OBJECTIVE To focus on the classic NOD-like receptor protein 3 （NLRP3）/Caspase-1/gasdermin D （GSDMD） pyroptosis pathway and explore the mechanism by which Huatan qushi huoxue formula （HQHF） inhibits macrophage pyroptosis to ameliorate metabolic dysfunction-associated steatohepatitis （MASH）. METHODS RAW264.7 cells were divided into 5 groups： Control group （10% blank serum）， Model group [10% blank serum+5 μg/mL lipopolysaccharide （LPS）]， HQHF-L group （2.5% drug-containing serum+7.5% blank serum+5 μg/mL LPS）， HQHF-M group （5% drug-containing serum+5% blank serum+5 μg/mL LPS）， and HQHF-H group （10% drug-containing serum+5 μg/mL LPS）. After 24 h of routine culture post-administration， cells and supernatants were collected for assays. Cell morphology was observed via scanning electron microscopy and phase-contrast microscopy； localization and expression of gasdermin D-N （GSDMD-N） were observed by immunofluorescence. Interleukin-1β （IL-1β） and IL-18 contents in supernatants were detected by ELISA； mRNA and protein expressions of NLRP3， Caspase-1， and GSDMD were measured using real-time PCR and Western blot. RESULTS Compared with the Control group， the Model group showed typical pyroptotic morphology （cell membrane bulging and pore formation）， increased aggregation and fluorescence intensity of GSDMD-N on the cell membrane （ P ＜0.05）， significantly increased the contents of IL-1β and IL-18 in cell supernatants （ P ＜0.05）， and significantly up-regulated mRNA and protein expressions of NLRP3， Caspase-1， and GSDMD in cells （ P ＜0.05）. Compared with the Model group， the HQHF-L， HQHF-M and HQHF-H groups showed improved pyroptotic morphology， reduced membrane localization and significantly weakened fluorescence intensity of GSDMD-N （ P ＜0.05）， significantly decreased the contents of IL-1β and IL-18 in cell supernatants （ P ＜0.05）， and significantly down-regulated mRNA and protein expressions of NLRP3， Caspase-1， and GSDMD in cells （ P ＜0.05）. CONCLUSIONS HQHF inhibits LPS-induced macrophage pyroptosis， and its mechanism of improving MASH may be associated with the suppression of the activation of the classical NLRP3/Caspase-1/GSDMD pyroptosis pathway.

Objective: To develop a prediction model for mild cognitive impairment (MCI) risk among the elderly, so as to provide a tool for MCI early screening. Methods : From July 2022 to September 2024, a multi-stage stratified random cluster sampling method was used to recruit permanent residents aged ≥65 years from the Xinjiang Uygur Autonomous Region as study participants. Data on sociodemographic characteristics, nutritional status, body composition indices, bone mineral density, and handgrip strength were collected through questionnaires and physical examinations. Sarcopenia was defined based on appendicular skeletal muscle index and handgrip strength. MCI was assessed using the Mini-Mental State Examination, with adjustments for educational level. Participants were randomly divided into a training set and a validation set in a 7∶3 ratio. LASSO regression and multivariable logistic regression models were employed to screen for predictors and construct an MCI risk prediction model. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results: A total of 1 641 participants were surveyed, including 755 males (46.01%) and 886 females (53.99%). The majority of participants were aged 65-<75 years, comprising 1 154 individuals (70.32%). MCI was detected in 517 participants, corresponding to a detection rate of 31.51%. Resultsfrom LASSO regression and multivariate logistic regression analysis showed that residence (rural, OR = 2.323, 95% CI: 1.682-3.210), age (75-<85 years, OR = 1.405, 95% CI: 1.019-1.937; ≥85 years, OR = 3.655, 95% CI: 1.696-7.875), educational level (primary school, OR = 0.341, 95% CI: 0.247-0.472; junior high school, OR = 0.255, 95% CI: 0.160-0.408; high school, OR = 0.286, 95% CI: 0.154-0.531; bachelor's degree or above, OR = 0.120, 95% CI: 0.041-0.351), history of alcohol consumption (yes, OR = 3.216, 95% CI: 2.164-4.779), risk of malnutrition (yes, OR = 1.464, 95% CI: 1.064-2.014), sarcopenia (yes, OR = 3.197, 95% CI: 2.332-4.385), and waist-to-hip ratio (abnormal, OR = 1.540, 95% CI: 1.159-2.048) were identified as predictive factors for MCI among the elderly. In the training set, the area under the ROC curve, sensitivity, and specificity were 0.788, 0.719, and 0.712, respectively. In the validation set, the corresponding values were 0.784, 0.913, and 0.542, respectively. DCA demonstrated that the model provided a higher clinical net benefit for predicting MCI risk when the risk threshold probability ranged from 0.124 to 0.764. Conclusion The prediction model developed in this study demonstrates good discriminative ability and clinical utility, indicating its substantial value for predicting the MCI risk among the elderly.

