ObjectiveTo investigate the effect and mechanism of modified Guizhi Fulingwan in preventing colorectal adenoma （CRA） in mice by regulating mitochondrial apoptosis pathway through the regulation of the phosphatase and tensin homolog （PTEN）/phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） pathway. MethodSixty SPF-grade male C57BL/6 mice were randomly divided into six groups： Normal group， model group， low， medium， and high dose groups of modified Guizhi Fulingwan （13， 26， 52 g·kg^-1·d^-1）， and positive control aspirin group （0.015 g·kg^-1·d^-1）. A mouse model of CRA was chemically induced using azoxymethane （AOM） and dextran sulfate sodium （DSS）. During the modeling process， mice received modified Guizhi Fulingwan or aspirin. Body weight of mice was measured weekly during the treatment. After 9 weeks， the number of adenomas formed was observed. Serum levels of tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and interleukin-1β （IL-1β） were determined by enzyme-linked immunosorbent assay （ELISA）. Hematoxylin-eosin （HE） staining was used to observe the histopathologic changes in adenoma tissues. The expression of Cyclin D₁ and proliferative nuclear antigen （Ki67） was detected by immunohistochemistry （IHC）. Terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） was used to assess the apoptosis in adenoma tissues. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot were used to observe the mRNA and protein expression levels of PTEN， PI3K， Akt， phosphorylated PI3K （p-PI3K）， phosphorylated Akt （p-Akt）， B-cell lymphoma-2 （Bcl-2）， Bcl-2 associated X protein （Bax）， cytochrome C （Cyt C）， Caspase-9， and caspase-3. ResultCompared with the normal group， the model group showed no significant change in body weight from week 1 to week 2， but a significant decrease from week 3 to week 9 （P<0.05，P<0.01）. The colorectal length was significantly shortened， and the colorectal weight increased with visible varying sized tumor-like protrusions on the mucosal surface （P<0.01）. Serum levels of TNF-α， IL-6， and IL-1β were elevated （P<0.01）. Histopathology showed disordered epithelial gland structure， elongated nuclei with pathological mitosis， and numerous lymphocytic infiltrations in the lamina propria. The positive expression rates of Cyclin D₁ and Ki67 were significantly increased （P<0.01）， while the apoptosis rate of adenoma cells was significantly decreased （P<0.01）. Expression levels of PI3K， Akt， Bcl-2 mRNA and proteins， as well as p-PI3K and p-Akt proteins， were significantly increased （P<0.01）， whereas PTEN， Bax， Cyt C， Caspase-9， and Caspase-3 mRNA and protein levels were significantly decreased （P<0.05， P<0.01）. Compared with the model group， all drug treatment groups showed an increase in body weight （P<0.01）， decreased intestinal weight， increased colorectal length， reduced number of adenomas significantly （P<0.05， P<0.01）， and significantly lowered serum levels of TNF-α， IL-6， and IL-1β （P<0.01）. Histopathology indicated improved glandular structure and reduced neutrophil infiltration in the mucosal lamina propria. The positive expression rates of Cyclin D₁ and Ki67 significantly decreased （P<0.01）， while the apoptosis rate of adenoma cells significantly increased （P<0.05， P<0.01）. Expression levels of PI3K， Akt， Bcl-2 mRNA and proteins， and p-PI3K and p-Akt proteins were significantly reduced （P<0.05， P<0.01）， while PTEN， Bax， Cyt C， Caspase-9， and Caspase-3 mRNA and protein levels significantly increased （P<0.05， P<0.01）. The high-dose modified Guizhi Fulingwan group exhibited the most significant intervention effects. ConclusionModified Guizhi Fulingwan may prevent CRA in mice by regulating the PTEN/PI3K/Akt signaling pathway and inducing the mitochondrial apoptosis pathway.

