The chemical constituents in dried roots of Atractylodes macrocephala were investigated in this study. Through utilizing normal-phase silica gel and ODS column chromatography, TLC, and semi-preparative HPLC, 4 new sesquiterpenoids were purified from the ethyl acetate extract of A. macrocephala. By various spectroscopic techniques, such as 1D and 2D NMR, HR-ESI-MS, IR, UV, and CD, their structures were identified as atractylmacron A (1), 9β-hydroxyasterolide (2), atractylenolide H (3), atractylenolide J (4). Compound 1 possesses a rare 6/7 bicyclic skeleton.

OBJECTIVE To investigate the effect and mechanism of Jingangteng capsules in the treatment of non-alcoholic fatty liver disease （NAFLD）. METHODS Thirty-two SD rats were randomly divided into normal group and modeling group. The modeling group was fed a high-fat diet to establish a NAFLD model. The successfully modeled rats were then randomly divided into model group， atorvastatin group[positive control， 2 mg/（kg·d）]， and Jingangteng capsules low- and high-dose groups [0.63 and 2.52 mg/（kg·d）]， with 6 rats in each group. The pathological changes of the liver were observed by hematoxylin-eosin staining and oil red O staining. Enzyme-linked immunosorbent assay was performed to determine the serum levels of triglycerides （TG）， total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， alanine transaminase （ALT）， aspartate transaminase （AST）， tumour necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， IL-6， IL-18. 16S rDNA amplicon sequencing and metabolomics techniques were applied to explore the effects of Jingangteng capsules on gut microbiota and metabolisms in NAFLD rats. Based on the E-mail：591146765@qq.com metabolomics results， Western blot analysis was performed to detect proteins related to the nuclear factor kappa-B （NF-κB）/NOD-like receptor family protein 3 （NLRP3） signaling pathway in the livers of NAFLD rats. RESULTS The experimental results showed that Jingangteng capsules could significantly reduce the serum levels of TG， TC， LDL-C， AST， ALT， TNF-α， IL-1β， IL-6， IL-18， while increased the level of HDL-C， and alleviated the hepatic cellular steatosis and inflammatory infiltration in NAFLD rats. They could regulate the gut microbiota disorders in NAFLD rats， significantly increased the relative abundance of Romboutsia and Oscillospira， and significantly decreased the relative abundance of Blautia （P＜0.05）. They also regulated metabolic disorders primarily by affecting secondary bile acid biosynthesis， fatty acid degradation， O-antigen nucleotide sugar biosynthesis， etc. Results of Western blot assay showed that they significantly reduced the phosphorylation levels of NF-κB p65 and NF-κB inhibitor α， and the protein expression levels of NLRP3， caspase-1 and ASC （P＜0.05 or P＜0.01）. CONCLUSIONS Jingangteng capsules could improve inflammation， lipid accumulation and liver injury in NAFLD rats， regulate the disorders of gut microbiota and metabolisms， and inhibit NF-κB/NLRP3 signaling pathway. Their therapeutic effects against NAFLD are mediated through the inhibition of the NF-κB/NLRP3 signaling pathway.

ObjectiveTo investigate the mechanism of Xuefu Zhuyu capsules against atherosclerosis via regulating polarization of macrophages based on Notch1/jagged canonical Notch ligand 1（Jagged1）/Hes family BHLH transcription factor 1（Hes1） signaling pathway. MethodThe mouse models with atherosclerosis were prepared by feeding the mice with an ApoE^-/- high-fat diet for four weeks， and they were randomly divided into the model group， Xuefu Zhuyu capsule group， and atorvastatin group. C57BL/6 mice were fed as a normal group. The Xuefu Zhuyu capsule group was intragastrically given Xuefu Zhuyu capsules （0.728 g·kg^-1·d^-1）， and the atorvastatin group was intragastrically given atorvastatin tablet （6.07 mg·kg^-1·d^-1）. The normal group and the model group were given equal volume of the deionized water by intragastric administration， and the intervention lasted for 12 weeks. Aortic plaque morphology was observed by hematoxylin-eosin （HE） staining， and aortic plaque area and lipid deposition were observed by oil red O staining. The positive expression levels of CD86 and CD206 in aortic tissue were detected by immunohistochemistry， and serum levels of tumor necrosis factor （TNF）-α， interleukin（IL）-1β， transforming growth factor （TGF）-β₁， and IL-10 were detected by enzyme-linked immunosorbent assay （ELISA）. The relative mRNA expressions of inducible nitric oxide synthase （iNOS）， arginase-1 （Arg-1）， Notch1， Jagged1， and Hes1 in aortic tissue were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. The relative protein expression of iNOS， Arg-1， Notch1， Jagged1， and Hes1 in aortic tissue was detected by Western blot. ResultCompared with the normal group， the model group had significant aortic plaque and lipid deposition， and the expression levels of pro-inflammatory cytokines TNF-α and IL-1β were increased （P<0.01）. The expression level of anti-inflammatory cytokine TGF-β₁ showed a downward trend， but the difference was not statistically significant. The mRNA and protein expressions of iNOS were increased （P<0.01）. The protein expression of Arg-1 was decreased （P<0.01）， and the mRNA expression of related pathway molecule Jagged1， as well as the protein expressions of Notch1， Jagged1， and Hes1 were increased in the model group （P<0.05， P<0.01）. Compared with those in the model group， the plaque area and lipid deposition had a decreasing trend in the Xuefu Zhuyu capsule group， and the expressions of TNF-α and IL-1β showed a downward trend. The expression of TGF-β₁ was increased （P<0.05）， and the expression of macrophage marker CD86 was decreased. The mRNA and protein expressions of iNOS were decreased （P<0.01）. The mRNA and protein expressions of Arg-1 were increased （P<0.05， P<0.01）. Furthermore， the mRNA and protein expressions of Notch1， Jagged1， and Hes1 were decreased （P<0.01）. ConclusionXuefu Zhuyu capsules can reduce aortic plaque area and lipid deposition in mice with atherosclerosis， alleviate inflammation， inhibit M1 macrophages， and promote the expression of M2 macrophages， and the mechanism may be related to the regulation of Notch1/Jagged1/Hes1 signaling pathway.

