced stagnation", this article elaborated on the relationship between IPF, "deficient-qi induced stagnation", and EMT from the perspective of TCM and Western medicine. It is believed that "deficient-qi induced stagnation" is the macroscopic pathogenesis of IPF, and EMT is the microscopic mechanism of IPF. The micro-mechanism was to inhibit EMT as the treatment target to prevent epithelial cell injury and apoptosis, thus reducing the release of inflammatory factors, pro-fibrosis factors and other factors that damage lung tissue and the transformation of damaged epithelial cells into fibroblasts and produce a large number of ECM deposition; the occurrence and development process of IPF was summarized in the macro pathogenesis. It was highly condensed that IPF was based on "deficiency-qi", "stagnation" as the standard, and the basic pathogenesis characteristics of "stagnation" due to deficiency, as well as the pathogenesis development characteristics of the vicious cycle of "deficiency leads to stagnation, and from stagnation to deficiency". Based on the theory of "deficient-qi induced stagnation", it should be used to tonify deficiency and clear stagnation; tonifying deficiency includes replenishing lung qi, benefiting qi and nourishing yin, and mutual generation between metal and water; clearing stagnation includes circulating qi and blood, drying the wetness and eliminating phlegm, and promoting blood circulation for removing obstruction in collaterals, etc. In clinical application, attention should be paid to the fact that tonifying deficiency and clearing stagnation should be used in parallel.

Clinical decision support system is a system that utilizes models or knowledge bases to assist clinical decision-making through human-computer interaction for semi-structured or unstructured clinical problems, with the aim of reducing decision-making errors among medical staff and improving the quality of medical and nursing services. In recent years, clinical decision support system has attracted wide attention in the field of clinical nursing of Traditional Chinese Medicine. This paper will review the development status, application advantages and existing problems of clinical decision support system in the field of clinical nursing of Traditional Chinese Medicine, aiming to provide reference for the development of a more specialized and systematic clinical decision support system for clinical nursing of Traditional Chinese Medicine.

Objective To establish a scientific and systematic quality evaluation system for the implementation of TCM nursing programs,and to provide references for promoting the standardized implementation and quality improvement of TCM nursing programs.Methods From October 2023 to December 2023,a research team was set up to form the first draft of the quality evaluation system for the implementation of TCM nursing programs based on the"structure-process-results"three-dimensional quality model,by combining literature research and focus group interviews,and the quality evaluation system for the implementation of TCM nursing programs was formulated by means of Delphi expert letter consultation and analytic hierarchy process.Results 2 rounds of professional consultations resulted in an excellent recovery rate of 100％;the expert authority coefficients were 0.853 and 0.958;the Kendall harmony coefficients of expert opinions were 0.151 and 0.152,respectively.Finally,the quality evaluation system of TCM nursing program implementation was determined,including 3 first-level indicators,including structure,process and result.There are 6 secondary indicators,including system management,implementation management,quality management,effect evaluation,safety evaluation,and satisfaction evaluation.There are 18 three-level indicators,including the implementation management system of TCM nursing program and regular optimization of TCM nursing program.Conclusion The quality evaluation system for the implementation of TCM nursing programs is scientific and reliable,but its practicability needs to be tested in clinical practice.

Objective To investigate the genetic diversity and genetic differentiation of different geographical isolates of Gohieria fusca.. Methods G. fusca isolates were sampled from Wuhu (WH), Bengbu (BB) and Bozhou cities (BZ) of Anhui Province and Jiaxing City of Zhejiang Province (JX). Mitochondrial cytochrome b (Cytb) and ribosomal internal transcribed spacer (ITS) genes were amplified in WH, BB, BZ and JX isolates of G. fusca using PCR assay. The gene sequences were edited and aligned using the software Chromas 2 and DNASTAR 1.00, and the haplotype, haplotype diversity (Hd) and nucleotide polymorphism (Pi) of each isolate were calculated using the software DnaSP 5.10.00. The genetic differentiation among isolates (F_st) and gene flow value (N_m) were estimated using the software MEGA 10.2, and a phylogenetic tree was built. Tests of neutrality and analysis of molecular variance (AMOVA) were performed using the software Arlequin 3.1 and a haplotype network was built based on the Median-Joining network using the software Network 10.2. Results PCR assay showed that the sizes of the Cytb and ITS genes were 372 bp and 1 301 to 1 320 bp, respectively. All four isolates of G. fusca presented high genetic diversity based on mitochondrial Cytb and ITS genes (Hd = 0.804, Pi = 0.006 91). AMOVA showed genetic differentiation among geographical isolates of G. fusca (F_st = 0.202 40, P < 0.05), and the genetic variation was mainly caused by intra-population variations (79.76%). Gene flow analysis showed a high level of gene flow among G. fusca isolates (N_m > 1). Tests of neutrality based on Cytb gene measured a Tajima’s D value of −1.796 31 (P < 0.05) and a Fu’s FS value of −3.293 98 (P < 0.05) in WH isolate of G. fusca, indicating population expansion in WH isolate of G. fusca. Haplotype network analysis and phylogenetic analysis revealed no remarkable geographical distribution pattern among different geographical isolates of G. fusca. All four isolates of G. fusca presented high genetic diversity (Hd = 0.985, Pi = 0.011 97). AMOVA showed moderate level of genetic differentiation between four isolates (F_st = 0.104 62, P < 0.05). The tests of neutrality based on ITS genes measured a Tajima’s D value of −6.088 20 and a Fu’s FS value of −1.935 99 (both P > 0.05) in the whole isolate of G. fusca, indicating no obviously population expansion. Conclusions The four geographical isolates of G. fusca have high genetic diversity and remarkable genetic differentiation. Since a high level of gene flow is detected among different geographical isolates of G. fusca, no obvious geographical distribution pattern of G. fusca is found.