Objective Watch the proprioceptive neuromuscular facilitation(PNF)in the treatment of patients with shoulder-hand syndrome,and to explore its relevant therapeutic mechanisms.Methods Sixty patients with shoulder-hand syndrome were split into two groups at random:thirty cases each for observation and control.The control group received both standard medication and training in rehabilitation.Intradermal needles were inserted at the Jianjing,Jianyu,Binao,Qing Lengyuan,Shouwuli,and Quchi points and left in place for 48 hours for the treatment group.The PNF treatment was administered for thirty minutes every day,five times a week,whereas the control group underwent four weeks of traditional drug treatment and rehabilitation training.Before and after therapy,the following measures were used:the Disability of the Arm,Shoulder and Hand(DASH),the Activity of Daily Living Scale(ADL),the Simplified Fugl-Meyer Scale(FMA),and the Visual Analog Scale(VAS).In order to measure changes in endothelin-1(ET-1),nitric oxide(NO),and bradykinin(BK),serum was collected.Result Scale score:①Within-group comparison,compared with before treatment,VAS and DASH scores were significantly lower,FMA,a significant rise in ADL scores,differences were statistically significant(P<0.01).②Comparison between groups,compared with the control group,observation group of DASH score significantly lower after treatment(P<0.05),a significant rise in FMA and ADL scores(P<0.05),VAS score has no obvious difference(P>0.05).Laboratory index test:①Intra-group comparison:compared with before treatment,BK and ET-1 expression levels increased,NO and CGRP expression levels decreased,the differences were statistically significant(P<0.01).②Comparison between groups:Following treatment,the observation group showed increases in BK and ET-1 expression degrees as well as decreased NO and CGRP expression degrees.This difference was statistically significant(P<0.01).Conclusions Intradermal needle combined with PNF can promote shoulder pain symptoms,increase upper limb mobility,also improve quality of life in patients with shoulder-hand syndrome.One of the mechanisms may be to upregulate the expression level of BK and ET-1,and downregulate the expression level of NO and CGRP,so as to improve the microcirculation function and reduce the neurogenic inflammatory response.

Objective To investigate the prevalence of hyperuricemia among ethnic groups in Gongshan county,Yunnan province through a cross-sectional study.Methods A total of 229 residents aged ≥ 18 years from Dulong,Nu,Tibetan,Bai and Lisu ethnic groups were randomly selected in Gongshan County of Yunnan Province for questionnaire survey,physical examinations and laboratory tests.SPSS 22.0 was used for t test,Chi-square test,correlation analysis,and multivariate logistic regression analysis.Results A total of 107 cases of hyperuricemia were identified,with a detection rate of 46.7％,among which the prevalence was 43.9％in males,52.63％in female,48％in the Dulong,51％in the Lisu,47％in the Nu,37.5％in the Bai,52％in the Tibetan and 50％in the Han.There were no statistically significant differences in prevalence among all nationalities(P＞0.05).The proportion of individuals with a history of diabetes,as well as levels of urea nitrogen and serum creatinine,were significantly higher in the hyperuricemia group compared to the non-hyperuricemia group(P＜0.05).Correlation analysis showed a positive correlation between hyperuricemia and diabetes,urea nitrogen and serum creatinine.(P＜0.05).Multivariate regression analysis showed that diabetes and elevated serum creatinine were independent risk factors for the onset of hyperuricemia(P＜0.05).Conclusion The detection rate of hyperuricemia is relatively high in Gongshan County,Yunnan Province,and there is no significant differences in prevalence among ethnic groups.Diabetes and elevated serum creatinine are associated with hyperuricemia,which increase the risk of developing hyperuricemia.