OBJECTIVE To elucidate the mechanisms responsible for the inhibitory effects of limonene on the proliferation of non-small cell lung cancer(NSCLC) by non-targeted metabolomics and additional approaches. METHODS The CCK-8 assay was utilized to evaluate the inhibitory effects of limonene on NSCLC A549 cell viability and to ascertain the IC50. In vitro experiments, encompassing colony formation, flow cytometry, iron content assessment, and mitochondrial staining, were conducted to assess the anti-lung cancer and iron-induced cell death effects of limonene. Metabolomic analysis was employed to identify potential pathways influenced by limonene, and Western blotting was carried out to validate pivotal proteins within these pathways. RESULTS In comparison to the control group, the limonene-treated group demonstrated a significant, dose-dependent reduction in A549 cell proliferation and colony formation. Optical microscopy revealed cellular detachment and pronounced changes in cellular morphology following exposure to limonene. Limonene induced apoptosis in A549 cells and arrested them in the G0-G1 phase of the cell cycle. Confocal microscopy unveiled diminished mitochondrial fluorescence and an augmented intracellular iron content, indicative of the classical phenomenon of ferroptosis. Metabolomic investigations unveiled divergent metabolic pathways, including glutathione(GSH) metabolism, arginine biosynthesis, D-glutamine and D-glutamate metabolism, as well as cysteine and methionine metabolism, with many of them intricately linked to intracellular GSH synthesis. Western blotting experiments underscored a marked reduction in the levels of SLC40A1, SLC7A11(xCT), and GPX4 proteins within the cells post-limonene treatment. CONCLUSION Limonene may induce ferroptosis in lung cancer cells by reducing GSH synthesis and increasing Fe2+ levels.

Objective:To compare the clinical efficacy and safety of Shuo Tong ureteroscopy(ST-URS) and flexible ureteroscope(FURS)combined with holmium laser lithotripsy in the treatment of upper ureteral calculi with CT numerical value ≥ 1000 HU.Methods:A retrospective analysis of the clinical data of patients of upper ureteral calculi with CT numberical value≥1000 HU in the First Affiliated Hospital of Xiamen University was made from January 2018 to November 2020.There were 61 cases treated with ShuoTong ureteroscopy holmium laser lithotripsy (ST-URS group), including 45 males and 16 females, with 40 on the left and 21 on the right, age of(48.3±12.7) years, body mass index of(24.7±2.7)kg/m 2, the diameter of stone of(1.50±0.45)cm, and the CT numberical value of(1 288.8±179.0)(1 017-1 738)HU. There were 87 cases were treated with flexible ureteroscopy holmium laser lithotripsy (FURS group), including 58 males and 29 females, with 56 on the left and 31 on the right, age of(48.5±13.0) years, body mass index of(24.1±3.8)kg/m 2, the stone diameter of(1.45±0.40)cm, and the CT numberical value of(1 311.3±188.9)(1 009-1 817)HU. There were no significant differences in gender, age, body mass index, the location of stone, the diameter of stone and the CT numberical value of stone( P>0.05)between the two groups. For ST-URS group, a rigid ureteral channel sheath and standard mirror(F7.5/11.5)were placed under direct vision, exiting the standard mirror, leaving the channel sheath, inserting a lithotripsy mirror(F4.5/6.5)and a holmium laser[Power: 8-30 W(0.4-1.0 J/20-30 Hz)], and withdrawing the stone fragments after crushing the stone by "nibbling method" . For FURS group, a hard ureteroscope(F8/9.8)was used to explore the lesion side of the ureter, inserting a guide wire and placing a soft ureteral sheath, then inserting a flexible ureteroscope(F8)for holmium laser lithotripsy, and useing a stone basket to remove larger stone fragments. Ureteral stent was routinely indwelled after the operation. On the day 1 and 1 month after the operation, imaging examinations were performed to evaluate the stone-free rate. No residual stones or the diameter of stone was ≤0.4 cm and no urinary tract infection or any symptoms were defined as stone free. The operation time, blood loss, success rate of stage Ⅰ ureteral access sheath placement, incidence of postoperative complications, stone-free rate(SFR) at 1 day after operation, SFR at 1 month after operation, postoperative hospital stay and hospitalization costs were compared between the two groups. According to the size of calculi, the 2 groups were divided into 2 subgroups(≥1.5 cm and <1.5 cm)in order to make further analysis. The operation time, stone-free rate(SFR) at day 1 after operation and SFR at 1 month after operation were compared between the two groups. Results:The operation time of the ST-URS group was shorter than the FURS group(40.10 min vs. 49.43 min, P=0.020), and the incidence of postoperative complications was lower than the FURS group[3.28%(2/61)vs. 13.79%(12/87), P=0.031]. The SFR at day 1 after operation was significantly higher than the FURS group[60.7%(37/61)vs. 25.3%(22/87), P<0.01], and the hospitalization cost was lower than that of the FURS group(27 686 yuan vs. 32 281 yuan, P<0.010). There were no significant differences in the blood loss[(4.92±9.51)ml vs.(3.95±6.04)ml, P=0.452], success rate of stageⅠureteral access sheath placement[ 96.7%(59/61)vs. 96.6%(84/87), P=1.000], SFR at 1 month after operation[81.97%(50/61) vs. 75.86%(66/87), P=0.375] and postoperative hospital stay[(2.5±1.4)d vs.(2.4±0.8)d, P=0.543] between the two groups. When the size of calculi was ≥1.5cm, the operation time of the ST-URS group was shorter than the FURS group (43.67 min vs 55.00 min), the SFR at 1 day after operation was higher than the FURS group[40.00%(12/30)vs. 9.38%(3/32)], and the above differences are all statistically significant ( P<0.05). Conclusions:Compared with the FURS, for the treatment of upper ureteral calculi with CT numerical value ≥1000 HU, the ST-URS has shorter in operative time, lower in hospitalization cost and incidence of postoperative complications and higher SFR at day 1 after operation. The ST-URS is a safe and effective surgical technique, which is superior in the treatment of larger(≥1.5 cm) stones.

