Clinical practice guidelines represent the best recommendations for patient care. They are developed through systematically reviewing currently available clinical evidence and weighing the relative benefits and risks of various interventions. However, clinical practice guidelines have to go through a long translation cycle from development and revision to clinical promotion and application, facing problems such as scattered distribution, high duplication rate, and low actual utilization. At present, the clinical practice guideline information platform can directly or indirectly solve the problems related to the lengthy revision cycles, decentralized dissemination and limited application of clinical practice guidelines. Therefore, this paper systematically examines different types of clinical practice guideline information platforms and investigates their corresponding challenges and emerging trends in platform design, data integration, and practical implementation, with the aim of clarifying the current status of this field and providing valuable reference for future research on clinical practice guideline information platforms.

ObjectiveTo explore the characteristics and regulatory mechanisms of cholestatic liver injury （CLI） caused by traditional Chinese medicine based on data mining， network pharmacology， and molecular docking. MethodChina National Knowledge Infrastructure and PubMed were searched for the relevant literature on CLI caused by traditional Chinese medicine from inception to 2024， and the information was standardized， summarized， and analyzed by cluster analysis. The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）， Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine （TCMIP）， GeneCards， Online Mendelian Inheritance in Man （OMIM）， and DisGeNET were used to retrieve the active ingredients and targets of core medicines. The Venn diagram was established to map the common targets shared by the core medicines and CLI. Cytoscape 3.10.2 was used to construct the protein-protein interaction （PPI） network of the common targets. DAVID was used for gene ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment of the core targets. Finally， molecular docking was performed by AutoDock Vina. ResultA total of 849 eligible articles were included in this study， from which 64 active ingredients of 39 herbal medicines that can cause cholestasis were counted and categorized according to the 2020 edition of the Pharmacopoeia of the People's Republic of China. The frequency of the medidicnes followed a descending order of heat-clearing medicines， exterior-releasing medicines， blood-activating and stasis-resolving medicines， purgative medicines， phlegm-resolving and cough- and dyspnea-relieving medicines， tonics， wind- and dampness-expelling medicines， interior-warming medicines， urination-promoting and dampness-draining medicines， Qi movement-regulating medicines， hemostatics， toxin-removing， worm-killing， and itch-relieving medicines， astringent medicines， dampness-eliminating medicines， and tranquiling medicines. The cluster analysis revealed that the reports of CLI caused by heat-clearing medicines accounted for the highest proportion of 39.69%. Among the heat-clearing medicines， Gardeniae Fructus （92 articles， accounting for 10.84%）， Scutellariae Radix （76 articles， 8.95%）， and Sophorae Flavescentis Radix （69 articles， 6.95%） were frequently reported. The core targets of cholestasis induced by Chinese herbal medicines reported to cause CLI mainly included tumor necrosis factor （TNF）， peroxisome proliferator activated receptor alpha （PPARA）， farnesoid X receptor （FXR）， glutamic-pyruvic transaminase 2 （GPT2）， superoxide dismutase 1 （SOD1）， interferon gamma （IFN-γ）， interleukin-6（IL-6）， CD36， Apolipoprotein A1（APOA1）， Angiotensin converting enzyme（ACE）， Cytochrome P450 3A4 enzyme（CYP3A4）， Protein kinase B1（Akt1）， APOB， albumin（ALB）， ATP binding cassette transporter A4（ABCB4）， SLC10A1， Estrogen Receptor alpha （ESR1）， signal transducer and activator of transcription1（STAT1）， β-actin（ACTB）， Endothelin 1（EDN1）， ABCG2， and peroxisome proliferator activated receptor gamma（PPARG）. The signaling pathways involved included bile secretion， ABC transporter， steroid biosynthesis， DNA adducts， drug metabolism， cytochrome P450， peroxisomes， primary bile acid biosynthesis， retinol metabolism， and Toll-like receptor. The molecular docking results showed that the active ingredients （e.g.， baicalin and berberine） of the heat-clearing medicines reported by high frequency to cause CLI had high binding affinity to the targets including ABCG2， IFN-γ， EDN1， IL-6 and SOD1， with the binding energy in the range of -13 kcal·mol^-1 to -9 kcal·mol^-1， and the regulatory pathways were highly correlated with transporters， microvascular function regulation， inflammation， and oxidative stress， which was consistent with the cluster analysis. ConclusionThe available reports about the Chinese herbal medicines causing CLI mainly focused on heat-clearing medicines， and the core targets included ABCG2， IFN-γ， EDN1， IL-6， and SOD1. The regulatory pathways were mainly related to transporters， microvascular function regulation， inflammation， and oxidative stress.

