Bioactive compounds derived from herbal medicinal plants modulate various therapeutic targets and signaling pathways associated with cardiovascular diseases (CVDs), the world's primary cause of death. Ginkgo biloba, a well-known traditional Chinese medicine with notable cardiovascular actions, has been used as a cardio- and cerebrovascular therapeutic drug and nutraceutical in Asian countries for centuries. Preclinical studies have shown that ginkgolide B, a bioactive component in Ginkgo biloba, can ameliorate atherosclerosis in cultured vascular cells and disease models. Of clinical relevance, several clinical trials are ongoing or being completed to examine the efficacy and safety of ginkgolide B-related drug preparations in the prevention of cerebrovascular diseases, such as ischemia stroke. Here, we present a comprehensive review of the pharmacological activities, pharmacokinetic characteristics, and mechanisms of action of ginkgolide B in atherosclerosis prevention and therapy. We highlight new molecular targets of ginkgolide B, including nicotinamide adenine dinucleotide phosphate oxidases (NADPH oxidase), lectin-like oxidized LDL receptor-1 (LOX-1), sirtuin 1 (SIRT1), platelet-activating factor (PAF), proprotein convertase subtilisin/kexin type 9 (PCSK9) and others. Finally, we provide an overview and discussion of the therapeutic potential of ginkgolide B and highlight the future perspective of developing ginkgolide B as an effective therapeutic agent for treating atherosclerosis.

Objective To summarize and explore the individualized surgical treatment strategy and prognosis of anomalous aortic origin of coronary artery (AAOCA). Methods The clinical data of children with AAOCA admitted to Shanghai Children's Medical Center from March 2018 to August 2021 were retrospectively analyzed. Results A total of 17 children were enrolled, including 13 males and 4 females, with a median age of 88 (44, 138) months and a median weight of 25 (18, 29) kg. All patients received operations. The methods of coronary artery management included coronary artery decapitation in 9 patients, coronary artery transplantation in 5 patients and coronary artery perforation in 3 patients. One patient with severe cardiac insufficiency (left ventricular ejection fraction 15%) received mechanical circulatory assistance after the operation for 12 days. No death occurred in the early postoperative period, the average ICU stay time was 4.3±3.0 d, and the total hospital stay was 14.4±6.1 d. All the children received regular anticoagulation therapy for 3 months after discharge. The median follow-up time was 15 (13, 24) months. All patients received regular anticoagulation therapy for 3 months after discharge. No clinical symptoms such as chest pain and syncope occurred again. The cardiac function grade was significantly improved compared with that before operation. Imaging examination showed that the coronary artery blood flow on the operation side was unobstructed, and no restenosis occurred. Conclusion AAOCA is easy to induce myocardial ischemia and even sudden cardiac death. Once diagnosed, operation should be carried out as soon as possible. According to the anatomic characteristics of coronary artery, the early effect of individualized surgery is satisfactory, and the symptoms of the children are significantly improved and the cardiac function recovers well in the mid-term follow-up.

Objective To analyze the predictive value of serum levels of procalcitonin(PCT)and cytokines on the prognosis of patients with COVID-19 at admission.Methods From November 2022 to February 2023,patients diagnosed with COVID-19 who were admitted to Beijing Chest Hospital were enrolled.Chemiluminescence was used to detect serum PCT levels,and flow microsphere array was used to detect serum cytokines IL-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17A,IL-17F,IL-22,TNF-α,TNF-β,IFN-γ level.ICU admission,mechanical ventilation and in-hospital death were defined as poor prognosis.After excluding patients with bacterial infection,the relationship between serum PCT and cytokine levels at admission and the prognosis of COVID-19 patients was analyzed.After excluding patients with bacterial infection,the relationship between serum PCT and cytokine levels at admission and the prognosis of COVID-19 patients was analyzed.Results A total of 176 patients with complete data were included,including 134 in the PCT-normal group and 42 in the PCT-elevated group,with a median age of 71.50 years and 71.59%males.Patients in the PCT elevated-group had significantly higher rates of ICU admission(38.41%vs.13.11%,P<0.05),mechanical ventilation(76.92%vs.24.59%,P<0.001)and in-hospital mortality(38.46%vs.6.56%,P<0.001)were significantly higher than those in the PCT-normal group.Serum levels of cytokines IL-6(7.40 pg/mL vs.4.78 pg/mL,P = 0.033 4)and IL-8(10.97 pg/mL vs.5.92 pg/mL,P<0.001)were significantly higher in patients with poor prognosis than in those with good prognosis.The area under the curve for PCT,IL-6,and IL-8 to predict poor prognosis in COVID-19 patients was 0.687,0.660,and 0.746,respectively;sensitivity was 52.78%,55.17%,and 72.41%,respectively;and specificity was 81.58%,74.19%,and 74.19%,respectively,as calculated from the ROC curve.When PCT,IL-6 and IL-8 jointly predict the prognosis of COVID-19 patients,the area under the curve is 0.764,the sensitivity is 70.00%,and the specificity is 80.00%.Conclusion Serum PCT and cytokines IL-6 and IL-8 could be used as predictive markers for poor prognosis in patients with COVID-19.

