ObjectiveTo explore the effects of the Tai Chi training on bone density， bone turnover markers， and heart rate variability for people with high-risk osteoporosis， and to provide evidence for the prevention of osteoporosis at early stage. MethodsSixty-six cases of people with high risk of osteoporosis were included， and they were divided into 33 cases each in the intervention group and the control group using the random number table method. The control group received osteoporosis health education three times a week， and the intervention group received Tai Chi training under the guidance of a trainer three times a week for 40 mins each time on the basis of the control group， and both groups were intervened for 12 weeks. Dual-energy X-ray absorptiometry was used to measure the bone density of L₁~L₄ vertebrae， bilateral femoral necks and bilateral total hips in the two groups before and after the intervention； enzyme-linked immunosorbent assay was used to determine bone turnover markers before and after the intervention， including pro-collagen type Ⅰ pro-amino-terminal prepropyl peptide （P1NP） and β-collagen type Ⅰ cross-linking carboxy-terminal peptide （β-CTX）. Seven cases with good compliance in the intervention group were selected. After wearing the heart rate sensor， they successively performed Tai Chi training and walking activities recommended by the guideline for 20 mins each， and the heart rate variability （HRV） during exercise was collected， including time-domain indexes such as standard deviation of normal sinus intervals （SDNN）， root-mean-square of the difference between adjacent RR intervals （RMSSD）， frequency-domain metrics such as low-frequency power （LF）， high-frequency power （HF）， and low-frequency/high-frequency power ratio （LF/HF）， as well as nonlinear metrics such as approximate entropy （ApEn）， sample entropy （SampEn）. ResultsFinally， 63 cases were included in the outcome analysis， including 30 cases in the intervention group and 33 cases in the control group. After the intervention， the differences of L₁~L₄ vertebrae， bone density of bilateral femoral neck and bilateral total hip in the intervention group were not statistically significant when compared with those before intervention （P＞0.05）， while the bone density of all parts of the control group decreased significantly compared with that before intervention （P＜0.05）， and the difference in the bone density of the L₁~L₄ vertebrae， bilateral femoral neck， and the right total hip before and after the intervention of the intervention group was smaller than that of the control group （P＜0.05）. The differences in P1NP and β-CTX between groups before and after intervention was not statistically significant （P＞0.05）. Compared with walking exercise， LF decreased， HF increased and LF/HF decreased during Tai Chi exercise （P＜0.05）； the time domain indexes and non-linear indexes between groups had no statistically significant difference （P＞0.05）. ConclusionTai Chi exercise can maintain lumbar， hip， and femoral bone density and improve sympathetic/parasympathetic balance in people at high risk for osteoporosis， but cannot significantly improve bone turnover markers.

Objective To observe the effects of Yixintai on lipid metabolism and the protein expressions of CPT-1 and CD36 in rats with heart failure;To explore the mechanism of its treatment of heart failure.Methods 106 out of 120 SD rats were selected to establish the heart failure model induced by myocardial infarction by ligating the left anterior descending coronary artery,and 14 rats were selected as the sham-operation group.The successful model rats were randomly divided into model group,trimetazidine group and Yixintai low-,medium-and high-dosage groups,with 14 rats in each group.The administration group was given corresponding drugs by gavage once a day for 4 weeks.LVEF,LVFS,LVIDd and LVIDs were measured by color doppler ultrasonography,the contents of ANP,BNP,LA and FFA in serum were detected by ELISA,the contents of TG,TC,LDL and HDL were detected by automatic biochemical analyzer,HE and Masson staining were used to observe the morphology of myocardial tissue,the expressions of CPT-1 and CD36 protein in myocardial tissue were detected by Western blot.Results Compared with the sham-operation group,LVEF and LVFS in the model group decreased(P<0.05),the LVIDs and LVIDd increased(P<0.05);the contents of serum ANP,BNP,LA,FFA,TG,TC and LDL increased(P<0.05),while the content of HDL decreased(P<0.05),with myocardial edema,irregular arrangement of myocardial fibers,increased inflammatory cell infiltration and collagen fiber deposition;the protein expressions of CPT-1 and CD36 in myocardial tissue decreased(P<0.05).Compared with the model group,the LVEF and LVFS in Yixintai each dosage groups and trimetazidine group increased(P<0.05),LVIDs and LVIDd decreased(P<0.05);the contents of ANP,BNP,LA,FFA,TG,TC and LDL in serum of Yixintai medium-and high-dosage groups and trimetazidine group decreased(P<0.05),the content of HDL increased(P<0.05);myocardial edema was improved,inflammatory cell infiltration was reduced,collagen fiber deposition was reduced,and the protein expressions of CPT-1 and CD36 in myocardial tissue increased(P<0.05).Conclusion Yixintai may improve myocardial energy metabolism and treat heart failure by increasing the expression of CPT-1 and CD36 protein in myocardial tissue and promoting fatty acid β oxidation.