OBJECTIVE To explore the specific application and evaluation effect of objective structured clinical examination(OSCE)-guided scenario-based practical teaching mode in training clinical pharmacists. METHODS Fifty-six trainees who participated in the clinical pharmacist training program in the Second Xiangya Hospital of Central South University from October 2020 to September 2022 were selected as the research objects. OSCE-guided teaching was conducted, and the application effect of OSCE-guided teaching mode in clinical pharmacist training was explored and analyzed by using theoretical examination results and OSCE assessment results as evaluation indicators. RESULTS Through comparative analysis, it was found that the OSCE-guided teaching mode not only enabled students to better grasp the theoretical knowledge points required by the training outline, but also improved their clinical thinking ability, problem-solving ability, and communication and coordination skills to varying degrees. CONCLUSION For clinical pharmacist trainees, the OSCE teaching mode is conducive to the comprehensive improvement of clinical pharmacist skills and is suitable for cultivating clinical pharmacists who are capable of independently carrying out clinical pharmacy services in the new situation.

Objective To evaluate the efficacy and safety of Shenbao tablet in the treatment of kidney-yang deficiency syndrome.Methods Patients with kidney-yang deficiency syndrome,will were treated with Shenbao Tablets orally,3 tablets once,3 times a day,and the course of treatment was 56 days or 84 days,depending on the condition.By comparing the clinical efficacy,the changes of symptom scores and syndrome scores before and after treatment,and symptoms remission time,the effectiveness of Shenbao tablet in the treatment of kidney-yang deficiency syndrome was evaluated.The safety was evaluated by adverse reactions.Results There were 339 patients in the 56-day group and 345 patients in the 84-day group.After treatment,the clinical effective rates of the 56-day group and the 84-day group were 91.74％and 97.97％,respectively,and the difference was statistically significant(P＜0.05).In the 56-day group and the 84-day group,the excellent rate were 58.41％and 59.13％,clinical control rates were 18.58％and 27.54％,and the progress rates were 14.75％and 11.30％,respectively.After treatment,the symptom scores of kidney-yang deficiency syndrome were significantly reduced respectively within both groups(P＜0.05).In the 56-day group and the 84-day group,the nocturia scores of were 0.89±1.27 and 0.60±1.03,the soreness of waist scores were 1.31±1.19 and 0.72±1.00,the morning diarrhea scores were 0.28±0.74 and 0.19±0.61,the anaphrodisia scores were 0.65±1.13 and 0.53±0.98,the low spirits scores were 0.29±0.81 and 0.08±0.40,the cold limbs score were 1.09±1.20 and 0.55±0.93,the edema scores were 0.14±0.55 and 0.05±0.30,the bright pale complexion scores were 0.20±0.59 and 0.24±0.65,respectively.There were significant differences in the reduction of each symptom score between the two groups(P＜0.05);the 56-day group had a more significant decrease in the score of cold limbs than the 84-day group.The remaining symptom scores decreased more significantly in the 84-day group.After treatment,the syndrome scores of kidney-yang deficiency syndrome in the two groups were significantly lower than those before treatment(all P＜0.05);the change rates of score in the 56-day group and the 84-day group were(-72.33±24.57)％and(-78.77±19.53)％,respectively,and the difference was statistically significant(P＜0.05).The self-reported time to first symptom relief was(14.85±7.18)days in the 56-day group and(14.10±7.78)days in the 84-day group,with no significant difference(P＞0.05).The incidence of adverse reactions of Shenbao tablets was 5.37％,mainly reflected in hepatobiliary system diseases,gastrointestinal system diseases and various examination abnormalities.Conclusions After taking Shenbao tablets for 2 to 3 months,the clinical symptoms of kidney-yang deficiency were better improved,and the improvement was more significant after 3 months of treatment.The security of Shenbao Tablets was good.