Objective:To identify the relationship between the CT arterial radiomics score and the treatment response to neoadjuvant therapy for pancreatic cancer.Methods:The clinical data of 243 pancreatic cancer patients who received surgical resection after neo-adjuvant therapy in the First Affiliated Hospital of Naval Medical University from March 2017 to March 2023 were retrospectively analyzed. Based on the tumor regression grade (TRG), the patients were divided into good response group (TRG 0-1, n=30) and non-good response group (TRG 2-3, n=213). The clinical, radiological and pathological features were compared between two groups. Fully-automated segmentation tool was used for segmenting the arterial CT scan of pancreatic tumor before and after treatment. Python package was applied to extract the radiomics features of tumors after segmentation and the extracted features were reduced and chosen using the least absolute shrinkage and selection operator (Lasso) logistic regression algorithm. Lasso logistic regression formula was applied to calculate the arterial radiomics score. Univariate and multivariate logistic regression models were used to analyze the association between arterial radiomics score and treatment response to neoadjucant therapy. Receiver operating-characteristics (ROC) curve was drawn and area under curve (AUC), specificity, sensitivity and accuracy for evaluating the treatment response were calculated. The clinical usefulness of arterial radiomics score for diagnosing the response of neoadjuvant treatment for pancreatic cancer were determined by decision curve analysis (DCA) . Results:A total of 330 arterial radiomics CT features were obtained, and 9-selected arterial phase features associated with treatment response were determined after being reduced by the Lasso logistic regression algorithm. Univariate analysis showed that the arterial radiomics score, three-dimensional diameter after neoadjuvant therapy, pancreatic contour, T stage, N stage, Peri-pancreatic nerve invasion, lymph-vascular space invasion (LVSI) and invasion of duodenum were all associated with treatment response (all P value <0.05). Multivariate logistic regression analyses confirmed that arterial radiomics score was obviously associated with the neoadjuvant treatment response ( P<0.001). At the cut-off value of 1.93, AUC of the arterial radiomics score for diagnosing neoadjuvant treatment response was 0.92, and the specificity, sensitivity and accuracy was 86.7%, 84.5% and 84.8%. DCA demonstrated that when the percentage for predicting the treatment response by using the arterial radiomics score was >0.2, the patients could benefit from the application of arterial radiomics score for evaluating neoadjuvant therapy response. Conclusions:The arterial radiomics score was strongly correlated with the neoadjuvant treatment response of pancreatic cancer, and can accurately predict neoadjuant treatment efficacy.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective:To analyze the genetic evolution and molecular characteristics of H7N9 avian influenza virus (AIV) isolated in a live poultry market.Methods:Samples such as poultry feces, sewage, and hair removal machine and chopping board swabs were collected. Real-time fluorescent quantitative PCR was used to detect influenza A virus and H7N9 AIV in the samples. The whole genome of H7N9 AIV was amplified with influenza A virus universal primers and sequenced. BLAST and MEGA X were used for sequence alignment, phylogenetic analysis and molecular characterization.Results:Seven poultry-related environment samples were collected in the live poultry market in Xuchang city in February 2023, and four were positive for H7N9 AIV. The whole genome sequences of three H7N9 AIV isolates were successfully obtained, and the isolates shared high nucleotide identity in different genes (98.37%-100.00%). BLAST analysis showed they were highly identical to H7N9 strains isolated from domestic poultry in China from 2020 to 2021. Genetic evolution analysis showed that the three isolates clustered in the same branch and were closer to the recent environmental isolates than to the recent strains isolated from human or avian. Through comparison with the sequences of the representative strains in different periods, it was found that the isolated strains in this study showed high avian pathogenicity with four amino acids KRAA inserted at the cleavage site; the hemagglutinin receptor-binding site was QSG, which was an avian binding receptor; there was a G186I mutation in hemagglutinin. Mammalian-adaptive mutation E627K was not detected in polymerase basic protein 2. Mutations (R292K and I38T) associated with drug resistance to neuraminidase inhibitor (oseltamivir) and polymerase acidic protein inhibitor (baloshavir) were not detected, suggesting that these isolates remained susceptible to these drugs. A S31N mutation was found in M2 protein, indicating they were resistant to alkamines.Conclusions:The three H7N9 AIV strains isolated in the live poultry market have high avian pathogenicity, but there are no significant increase in mutations related to the binding ability to human receptors, mammalian pathogenicity, viral transmissibility, or drug resistance as compared with previous representative strains causing human or avian infection.