Objective To investigate the causal relationship between psychiatric and psychological disorders(depression,bipolar dis-order,and schizophrenia)and non-alcoholic fatty liver disease(NAFLD).Methods The two-sample Mendelian randomization(MR)method was adopted,with depression,bipolar disorder,and schizophrenia as exposure variables and NAFLD as the outcome variable.The single nucleotide polymorphisms(SNPs)independently associated with exposure variables were obtained from the summary data of the genome-wide association study(GWAS)as instrumental variables for MR analysis.The analysis results of the inverse-variance weighted(IVW)were used as the primary outcome indicators,while those of the MR Egger regression method,weighted median,and weighted mode as supplementary results.The Cochran's Q test,MR-Egger intercept,and"leave-one-out"method were used for sensi-tivity analysis.Results The results of IVW analysis showed that depression was positively correlated with the incidence risk of NAFLD(OR=1.21,95％CI:1.01-1.44,P＜0.05),while bipolar disorder was negatively correlated with the incidence risk of NAFLD(OR=0.91,95％CI:0.84-1.00,P＜0.05).No causal relationship was found between schizophrenia and NAFLD.The heterogeneity and sen-sitivity analysis supported the robustness of the results of the study.Conclusion Depression and bipolar disorder are causally associat-ed with the incidence of NAFLD.Depression is associated with an increased risk of NAFLD,while bipolar disorder is associated with a reduced risk of NAFLD.

Objective To investigate the causal relationship between psychiatric and psychological disorders(depression,bipolar dis-order,and schizophrenia)and non-alcoholic fatty liver disease(NAFLD).Methods The two-sample Mendelian randomization(MR)method was adopted,with depression,bipolar disorder,and schizophrenia as exposure variables and NAFLD as the outcome variable.The single nucleotide polymorphisms(SNPs)independently associated with exposure variables were obtained from the summary data of the genome-wide association study(GWAS)as instrumental variables for MR analysis.The analysis results of the inverse-variance weighted(IVW)were used as the primary outcome indicators,while those of the MR Egger regression method,weighted median,and weighted mode as supplementary results.The Cochran's Q test,MR-Egger intercept,and"leave-one-out"method were used for sensi-tivity analysis.Results The results of IVW analysis showed that depression was positively correlated with the incidence risk of NAFLD(OR=1.21,95％CI:1.01-1.44,P＜0.05),while bipolar disorder was negatively correlated with the incidence risk of NAFLD(OR=0.91,95％CI:0.84-1.00,P＜0.05).No causal relationship was found between schizophrenia and NAFLD.The heterogeneity and sen-sitivity analysis supported the robustness of the results of the study.Conclusion Depression and bipolar disorder are causally associat-ed with the incidence of NAFLD.Depression is associated with an increased risk of NAFLD,while bipolar disorder is associated with a reduced risk of NAFLD.