Objective To investigate the clinical efficacy of multidisciplinary team (MDT) model combined with Da Vinci robot-assisted thoracic surgery in the treatment of early non-small cell lung cancer (NSCLC). Methods From July 2020 to December 2021, the patients with NSCLC who received Da Vinci robot-assisted thoracic surgery in the Department of Thoracic Surgery, General Hospital of Northern Theater Command were collected. According to whether MDT were performed before hospitalization, the patients were divided into an MDT group and a common group. The recovery and clinical efficacy were compared between the two groups. Results A total of 187 patients were enrolled, including 81 males and 106 females, aged 63 (56, 67) years. There were 85 patients in the MDT group, and 102 patients in the common group. Compared with the common group, the MDT group had lower incidence of postoperative complications (9.4% vs. 29.4%, P=0.017), shorter intraoperative operation time [55 (45, 61) min vs. 79 (65, 90) min, P<0.001], and less intraoperative blood loss [25 (20, 30) mL vs. 30 (20, 50) mL, P=0.029] in the same operation mode. In addition, the drainage volume on the second postoperative day [270 (200, 350) mL vs. 215 (190, 300) mL, P=0.004], the number of dissected lymph nodes groups [6 (5, 6) groups vs. 5 (3, 6) groups, P=0.004] and the number of dissected lymph nodes [16 (13, 21) vs. 13 (9, 20), P=0.005] in the MDT group were significantly better than those in the common group. The differences in the postoperative intubation time and postoperative hospital stay between the two groups were not statistically significant (P>0.05). Conclusion MDT combined with Da Vinci robot-assisted thoracic surgery can further reduce the risk of surgery, improve the clinical treatment effect, reduce the incidence of postoperative complications, and accelerate the rehabilitation of patients.

Objective To analyze the learning curve of Da Vinci robotic segmentectomy. Methods Cumulative sum analysis (CUSUM) was used to analyze the learning curve of Da Vinci robotic segmentectomy performed by the General Hospital of Northern Theater Command from February 2018 to December 2020. The learning curve was obtained by fitting, and R2 was used to judge the goodness of fitting. The clinical data of patients in different stages of learning curve were compared and analyzed. Results The first 50 patients who received Da Vinci robotic segmentectomy were included, including 24 males and 26 females, with an average age of 61.9±10.6 years. The operation time decreased gradually with the accumulation of operation patients. The goodness of fitting coefficient reached the maximum value when R2=0.907 (P<0.001), CUSUM (n) =0.009×n3−0.953×n2+24.968×n−7.033 (n was the number of patients). The fitting curve achieved vertex crossing when the number of patients reached 17. Based on this, 50 patients were divided into two stages: a learning and improving stage and a mastering stage. There were statistical differences in the operation time, intraoperative blood loss, postoperative drainage volume, number of lymph node dissection, postoperative catheter time, postoperative hospital stay, and postoperative complications between the two stages (P<0.05). Conclusion It shows that the technical competency for assuring feasible perioperative outcomes can be achieved when the cumulative number of surgical patients reaches 17.

Objective:To analyze the factors influencing the theoretical score of graduation examination of standardized residency training in a class-A tertiary general hospital in Shanghai from 2018 to 2021, and establish prediction models, and to provide a reference for further improving the quality of residency training.Methods:We collected the data of 556 residents who participated in the residency training graduation examination at the hospital from 2018 to 2021. Binary regression and logistic regression analyses were used to determine the association of residents' basic information, their routine assessment results at the bases, and the base performance assessment score (indicating the bases' training quality) with theoretical graduation examination results; and prediction models for the theoretical graduation examination score were established, using binary regression and logistic regression methods to construct model datasets. SPSS 26.0 was used for statistical analysis.Results:From 2018 to 2021, a total of 556 people participated in the residency training graduation examination at the hospital. The first-time pass rate of the first station theoretical examination station was 97.48% (542/556). Trainees graduating from double first-class schools had the highest first-time pass rate of 98.09% (359/366); doctoral students had the highest first-time pass rate of 98.59% (140/142); and residents of the two-year training program had the highest first-time pass rate of 98.34% (297/302). According to the binary regression analysis of categorical variables such as residents' basic information, the base level was associated with whether residents passed the theoretical examination ( P<0.05). According to the logistic regression analysis of residents' routine assessment scores and the base performance assessment score, the annual theoretical assessment score, the first-time theoretical score of the national medical licensing examination, the annual professional performance test score, and the base performance assessment score were key factors affecting the theoretical graduation examination score ( P<0.05). In the regression analysis associated with the theoretical graduation examination score, the annual professional performance test score showed the highest regression coefficient and the highest variance inflation factor, indicating strong multicollinearity. Therefore, the annual professional performance test score was important in predicting the theoretical score of the graduation examination. Conclusions:This study used binary regression and logistic regression models to analyze the possible factors affecting the theoretical graduation examination score and the degree of association, and also established two prediction models of the theoretical graduation examination score to predict trainees at risk. Through implementing the concept of hierarchical progression, adding personalized tutoring, realizing information management for residency training, and providing intelligent early intervention, the pass rate of residency training graduation examination is expected to be further improved, ultimately achieving the purpose of improving the quality of residency training.