Objective:To develop and validate the models based on mixed enhanced computed tomography (CT) radiomics and deep learning features, and evaluate the efficacy for differentiating pancreatic adenosquamous carcinoma (PASC) from pancreatic ductal adenocarcinoma (PDAC) before surgery.Methods:The clinical data of 201 patients with surgically resected and histopathologically confirmed PASC (PASC group) and 332 patients with surgically resected histopathologically confirmed PDAC (PDAC group) who underwent enhanced CT within 1 month before surgery in the First Affiliated Hospital of Naval Medical University from January 2011 to December 2020 were retrospectively collected. The patients were chronologically divided into a training set (treated between January 2011 and January 2018, 156 patients with PASC and 241 patients with PDAC) and a validation set (treated between February 2018 and December 2020, 45 patients with PASC and 91 patients with PDAC) according to the international consensus on the predictive model. The nnU-Net model was used for pancreatic tumor automatic segmentation, the clinical and CT images were evaluated, and radiomics features and deep learning features during portal vein phase were extracted; then the features were dimensionally reduced and screened. Binary logistic analysis was performed to develop the clinical, radiomics and deep learning models in the training set. The models' performances were determined by area under the ROC curve (AUC), sensitivity, specificity, accuracy, and decision curve analysis (DCA).Results:Significant differences were observed in tumor size, ring-enhancement, upstream pancreatic parenchymal atrophy and cystic degeneration of tumor both in PASC and PDAC group in the training and validation set (all P value <0.05). The multivariable logistic regression analysis showed the tumor size, ring-enhancement, dilation of the common bile duct and upstream pancreatic parenchymal atrophy were associated with PASC significantly in the clinical model. The ring-enhancement, dilation of the common bile duct, upstream pancreatic parenchymal atrophy and radiomics score were associated with PASC significantly in the radiomics model. The ring-enhancement, upstream pancreatic parenchymal atrophy and deep learning score were associated with PASC significantly in the deep learning model. The diagnostic efficacy of the deep learning model was highest, and the AUC, sensitivity, specificity, and accuracy of the deep learning model was 0.86 (95% CI 0.82-0.90), 75.00%, 84.23%, and 80.60% and those of clinical and radiomics models were 0.81 (95% CI 0.76-0.85), 62.18%, 85.89%, 76.57% and 0.84 (95% CI 0.80-0.88), 73.08%, 82.16%, 78.59% in the training set. In the validation set, the area AUC, sensitivity, specificity, and accuracy of deep learning model were 0.78 (95% CI 0.67-0.84), 68.89%, 78.02% and 75.00%, those of clinical and radiomics were 0.72 (95% CI 0.63-0.81), 77.78%, 59.34%, 65.44% and 0.75 (95% CI 0.66-0.84), 86.67%, 56.04%, 66.18%. The DCA in the training and validation sets showed that if the threshold probabilities were >0.05 and >0.1, respectively, using the deep learning model to distinguish PASC from PDAC was more beneficial for the patients than the treat-all-patients as having PDAC scheme or the treat-all-patients as having PASC scheme. Conclusions:The deep learning model based on CT automatic image segmentation of pancreatic neoplasm could effectively differentiate PASC from PDAC, and provide a new non-invasive method for confirming PASC before surgery.

