Serving as cerebral macrophages， microglial cells are meticulously regulated by the microenvironment of the central nervous system.In response to various environmental and cellular stresses， microglial cells are rapidly activated and exhibit either pro-inflammatory or anti-inflammatory phenotypes to maintain brain tissue homeostasis， and during this process， significant changes are observed in glucose metabolism of microglial cells. Aerobic glycolysis is the primary energy source for pro-inflammatory microglial cells， while oxidative phosphorylation is the energy source for anti-inflammatory microglial cells.This article systematically elaborates on glucose metabolism and glucose metabolic reprogramming pathways in microglial cells， as well as their role in central nervous system diseases. In addition， this article also discusses the potential of targeting glucose metabolic reprogramming in microglial cells for the treatment of related diseases.

Objective: To analyze the regulatory effect of Atractylodes macrocephala Koidz. extract on the immune function of mice, so as to provide a reference for the study of the mechanism of Atractylodes macrocephala Koidz. regulating immune function. Methods: Forty-eight SPF healthy male ICR mice were randomly divided into control group and low (0.5 g/kg), medium (2.0 g/kg), and high (4.0 g/kg) dose groups, with 12 mice in each group. The mice in control group were given the pure water by gavage once a day, while the mice in each dose group were given the corresponding dose of Atractylodes macrocephala Koidz. extract by gavage once a day. The delayed allergy test was performed for 28 consecutive days. Sixty SPF healthy male ICR mice were randomly divided into a control group, polyinosinic acid injection group (model group), and low, medium, and high dose groups, with 12 mice in each group. The mice in control group were given the pure water by gavage once a day, while the mice in each dose group were given the corresponding dose of Atractylodes macrocephala Koidz. extract by gavage once a day for 14 consecutive days. On days 13 and 14 of administration, the mice in the model group and each dose group were intraperitoneally injected with sterile polyinosinic acid solution to perform the immunosuppressive experiment induced by polyinosinic acid. The mouse ear pieces were weighed, and the thymus and spleen of the mice were weighed and stained with HE to calculate the pathological scores. Peripheral blood was collected for blood cell detection and T cell classification. Results: Mice in each group had normal feeding, activity, and growth status, and no abnormality was observed. In the delayed allergy test, compared with the control group, the degree and rate of ear swelling in the low, medium and high dose groups were higher, the white blood cell count in the medium dose group was higher, and the absolute values of lymphocytes in the low and medium dose groups were higher (all P<0.05). Compared with the control group, the pathological scores of the thymus and spleen in the model group were higher (both P<0.05). In the immunosuppressive experiments in mice induced by polyinosinic acid, compared with the model group, the pathological score of the thymus in the high dose group was lower (P<0.05), and the boundary between the thymus cortex and medulla was improved. Conclusions Atractylodes macrocephala Koidz. extract can increase the degree of ear swelling and peripheral blood white blood cell count in mice. High dose of Atractylodes macrocephala Koidz. extract can improve the thymus injury induced by polyinosinic acid, and has an immunomodulatory effect.

High quality continuing medical education is important to ensure the clinical competence of doctors. However, the current continuing medical education of general practitioners has some problems, such as low motivation to participate in and poor training effect. We tried a new model of continuing medical education to deal with these problems. In this new model, position competence improvement is the aim, online group learning is the main method, individualized learning goals are developed and results are evaluated in verifiable ways.

