Bronchial asthma （asthma） is a heterogeneous disease characterized by airflow limitation， airway remodeling， and recurrent symptoms such as wheezing， shortness of breath， chest tightness， and cough. Its prevalence is gradually increasing， and a portion of patients are still poorly controlled， leading to a serious social and medical burden. Modern studies have proposed the concept of the "lung-gut axis"， which is based on the crosstalk between microorganisms and their metabolites in the lungs and large intestine， and have indicated that microbial dysbiosis in these organs may affect the onset and progression of asthma. Traditional Chinese medicine （TCM） has found the phenomenon of lung-intestinal comorbidity and put forward the importance of "lung-intestinal coordination therapy" in the treatment of lung-related diseases. It has been found that intestinal flora and their metabolites can modulate immune responses through the lung-gut axis， demonstrating great potential for predicting asthma susceptibility， anticipating phenotypes， assessing asthma severity， and guiding treatment. TCM comopunds that embody lung-intestinal coordination therapy， including herbal formulas， single herbs， acupuncture， moxibustion， acupoint application， and spinal pinching therapy， has been shown to regulate intestinal flora， improve metabolism， regulate immunity， alleviate lung inflammation， reduce mucus secretion， inhibit airway remodeling， effectively alleviate symptoms， and delay lung function decline. Based on "lung-intestinal coordination therapy"， this paper used intestinal flora as the entry point to summarize the underlying mechanisms of TCM in asthma treatment and highlighted the pivotal role of intestinal flora in asthma， providing a new idea for its clinical treatment through the intestinal flora .

Objective:To investigate the influence of curative-intent resection with textbook outcomes of liver surgery (TOLS) on long-term prognosis of gallbladder carcinoma (GBC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 824 patients with GBC in the national multicenter database of Biliary Surgery Group of Elite Group of Chinese Journal of Digestive Surgery, who were admitted to 15 medical centers from January 2014 to January 2021, were collected. There were 285 males and 539 females, aged (62±11)years. According to the evalua-tion criteria of TOLS, patients were divided into those who achieved TOLS and those who did not achieve TOLS. Measurement data with normal distribution were represented as Mean± SD, and com-parison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data were conduc-ted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and the Log-rank test was used for survival analysis. The COX stepwise regression model with backward Wald method was used for univariate and multivariate analyses. Results:(1) Achievement of TOLS. Of the 824 patients undergoing curative-intent resection for GBC, there were 510 cases achieving TOLS and 314 cases not achieving TOLS. (2) Follow-up. Of the 824 patients undergoing curative-intent resection for GBC, after excluding 112 deaths within 90 days after discharge, 712 cases were included for the survival analysis. The median follow-up time, median overall survival time and 5-year overall survival rate of the 510 patients achieving TOLS were 22.1(11.4,30.1)months, 47.6(30.6,64.6)months and 47.5%. The median follow-up time, median overall survival time and 5-year overall survival rate of the 202 patients not achieving TOLS were 14.0(6.8,25.5)months, 24.3(20.0,28.6)months and 21.0%. There was a significant difference in overall survival between patients achieving TOLS and patients not achieving TOLS ( χ2=58.491, P<0.05). (3) Analysis of factors influencing prognosis of patients. Results of multivariate analysis showed that TOLS, carcinoembryonic antigen (CEA), CA19-9, poorly differentiation of tumor, T2 stage of eighth edition of American Joint Committee on Cancer (AJCC) staging, T3 and T4 stage of eighth edition of AJCC staging, N1 stage of the eighth edition of AJCC staging, N2 stage of the eighth edition of AJCC staging, adjuvant therapy were independent factors influencing overall survival time of patients undergoing curative-intent resection for GBC ( hazard ratio=0.452, 1.479, 1.373, 1.612, 1.455, 1.481, 1.835, 1.978, 0.538, 95% c onfidence interval as 0.352-0.581, 1.141-1.964, 1.052-1.791, 1.259-2.063, 1.102-1.920, 1.022-2.147, 1.380-2.441, 1.342-2.915, 0.382-0.758, P<0.05). Conclusion:Patients under-going curative-intent resection for GBC with TOLS can achieve better long-term prognosis.