Objective To observe the effects of Yixintai on lipid metabolism and the protein expressions of CPT-1 and CD36 in rats with heart failure;To explore the mechanism of its treatment of heart failure.Methods 106 out of 120 SD rats were selected to establish the heart failure model induced by myocardial infarction by ligating the left anterior descending coronary artery,and 14 rats were selected as the sham-operation group.The successful model rats were randomly divided into model group,trimetazidine group and Yixintai low-,medium-and high-dosage groups,with 14 rats in each group.The administration group was given corresponding drugs by gavage once a day for 4 weeks.LVEF,LVFS,LVIDd and LVIDs were measured by color doppler ultrasonography,the contents of ANP,BNP,LA and FFA in serum were detected by ELISA,the contents of TG,TC,LDL and HDL were detected by automatic biochemical analyzer,HE and Masson staining were used to observe the morphology of myocardial tissue,the expressions of CPT-1 and CD36 protein in myocardial tissue were detected by Western blot.Results Compared with the sham-operation group,LVEF and LVFS in the model group decreased(P<0.05),the LVIDs and LVIDd increased(P<0.05);the contents of serum ANP,BNP,LA,FFA,TG,TC and LDL increased(P<0.05),while the content of HDL decreased(P<0.05),with myocardial edema,irregular arrangement of myocardial fibers,increased inflammatory cell infiltration and collagen fiber deposition;the protein expressions of CPT-1 and CD36 in myocardial tissue decreased(P<0.05).Compared with the model group,the LVEF and LVFS in Yixintai each dosage groups and trimetazidine group increased(P<0.05),LVIDs and LVIDd decreased(P<0.05);the contents of ANP,BNP,LA,FFA,TG,TC and LDL in serum of Yixintai medium-and high-dosage groups and trimetazidine group decreased(P<0.05),the content of HDL increased(P<0.05);myocardial edema was improved,inflammatory cell infiltration was reduced,collagen fiber deposition was reduced,and the protein expressions of CPT-1 and CD36 in myocardial tissue increased(P<0.05).Conclusion Yixintai may improve myocardial energy metabolism and treat heart failure by increasing the expression of CPT-1 and CD36 protein in myocardial tissue and promoting fatty acid β oxidation.

Objective To investigate the mechanism of matrix metalloproteinase(MMP)-9 involved in epithelial mesenchymal transformation(EMT)in chronic sinusitis(CRS).Methods The expression of MMP-9 from polypoid middle turbinate tissue was detected by immunohistochemical staining qPCR and Western blot assay in 42 patients with CRS and 8 patients underwent septoplasty.Primary human nasal epithelial cells HNEpc were cultured in vitro and divided into the control group,the TGF-β1 group(5 μg/L TGF-β1 intervention)and the TGF-β1+si-MMP-9 group(transfected with si-MMP-9 and 5 μg/L TGF-β1 intervention).The expression of MMP-9 was detected by cell immunofluorescence staining.Expression levels of TGF-β1,MMP-9 and EMT-related proteins E-cadherin,vimentin and α-SMA were detected by Western blot assay.Results(1)The positive expression rate of MMP-9 was significantly higher in the nasal mucosa of CRS with nasal polyps(CRSwNP)group(54.5%,12/22)than that of the CRS without polyps(25.0%,5/20)group and the control group(12.8%,1/8).The relative expression levels of MMP-9 mRNA and protein in nasal mucosa were higher in the CRSwNP group than those in the CRSsNP group and the control group(P＜0.05).(2)Compared with the control group,the expressions levels of TGF-β1,MMP-9,vimentin and α-SMA were increased in the TGF-β1 group,while the expression of E-cadherin was decreased(P＜0.05).Compared with the TGF-β1 group,expression levels of TGF-β1,MMP-9,vimentin and α-SMA were decreased in the TGF-β1+si-MMP-9 group,and the expression of E-cadherin was increased(P＜0.05).Conclusion The expression of MMP-9 is increased in CRS patients,which may be involved in the development of CRS through the regulation of EMT.

The thinking process of medical diagnosis requires a comprehensive and analytical judgment.However,in both judgment processes,human thinking has inevitable limitations.With the development of artificial intelligence(AI)technology,symbolism and connectionism can effectively compensate for the deficiencies of human thinking in some respects,making more accurate diagnostic judgments,but they also have their limitations.It is conceivable that the integration and development of symbolism and connectionism will assist in enhancing the capabilities of medical-assisted diagnosis.However,there is still a tension between accuracy,transparency,and interpretability regarding the application of connectionism in AI,and many concerns about AI have arisen due to its lack of transparency and interpretability.By sorting out the thought process of medical diagnosis,organizing the differences among various AI paradigms and the changes in semantic philosophy and truth concepts behind AI,ethical concerns about the application of AI can be alleviated to a certain extent,and the practical application of AI in the field of medical diagnosis can be promoted.