In recent years, the incidence of single-gene nephrolithiasis has been increasing year by year. With the application of whole-genome analysis and whole-exome sequencing technology, the etiology of single-gene mutations leading to the development of urinary calculi has been extensively verified. Therefore, this article reviews the research on urinary calculi-related genetic diseases at home and abroad, and introduces transport proteins and channels; ions, protons and amino acids. The role of urinary calculi in the majority of clinicians realizes the significance of genetic testing in such diseases, thereby increasing the understanding of genetically related urinary calculi and improving the level of clinical diagnosis and treatment.

ObjectiveTo investigate the quality of Amomi Fructus in the market， and to compare the difference between the seed mass and shell， so as to provide a basis for standardizing the usage of Amomi Fructus. MethodThe properties， thin layer identification， moisture， the content of bornyl acetate were determined by the methods in the 2020 edition of Chinese Pharmacopoeia， and the ash and extract content were determined according to the collection method of the 2020 edition of Chinese Pharmacopoeia. ResultAmong the 17 batches of samples， except the content of bornyl acetate in 2 batches of Amomum longiligulare， 2 batches of A. longiligulare and A. villosum mixture was lower than the standard， the quality of other samples all met the standard of the 2020 edition of Chinese Pharmacopoeia， but there were two specifications with shell and without shell. The husk rate， volatile oil， extract and bornyl acetate contents of the seed mass and shell were tested. It was found that the content of volatile oil in three kinds of Amomi Fructus seed mass was 1.8-5.3 times that of the corresponding shell， and the content of bornyl acetate in the seed mass was 8.8-62.1 times that of the corresponding shell， but there was little difference in the extract content. ConclusionBased on the above research， it is considered that the content of bornyl acetate in A. longiligulare contained in the 2020 edition of Chinese Pharmacopoeia remains to be discussed. It is tentatively determined that the total ash content of Amomi Fructus should not be more than 10.0%， and the extract content should not be less than 15.0%. At the same time， it is suggested that when Amomi Fructus is used as medicine， the dosage of Amomi Fructus should be calculated according to the removal rate of 20%-30% of shell， and it should be crushed regardless of whether it is used in shell or not.

Objective:To analyze the prognostic factors and evaluate the accuracy of existing survival prediction models in patients with lung cancer-derived spinal metastases who have undergone open surgery.Methods:According to the inclusion criteria, the data of 76 patients with spinal metastasis of lung cancer who underwent open surgery in the department of Orthopedics in Guangdong Provincial People's Hospital were collected from January 2019 to November 2021. The relationship between the number of bone metastasis, pathological type, visceral metastasis, epidermal growth factor receptor mutation, serum alkaline phosphatase (ALP), hemoglobin (Hb), Frankel grade and postoperative survival time in 76 cases was analyzed by Cox logical regression analysis and Kaplan-Meier method to determine the potential prognostic factors. The accuracy of Tomita score, Tokuhashi revised score, Katagiri New score, New England Spinal Metastasis Score score (NESMS) and Skeletal Oncology Research Group (SORG) machine learning algorithm in predicting postoperative survival time was verified by drawing receiver operating characteristic (ROC) curve.Results:The median follow-up time of the patients was 18.0 months (2.3-36.0 months). The median survival time was 12.6 months [95% CI (10.8, 14.4)]. The survival rates at 6 and 12 months after operation were 71.6% and 52.0%, respectively. Multivariate regression analysis showed that ALP [ HR=0.23, 95% CI (0.11, 0.48), P<0.001], Hb [ HR=4.48, 95% CI (2.07, 9.70), P< 0.001] and EGFR mutation [ HR=2.22, 95% CI (1.04, 4.76), P=0.040] were independent predictors of prognosis. The accuracy of Tomita score, Tokuhashi revised score (2005), Katagiri New score and NESMS score in predicting 1-year mortality was 58.7%, 65.7%, 70.5% and 65% respectively, and the accuracy in predicting 6-month mortality was 63.7%, 62.2%, 61.2% and 56.8% respectively. The accuracy of SORG machine learning algorithm in predicting 1-year and 90 d mortality was 81.1%, 67.5%, respectively. Conclusion:No EGFR mutation, ALP>164 U/L and Hb≤125 g/L were risk factors affecting the survival of patients with spinal metastasis of lung cancer. SORG machine learning algorithm has good accuracy in predicting the postoperative survival rate of patients with lung cancer spinal metastasis.