Objective To investigate independent risk factors for unintended initial dissection of the posterior plane(UIDPP)during small incision lenticule extraction(SMILE)by surgeons with different qualifications.Methods A total of 1 600 patients(3 003 eyes)who underwent SMILE performed by three surgeons with different qualifications from April to September 2021 were selected as the research subjects,including 911 males and 689 females,with an average age of(21.82±3.55)years.The incidence of UIDPP in patients was recorded,along with a comprehensive summary of the age,gender,eyes,surgeons,surgical proficiency,subjective refraction,central corneal thickness,lenticule thickness,side cut angle,and peripheral lenticule thickness of the patients.Independent risk factors of UIDPP were analyzed using the binary logistic regression.Test level:α=0.05.Results In this study,the incidence of UIDPP was 6.56％(197/3 003),and the lenticule was successfully removed in all eyes.Multivariate logistic regression analysis demonstrated that surgeon(P=0.035),surgical proficiency(P=0.026),eyes(P=0.007),lenticule thickness(P＜0.001),and peripheral lenticule thick-ness(P＜0.001)were independent risk factors associated with the UIDPP during SMILE surgery.No significant differences were observed in other parameters(all P＞0.05).Conclusion Surgeons,surgical proficiency,eyes,lenticule thick-ness,and peripheral lenticule thickness are independent risk factors of UIDPP.

Objective To investigate the application value of prognostic nutritional index and urea/creatinine ratio in nutritional status assessment for patients with esophageal cancer undergoing radiotherapy and chemotherapy.Methods A total of 138 patients with esophageal cancer who received radiotherapy and chemotherapy were screened.NRS 2002 nutritional screening was used as the standard.Prognostic nutritional index(PNI)and urea/cre-atinine ratio(UCR)were used to evaluate the malnutrition of patients with esophageal cancer.ROC curve was used to evaluate and compare the diagnostic efficacy of different nutritional screening tools.Results The biochemical and hematological indexes of patients with esophageal cancer showed certain characteristics,in which the levels of urea,creatinine,UCR,ALB,PALB,TP,TC,TG,HDL and LDL all fluctuated within the normal range.In terms of nutritional risk screening,the NRS 2002 score identified nutritional risk in 57.97%of patients,while the PNI and UCR predicted nutritional risk in 31.16%and 40.58%of patients,respectively.Consistency test showed that the Kappa value of PNI and NRS 2002 scores was 0.460(P<0.05),and the Kappa value of UCR and NRS 2002 scores was 0.522(P<0.05),indicating that there was a certain correlation between them and NRS 2002 scores in nutri-tional risk screening.Correlation analysis showed that NRS 2002 score was significantly correlated with UCR,ALB,PALB,PBL,Cr,HDL and TP(P<0.05),while PNI was significantly correlated with ALB,PALB,PBL,Cr,HDL,TP and UREA(P<0.05).There were significant correlations between UCR and PALB,UREA and Cr(P<0.05).Logistic univariate regression analysis further confirmed these correlations and revealed that malnutrition was negatively correlated with albumin,prealbumin,total protein,lymphocytes,creatinine and BMI,and positively correlated with urea.However,multivariate regression analysis did not find any statistical difference between these related factors and the two objective evaluation measures.The results of diagnostic efficacy evaluation showed that the area under ROC curve of PNI and UCR evaluation to predict esophageal cancer malnutrition was 0.779 and 0.736,respectively,with statistical significance(P<0.001).Among them,UCR showed higher sensitivity and PNI showed higher specificity,but there was no significant difference in diagnostic value between them.Conclusion PNI and UCR as nutritional assessment tools have certain application value in the nutritional risk screening of patients with esophageal cancer,but their consistency with NRS 2002 score needs to be improved.When assessing the nutritional status of patients,a combination of various indicators and methods should be used to achieve more accurate diagnostic results.

