The Chinese version of Defensive Medicine Scale (DMS): reliability and validity test among physicians.

BACKGROUND: Physicians are inclined to resort to defensive medicine (DM) for self-protection due to the increasing potential risk of medical litigation. DM is globally prevalent and has become an impediment to the development of healthcare. However, there is a lack of validated tools specifically designed to assess DM in China. Therefore, this study aimed to evaluate the psychometric properties of the Chinese version of Defensive Medicine Scale (DMS) among clinicians to provide a practicable tool for relevant research. METHODS: The present research consists of two phases. In Phase 1, DMS was administered to survey 327 physicians, and the collected data were obtained for item analysis and exploratory factor analysis. Phase 2 applied DMS to survey 323 physicians, from which the data was used for confirmatory factor analysis, and reliability and cross-cohort consistency tests. Moreover, the participants of Phase 2 were required to complete Workplace Well-Being Scale (WWBS), Career Commitment Scale (CCS), Occupational Disidentification Scale (ODS), Intent to Leave Scale (ILS), and Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) to test the convergent validity of DMS. RESULTS: The Chinese version of DMS consists of 10 items divided into 2 dimensions, Positive Defensive Medicine (PDM) and Negative Defensive Medicine (NDM). The confirmatory factor analysis showed that the two-factor model fitted well (χ2/df = 2.540, RMSEA = 0.069, CFI = 0.981, IFI = 0.981, TLI = 0.971, PNFI = 0.646, PCFI = 0.654, SRMR = 0.044). Furthermore, the total score and the score of each dimension for DMS had a significant negative correlation with WWBS and CCS scores, and a significant positive correlation with ODS, ILS, and DDPRQ-10 scores. The Cronbach's α coefficients for the total DMS and PDM and NDM dimensions were 0.917, 0.935, and 0.842, respectively; the split-half reliability coefficients were 0.922, 0.947, and 0.839, respectively. In addition, DMS showed cross-gender invariance. CONCLUSION: The Chinese version of DMS has been demonstrated to be an effective tool to assess defensive medicine among Chinese physicians with good psychometric properties.

Efficacy of curculigoside in protecting against ischemic brain injury through regulation of oxidative stress and NF-κB and PI3K/Akt expression.

ETHNOPHARMACOLOGICAL RELEVANCE: The ancient Chinese medicine book "Huangdi Neijing" reports that "the brain is the sea of marrow" and that the kidney "mainly induces bones to produce marrow". Therefore, Chinese medicine has a "kidney-brain axis" theory, but supporting evidence is lacking. In this study, curculigoside, the main component of the kidney-tonifying drug Rhizoma Curculiginis, was used to explore whether a kidney-tonifying drug could regulate the pathological state of the brain. AIM OF THE STUDY: To explore the efficacy of curculigoside in protecting against ischemic brain injury (IBI) through the regulation of oxidative stress and NF-κB and PI3K/Akt expression. MATERIALS AND METHODS: Middle cerebral artery occlusion (MCAO) was used to induce IBI in rats, and curculigoside was administered. The degree of IBI, morphological changes and severity of nerve injury (using neurological severity scores; NSSs) in the rats were assessed. Enzyme-linked immunosorbent assays (ELISAs), Western blotting, and immunohistochemistry were used to evaluate changes in hydrogen peroxide (H2O2), nitric oxide (NO), malondialdehyde (MDA), TNF-α, IL-1ß, catalase (CAT), superoxide dismutase (SOD), nitric oxide synthase (NOS), NF-κB, PI3K and Akt levels. RESULTS: Curculigoside significantly alleviated behavioral deficits and reduced the degree of cerebral ischemia in the rats. After curculigoside treatment, the levels of H2O2, NO, MDA, NOS, iNOS, TNF-α, IL-1ß, intercellular adhesion molecule-1 (ICAM-1) and NF-κB in the ischemic area of the brain were significantly reduced. The activities of CAT, SOD, PI3K and Akt were significantly increased. CONCLUSION: Curculigoside is a potentially effective drug for the treatment of IBI.

Network-Based Elaboration of the Efficacy of the Dachangshu (BL25) and Tianshu (ST25) Points in the Treatment of Functional Constipation in Children through Inflammation, Adipocytokine, or Leptin Pathways.