Objective To investigate the impacts of quercetin(QUE)on angiogenesis and hypoxia inducible factor-1α/vascular endothelial growth factor(HIF-1α/VEGF)signaling pathway in periodontal tissue of orthodontic tooth movement in rats.Methods A rat model of orthodontic tooth movement was constructed,and the modeled rats were randomly separated into the model group,the low-dose quercetin treatment(QUE-L)group,the high-dose quercetin treatment(QUE-H)group and the QUE-H+pathway inhibitor YC-1(QUE-H+YC-1)group,with 12 rats in each group.Another 12 rats were regarded as the control group.The movement distance of the first molar of rats in each group was measured.HE staining was applied to observe the pathological changes of periodontal tissue and count the number of blood vessels generated in periodontal tissue.Immunohistochemistry was applied to detect expression levels of bone morphogenetic protein 2(BMP2)and bone morphogenetic protein 4(BMP4)in periodontal tissue.Western blot assay was applied to detect the expression of HIF-1α/VEGF signaling pathway related proteins.Results Compared with the control group,the periodontal tissue fibers were scattered and disordered in the model group,with an increased intercellular space,infiltration of a large number of inflammatory cells and bone resorption pits,the movement distance of the first molar increased,the number of periodontal tissue blood vessels decreased,and the expression of BMP2,BMP4,HIF-1α and VEGF decreased(P＜0.05).The fibrous arrangement of periodontal tissue was relatively tight in the QUE-L group and the QUE-H group compared to the model group,with reduced infiltration of inflammatory cells and reduced alveolar bone resorption.The movement distance of the first molar decreased,the number of periodontal tissue blood vessels increased,and the expression of BMP2,BMP4,HIF-1α and VEGF increased(P＜0.05).Compared with the QUE-H group,the periodontal tissue fibers in the QUE-H+YC-1 group were scattered and disordered,with obvious intercellular gaps,increased infiltration of inflammatory cells and increased bone resorption pits,the movement distance of the first molar increased,the number of blood vessels in periodontal tissue decreased,and the expression of BMP2,BMP4,HIF-1α and VEGF decreased(P＜0.05).Conclusion Quercetin can promote angiogenesis in periodontal tissue during orthodontic tooth movement in rats,and its mechanism is related to the activation of the HIF-1α/VEGF signaling pathway.

Objective To investigate the effect of ultrasound-guided erector spinae plane block(ESPB)on early postoperative respiratory function and inflammatory cytokines in patients with multiple rib fractures(MRFs).Methods Fifty-eight patients who underwent MRFs surgery,42 males and 16 females,aged 18-64 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were selected from February 2019 to December 2021.The patients were divided into two groups using random number method:ESPB combined with general anesthesia group(group E)and general anesthesia alone group(group G),29 pa-tients in each group.All the patients in group E underwent ultrasound-guided ESPB in the lateral decubitus position after general anesthesia induction,and 0.5％ropivacaine 0.4 ml/kg was administered.Forced vital capacity(FVC),arterial blood gas analysis,VAS pain scores at rest and cough were recorded before anes-thesia induction,at discharge from PACU,24 and 48 hours after operation.The number of effective PCIA compressions during 0-24 hours and 24-48 hours after surgery and the number of rescue analgesia were re-corded.The concentrations of IL-6 and TNF-α were recorded before anesthesia induction,24 and 48 hours after operation.Results Compared with group G,the FVC was significantly higher,and the VAS score and PaCO2 were significantly lower in group E at discharge from PACU,24 and 48 hours after operation(P＜0.05).The number of effective PCIA compressions during 0-24 hours and 24-48 hours after surgery,the rate of rescue analgesia,the concentrations of IL-6 and TNF-α 24 and 48 hours after operation in group E were significantly lower than those in group G(P＜0.05).Conclusion Ultrasound-guided ESPB can pro-vide good postoperative analgesia,promote early postoperative recovery of respiratory function in patients with MRFs.

[This corrects the article DOI: 10.1016/j.apsb.2023.04.002.].

Purpose To explore the value of insulinoma associated protein 1(INSM1)in the pathological diagnosis and differential diagnosis of medullary thyroid carcinoma(MTC).Methods Twenty-eight cases of MTC were collected as the ex-perimental group and 25 cases of thyroid tumors(6 cases of transparent trabecular tumors,16 cases of poorly differentiated cancer,2 cases of spindle cell papillary carcinoma,and 1 case of thyroid paraganglioma)that needed to be differentiated from MTC in the same period were collected as the control group.The expression of INSM1 was detected using immunohistochemical EnVision method,and the sensitivity and specificity of INSM1 in MTC were analyzed,and compared with traditional MTC markers(Syn,CgA,CT,and CEA).Results The positive rate of IN-SM1 in the MTC group was96.4%(27/28),significantly high-er than the control group of 4.0%(1/25)(P<0.05).INSM1 had a sensitivity of 96.4%in MTC,significantly higher than CgA(71.4%)(P<0.05),and was positively expressed in CT negative MTC cases.The specificity of INSM1 in MTC was 96.0%,significantly higher than that of CEA(72.0%)(P<0.05).Conclusion INSM1 has high sensitivity and specificity in MTC,with a nuclear positive staining pattern,clear back-ground,and easy identification.It is superior to the traditional biomarkers and has high diagnostic value in MTC.