Objective To investigate the effect of Jaceosidin on inflammatory response in gestational diabetes mellitus(GDM)rats and its mechanism.Methods The GDM rat model was established by intraperitoneal injection of streptozotocin into pregnant rats.The successfully established rats were separated into the GDM group,the Jaceosidin L,M,H groups and the Jaceosidin+CTCE-0214[stromal cell-derived factor-1α(SDF-1α)/C-X-C chemokine receptor 4(CXCR4)activator]group,with 10 rats in each group.Meantime,10 healthy pregnant rats were taken as the control group.The Jaceosidin L,M and H groups were gavaged with 2,3 and 4 mg/kg Jaceosidin,respectively.The Jaceosidin+CTCE-0214 group was intraperitoneally injected with 10 mg/kg CTCE-0214 and gavaged with 4 mg/kg Jaceosidin.The control group and the GDM group were given equal amounts of physiological saline.The fasting blood glucose,fasting insulin and insulin resistance index were compared between each group of rats.Enzyme-linked immunosorbent assay was applied to detect levels of IL-1β and TNF-α in placental tissue.HE staining was applied to observe pathological changes of placental tissue.Apoptosis of placental tissue was detected by TUNEL.Western blot assay was applied to detect levels of SDF-1α/CXCR4 pathway related proteins in placental tissue.Results The intervention of different doses of Jaceosidin in GDM rats reduced levels of fasting blood glucose,fasting insulin,insulin resistance index and proinflammatory cytokines,improved the placental injury and apoptosis of GDM rats,and inhibited the activation of SDF-1α/CXCR4 signaling pathway in a dose-dependent manner(P＜0.05).SDF-1α/CXCR4 activator combined Jaceosidin could inhibit the above effects of Jaceosidin.Conclusion Jaceosidin can reduce inflammation and insulin resistance in GDM rats by suppressing the activation of SDF-1 α/CXCR4 signaling pathway.

Objective To investigate the role of H9c2-derived exosomes in regulating angiogenesis in rat cardiomyocytes under hypoxia.Methods The hypoxia model of H9c2 cells was prepared by mixed gas method(the hypoxia model group),and the normal cultured cells were used as the control group.The exosomes secreted by the two groups of cells were extracted respectively.The concentration and particle size of exosomes were detected by nanoparticle tracking analysis.The morphology and size of exosomes were detected by transmission electron microscopy.Western blot assay was used to verify the exosome marker proteins.The hypoxia model of human umbilical vein endothelial cells(HUVEC)was established.HUVECs were incubated with H9c2 exosomes and divided into the normoxia group,the hypoxia group,the hypoxia+normal H9c2 exosomes(EXO-C)group and the hypoxia+hypoxia H9c2 exosomes(EXO-M)group.The proliferation,migration and tube formation of HUVECs were detected by CCK-8 method,cell scratch test and Matrigel in vitro three-dimensional forming test.Results The results of exosome identification showed that the particle concentration of H9c2 exosome samples was 1×107-1×1012 particles/mL and the particle size was 40-160 nm in the normoxia group and the hypoxia group.The morphological characteristics were spherical or saucer-like structure,uniform in size and complete in shape.Exosome marker proteins TSG101,CD63 and CD9 were expressed,and there was no expression of negative protein Calnexin.Compared with the normoxic group,the proliferation ability,migration area and migration rate of HUVEC were significantly decreased in the hypoxic group,and the length of tube,the number of branches and the number of nodes were decreased(P＜0.01).Compared with the hypoxia group,the proliferation ability of HUVEC cells was decreased,the migration area was decreased,the migration rate was decreased and the length and number of branches involved in tube formation were further decreased in the EXO-M group(P＜0.05).Compared with the EXO-C group,the proliferation ability of the EXO-M group decreased,the cell migration area decreased and the migration rate decreased(P＜0.01).Conclusion Exosomes derived from hypoxic H9c2 can inhibit the proliferation,migration and tube formation of HUVEC.