OBJECTIVE To explore the correlation between changes in intestinal toxicity and changes in component composition of the Mongolian medicine Euphorbiae pekinensis Radix(EPR)before and after processing with milk.METHODS Mice were given 95%ethanol extract of raw EPR,milk-processed EPR and water-processed EPR by gavage.The purgative effect and intestinal inflam-matory toxicity changes of EPR before and after milk processing were investigated using the fecal water content and the levels of inflam-matory factors TNF-α and IL-1β in each intestinal segment of mice as indicators;LC-MS/MS was used to analyze the composition changes of the 95%alcohol extract of EPR before and after milk processing.RESULTS Compared with the blank group,the raw and water processed products of EPR could significantly increase the water content of mouse feces and the levels of TNF-α and IL-1β in each intestinal segment(P＜0.05);compared with the raw product group,all indicators in the milk processing group were significantly reduced(P＜0.05),while there was no significant difference in the water processing group,indicating that water processing cannot at-tenuate toxicity,and the auxiliary material milk is the key auxiliary material to reduce the toxicity of EPR.Mass spectrometry analysis results showed that a total of 50 components were identified in EPR,including 38 terpenoid components,6 phenolic acid components,and 6 other components.The content of each component decreased to varying degrees after milk processing.Principal component analy-sis(PCA)and orthogonal partial least squares discriminant analysis(OPLS-DA)were performed on the mass spectrum data of raw ma-terials and products,and it was found that the components of raw materials and products can be obviously clustered into 2 categories.13 differential components of raw materials and products were screened through t test,and 11 of which were terpene compo-nents,indicating that the composition of terpene components changed significantly after milk processing.17 components derived from EPR were detected in the residual liquid of milk excipients after processing,of which 16 were terpenoids,indicating that the terpenoid components of EPR were transferred to the excipient milk during the soaking and processing processes.CONCLUSION The toxicity of EPR is reduced and the purgative effect is alleviated after milk processing.The attenuation mechanism may be that during the milk soaking and processing processes,terpenoid components are transferred to the milk,and the content of toxic components in the decoc-tion pieces is reduced,thereby reducing the toxicity.

The grading of evidence is an important factor in clinical decision-making. The current evidence grading system based on western medicine is limited in the clinical practice of traditional Chinese medicine （TCM）， therefore we propose the solutions to the development of grading system for TCM interventional evidence， following the international evidence grading standards， taking into considerations of the unique characteristics of TCM practice， based on the Grades of recommendation， assessment， development and evaluation （GARDE） evaluation system， and integrating with grading system regarding TCM classical literature and empirical evidence from modern famous doctors. The evidence from classical literature is suggested to be evaluated from three aspects including source of ancient medical records， comprehensive of treatment details， and the inheritance. The qualification of famous doctors， content integrity， and inheritance of experiences will be used to evaluate the evidence from famous doctors' experience. The multi-sourced evidence such as TCM classical literature， experience of modern famous doctors， and modern researches is mainly integrated in a qualitative way， and the overall level of evidence of TCM interventions will be graded consistently with the GRADE system based on modern research. The evidence from classical literature and modern famous doctors' experience will be assessed and considered as supplementary evidence， which will make the evaluation of clinical evidence more objectively and comprehensively， thereby guiding clinical practice further.