Objective To observe the effects of acute normovolemic hemodilution(ANH)on target-controlled infusion(TCI)of etomidate blood drug concentration and adrenal cortical function.Methods Sixty patients who undergo elective multisegmental spine surgery,35 males and 25 females,aged 30-60 years,BMI 20-25 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups using random number table method:ANH group and control group,30 patients in each group.Both groups used a target-controlled infusion of etomidate for anesthesia induction and anesthesia maintenance.In the ANH group,ANH was performed after steady anesthesia induction,ideal Hct 28％to 30％,and transfused within 1 hour after surgery;the control group was routinely treated.The dosage of etomidate was recorded.Liquid chroma-tography-tandem mass spectrometry(LC-MS/MS)was used to detect etomidate blood concentrations at the immediate postoperative,10,20,and 30 minutes postoperative periods in the two groups,and the immedi-ate moment autologous blood collected into the storage bag,preserved in the storage bag for 1 hour,and the immediate moment transfused back in the ANH group.Plasma concentrations of cortisol(Cor),adrenocorti-cotropic hormone(ACTH),and aldosterone(ALD)were measured by chemiluminescence immunoassay(CLIA)before the induction of anesthesia,immediately after the operation,and at 1 day and 2 days postop-eratively.Results There was no significant difference in the total dosage of etomidate between the two groups.Compared with the immediate postoperative period,the plasma etomidate concentration was signifi-cantly decreased 10,20,and 30 minutes after surgery(P<0.05).Compared with the control group,the concentration increased significantly 10 minutes after surgery in the ANH group(P<0.05).The plasma concentrations of etomidate were(547.8±119.4)ng/ml at the immediate moment autologous blood collected into the storage bag,(536.7±107.8)ng/ml at the preserved in the storage bag for 1 hour,and(522.8±91.7)ng/ml at theimmediatemoment transfusedbackinthe ANHgroup.Comparedwithbeforein-duction of anesthesia,the concentration of Cor and ALD immediately after the operation decreased signifi-cantly(P<0.05)and the concentration of ACTH was significantly higher(P<0.05).There were no sta-tistically significant differences in the concentrations of Cor,ALD,and ACTH between the two groups before induction of anesthesia 1 day and 2 days postoperatively.Conclusion In the orthopedic surgery of TCI eto-midate,return transfusion of collected autologous blood transiently(about 10 minutes)increases etomidate blood concentrations,the function of adrenal cortical will recover to the preoperative level within 24 hours after the operation.

Objective To investigate the effect of renal denervation on cardiac function and sympa-thetic nerve remodeling in spontaneously hypertensive rats(SHR).Methods Sixteen SPF male SHRs were randomly and equally divided into renal denervation(RDN)group and sham operation group,and 8 SPF Wistar-Kyoto(WKY)rats served as the normotensive control group.Blood pressure and heart rate of each group were non-invasively recorded every two weeks.In 8 weeks after the RDN procedure,mean arterial pressure was recorded after carotid artery catheterization,and heart rate variability,including low-frequency power(LF),high-frequency power(HF),and LF/HF ratio,was detected with electrocardiography.Cardiac function was assessed using echocar-diography(ECG),with indicators such as left ventricular ejection fraction(LVEF),left ventricu-lar fractional shortening(LVFS),left ventricular end-diastolic diameter(LVEDD),and left ven-tricular end-systolic diameter(LVESD).HE staining was used to assess myocardial injury,while immunohistochemical staining was employed to detect myocardial tyrosine hydroxylase(TH)density.RT-PCR was performed to measure the mRNA expression of IL-1β and TNF-α.Results The SBP before surgery,as well as at 2,4,6,and 8 weeks post-surgery,and the mean arterial pressure(MAP)were significantly higher in the sham operation and RDN groups than the control group,while,the MAP in the RDN group at 2,4,6,and 8 weeks post-surgery was significantly lower than that in the sham operation group(P＜0.05).Compared with the control group,the sham operation group showed significant increases in LVEDD,LVESD,heart weight-to-body weight ratio,myocardial TH,LF and LF/HF ratio,and myocardial IL-1β and TNF-α expression,while HF,LVEF,and LVFS were significantly reduced(P＜0.05,P＜0.01).Compared with the sham operation group,the RDN group showed significant increases in LVEF[(83.32±2.34)％vs(75.33±2.46)％,P＜0.05],LVFS[(45.57±2.42)％vs(38.42±1.64)％,P＜0.05],and HF(66.73±2.33 vs 60.23±1.54,P＜0.01).Meanwhile,LVESD[(3.56±0.34)mm vs(4.33±0.36)mm,P＜0.05],LVEDD[(6.43±0.38)mm vs(7.23±0.42)mm,P＜0.05],heart weight-to-body weight ratio(3.52±0.16 vs 3.82±0.22,P＜0.05),myocardial TH(0.15±0.01 vs 0.19±0.02,P＜0.05),LF[(15.55±1.08)％vs(19.91±1.79)％,P＜0.01]and LF/HF ratio(0.23±0.01 vs 0.33±0.03,P＜0.01),and the mRNA levels of myocardial IL-1β(2.47±0.15 vs 3.12±0.18,P＜0.05)and TNF-a(3.15±0.21 vs 3.79±0.17,P＜0.05)were significantly reduced.Conclusion RDN can reduce blood pressure in SHR,improve cardiac structure and function,and inhibit cardi-ac sympathetic nerve remodeling,which may be through alleviating neuroinflammation.