Background/Aims: Ubiquitination is widely involved in the progression of hepatocellular carcinoma (HCC) by regulating various cellular processes. However, systematic strategies for screening core ubiquitin-related genes, clarifying their functions and mechanisms, and ultimately developing potential therapeutics for patients with HCC are still lacking. Methods: Cox and LASSO regression analyses were performed to construct a ubiquitin-related gene prediction model for HCC. Loss- and gain-of-function studies, transcriptomic and metabolomics analysis were used to explore the function and mechanism of UBE2S on HCC cell glycolysis and growth. Results: Based on 1,423 ubiquitin-related genes, a four-gene signature was successfully constructed to evaluate the prognosis of patients with HCC. UBE2S was identified in this signature with the potential to predict the survival of patients with HCC. E2F2 transcriptionally upregulated UBE2S expression by directly binding to its promoter. UBE2S positively regulated glycolysis in a HIF-1α-dependent manner, thus promoting the proliferation of HCC cells. Mechanistically, UBE2S enhanced K11-linkage polyubiquitination at lysine residues 171 and 196 of VHL independent of E3 ligase, thereby indirectly stabilizing HIF-1α protein levels by mediating the degradation of VHL by the proteasome. In particular, the combination of cephalomannine, a small molecule compound that inhibits the expression of UBE2S, and PX-478, an inhibitor of HIF-1α, significantly improved the anti-tumor efficacy. Conclusions UBE2S is identified as a key biomarker in HCC among the thousands of ubiquitin-related genes and promotes glycolysis by E3 enzyme-independent ubiquitination, thus serving as a therapeutic target for the treatment of HCC.

Objective:To review the paper on the admittance evaluation indicators of palliative care for patients with heart failure, and clarify the admittance evaluation indicators of palliative care for patients with heart failure and corresponding evaluation criteria or tools at home and abroad.Methods:Based on the framework of the scoping review, paper retrieval was carried out through computer in PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), WanFang Database, Chinese Biomedical Literature Database and VIP. The retrieval time limit was from the establishment of the database to April 30, 2022. The original research and review on the admittance evaluation of palliative care for patients with heart failure were included, and the data were independently screened and extracted by two researchers.Results:A total of 15 papers were included. The results of document integration showed that the admittance evaluation indicators of palliative care for patients with heart failure included four categories, namely, disease progress, patient needs, medical resource utilization and medical institutions. It included 12 evaluation indicators and corresponding evaluation criteria or evaluation tools, including the patient's expected survival period, cardiac function, high-risk biomarkers, exercise status, complications, advanced treatment, patient's subjective will, complex symptom relief needs, social support needs, multiple unplanned admissions, hospital stay extension, and medical institution software and hardware resources.Conclusions:The content of the admittance evaluation indicators of palliative care for patients with heart failure is comprehensive, but the evaluation criteria for some indicators are not clear, and there is no consensus on the whole. In the future, researchers can select sensitive evaluation indicators on the basis of existing research, construct the admittance evaluation indicators of palliative care for patients with heart failure, and verify it in clinical practice, so as to promote the application of palliative care in the disease management of patients with heart failure.

Objective:To construct the clinical training content system for master of nursing specialist (MNS) in China.Methods:The first draft of clinical training content system for MNS was constructed through literature review, national status survey and semi-structured interview. Delphi expert consultation was used to form the final draft, and analytic hierarchy process was used to determine the weight of indicators at all levels.Results:Two rounds of consultation were conducted among 20 experts. The questionnaire recovery rate was 100% and the expert authority coefficient was 0.93. The Kendall concordance coefficients of the two rounds were 0.499 and 0.387, respectively, with a statistically significant difference ( P<0.001) . The average assigned value of importance of indicators at all levels was 4.60 to 5.00. The final version of the clinical training content system for MNS included 6 first-level items, 17 second-level items and 24 third-level items. Conclusions:The clinical training content system for MNS has good practicability, scientificity and reliability, which can provide reference and guidance for MNS clinical training.