Objective:To investigate the mechanism of bladder cancer treatment by using Scutellaria barbata and Codonopsis pilosula drug pair through network pharmacology. Methods:The drug composition of the drug pair was screened using TCMSP, and their action targets were predicted using Swiss Target Prediction. GeneCards was used to obtain disease targets of bladder cancer, and venny 2.1 was used to obtain intersection targets. PPI analysis was performed using STRING, and a network diagram was constructed using Cytoscape. GO and KEGG analysis were conducted using Metascape. A drug-target-pathway network map was constructed using Cytoscape software. Nude mice were randomly divided into a model group and a treatment group to establish a bladder cancer mouse model. On the 8th day after model formation, the mice in the model group were administered intragastrically with a dose of 342.86 mg/kg, 0.2 ml, twice/day. On the 28th day after modeling, the tumor size of nude mice was measured. Prostaglandin G/H Synthetase 2 (PTGS2), PTGS1, Nuclear Receptor Coactivator 2 (NCOA2), Retinoic Acid X Receptor α (RXRA), Progesterone Receptor (PGR), Mitogen-Activated Protein Kinase 1 (MAPK1), Reticuloendothelial Proliferation virus oncogene homology A (RELA), and Akt1 levels were detected by enzyme-linked immunosorbent assay.Results:The results show that 45 active components of the drug pair directly acted on 187 disease targets through multiple pathways to treat bladder cancer, in which Quercetin, luteolin, wogonin, 7-Methoxy-2-methyl isoflavone, baicalein, beta-sitosterol, Stigmastero, and other core ingredients, as well as PTGS2, PTGS1, NCOA2, RXRA, PGR, MAPK1, RELA, and Akt1 are critical targets. The results of gene function annotation analysis show that the biological processes most likely related to crossover genes mainly involved responses to hormones, cell responses to lipids, responses to foreign stimuli, and responses to bacterial molecules. The cell components mainly involves transcription regulatory complexes, membrane rafts, membrane microregions, and RNA polymerase Ⅱ transcriptional regulatory complexes, etc. The molecular functions mainly involve transcription factor binding, DNA-binding transcription factor binding, RNA polymerase Ⅱ specific DNA-binding transcription factor binding, nuclear receptor activity, ligand-activated transcription factor activity, etc. The results of pathway enrichment analysis suggests that the main signaling pathways are AGE-RAGE, IL-17, PI3K-Akt, TNF, MAPK, HIF-1, apoptosis, p53, toll-like receptor, etc. Animal experiments show that the Scutellaria barbata and Codonopsis pilosula drug pair can significantly improve tumor size and also improve the expression levels of PTGS2, PTGS1, NCOA2, RXRA, PGR, MAPK1, RELA, and Akt1. Conclusions:The Scutellaria barbata and Codonopsis pilosula drug pair can regulate PTGS2, PTGS1, NCOA2, RXRA, PGR, MAPK1, RELA, and Akt1 and other diseases mainly through the regulation of AGE-RAGE, IL-17, PI3K-Akt, TNF, MAPK, HIF-1, apoptosis, p53, toll-like receptor, and other signaling pathways. Targeting enzyme activity and cell apoptosis can treat bladder cancer by regulating these biological processes.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

Objective:To investigate the clinical and pathological features of congenital hepatic fibrosis (CHF).Methods:The clinical and pathological findings of 20 patients diagnosed with CHF from 2017 to 2023 were retrospectively analyzed.Results:Among the 20 patients, 8 were males and 12 were females with a median age of 21.5 years. Mostly patients were admitted to the hospital with cirrhosis, portal hypertension and upper gastrointestinal bleeding. Pathological features were diffuse fibrosis in the portal area, formation of fibrous septa of varying width, segmentation of the liver parenchyma, with hyperplasia of small bile ducts. Among them, 1 case (5%) was complicated with Caroli's disease, and 1 case (5%) was HNF1α hepatocellular adenoma. IHC GS showed that was positively expressed in acinar region 3 in 75% cases.Conclusion:CHF is mainly manifested by portal hypertension and its complications. Histopathology is the gold standard for diagnosis. The possibility of CHF should be considered first in children and adolescents with portal hypertension but no history of hepatitis, and complicated kidney disease. The positive pattern of acinus-3 region of GS in IHC is helpful for the diagnosis of CHF.

