This study investigates the clinical differentiation and treatment strategies for bipolar disorder （BD） by analyzing the relationship of its core pathomechanisms including qi stagnation， blood stasis， phlegm turbidity， and heat constraint with bile acid metabolism. The imbalance of "yin in form and yang in function" leads to qi stagnation， blood stasis， phlegm turbidity， and heat constraint， which are critical in the pathogenesis and progression of BD. Bile acids regulate neuroinflammation， neural plasticity， and intestinal flora homeostasis through receptor-mediated pathways. It is believed that the physiological functions of bile acids concretely embody the concept of the "liver is yin in form and yang in function" theory. Clinically， prescriptions such as Sini Powder （四逆散） with the function of venting pathogen and resolving constraint， Wendan Decoction （温胆汤） of drying dampness and resolving phlegm， Longdan Xiegan Decoction （龙胆泻肝汤） of clearing liver and draining fire， and Huanglian Ejiao Decoction （黄连阿胶汤） of nourishing yin and blood can be used to nourish liver yin and restore liver yang function. These strategies may improve BD prognosis by modulating bile acid synthesis and metabolism.

Objective:To investigate the subacute toxicity and target organs of triethylenediammonium perchlorate ammonium complex salt (DAP-4) .Methods:In August 2024, 40 SPF-grade SD rats were selected, with 10 rats in each group, half male and half female. There were 45, 140, and 420 mg/kg DAP-4 groups and a control group. Rats in each dose DAP-4 group were orally administered the corresponding amount of DAP-4 solution, while the control group was given the same dose of 1% sodium carboxymethyl cellulose. SD rats were given intragastric administration once a day for 28 consecutive days. The behaviors, histopathological changes, and blood physiological and biochemical indicators of rats were detected at the corresponding time points respectively. One-way analysis of variance was used for the comparison of quantitative data between groups.Results:Compared with the control group, the body weight, food intake and food utilization rate of female and male rats in the 420 mg/kg DAP-4 group were significantly decreased ( P<0.05), while no abnormalities were observed in the other dose groups. Compared with the control group, the white blood cell count of female rats in the 420 mg/kg DAP-4 group decreased, while the hemoglobin and hematocrit decreased and the total serum protein increased of male rats ( P<0.05). Compared with the control group, fibrinogen was increased in both female and male rats in the 420 mg/kg DAP-4 group, and the thrombin time of female rats was shortened ( P<0.05). In each dose group, the livers of female and male rats showed varying degrees of vacuolar degeneration, and the renal tubules of female rats were swollen. Conclusion:420 mg/kg DAP-4 can cause damage to the liver and kidney of rats, and the maximal no effect level of DAP-4 for rats is 140 mg/kg.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Objective:To investigate the subacute toxicity and target organs of triethylenediammonium perchlorate ammonium complex salt (DAP-4) .Methods:In August 2024, 40 SPF-grade SD rats were selected, with 10 rats in each group, half male and half female. There were 45, 140, and 420 mg/kg DAP-4 groups and a control group. Rats in each dose DAP-4 group were orally administered the corresponding amount of DAP-4 solution, while the control group was given the same dose of 1% sodium carboxymethyl cellulose. SD rats were given intragastric administration once a day for 28 consecutive days. The behaviors, histopathological changes, and blood physiological and biochemical indicators of rats were detected at the corresponding time points respectively. One-way analysis of variance was used for the comparison of quantitative data between groups.Results:Compared with the control group, the body weight, food intake and food utilization rate of