To investigate the effect of long-term indwelling gastric tube on the prevention and treatment of esophageal stenosis after endoscopic submucosal dissection (ESD) for esophageal circumferential superficial cancer, data of patients with esophageal circumferential superficial cancer who underwent ESD in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021 were retrospectively analyzed. There were 15 patients with gastric tube placement (GTP) after ESD (the GTP group ), and 23 patients without GTP (the non-GTP group). The general information, lesion location, pathological stage, postoperative complications, degree of esophageal stenosis (water intake), pain conditions, number of hospitalizations and medical expenses were compared between the two groups. The results showed that there was no significant difference in age, gender, lesion location or postoperative pathological stage between the two groups ( P>0.05). Compared with the non-GTP group, the rate of water intake in the GTP group was significantly higher (11/15 VS 6/23, P<0.05), the frequency of pain was less in the GTP group (7.3±3.1 times VS 10.7±3.6 times, t=3.00, P<0.05), and the number of hospitalizations and the medical expenses after ESD to before and after stent placement were significantly lower in the GTP group than those in the non-GTP group ( P<0.05). There were no significant differences in the incidence of delayed bleeding and perforation, or time of the first stenosis after ESD between the two groups ( P>0.05). The results of the study initially showed that long-term indwelling gastric tube after ESD can reduce the degree of esophageal stenosis with good safety for esophageal circumferential superficial lesions.

Objective:To systematically evaluate the effect of virtual reality technology in postoperative rehabilitation of patients with total knee and hip arthroplasty replacement.Methods:Randomized controlled trials of the effect of virtual reality technology in postoperative rehabilitation of patients with total knee and hip arthroplasty replacement were searched through PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, CBM, VIP and Wanfang data.The retrieval period was from the establishment of database to November 25, 2021. Literature screening, information extraction and quality evaluation were conducted by 2 researchers. RevMan 5.4 software was used for Meta-analysis.Results:A total of 9 literatures and 668 patients were included. The Meta-analysisresults showed that virtual reality technology compared with traditional rehabilitation methods could reduce pain score ( MD=-0.64, 95% CI: -0.86--0.42, P<0.001), improve joint function ( MD=-4.46, 95% CI: -5.85--3.07, P<0.001; MD=9.78, 95% CI: 6.61-12.95, P<0.001; SMD=1.84, 95% CI: 0.85-2.83, P<0.001), increase joint range of motion ( MD=7.25, 95% CI: 6.48-8.02, P<0.001), improve patient's balance function ( MD=6.20, 95% CI: 5.01-7.38, P<0.001) and quality of life ( SMD=1.30, 95% CI: 0.90-1.71, P<0.001) . Conclusions:Virtual reality technology can improve joint function, range of motion, balance function and quality of life of patients with total knee and hip arthroplastyreplacement, reduce pain scores. However, the existing evidence cannot prove the effect of virtual reality technology on psychological function, enthusiasm and interest of patients, and further discussion is needed in the future.

Objective:To establish a clinical diagnostic scoring model for preoperative predicting hepatocellular carcinoma (HCC) microvascular invasion (MVI) based on gadolinium-ethoxybenzyl-diethylenetriamine pentacetic acid (Gd-EOB-DTPA) enhanced MRI, and verify its effectiveness.Methods:From January 2014 to December 2020, a total of 251 cases with pathologically confirmed HCC from Tianjin First Central Hospital and Jilin University First Hospital were retrospectively collected to serve as the training set, while 57 HCC patients from Tianjin Medical University Cancer Hospital were recruited as an independent external validation set. The HCC patients were divided into MVI positive and MVI negative groups according to the pathological results. The tumor maximum diameters and apparent diffusion coefficient (ADC) values were measured. On the Gd-EOB-DTPA MRI images, tumor morphology, peritumoral enhancement, peritumoral low intensity (PTLI), capsule, intratumoral artery, intratumoral fat, intratumoral hemorrhage, and intratumoral necrosis were observed. Univariate analysis was performed using the χ 2 test or the independent sample t-test. The independent risk factors associated with MVI were obtained in the training set using a multivariate logistic analysis. Points were assigned to each factor according to the weight value to establish a preoperative score model for predicting MVI. The receiver operating characteristic (ROC) curve was used to determine the score threshold and to verify the efficacy of this scoring model in predicting MVI in the independent external validation set. Results:The training set obtained 98 patients in the MVI positive group and 153 patients in the MVI negative group, while the external validation set obtained 16 patients in the MVI positive group and 41 patients in the MVI negative group. According to logistic analysis, tumor maximum diameter>3.66 cm (OR 3.654, 95%CI 1.902-7.018), hepatobiliary PTLI (OR 9.235, 95%CI 4.833-16.896) and incomplete capsule (OR 6.266, 95%CI 1.993-9.345) were independent risk factors for MVI in HCC, which were assigned scores of 3, 4 and 2, respectively. The total score ranged from 0 to 9. In the external validation set, ROC curve analysis showed that the area under the curve of the scoring model was 0.918 (95%CI 0.815-0.974, P=0.001). When the score>4 was used as the threshold, the accuracy, sensitivity, and specificity of the model in predicting MVI were 84.2%, 81.3%, and 85.4%, respectively. Conclusions:A scoring model based on Gd-EOB-DTPA-enhanced MRI provided a convenient and reliable way to predict MVI preoperatively.