Objective:To investigate the effect of nurse-led stress inoculation training on fear of self-injecting and self-testing and self-management behaviors in elderly type 2 diabetic patients and provide reference for diabetes nursing care.Methods:A total of 110 elderly type 2 diabetic patients of Department of Endocrinology of Hainan People′s Hospital from January 2018 to January 2020 were divided into experimental group and control group according to odd and even numbers, with 55 patients in each group. The control group received routine nursing care, while the experimental group implemented nurse-led stress inoculation training for 4 weeks. The intervention effect was assessed by Diabetes Fear of Injecting and Self-testing Ouestionnaire (D-FISQ) and Diabetes self-management behaviors among older (DSMB-O), respectively.Results:In the study, one patient in the experimental group fell off, and finally included 54 cases in the experimental group and 55 cases in the control group. After intervention, the fear of self-injecting scores, fear of self-testing scores, and total D-FISQ scores were 13.15 ± 3.02, 15.67 ± 3.59 and 28.81 ± 5.08 in the experimental group, significantly lower than those in the control group (15.25 ± 3.18, 17.56 ± 3.92 and 32.82 ± 4.89), the difference was statistically significant ( t=3.55, 2.63, 4.19, P<0.05). Active exercises, current medication, blood glucose monitoring, dealing with problem, active response, reducing risks scores and total DSMB-O scores were 2.39 ± 0.49, 2.39 ± 0.49, 2.20 ± 0.81, 4.41 ± 0.92, 4.70 ± 1.13, 5.06 ± 0.79 and 25.28 ± 2.57 in the experimental group, significantly higher than those in the control group (3.95 ± 0.85, 2.11 ± 0.85, 1.51 ± 0.50, 3.95 ± 0.78, 4.13 ± 1.43, 4.38 ± 1.16 and 22.09 ± 2.24), the difference was statistically significant ( t values were 2.10-6.90, P<0.05). Conclusions:Nurse-led stress inoculation training can effectively alleviate fear of self-injecting and self-testing and promote self-management behaviors of elderly patients with type 2 diabetes.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective:To investigate the clinicopathological characteristics, diagnosis, differential diagnosis and prognostic factors of SMARCB1 (INI1)-deficient sinonasal carcinoma (SDSC).Methods:Sixteen cases of SDSC diagnosed in the Department of Pathology, Beijing Tongren Hospital from January 2016 to September 2020 were enrolled. Ninety-nine cases of small round cell malignant tumors of the head and neck were selected as the control, including poorly-differentiated squamous cell carcinoma ( n=10), poorly-differentiated adenocarcinoma ( n=5), undifferentiated carcinoma (SNUC, n=4), NUT carcinoma ( n=5), neuroendocrine carcinoma ( n=10), and other non-epithelial tumors [olfactory neuroblastoma ( n=10), rhabdomyosarcoma ( n=10), NK/T-cell lymphoma ( n=10), malignant melanoma ( n=10), Ewing′s sarcoma/primitive neuroectodermal tumor (EWS/PNET, n=5)] and non-keratinizing undifferentiated nasopharyngeal carcinoma ( n=20). The clinical and pathologic characteristics of SDSC, and immunohistochemical (IHC) expression of broad-spectrum CKpan, CK7, CK8/18, CK5/6, p63, p40, p16, INI1, NUT and neuroendocrine markers (Syn, CgA, CD56) were evaluated. In situ hybridization (ISH) was used to detect EBER and fluorescence in situ hybridization (FISH) to detect INI1 gene deletion. Results:The 16 cases of SDSC accounted for 1.3% (16/1 218) of all malignant sinonasal tumors in the author′s unit during this time period, and 2.4% (16/657) of all malignant epithelial tumors. Microscopically, there was no clear squamous and adenomatous differentiation, but "rhabdoid-like" cells, are often seen. All SDSC cases were positive for CKpan and CK8/18, negative for INI1; Epstein-Barr virus was not detected by ISH; and INI1 gene deletion was observed in all 11 SDSC patients with FISH. Twelve cases were followed up for 3-47 months. One died of tumor-related diseases half a year after diagnosis, and the remaining patients were alive with tumor, the longest survival time was 47 months.Conclusion:SDSC should be differentiated from a variety of poorly-differentiated tumors in the sinonasal area. Histologically, SDSC has no clear differentiation, but the tumor cells are characteristically basal-like or rhabdoid-like, with non-specific vacuoles, translucent or vacuolar nuclei, prominent nucleoli and necrotic foci. They are negative for INI1 IHC staining, and FISH demonstrates INI1 gene deletion. The clinical prognosis is still unclear, further studies on its biologic behavior and treatment methods are warranted.

As an important platform compound, 3-hydroxypropionic acid (3-HP) can be used as a substrate to synthesize a variety of biological products with commercial potential. The titer of 3-HP by wild-type bacteria is low, which severely limits the large-scale application and production of 3-HP. By modifying the genes related to the metabolic pathway, engineered bacteria using cheap substrates as carbon sources are constructed, the aim of reducing production cost and increasing output is realized. In this paper, the recent progress in the synthesis of 3-HP by metabolic engineering at home and abroad is reviewed. The advantages and disadvantages of glycerol pathway, malonyl-CoA pathway and beta-alanine pathway for synthesis of 3-HP are also summarized and analyzed, and the future development of 3-HP is prospected.
Glycerol ; metabolism ; Industrial Microbiology ; trends ; Lactic Acid ; analogs & derivatives ; biosynthesis ; Metabolic Engineering ; Metabolic Networks and Pathways ; genetics

Objective:To study the effect of spousal voice stimulation on the recovery period of patients undergoing thoracic/lumbar surgery under general anesthesia.Methods:A total of 67 patients undergoing thoracic/lumbar surgery under general anesthesia who met the inclusion exclusion criteria were divided into 34 patients in the control group and 33 patients in the experimental group according to the random number table method. Awakening in the recovery period patients were given general anesthesia care, on the basis of the control group recovery period voice wake up by paramedics. The recovery time, pain score, the incidence of restlessness and nausea and vital signs between the two groups were compared.Results:The extubation time, exhalation time, recovery time of choking cough, recovery time, and pain score in the recovery stage were (14.00±3.90) min, (11.67±3.83) min, (10.03±3.58) min, (21.24±4.28) min, (4.15±0.79) points in the experimental group, respectively. Those were (18.00±6.60) min, (15.59±5.86) min, (12.68±5.01) min, (29.50±8.25) min, (5.26±0.86) points in the control group, respectively. The differences between the two groups were statistically significant ( t values were 2.481-5.483, P<0.05 or 0.01). There was no significant difference in the incidence of restlessness and nausea and vital signs between the two groups( P>0.05). Conclusions:Spoused-voice stimulation can shorten the extubation time, exhalation time, recovery time and recovery time of choking cough in patients undergoing thoracolumbar surgery under general anesthesia, and reduce the pain in the recovery period.