female and male rats in the 420 mg/kg DAP-4 group were significantly decreased ( P<0.05), while no abnormalities were observed in the other dose groups. Compared with the control group, the white blood cell count of female rats in the 420 mg/kg DAP-4 group decreased, while the hemoglobin and hematocrit decreased and the total serum protein increased of male rats ( P<0.05). Compared with the control group, fibrinogen was increased in both female and male rats in the 420 mg/kg DAP-4 group, and the thrombin time of female rats was shortened ( P<0.05). In each dose group, the livers of female and male rats showed varying degrees of vacuolar degeneration, and the renal tubules of female rats were swollen. Conclusion:420 mg/kg DAP-4 can cause damage to the liver and kidney of rats, and the maximal no effect level of DAP-4 for rats is 140 mg/kg.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Background Formaldehyde and benzene homologues are common environmental pollutants, and their neurotoxicity has aroused widespread concern. Objective To investigate the effect of taurine on cognitive impairment after exposure to formaldehyde and benzene analogues in young rats. Methods Twenty four-week old SD rats were randomly divided into four groups, with six rats in each group: control group (clean air), model group (5 mg·m⁻³ formaldehyde + 5 mg·m⁻³ benzene + 10 mg·m⁻³ toluene + 10 mg·m⁻³ xylene), low-dose taurine intervention group (5 g·L⁻¹ taurine + mixture of formaldehyde and benzene analogues), and high-dose taurine intervention group (10 g·L⁻¹ taurine + formaldehyde and mixture of benzene analogues), and the exposure was administered by oral and nasal aerosol inhalation for 28 d. At the end of exposure, the learning and memory ability of rats in each group was measured by Morris water maze test. After the behavioral test, the rats were anesthetized and neutralized, and the brain tissue was harvested for histopathological and molecular biological tests. The apoptosis rate of neurons in hippocampal CA1 area was detected by Tunel assay, and the expression levels of apoptosis-related proteins such as caspase 3, bax, and bcl-2 in hippocampal tissue were detected by Western blotting. Results The growth and development of rats in each group were good during inhalation. During the Morris water maze experiment, the escape latencies of rats in the taurine intervention groups were not different from that in the control group (P>0.05) from day 3 to day 5 of training, while the escape latency of rats in the model group was significantly higher than that in the control group (P <0.05). The number of crossing platform and the target quadrant residence time in the high-dose taurine intervention group were not different from those in the control group (P>0.05), while the two variables in the model group and low-dose taurine intervention group were significantly lower than those in the control group (P <0.05). The apoptotic rates of neurons in the hippocampal CA1 area of rats in the control group, model group, and low-dose and high-dose taurine intervention groups were 5.11%, 18.87%, 9.39%, and 4.63%, respectively. The apoptotic rate in the model group was higher than those in the control group and low-dose and high-dose taurine intervention groups (P<0.05). The expression levels of caspase 3, bax, and bcl-2 in the hippocampus of rats in the low-dose and high-dose taurine intervention groups showed no difference compared with the control group (P>0.05). The expression levels of caspase 3 and bax in the model group were higher than those in the control group and low-dose or high-dose taurine intervention groups (P<0.05), and the expression levels of bcl-2 was lower (P<0.05). Conclusion The mixed exposure to formaldehyde and benzene analogues can damage the learning and memory ability of young rats, and increase the apoptosis of neurons in hippocampal CA1 region. Taurine can reverse the damage induced by formaldehyde and benzene analogues.