Objective To evaluate the clinical efficacy of liver transplantation in children with Alagille syndrome (ALGS). Methods Clinical data of 12 children with ALGS were collected and retrospectively analyzed. Clinical characteristics of children with ALGS, pathological characteristics of liver tissues, characteristics of liver transplantation, postoperative complications and follow-up of children with ALGS were analyzed. Results JAG1 gene mutation and typical facial features was present in all 12 children. Jaundice was the most common initial symptom, which occurred at 7 (3, 40) d after birth. Upon liver transplantation, the Z scores of height and body weight were calculated as -2.14 (-3.11, -1.83) and -2.32 (-3.12, -1.12). Five children developed severe growth retardation and 4 children with severe malnutrition. Eight of 12 children were diagnosed with cardiovascular abnormalities. Pathological examination showed that the lobular structure of the diseased livers of 4 children was basically maintained, and 8 cases of nodular liver cirrhosis in different sizes including 1 case of single early moderately-differentiated hepatocellular carcinoma. Three children were misdiagnosed with biliary atresia and underwent Kasai portoenterostomy. Eight children underwent living donor liver transplantation, three children underwent cadaveric donor liver transplantation (two cases of split liver transplantation and one case of cadaveric total liver transplantation), and one child underwent domino liver transplantation (donor liver was derived from a patient with maple syrup urine disease). during the follow-up of 30.0(24.5, 41.7) months, the survival rates of the children and liver grafts were both 100%. During postoperative follow-up, the Z scores of height and body weight were calculated as -1.24 (-2.11, 0.60) and -0.83 (-1.65, -0.43), indicating that the growth and development of the children were significantly improved after operation. Conclusions Liver transplantation is an efficacious treatment for children with ALGS complicated with decompensated cirrhosis, severe itching and poor quality of life. For children with ALGS complicated with cardiovascular abnormalities, explicit preoperative evaluation should be delivered, and consultation with pediatric cardiologists should be performed if necessary.

Objective:To investigate the application and surgical effect of lobed anterolateral femoral chimeric perforator flap in repairing the complex soft tissue defects of limbs.Methods:Clinical materials of 52 cases with complex soft tissue defects of limbs were retrospectively reviewed from October 2013 to October 2020. Thirty-two males and 20 females were reviewed, and the age of them ranged from 6 to 65(mean 39) years old. The injuries include 17 cases of traffic accidents, 15 machine crush injuries, 12 engineering accidents, and 8 extensive resection of malignant tumors. The size of soft tissue defects ranged from 26.0 cm×10.0 cm to 35.0 cm×15.0 cm. Lobed anterolateral thigh chimeric perforator flaps or lobed Flow-through chimeric perforator flaps were designed according to the soft tissue defects and blood circulation of the distal extremities. Start from 8-month post-operation, upper limb function was assessed according to the Upper Limb Function Assessment Standard of Hand Surgery Branch of Chinese Medical Association and Disability of arm shoulder and hand(DASH) score scale, and Fugl-Meyer score system was used to evaluate the lower limb function. Long-term follow-up was conducted through WeChat video call and outpatient clinic evaluation.Results:All flaps survived. One patient with crush injury got delayed wound healing due to deep hemaetoma after surgery, and the rest were healed at the first stage. All the cases entered followed-up, ranged from 6 to 20(mean 8) months. The appearance of the flaps was satisfactory, and the color of the flaps has no significant difference compared with the recipient area. No recurrence of tumor was reported during the follow-up period. According to the Upper Limb Function Assessment Standard of Hand Surgery Branch of Chinese Medical Association, there were 21 excellent cases and 8 good cases, and the total excellent and good rate was 100%. The DASH score of upper limbs ranges from 11.5 to 45.1(mean 25.4±13.7), and the Fugl-Meyer score of lower limbs range from 18.6 to 31.8(mean 26.2±11.2) at the last follow-up.Conclusion:The complex soft tissue defect of limbs is a common complication caused by high-energy trauma, which is difficult to repair. The lobed anterolateral thigh chimeric perforator flap through a Decompose-Combine and arrange method for reconstruction, which is flexible in flap design. A variety of tissue flaps can be obtained by anastomosing only one group of blood vessels. It is an ideal choice for repairment of complex soft tissue defects of limbs.