Constipation commonly occurs during childhood, and more than 95% of cases are classified as functional constipation. If not effectively treated, 20% of patients with childhood constipation can continue to exhibit symptoms into adulthood, which seriously affects their mental health and quality of life. The main feature of acupuncture or acupoint stimulation, a special branch of traditional Chinese medicine, is the selection of different acupoints for different diseases, and many worthy guidelines have been established for matching acupoints. The back-shu and front-mu point combination adheres to an important acupoint compatibility law that has been used since its proposal 2,500 years ago but has not yet been verified by the modern evidence-based experiments. This study focused on the back-shu and front-mu point combination using the Dachangshu (BL25) and Tianshu (ST25) points as examples to explore possible research methods for network acupoint-based stimulation based on existing evidence and to elucidate the mechanisms induced by BL25 and ST25 in the treatment of functional constipation in children (FCC). The study found that BL25 and ST25 have 20 common targets, namely, AQP8, DRD2, VIP, TAC1, IL6R, TNF, FOS, KIT, CHAT, HTR3A, GAS8, SOD3, TRPV1, MPO, CALCA, IL1B, P2RX7, NPY2R, IL10RA, and TPH1, and these targets may provide a strategy for the combined usage of BL25 and ST25. In addition, BL25 and ST25 can affect FCC treatment through inflammation-relatedTh17-cell differentiation, the NF-kappa B signaling pathway, and the Toll-like receptor signaling pathway. Adipocytokines or leptin may also comprise the mechanism through which BL25 and ST25 regulate FCC. In addition, BL25 and ST25 regulate FCC through 13 core targets, namely, NFKBIA, RELA, TNF, IKBKB, IRAK1, TLR4, MYD88, TNFRSF1A, IL1R1, TLR2, IL1B, TRAF6, and TNFRSF1B. In short, this study provides new ideas and methods for studying the mechanism of acupuncture points.

Research progress and clinical prospect of immunocytotherapy for the treatment of hepatocellular carcinoma.

As a common malignant tumor, hepatocellular carcinoma (HCC) has high fatality rate due to its strong metastasis and high degree of malignancy. Current treatment strategies adopted in clinical practice were still conventional surgery, assisted with interventional therapy, radiotherapy and chemotherapy. However these treatments have limited effects with high recurrence rate. Current research progress of immunocytotherapy has shown that tumor cells can be directly identified and killed by stimulating the immune function and enhancing the anti-tumor immunity in tumor microenvironment. Targeted immunotherapeutics have therefore become the hope of conquering cancer in the future. It can kill tumor cells without damaging the body's immune system and function, restore and strengthen the body's natural anti-tumor immune system. It can reduce the toxic side effects of radiotherapy and chemotherapy, reduce the recurrence rate and prolong the survival period of patients with HCC. Currently, the immune cells widely studied are mainly as follows: Dendritic cells (DC), Cytokine-induced killer (CIK), DC-CIK, Chimeric antigen receptor T cells (CAR-T), Tumor infiltrating lymphocyte (TIL) and Natural killer cell (NK). Immunocytotherapy is a long-term treatment method, some studies have combined traditional therapy with immunocytotherapy and achieved significant effects, providing experimental basis for the application of immunocytotherapy. However, there are still some difficulties in the clinical application of immune cells. In this article, we discuss the application of immunocytotherapy in the clinical treatment of HCC, their effectiveness either alone or in combination with conventional therapies, and how future immunocytotherapeutics can be further improved from investigations in tumour immunology.

Upregulation of microRNA-31 targeting integrin α5 suppresses tumor cell invasion and metastasis by indirectly regulating PI3K/AKT pathway in human gastric cancer SGC7901 cells.

To verify the hypothesis that upregulation of microRNA-31 (miR-31) targeting integrin α5 (ITGA5) suppresses tumor cell invasion and metastasis by indirectly regulating phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway in human SGC7901 gastric cancer (GC) cells. The miRTarBase was used to predict whether ITGA5 is the target gene of miR-31, which was further confirmed by luciferase reporter gene assay. The SGC7901 GC cells were divided into five groups including the blank, miR-31 mimic, miR-31 mimic control, miR-31 inhibitor, and miR-31 inhibitor control groups. Reverse transcriptase-polymerase chain reaction (RT-PCR), western blotting, cell scratch test, and transwell assays were respectively performed in our study. TGA5 was found as the target gene of miR-31. The RT-PCR detection revealed that, compared with the blank group, ITGA5 messenger RNA (mRNA) expression decreased in the miR-31 mimic group, but increased in the miR-31 inhibitor group. The western blotting examination suggested that the expressions of ITGA5, PI3K, and AKT proteins reduced in the miR-31 mimic group, but enhanced in the miR-31 inhibitor group when compared to the blank group, respectively. The cell scratch and transwell assays indicated that the miR-31 expressions were negatively associated with GC cell migration and invasion. Besides, RT-PCR combined with western blotting demonstrated that the miR-31 expressions were higher in the normal tissues than those in the GC tissues, while the ITGA5 mRNA and protein showed lower expression in the normal tissues than they did in the GC tissues. Our study concluded that upregulation of miR-31 targeting ITGA5 may suppress tumor cell invasion and metastasis by indirectly regulating PI3K/AKT signaling pathway in human SGC7901 GC cells.