The effective implementation of curricular ideology should be vigorously promoted in the training process of postgraduate students in critical care medicine.The clinical practice of critical care medicine contains a large number of ideological elements.In the process of teaching,teachers need to explore the ideological and political elements closely related to critical care medicine,mainly including:correct value of life,self-supervision spirit,communication and collaboration ability,healer's benevolence,craftsmanship,honesty and integrity in medical practice,as well as the supremacy of the country and the people,and so on.In the process of implementing curriculum ideological and political teaching,teachers are required to continuously improve their professionalism and ethics,improve their teaching methods,and set a good example in their clinical work.In order to better implement the curriculum ideological and political education,it is necessary to establish a perfect teaching system and a unified curriculum ideological and political education material library.

Objective: To evaluate the efficacy and safety of oseltamivir in the treatment of suspected influenza in children. Method: A multicenter, randomized and open-label trial was conducted among 229 individuals with suspected influenza which were collected from the clinic of 5 hospitals in Guangdong province (Guangzhou Women and Children′s Medical Center, Shenzhen Baoan District Maternity and Child Care Service Center, the Second Affiliated Hospital of Shantou University Medical College, Dongguan Maternity and Child Care Service Centre, Yuexiu District Children′s Hospital of Guangzhou) from April to July 2015. They were randomized either to oseltamivir group (oseltamivir 30-75 mg, twice daily for 5 days) or control group who were given symptom relief medicines for 5 days. Result: No significant difference was found between two groups in influenza symptoms of the patients before the treatment(P>0.05). Altogether 229 individuals (114 in oseltamivir group, 115 in control group) were analyzed for efficacy, in which 73 individuals (42 oseltamivir, 31 control), 31.9%, were identified as influenza-infected through laboratory test. No significant difference was found between the two groups in the duration of fever although shortened. In the 229 individuals , the cumulative alleviation proportion between oseltamivir and control group was not significantly different (P>0.05): the median duration of illness was 69.9 hours (95% CI 65.3-91.5) in oseltamivir group and 75.4 hours (95%CI 63.9-91. 7) in control group; the median duration of fever was 40.4 hours (95%CI 31.5-53.4) in oseltamivir group and 44.0 hours (95%CI 33.2-50.0) in control group. In the 73 individuals, the cumulative alleviation proportion between oseltamivir and control group was significantly different (P<0.05). The median duration of illness was 61.2 hours (95%CI 48.0-121. 0) in oseltamivir group, being significantly shorter than that of 116.0 hours (95%CI 91.5-175.0) in control group. But it was not significantly different that the median duration of fever was 32.8 hours (95%CI 24.0-47.0 ) in oseltamivir group and 55.8 hours (95%CI 43.6-78.3 ) in control group (P>0.05). And the median duration of fever in 60 individuals (38 oseltamivir, 22 control) was significantly different between two groups(P<0.05), who had finished a course of taking oseltamivir in the 73 individuals, 34.8 hours (95%CI 24.0-48.5 ) in oseltamivir group being significantly shorter than that of 53.3 hours (95%CI 43.6-104.0 ) in control group. There was certain difference in side effects rate between the two groups (oseltamivir 10%, control 2%, P<0.05). The main side-effects were gastrointestinal symptoms (stomachache, diarrhea, poor appetite, vomiting). Conclusion The duration of illness and fever in suspected influenza patients treated with oseltamivir was shorter than those in the patients treated with no oseltamivir, the difference was not statistically significant, when 31.9% was confirmed with positive result of virus test in suspected influenza in children. But in these patients with positive result of virus test, the duration of illness was significantly shortened with treatment with oseltamivir as compared with no treatment with oseltamivir, and it would be better if full oseltamivir course was completed for reducing the duration of fever. Oseltamivir treatment was safe with mild side effects.

Objective To explore the nosocomial infection knowledge of medical staff in tertiary hospitals of Beijing,and identify the influencing factors of nosocomial infection knowledge among medical staff.Methods By random sampling method,848 medical workers in a tertiary hospital were investigated by the self-designed questionnaire of medical workers′ knowledge about nosocomial infection control questionnaire.Results The average score of medical workers′ knowledge about nosocomial infection control was(68.78±11.70). The univariate analysis on the influencing factors of nosocomial infection knowledge showed that,the scores of medical workers′ knowledge about nosocomial infection were significantly different among workers in different departments and with different professional titles (t=6.715,53.166;P<0.05).Conclusions The medical workers′ knowledge about nosocomial infection in tertiary hospitals is at a medium level. Aimed at the items with low knowledge score in different groups and different medical workers,we should enhance the training among medical workers to reduce the occurrence of nosocomial infection and the incidence rate of nosocomial infection.

Objective To validate the efficacy of Pediatric Early Warning Score (PEWS) in severity evaluation of respiratory inpatients.Methods Four hundred and thirteen children with respiratory disease were hospitalized in Pneumology Department of Guangzhou Women and Children's Medical Centre from October 2012 to October 2013,of which 36 cases required Intensive Care Unit (ICU) treatment while the rest 377 controls did not.According to the disease severity,cases and controls were further categorized into 3 groups:no-monitor-required group (n =302,controls),monitor-required group (n =75,controls),ICU group (n =36).PEWS was assessed at admission in controls and 12 hours before ICU transfer,respectively.PEWS were compared among all groups and receiver operator characteristic curve(ROC) was performed.Results The median [interquartile rang(IQR)] age in ICU group was 10 months(4-13 months),monitor-required group was 10 months (6-16 months),and no-monitor-required group was 14months(6-24 months),and the difference was significant (H =13.59,P ＜ 0.01).The median (IQR) of PEWS in ICU group was 6 scores (6-7 scores),monitor-required groups was 5 scores (4-5 scores),on-monitor-required group was 2 scores (1-2 scores),and the difference was significant (x2 =255.641,P ＜ 0.01).PEWS in monitor required group and ICU group was 3.5 score with area under ROC (AUC) as 0.898 (95％ CI:0.867-0.929,sensitivity0.907,specificity 0.893) and 4.5 with AUC as 0.978 (95％ CI:0.964-0.992,sensitivity 1.000,specificity 0.862),respectively.Conclusions PEWS can be indicative for severity classification in hospitalized respiratory pediatric patients,and can serve as a potentially excellent screening tool for prediction of ICU admission.