Objective : To investigate the epidemiological characteristics of severe fever with thrombocytopenia syndrome (SFTS) in Dongyang City, Zhejiang Province from 2017 to 2022, so as to provide insights into SFTS prevention and control. Methods: Data pertaining to patients with SFTS in Dongyang City from 2017 to 2022 were collected from Notifiable Infectious Disease Reporting System of Chinese Disease Prevention and Control Information System. The epidemiological and clinical characteristics of patients with SFTS were descriptively analyzed, and the trends in incidence of SFTS was evaluated using annual percent change (APC). Results: A total of 32 SFTS cases were reported in Dongyang City from 2017 to 2022, with mean annual incidence of 0.63/105, and 8 cases died, with a fatality rate of 25.00%. The incidence of SFTS appeared a tendency towards a rise from 2017 to 2022 (APC=40.697%, P<0.05). The male to female ratio of SFTS cases was 0.78∶1, and farmer was the predominant occupation (31 cases, 96.88%). SFTS predominantly occurred among individuals at ages of 51 to 69 years (20 cases, 62.50%), and the incidence peaked during the period between March and May and between July and August (28 cases, 87.50%). SFTS cases were reported in 11 out of the 18 townships (streets) in Dongyang City, with the highest number found in Zuocun Township (8 cases, 28.13%), and had the lowest platelet count of (41.46±5.19)×109 platelets/L, with the lowest count of (3.00 to 67.00) ×109 platelets/L. All the SFTS cases had a history of mountain forest and farmland activities 2 weeks prior to onset of the disease, and 5 cases (15.63%) had a history of tick bites. Conclusions The incidence of SFTS appeared a tendency towards a rise in Dongyang City from 2017 to 2022, and SFTS was highly prevalent in spring and summer, with high incidence among farmers. Intensified health education of SFTS is recommended among residents in high-incidence areas.

Objective:To explore expression patterns of transcription factor TFAP2B in epidermal melanocytes of healthy individuals and vitiligo patients.Methods:Lesional tissues were collected from 5 patients confirmedly diagnosed with progressive vitiligo at the Department of Dermatology, Xijing Hospital, Air Force Medical University from January 2020 to December 2022. At the same time, some discarded normal skin tissues were obtained from 5 gender- and age-matched healthy individuals after plastic surgeries. The immortalized healthy human epidermal melanocyte cell line PIG1, the vitiligo epidermal melanocyte cell line PIG3V, and primary human epidermal melanocytes, which were isolated from the discarded foreskin tissues of 3 healthy males after urological surgeries in Xijing Hospital, were cultured in vitro. Tissue immunofluorescence assay was performed to determine the expression and localization of TFAP2B and dopachrome tautomerase (DCT) in healthy skin tissues and vitiligo lesions, and cell immunofluorescence assay and Western blot analysis were conducted to determine the TFAP2B expression in human epidermal melanocytes. Comparisons between two groups were performed using t test, and correlation analysis was performed using Pearson correlation coefficients. Results:Tissue immunofluorescence assay showed that TFAP2B was specifically expressed in human epidermal melanocytes and localized in the nuclei. Western blot analysis showed that TFAP2B was strongly expressed in the human epidermal melanocyte cell line PIG1 and primary melanocytes, with the relative expression levels being 0.45 ± 0.05 and 0.36 ± 0.04, respectively. Tissue immunofluorescence analysis showed that the fluorescence intensity of TFAP2B (623 917.5 ± 88 784.0) was significantly and positively correlated with that of DCT (2 232 655.3 ± 588 810.4; r = 0.91, P < 0.001) in human epidermal tissues from 5 healthy controls and 5 vitiligo patients. In addition, the relative fluorescence intensity of TFAP2B in epidermal melanocytes was significantly lower in the vitiligo lesions (0.12 ± 0.05) than in the healthy skin tissues (1, t = 19.35, P < 0.001). Western blot analysis showed that the relative expression level of TFAP2B was also significantly lower in the PIG3V cells (0.62 ± 0.09) than in the PIG1 cells (1, t = 5.92, P < 0.027) . Conclusions:TFAP2B was specifically and highly expressed in human epidermal melanocytes, and its expression level was significantly and positively correlated with that of the melanocyte marker DCT. Additionally, TFAP2B was obviously lowly expressed in the epidermal melanocytes of patients with vitiligo.