Objective:To evaluate the application effect of palliative care based on multidisciplinary cooperation in patients with heart failure.Methods:Randomized controlled trials of palliative care in patients with heart failure were searched by computer in PubMed, Embase, CINAHL, The Cochrane Library, China Biology Medicine disc, CNKI, Wanfang Database, VIP and other Chinese and English databases. The search time limit was from the establishment of the databases to December 31, 2020. Two researchers independently screened the literature, extracted the data and evaluated the quality. RevMan 5.4 software was used to conduct a meta-analysis of the included studies.Results:A total of 12 studies were included, including 1 402 patients. Meta-analysis results showed that compared with conventional management, palliative care based on multidisciplinary collaboration could improve quality of life of patients with heart failure ( SMD=0.72, 95% CI: 0.32-1.11, P<0.01), reduce the burden of symptoms on patients ( MD= -12.90, 95% CI: -20.25--5.54, P<0.01), and reduce depression level ( MD=-0.38, 95% CI: -3.69--0.08, P<0.05), anxiety level ( MD=-0.35, 95% CI: -0.66--0.05, P<0.05) and rehospitalization rate of patients ( RR=0.70, 95% CI: 0.57-0.86, P<0.01). There was no statistically significant difference in mortality between patients ( RR=1.02, 95% CI: 0.63-1.63, P=0.94) . Conclusions:Palliative care based on multidisciplinary collaboration can improve the quality of life of patients with heart failure, reduce the burden of symptoms, depression level and anxiety level and reduce the rehospitalization rate of patients, but it has no significant effect on reducing the mortality rate of patients. Given that palliative care is still in its infancy in China and is limited by the quality and quantity of included studies, the above conclusions need to be verified by more large-sample and high-quality studies.

Objective:To systematically synthesize the qualitative research on the attitude and experience of health care personnel towards the hospice care of patients with heart failure, so as to provide evidence support for hospice care.Methods:Qualitative research on the attitude and experience of health care personnel towards the hospice care of patients with heart failure was retrieved through computers in PubMed, Embase, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database, VIP and Wanfang. The retrieval time limit was from the establishment of the database to July 1, 2022. The quality of the included article was evaluated using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center in Australia. The results were synthesized using the aggregation synthesis method.Results:Totally 15 articles were included. A total of 61 results were extracted, and 9 categories were included and 3 synthetic results were synthesized and summarized, namely, the timing of intervention, obstacle factors and promotion strategies of hospice care for patients with heart failure.Conclusions:Health care personnel should involve in hospice care in the early stage of heart failure and take into account the wishes, needs of patients and their families and prognosis of patients. Health care personnel should strengthen multidisciplinary cooperation and communication with patients and their families. Relevant departments need to provide guidance and support from the policy aspect, and strengthen the publicity and education of health care personnel, patients and their families. We will work together to integrate hospice care into the disease management of patients with heart failure, so as to improve the quality of life of patients.

Objective:To study the hepatic hemodynamics changes and pathophysiological mechanisms of the use of a functional shunt after auxillary liver transplantation to treat portal hypertension associated with a small-for-size graft.Methods:A retrospective analysis of the clinical data of patients with portal hypertension treated with functional shunting of small-volume grafts from a living donor liver at the Beijing Friendship Hospital, Capital Medical University from July 2014 to December 2018, and a total of 6 patients were included as the research objects, including 4 males and 2 females, with a median age of 35.5 (29.0-52.0) years old. Blood flow monitoring data were collected during and after operation, and the characteristics of liver hemodynamics were analyzed.Results:The portal venous blood flow of the remnant native liver gradually decreased to no flow. As a buffer response, the flow velocity of hepatic artery increased. The portal venous blood flow of the graft gradually increased in the early postoperative period and then gradually decreased from post-operation Day 5 to 10 due to gradual increase in portal venous resistance. However, the portal venous perfusion gradually increased from Day 10 after the operation, reached to a level and declined to a stable level about 1 month after the operation. The volume of abdominal drainage slowly decreased after the peak level at Day 5-10 after the operation, and disappeared completely at Day 30 after operation.Conclusions:When using auxiliary liver transplantation for functional shunting to treat portal hypertension, autologous residual liver can act as a guide buffer for the pressure gradient of portal vein hyperperfusion in liver transplantation, and reach a steady state of blood flow distribution about 1 month after surgery, while relying on autologous remnant liver hepatic artery buffer response prevents small liver syndrome.