BACKGROUND:In the occurrence and development of demyelinating diseases of the central nervous system,neuroinflammation caused by microglia is the main pathological feature,so inhibiting the inflammatory response is very important to alleviate demyelination.Hydroxysafflor yellow A can protect the blood-brain barrier,inhibit neuronal apoptosis,and improve neurological function.OBJECTIVE:To explore the mechanism of hydroxysafflor yellow A inhibiting bicyclohexanone oxalyl dihydrazone-induced demyelination in mice.METHODS:(1)In vivo:Thirty healthy male C57BL/6 mice were randomly divided into three groups:normal group,cuprizone group,and hydroxysafflor yellow A group.The mice in the cuprizone group and the hydroxysafflor yellow A group were fed with 0.2％cuprizone diet for 6 weeks to establish mouse models of demyelination.The mice in the normal group were fed with normal diet.At the end of the 4th week,the mice in the hydroxysafflor yellow A group were intraperitoneally injected with hydroxysafflor yellow A 20 mg/kg per day.The mice in the normal and cuprizone groups were intraperitoneally injected with normal saline for 2 weeks.The behavioral changes of mice were evaluated by open field test and elevated plus maze test.The loss of myelin sheath in corpus callosum was detected by black gold staining,myelin basic protein and degraded myelin basic protein immunofluorescence staining.The activation of microglia and the expression of inflammatory factors were detected by I ba-1 immunofluorescence staining and ELISA,respectively.The protein expression levels of Toll-like receptor 4,myeloid differentiation factor 88,and nuclear factor κB p65 in the brain of mice in each group were detected by western blot assay.(2)In vitro experiment:The inflammation model of BV2 microglia was established by lipopolysaccharide induction.BV2 cells were divided into normal group,lipopolysaccharide group(1 μg/mL),and lipopolysaccharide(1 μg/mL)+hydroxysafflor yellow A(25 μmol/L)group.The expression levels of tumor necrosis factor α and interleukin 6 in the supernatant were detected by ELISA.RESULTS AND CONCLUSION:(1)Compared with the normal group,the mice in the cuprizone group had severe anxiety,abnormal autonomic movement ability,and a large amount of myelin sheath loss in the corpus callosum.The average fluorescence intensity of myelin basic protein was significantly reduced,and the average fluorescence intensity of degraded myelin basic protein was significantly increased.The number of lba1+microglia increased,the contents of interleukin 1β,tumor necrosis factor α,and interleukin 6 in the brain increased,and the protein expression levels of Toll-like receptor 4,myeloid differentiation factor 88,and nuclear factor κB p65 increased significantly.The above symptoms and indexes of mice were reversed after hydroxysafflor yellow A treatment.(2)Hydroxysafflor yellow A significantly inhibited the expression of inflammatory factors such as tumor necrosis factor α,and interleukin 6 induced by lipopolysaccharide in BV2 microglia.(3)The above results demonstrate that hydroxysafflor yellow A can significantly improve cuprizone-induced demyelination in mice.The mechanism of action is related to the inhibition of microglial activation-mediated inflammatory response through the Toll-like receptor 4/myeloid differentiation factor 88/nuclear factor κB p65 signaling pathway.