Objective To construct a nomogram model to predict the risk of pressure injuries(PI)in mechanically ventilated patients in the intensive care unit(ICU).Methods Clinical data of mechanically ventilated patients in the ICU of Zhongshan Hospital,Fudan University from January 1,2020 to March 15,2023 were retrospectively collected as the training set,and data from ICU of the same hospital from October 1,2023 to December 11,2023 were collected as the external validation set.Risk variables for PI were selected using LASSO regression and Cox proportional hazards model,and a nomogram model was constructed.Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate the model.Calibration curve and decision curve analysis(DCA)were used to assess the model's calibration and clinical applicability.The external validation was performed using the validation set data.Results A total of 580 mechanically ventilated patients were included in the training set,with 84 cases(14.5％)of PI.LASSO regression and Cox proportional hazards model selected 10 variables to construct the nomogram model.The ROC curve showed an AUC of 0.830 for predicting PI in mechanically ventilated patients.Calibration curve and DCA indicated good calibration and predictive performance of the model.The external validation set included 100 patients,with 12 cases of PI,and the AUC was 0.870.Calibration curve and DCA showed good model performance.Conclusions The nomogram model based on LASSO-Cox regression has good predictive performance and can be used to screen high-risk population for PI in mechanically ventilated patients.

Objective To analyze the resistance mechanism,characteristics of drug sensitivity,and homology of polymyxin resistant Escherichia coli,and provide molecular epidemiological basis for the effective prevention and control of its outbreak and epidemic.Methods The strains of polymyxin resistant Escherichia coli isolated from our hospital during May 2016 and June 2022 were collected.The PCR technology was used to screen for the mobile colistin resistance(MCR)gene and the micro broth dilution method was used to determine the minimum inhibitory concentration.The clinical data of the patients were collected.The homology of the collected strains was analyzed by the pulsed field gel electrophoresis(PFGE).One of the strains was performed whole genome sequencing.Results Four strains of polymyxin resistant Escherichia coli carrying the MCR-1 gene were isolated and identified.Except for being sensitive to tigecycline,all four strains showed varying degrees of resistance to the vast majority of clinically common antibiotics.Clinical data showed that no polymyxin was used in the patients with polymyxin resistant Escherichia coli.The four strains of bacteria could be divided into two types,including three strains of type A and one strain of type B.The whole genome sequencing analysis of one of the bacteria revealed that the MCR-1 gene was located on a plasmid with a size of 70 kb.Conclusion The Escherichia coli carrying the MCR-1 gene has a potential threat to clone transmission and exhibits high resistance to common antibiotics in clinical practice,posing a serious challenge to clinical treatment.Therefore,it is necessary to strengthen protective measures to prevent its outbreak and epidemic.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Fat accumulation "sensitizes" the liver to insult and leads to nonalcoholic steatohepatitis (NASH). G protein-coupled receptor 35 (GPR35) is involved in metabolic stresses, but its role in NAFLD is unknown. We report that hepatocyte GPR35 mitigates NASH by regulating hepatic cholesterol homeostasis. Specifically, we found that GPR35 overexpression in hepatocytes protected against high-fat/cholesterol/fructose (HFCF) diet-induced steatohepatitis, whereas loss of GPR35 had the opposite effect. Administration of the GPR35 agonist kynurenic acid (Kyna) suppressed HFCF diet-induced steatohepatitis in mice. Kyna/GPR35 induced expression of StAR-related lipid transfer protein 4 (STARD4) through the ERK1/2 signaling pathway, ultimately resulting in hepatic cholesterol esterification and bile acid synthesis (BAS). The overexpression of STARD4 increased the expression of the BAS rate-limiting enzymes cytochrome P450 family 7 subfamily A member 1 (CYP7A1) and CYP8B1, promoting the conversion of cholesterol to bile acid. The protective effect induced by GPR35 overexpression in hepatocytes disappeared in hepatocyte STARD4-knockdown mice. STARD4 overexpression in hepatocytes reversed the aggravation of HFCF diet-induced steatohepatitis caused by the loss of GPR35 expression in hepatocytes in mice. Our findings indicate that the GPR35-STARD4 axis is a promising therapeutic target for NAFLD.