Objective:To compare the efficacy and safety of stone extraction with a single peroral choledochoscopy system under direct visualization and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) for non-difficult common bile duct stones.Methods:A total of 164 patients with common bile duct stones who underwent stone extraction by using the single peroral choledochoscopy system under direct visualization (the observation group, n=82) and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) (the control group, n=82) from January 2018 to April 2022 in Dongfang Hospital, Beijing University of Chinese Medicine were enrolled. The observation group was directly selected from the database, while the control group was randomly matched by age stratification with baseline data validated. The success rates of intubation, stone removal, postoperative complication incidence, and radiation exposure between the two groups were compared. Results:There was no significant difference between the baseline data of the observation group and the control group ( P>0.05). The number of patients with detected stones≥2 in the observation group and the control group were 59 (71.95%) and 37 (45.12%) respectively with significant difference ( χ 2=12.16, P=0.001). The success rates of bile duct intubation in the observation group and the control group were both 100.00% (82/82). The success rates of stone extraction were 98.78% (81/82) and 100.00% (82/82) respectively with no significant difference ( P>0.05). The one-time stone removal rates of the two groups were 93.90% (77/82) and 92.68% (76/82) respectively with no significant difference ( χ2=0.10, P=0.755). There was no significant difference in the incidence of postoperative complications between the observation group and the control group ( P>0.05). The amount of intraoperative ray exposure volume in the observation group was significantly lower than that of the control group [10.20 (6.69, 18.94) mGy VS 15.41 (10.70, 22.77) mGy, U=2 462.00, P=0.003]. Conclusion:The efficacy and safety of stone extraction with single peroral choledochoscopy system under direct visualization are comparable to those of traditional X-ray ERCP for non-difficult common bile duct stones, but it can significantly reduce the intraoperative ray exposure volume during therapeutic ERCP stone extraction.

Deacetylation of chitin is closely related to insect development and metamorphosis. Chitin deacetylase (CDA) is a key enzyme in the process. However, to date, the CDAs of Bombyx mori (BmCDAs), which is a model Lepidopteran insect, were not well studied. In order to better understand the role of BmCDAs in the metamorphosis and development of silkworm, the BmCDA2 which is highly expressed in epidermis was selected to study by bioinformatics methods, protein expression purification and immunofluorescence localization. The results showed that the two mRNA splicing forms of BmCDA2, namely BmCDA2a and BmCDA2b, were highly expressed in the larval and pupal epidermis, respectively. Both genes had chitin deacetylase catalytic domain, chitin binding domain and low density lipoprotein receptor domain. Western blot showed that the BmCDA2 protein was mainly expressed in the epidermis. Moreover, fluorescence immunolocalization showed that BmCDA2 protein gradually increased and accumulated with the formation of larval new epidermis, suggesting that BmCDA2 may be involved in the formation or assembly of larval new epidermis. The results increased our understandings to the biological functions of BmCDAs, and may facilitate the CDA study of other insects.
Animals ; Bombyx/metabolism* ; Metamorphosis, Biological/genetics* ; Larva/metabolism* ; Gene Expression ; Insect Proteins/metabolism* ; Chitin

Type 2 diabetes mellitus (T2DM) therapy is facing the challenges of long-term medication and gradual destruction of pancreatic islet β-cells. Therefore, it is timely to develop oral prolonged action formulations to improve compliance, while restoring β-cells survival and function. Herein, we designed a simple nanoparticle with enhanced oral absorption and pancreas accumulation property, which combined apical sodium-dependent bile acid transporter-mediated intestinal uptake and lymphatic transportation. In this system, taurocholic acid (TCA) modified poly(lactic-co-glycolic acid) (PLGA) was employed to achieve pancreas location, hydroxychloroquine (HCQ) was loaded to execute therapeutic efficacy, and 1,2-dilauroyl-sn-glycero-3-phosphocholine (DLPC) was introduced as stabilizer together with synergist (PLGA-TCA/DLPC/HCQ). In vitro and in vivo results have proven that PLGA-TCA/DLPC/HCQ reversed the pancreatic islets damage and dysfunction, thus impeding hyperglycemia progression and restoring systemic glucose homeostasis via only once administration every day. In terms of mechanism PLGA-TCA/DLPC/HCQ ameliorated oxidative stress, remodeled the inflammatory pancreas microenvironment, and activated PI3K/AKT signaling pathway without obvious toxicity. This strategy not only provides an oral delivery platform for increasing absorption and pancreas targetability but also opens a new avenue for thorough T2DM treatment.