ObjectiveThis paper aims to study the effects of four weeks of aerobic exercise combined with Anmeidan on the synaptic plasticity marker protein and synaptic ultrastructure of the hippocampus in the model rats with sleep deprivation， thereby investigating the possible mechanism of its action to improve the learning memory of rats with sleep deprivation. Methods50 Sprague-Dawley （SD） rats were randomly divided into blank control group （group C）， sleep deprivation group （group M）， aerobic exercise + sleep deprivation group （group MEX）， Anmeidan + sleep deprivation group （group MA， 18.18 g∙kg^-1∙d^-1）， and aerobic exercise + Anmeidan + sleep deprivation group （group MEXA， 18.18 g∙kg^-1∙d^-1）. Anmeidan was administered by gavage in the MA group for four weeks. Aerobic exercise was performed in the MEX group for four weeks. Anmeidan was administered by gavage in the MEXA group in combination with aerobic exercise for four weeks， and sleep deprivation was performed for 72 h by using the multi-platform water environment method. At the end of sleep deprivation， Morris water maze was used to assess the learning and memory ability of rats in each group， and hematoxylin-eosin （HE） staining was used to observe the morphological changes of rats' hippocampal neurons. A transmission electron microscope was used to observe the synaptic ultrastructure of rats' hippocampus. The expression levels of brain-derived neurotrophic factor （BDNF）， tyrosine kinase receptor B （TrkB）， cAMP-response element binding protein （CREB）， postsynaptic density-95 （PSD-95）， and synaptophysin （SYN） were detected by Western blot， and the real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the relative mRNA expression levels of BDNF， TrkB， and CREB in the rats' hippocampus. ResultsCompared with those in group C， rats in group M had significantly longer latency and total swimming distance on the platform （P<0.01） and a significantly reduced number of traversals across the platform as well as the residence time in the target quadrant （P<0.01）. Part of the hippocampal neurons damaged， with a reduced number， disorganized arrangement， fuzzy synaptic gaps， thinning of post-synaptic dense material， and uneven density of synaptic vesicles. The protein expression levels and relative mRNA expression levels of BDNF， TrkB， and CREB were significantly reduced （P<0.01）， and the protein expression levels of PSD-95 and SYN were significantly reduced （P<0.01）. Compared with those in group M， rats in MA， MEX， and MEXA groups showed a decrease in latency to platform and total distance swum， an increase in the number of traversals across the platform and residence time in the target quadrant （P<0.05， P<0.01）， a reduction in hippocampal neuronal damage， a better arrangement， a more intact synaptic structure， a thickening of post-synaptic dense material， a uniform density of synaptic vesicles， and an increase in the protein expression levels and mRNA expression levels of BDNF， TrkB， and CREB （P<0.05， P<0.01）. The protein expressions of PSD-95 and SYN rose （P<0.05， P<0.01）. ConclusionAerobic exercise combined with Anmeidan can improve learning memory in rats with sleep deprivation， and its mechanism of action may be related to the modulation of the BDNF/TrkB/CERB signalling pathway， up-regulation of the expression of PSD-95 and SYN， and improvement of synaptic structural damage. The combination of interventions is superior to single exercise or drugs.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

BACKGROUND:Previous studies have demonstrated that moxibustion can alleviate osteoarthritis-induced cartilage lesions and delay the progression of knee osteoarthritis. In a previous study conducted by our research group,it was found that regulating the circPan3/miR-667-5p/Ghrelin signaling pathway can enhance the level of autophagy in chondrocytes,thereby exerting a cartilage protective role in knee osteoarthritis. OBJECTIVE:To explore the effect of moxibustion on knee osteoarthritis cartilage in rats based on the circPan3/miR-667-5p/Ghrelin signaling pathway. METHODS:Sprague-Dawley rats were randomly divided into three groups (n=10 per group):sham operation,model,and moxibustion groups. A rat model of knee osteoarthritis was established in the latter two groups by anterior cruciate ligament transection and medial meniscus resection. Rats in the sham operation group underwent arthrotomy only. At 6 weeks after modeling,moxibustion intervention at Zusanli and Shenyu acupoints was applied in the moxibustion group,20 minutes