Objective To investigate the effect of renal denervation on cardiac function and sympa-thetic nerve remodeling in spontaneously hypertensive rats(SHR).Methods Sixteen SPF male SHRs were randomly and equally divided into renal denervation(RDN)group and sham operation group,and 8 SPF Wistar-Kyoto(WKY)rats served as the normotensive control group.Blood pressure and heart rate of each group were non-invasively recorded every two weeks.In 8 weeks after the RDN procedure,mean arterial pressure was recorded after carotid artery catheterization,and heart rate variability,including low-frequency power(LF),high-frequency power(HF),and LF/HF ratio,was detected with electrocardiography.Cardiac function was assessed using echocar-diography(ECG),with indicators such as left ventricular ejection fraction(LVEF),left ventricu-lar fractional shortening(LVFS),left ventricular end-diastolic diameter(LVEDD),and left ven-tricular end-systolic diameter(LVESD).HE staining was used to assess myocardial injury,while immunohistochemical staining was employed to detect myocardial tyrosine hydroxylase(TH)density.RT-PCR was performed to measure the mRNA expression of IL-1β and TNF-α.Results The SBP before surgery,as well as at 2,4,6,and 8 weeks post-surgery,and the mean arterial pressure(MAP)were significantly higher in the sham operation and RDN groups than the control group,while,the MAP in the RDN group at 2,4,6,and 8 weeks post-surgery was significantly lower than that in the sham operation group(P＜0.05).Compared with the control group,the sham operation group showed significant increases in LVEDD,LVESD,heart weight-to-body weight ratio,myocardial TH,LF and LF/HF ratio,and myocardial IL-1β and TNF-α expression,while HF,LVEF,and LVFS were significantly reduced(P＜0.05,P＜0.01).Compared with the sham operation group,the RDN group showed significant increases in LVEF[(83.32±2.34)％vs(75.33±2.46)％,P＜0.05],LVFS[(45.57±2.42)％vs(38.42±1.64)％,P＜0.05],and HF(66.73±2.33 vs 60.23±1.54,P＜0.01).Meanwhile,LVESD[(3.56±0.34)mm vs(4.33±0.36)mm,P＜0.05],LVEDD[(6.43±0.38)mm vs(7.23±0.42)mm,P＜0.05],heart weight-to-body weight ratio(3.52±0.16 vs 3.82±0.22,P＜0.05),myocardial TH(0.15±0.01 vs 0.19±0.02,P＜0.05),LF[(15.55±1.08)％vs(19.91±1.79)％,P＜0.01]and LF/HF ratio(0.23±0.01 vs 0.33±0.03,P＜0.01),and the mRNA levels of myocardial IL-1β(2.47±0.15 vs 3.12±0.18,P＜0.05)and TNF-a(3.15±0.21 vs 3.79±0.17,P＜0.05)were significantly reduced.Conclusion RDN can reduce blood pressure in SHR,improve cardiac structure and function,and inhibit cardi-ac sympathetic nerve remodeling,which may be through alleviating neuroinflammation.