South Africa is an ethnically and culturally diverse presidential republic country. The medical and health system consists of public and private medical care. AIDS, lower respiratory infections, neonatal diseases, and interpersonal violence and road injuries are the leading causes of adult death. South Africa has rich herbal resources, and a long history of traditional medicine, which is mainly black African traditional medicine. Until the establishment of diplomatic relations between China and South Africa in 1998, the development of TCM was significantly improved, and legislation of TCM was adopted by the government in 2000. Chinese herbal medicine has not yet formed industrial standardization, the TCM application and TCM education are insufficient. Therefore, it is suggested to accelerate the standardization of TCM, to strengthen the TCM education for professional TCM practitioners, and to form a large-scale, industrial and standardized development model. Only in these ways can TCM provide good medical services for residents in South African.

Serbia is a parliamentary republic country in Southeast Europe. It implements a health security system with social insurance as the mainstay and social assistance as a supplement. Ischemic heart disease, stroke and Alzheimer’s disease are the major causes of death, and the mortality rates of cardiomyopathy and chronic kidney disease are increasing. Serbia has relevant legislation on traditional medicine. Acupuncture, as the main form of Traditional Chinese Medicine (TCM), has been introduced to Serbia in an early stage. Acupuncture was recognized as a legal medical method in 2005, and then the corresponding educational institutions of TCM were established soon. However, the limitation of acupuncture treatment application, difficulty in access to Chinese medicine, and undeveloped of TCM education system, all of them restrict the development of TCM in Serbia. It is recommended to improve the development and dissemination of Chinese medicine in Serbia, like to increase the promotion of acupuncture, pay attention to the Chinese medicine for preventive health care, and strengthen TCM education.

This paper summarizes and analyzes the current conditions of Tanzania traditional medicine practitioners, organization structure, herbal medicine resources, and the exported pharmaceutic products and related companies. The result shows that Tanzania government gradually pays the attention to the development of its own traditional medicine industry. Due to the current TCM cooperation dilemma with Tanzania, coping strategies should be adopted to provide certain references for the next stage of China-Tanzania TCM cooperation, such as adjusting the professional fields of dispatched experts, adjusting cooperative fields, including the export and investigation of TCM companies to Tanzania.

Objective To observe and analyze the morbidity and risk factors of postoperative delirium in the patients un-dergoing cardiac surgery.Methods From March 2017 to March 2018, 478 patients who need cardiac surgery were selected from our hospital.According to the postoperative results evaluated with Confusion Assessment Method(CAM), they were divid-ed into delirium group(54 patients)and control group(424 patients).Morbidity and risk factors of postoperative delirium were analyzed.Results Delirium occurred in 54 patients of 478 patients and morbidity of postoperative delirium was 11.3％.Psy-chomotor excitement is the most common clinical presentations , followed by attention impairment and a reduced level of con-sciousnes.Single factor analysis result showed that delirium was associated with advanced age (≥65 years) , hypertension, pre-vious cerebral vascular event(previous cerebral infarction, previous brain heamorhage), intraoperative blood loss, mechanical ventilation time, intensive care unit duration time.The multiple-logistic regression analysis indicated that the perioperative risk factors of delirium included advanced age, cerebrovascular accident history and ICU duration time.Conclusion The patients with advanced age, hypertension, previous cerebral vascular event(previous cerebral infarction, previous brain heamorhage) are the high risk groups for delirium after cardiac surgery.Advanced age, hypertension, previous cerebral vascular event(previ-ous cerebral infarction, previous brain heamorhage) are risk factors for delirium in patients undergoing cardiac surgery.