daily for 4 weeks,while the other two groups did not receive any special treatment. After 4 weeks,histopathological staining was performed to observe the degree of synovial lesions and cartilage damage in the knee joint. Additionally,changes in the serum levels of inflammatory cytokines,interleukin-6 and tumor necrosis factor-α,were detected by enzyme-linked immunosorbent assay. Furthermore,chondrocytes isolated from the above three groups of rats were divided into three groups:a normal control group,a model group,and a moxibustion group. The expression levels of cartilage matrix anabolic molecules (type Ⅱ collagen and Sox9),matrix degradation molecules (matrix metalloproteinase 13 and ADAMTS5),autophagy markers (ATG5,Beclin-1,microtubule-associated protein 1 light chain 3),Ghrelin,CircPan3,and miR-667-5P were determined by western blot and qRT-PCR in each group. RESULTS AND CONCLUSION:After 4 weeks of treatment,the model group exhibited significant thickening of the synovium,infiltration of inflammatory cells,narrowing of the joint space,rough and uneven cartilage surfaces,thinning,reduction in the number of chondrocytes,a significant increase in synovitis and Osteoarthritis Research Society International scores,and a significant up-regulation of interleukin-6 and tumor necrosis factor-α levels (P<0.0001). In comparison,the sham operation group showed no significant changes. Compared with the model group,the moxibustion group exhibited a reduction in synovial thickening,a decrease in inflammatory cell infiltration,an increase in joint space,a reduction in cartilage roughness and loss of integrity,an increase in the number of chondrocytes,a reduction in synovitis and Osteoarthritis Research Society International scores,and a significant reduction in the levels of interleukin-6 and tumor necrosis factor-α (P<0.0001). The results of in vitro experiments demonstrated that the expression of matrix metalloproteinase 13,ADAMTS5,and miR-667-5P was elevated,while the expression of type Ⅱ collagen,Sox9,autophagy markers,Ghrelin,and Circpan3 was reduced in the model group compared with the normal control group (P<0.01). Moxibustion was found to reverse these changes in the moxibustion group compared with the model group (P<0.01). To conclude,moxibustion may enhance chondrocyte autophagy by modulating the circPan3/miR-667-5p/Ghrelin signaling pathway,which may inhibit knee osteoarthritis inflammation and cartilage destruction,exerting a protective effect on cartilage.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

OBJECTIVES: This study aimed to evaluate the filling effects of three biomaterial root canal sealers [iRoot SP, C-Root SP, and GuttaFlow Bioseal (GFB)] by using Micro-CT. METHODS: Sixty single-canal detached premolars were selected. After crown amputation, their uniform working length was set at 12 mm and prepared to a 06 taper 30# with M3 nickel-titanium file. The samples were randomly divided into six groups with different sealers and obturation techniques: iRoot SP+single-cone technique (SC), C-Root SP+SC, GFB+SC, iRoot SP+single cone-mediated ultrasonic technique (SU), C-Root SP+SU, and GFB+SU. Samples were scanned by Micro-CT, and the total and segmented filling rates were calculated with Mimics 22.0 software after 3D reconstruction. RESULTS: The overall filling rate of the three biomaterial root canal sealers was higher than 90%. The overall and coronal third and middle third segment filling rate of groups iRoot SP+SC, C-Root SP+SC was higher than that of group GFB+SC (P<0.01), with no significant difference between groups iRoot SP+SC and C-Root SP+SC (P>0.05). On the apical third, no significant difference was found among each group (P>0.05). The overall and segment filling rate of groups iRoot SP+SU and C-Root SP+SU was higher than that of GFB+SU (P<0.01), with no significant difference between groups iRoot SP+SU and C-Root SP+SU (P>0.05). The filling rate of the apical 1/3 of group C-Root+SC was lower than that of group C-Root+SU (P<0.01), and the filling rate of the coronal 1/3 of group GFB+SC was higher than that in the GFB+SU (P<0.01). Nevertheless, no significant difference was found in other filling rate of two obturation techniques (P>0.05). CONCLUSIONS The overall filling rate of the three biomaterial root canal sealers using SC and SU are satisfactory. iRoot SP and C-Root SP have similar filling rates, which are significantly higher than that of GFB. C-Root SP combined with SU technique can improve the filling quality of the root apical.