Objective:Based on the business reengineering theory, to construct the emergency nursing process of acute massive hemoptysis in hospital and explore the effect of it.Methods:According to the order of hospitalization, 200 patients with acute massive hemoptysis admitted to the emergency department in Shanghai Pulmonary Hospital Affilated to Tongji University from January to June in 2020 were selected as the control group, and the original treatment process was adopted. Two hundred patients admitted to the emergency department of this hospital from July to December in 2020 were selected as the experimental group, and the reconstructed in-hospital emergency nursing process for acute massive hemoptysis was applied. In both groups, the researchers recorded the time spent in each sub-process by using the in-hospital treatment time record of acute massive hemoptysis and collected the clinical outcomes of patients through electronic cases. The time-consuming, treatment efficiency and patient outcome of each link of the treatment process in the backyard of the two groups were compared.Results:Finally, 192 patients were enrolled in the control group and the experimental group. The median time from admission to intravenous use of hemostatic drugs and from admission to endovascular treatment in the experimental group were 21.50(20.00, 22.50) and 82.50(79.50, 84.50) min, which were lower than those in the control group which spent 40.87(37.06, 44.43) and 135.50(123.50, 147.00) min, and the differences between the two groups were statistically significant ( Z=-16.84, 16.63, both P<0.01). The incidence of asphyxia caused by acute massive hemoptysis in the experimental group was 4.2%(8/192), which was lower than that in the control group, which was 13.0%(25/192) . There was a statistically significant difference in the incidence of asphyxia between the two groups( χ2=9.58, P<0.01). Conclusions:The emergency nursing process of acute massive hemoptysis effectively shortens the time of in-hospital treatment of acute massive hemoptysis, further promotes the seamless connection of multiple links of in-hospital treatment of acute massive hemoptysis, and improves the overall efficiency of in-hospital treatment of patients with acute massive hemoptysis.

Lipids have been found to modulate tumor biology, including proliferation, survival, and metastasis. With the new understanding of tumor immune escape that has developed in recent years, the influence of lipids on the cancer-immunity cycle has also been gradually discovered. First, regarding antigen presentation, cholesterol prevents tumor antigens from being identified by antigen presenting cells. Fatty acids reduce the expression of major histocompatibility complex class I and costimulatory factors in dendritic cells, impairing antigen presentation to T cells. Prostaglandin E2 (PGE2) reduce the accumulation of tumor-infiltrating dendritic cells. Regarding T-cell priming and activation, cholesterol destroys the structure of the T-cell receptor and reduces immunodetection. In contrast, cholesterol also promotes T-cell receptor clustering and relative signal transduction. PGE2 represses T-cell proliferation. Finally, regarding T-cell killing of cancer cells, PGE2 and cholesterol weaken granule-dependent cytotoxicity. Moreover, fatty acids, cholesterol, and PGE2 can improve the activity of immunosuppressive cells, increase the expression of immune checkpoints and promote the secretion of immunosuppressive cytokines. Given the regulatory role of lipids in the cancer-immunity cycle, drugs that modulate fatty acids, cholesterol and PGE2 have been envisioned as effective way in restoring antitumor immunity and synergizing with immunotherapy. These strategies have been studied in both preclinical and clinical studies.

Mevalonate metabolism plays an important role in regulating tumor growth and progression; however, its role in immune evasion and immune checkpoint modulation remains unclear. Here, we found that non-small cell lung cancer (NSCLC) patients with higher plasma mevalonate response better to anti-PD-(L)1 therapy, as indicated by prolonged progression-free survival and overall survival. Plasma mevalonate levels were positively correlated with programmed death ligand-1 (PD-L1) expression in tumor tissues. In NSCLC cell lines and patient-derived cells, supplementation of mevalonate significantly up-regulated the expression of PD-L1, whereas deprivation of mevalonate reduced PD-L1 expression. Mevalonate increased CD274 mRNA level but did not affect CD274 transcription. Further, we confirmed that mevalonate improved CD274 mRNA stability. Mevalonate promoted the affinity of the AU-rich element-binding protein HuR to the 3'-UTR regions of CD274 mRNA and thereby stabilized CD274 mRNA. By in vivo study, we further confirmed that mevalonate addition enhanced the anti-tumor effect of anti-PD-L1, increased the infiltration of CD8⁺ T cells, and improved cytotoxic function of T cells. Collectively, our findings discovered plasma mevalonate levels positively correlated with the therapeutic efficacy of anti-PD-(L)1 antibody, and provided the evidence that mevalonate supplementation could be an immunosensitizer in NSCLC.