Root Canal Filling Materials ; X-Ray Microtomography ; Humans ; Root Canal Obturation/methods* ; Gutta-Percha ; Dimethylpolysiloxanes ; Drug Combinations ; Dental Pulp Cavity/diagnostic imaging* ; Bicuspid

Objective To evaluate the patterns of sleep duration by integrating nocturnal and daytime sleep,and to explore their asso-ciations with activities of daily living(ADL)in middle-aged and older adults.Methods The data of sleep and ADL were obtained from 11 085 subjects aged 45 and older,which were collected from the China Health and Retirement Longitudinal Study(CHARLS).At enrollment in 2011,data on nocturnal and daytime sleep duration were collected through questionnaires.Firstly,subjects were divided into three groups based on the 33rd and 66th percentiles of nocturnal sleep duration,assigned scores of 1,2 and 3,respectively.Subsequently,subjects were divided into three groups based on the 33rd and 66th percentiles of daytime sleep du-ration,assigned scores of 3,2 and 1,respectively.Finally,the scores for nocturnal and daytime sleep were summed to create a total sleep score ranging from 2 to 6.A total sleep score of 6 was defined as sleep duration pattern 1,indicating a longer nocturnal sleep duration with no or shorter daytime sleep duration.Similarly,total sleep scores of 5,4,3 and 2 were defined as sleep duration patterns 2,3,4 and 5,respectively,with sleep duration pattern 5 indicating a shorter nocturnal sleep duration and a longer daytime sleep duration.The status of ADL was assessed using the Activities of Daily Living Scale(Katz edition)at baseline and during follow-up in 2013,2015 and 2018.The association between sleep duration patterns and the risk of ADL disability was evaluated us-ing a Cox proportional hazards model.Results A total of 63 015 person-years were followed,with 11 085 subjects,during which 3 239 individuals experienced ADL disability.The 33rd and 66th percentiles of the nocturnal sleep duration in the study population were 6.00 hours and 7.00 hours,respectively;while the 33rd and 66th percentiles of the daytime sleep duration were 0.00 hours and 1.00 hours,respectively.Of those,1 522 were classified into sleep duration pattern 1,2 196 into sleep duration pattern 2,4 299 into sleep duration pattern 3,2 304 into sleep duration pattern 4,and 764 into sleep dura-tion pattern 5.Compared to sleep duration pattern 1,the risk of ADL disability of patterns 3,4 and 5 were higher(P<0.05),with P-value for the trend less than 0.001,after adjusting for age,sex,body mass index,marital sta-tus,educational level,residence,smoking,drinking,history of chronic diseases,depression status and season.No interaction effect between gender,age and season,and sleep duration patterns was observed(P>0.05).Com-pared to subjects with nocturnal sleep duration≥9 hours and daytime sleep duration<2 hours,those with noctur-nal sleep duration<7 hours and daytime sleep duration≥2 hours had a higher risk of ADL disability(P<0.05).Conclusion Older adults who sleep less at night but take longer naps during the day are at a higher risk of experiencing limitations in their ADL.Sleep patterns may influence ADL among middle-aged and older populations,and man-aging their sleep duration patterns could help prevent the onset of ADL limitations.

Objective To evaluate the patterns of sleep duration by integrating nocturnal and daytime sleep,and to explore their asso-ciations with activities of daily living(ADL)in middle-aged and older adults.Methods The data of sleep and ADL were obtained from 11 085 subjects aged 45 and older,which were collected from the China Health and Retirement Longitudinal Study(CHARLS).At enrollment in 2011,data on nocturnal and daytime sleep duration were collected through questionnaires.Firstly,subjects were divided into three groups based on the 33rd and 66th percentiles of nocturnal sleep duration,assigned scores of 1,2 and 3,respectively.Subsequently,subjects were divided into three groups based on the 33rd and 66th percentiles of daytime sleep du-ration,assigned scores of 3,2 and 1,respectively.Finally,the scores for nocturnal and daytime sleep were summed to create a total sleep score ranging from 2 to 6.A total sleep score of 6 was defined as sleep duration pattern 1,indicating a longer nocturnal sleep duration with no or shorter daytime sleep duration.Similarly,total sleep scores of 5,4,3 and 2 were defined as sleep duration patterns 2,3,4 and 5,respectively,with sleep duration pattern 5 indicating a shorter nocturnal sleep duration and a longer daytime sleep duration.The status of ADL was assessed using the Activities of Daily Living Scale(Katz edition)at baseline and during follow-up in 2013,2015 and 2018.The association between sleep duration patterns and the risk of ADL disability was evaluated us-ing a Cox proportional hazards model.Results A total of 63 015 person-years were followed,with 11 085 subjects,during which 3 239 individuals experienced ADL disability.The 33rd and 66th percentiles of the nocturnal sleep duration in the study population were 6.00 hours and 7.00 hours,respectively;while the 33rd and 66th percentiles of the daytime sleep duration were 0.00 hours and 1.00 hours,respectively.Of those,1 522 were classified into sleep duration pattern 1,2 196 into sleep duration pattern 2,4 299 into sleep duration pattern 3,2 304 into sleep duration pattern 4,and 764 into sleep dura-tion pattern 5.Compared to sleep duration pattern 1,the risk of ADL disability of patterns 3,4 and 5 were higher(P<0.05),with P-value for the trend less than 0.001,after adjusting for age,sex,body mass index,marital sta-tus,educational level,residence,smoking,drinking,history of chronic diseases,depression status and season.No interaction effect between gender,age and season,and sleep duration patterns was observed(P>0.05).Com-pared to subjects with nocturnal sleep duration≥9 hours and daytime sleep duration<2 hours,those with noctur-nal sleep duration<7 hours and daytime sleep duration≥2 hours had a higher risk of ADL disability(P<0.05).Conclusion Older adults who sleep less at night but take longer naps during the day are at a higher risk of experiencing limitations in their ADL.Sleep patterns may influence ADL among middle-aged and older populations,and man-aging their sleep duration patterns could help prevent the onset of ADL limitations.

BACKGROUND:Previous studies have demonstrated that moxibustion can alleviate osteoarthritis-induced cartilage lesions and delay the progression of knee osteoarthritis. In a previous study conducted by our research group,it was found that regulating the circPan3/miR-667-5p/Ghrelin signaling pathway can enhance the level of autophagy in chondrocytes,thereby exerting a cartilage protective role in knee osteoarthritis. OBJECTIVE:To explore the effect of moxibustion on knee osteoarthritis cartilage in rats based on the circPan3/miR-667-5p/Ghrelin signaling pathway. METHODS:Sprague-Dawley rats were randomly divided into three groups (n=10 per group):sham operation,model,and moxibustion groups. A rat model of knee osteoarthritis was established in the latter two groups by anterior cruciate ligament transection and medial meniscus resection. Rats in the sham operation group underwent arthrotomy only. At 6 weeks after modeling,moxibustion intervention at Zusanli and Shenyu acupoints was applied in the moxibustion group,20 minutes daily for 4 weeks,while the other two groups did not receive any special treatment. After 4 weeks,histopathological staining was performed to observe the degree of synovial lesions and cartilage damage in the knee joint. Additionally,changes in the serum levels of inflammatory cytokines,interleukin-6 and tumor necrosis factor-α,were detected by enzyme-linked immunosorbent assay. Furthermore,chondrocytes isolated from the above three groups of rats were divided into three groups:a normal control group,a model group,and a moxibustion group. The expression levels of cartilage matrix anabolic molecules (type Ⅱ collagen and Sox9),matrix degradation molecules (matrix metalloproteinase 13 and ADAMTS5),autophagy markers (ATG5,Beclin-1,microtubule-associated protein 1 light chain 3),Ghrelin,CircPan3,and miR-667-5P were determined by western blot and qRT-PCR in each group. RESULTS AND CONCLUSION:After 4 weeks of treatment,the model group exhibited significant thickening of the synovium,infiltration of inflammatory cells,narrowing of the joint space,rough and uneven cartilage surfaces,thinning,reduction in the number of chondrocytes,a significant increase in synovitis and Osteoarthritis Research Society International scores,and a significant up-regulation of interleukin-6 and tumor necrosis factor-α levels (P<0.0001). In comparison,the sham operation group showed no significant changes. Compared with the model group,the moxibustion group exhibited a reduction in synovial thickening,a decrease in inflammatory cell infiltration,an increase in joint space,a reduction in cartilage roughness and loss of integrity,an increase in the number of chondrocytes,a reduction in synovitis and Osteoarthritis Research Society International scores,and a significant reduction in the levels of interleukin-6 and tumor necrosis factor-α (P<0.0001). The results of in vitro experiments demonstrated that the expression of matrix metalloproteinase 13,ADAMTS5,and miR-667-5P was elevated,while the expression of type Ⅱ collagen,Sox9,autophagy markers,Ghrelin,and Circpan3 was reduced in the model group compared with the normal control group (P<0.01). Moxibustion was found to reverse these changes in the moxibustion group compared with the model group (P<0.01). To conclude,moxibustion may enhance chondrocyte autophagy by modulating the circPan3/miR-667-5p/Ghrelin signaling pathway,which may inhibit knee osteoarthritis inflammation and cartilage destruction,exerting a protective effect on cartilage.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.