Objective:Conduct an in-depth investigation into the current status and development needs of infectious disease clinical testing at medical institutions at all levels across the country.Methods:A cross-sectional survey was carried out from January 5, 2023, to June 1, 2023, using a web-based questionnaire distributed to healthcare organizations at all levels nationwide. A total of 3 462 questionnaires were collected, and after quality control and a no-return random sampling process, 2 778 questionnaires were included in the analysis. The research covered basic information about medical institutions, the current emergency response capacity of infectious disease laboratories, the status of the implementation of statutory infectious diseases, the demand for infectious disease testing programs, and the reasons for any lack of implementation. Additionally, the study further analyzed the participation rates of medical institutions at all levels, laboratory accreditation, the presence of infectious disease testing departments, and the testing rates for major infectious diseases.Results:Among the 2 778 questionnaires, the proportions of tertiary, secondary, and primary hospitals were 39.13% (1 087/2 778), 53.20% (1 478/2 778) and 4.46% (124/2 778), respectively. The proportion of specialized infectious disease medical institutions was 8.89% (247/2 778). The proportion of medical institutions with laboratory accreditation was 12.92% (359/2 778). The proportion of clinical laboratory performing infectious disease testing was 98.56% (2 738/2 778). Among the infectious disease pathogens included in the analysis, the implementation rates of testing related to hepatitis B virus, hepatitis C virus, 2019-nCoV, human immunodeficiency virus, and syphilis spirochete were 97.62% (2 712/2 778), 94.85% (2 635/2 778), 93.27% (2 591/2 778), 96.33% (2 676/2 778) and 96.22% (2 673/2 778), respectively. In the research on the demand for clinical infectious disease pathogen testing, the demand for testing of Brucella spp. bacteria and Mycobacterium tuberculosis was 25.50% (90/353) and 8.22% (29/353), respectively. The main factors that did not meet the demand for clinical infectious disease testing were the lack of space in the laboratory to carry out the tests, insufficient manpower, and the absence of a fee schedule, accounting for 44.10% (1 225/2 778), 42.55% (1 182/2 778) and 36.00% (1 000/2 778), respectively.Conclusions:Clinical testing for infectious diseases in our country is mainly carried out in the laboratories of tertiary and secondary medical institutions, which can adequately meet the laboratory testing needs for common infectious diseases. However, there are situations such as limited infectious disease testing projects and insufficient spatial, human, and material resources. Improvements in laboratory construction and methodology can be made according to the actual conditions of each region.

Objective To assess renal oxygen metabolism and iron deposition in type 2 diabetes mellitus(T2DM)patients using a combination of blood oxygen level-dependent(BOLD)and mDixon Quant techniques.Methods Clinical data of 58 T2DM patients from Tianjin First Central Hospital(September 2022-December 2023)were prospectively collected.According to urinary albumin-to-creation ratio(ACR),patients were divided into the normal albuminuria(NAU,ACR＜30 mg/g,n=35)group and the microalbuminuria(MAU,30 mg/g≤ACR＜300 mg/g,n=23)group.Thirty-three healthy volunteers were included as the control group during the same period.All participants underwent renal BOLD and mDixon Quant MRI to obtain cortical and medullary apparent relaxation rate(R2*)values.The differences of general data and image parameter values were compared between groups.Receiver operating characteristic(ROC)curves were used to analyze the diagnostic efficacy of relevant parameters for early renal function changes.Results There were significant differences in body weight,estimated glomerular filtration rate(eGFR)and ACR between the control group,the NAU group and the MAU group(P＜0.01).The R2* value in renal cortex was lower than that in renal medulla(P＜0.01)in the same group.Apart from R2* value of BOLD renal cortex,which showed no significant difference between the three groups(P＜0.05),and the differences in the other parameters were statistically significant(P<0.05).When distinguishing between the control group and the NAU group,the NAU group and the MAU group,as well as between the control group and the early-stage T2DM(NAU+MAU)group,the combined two-sequence approach demonstrated higher area under the curve(AUCs)than any single sequence alone,with AUC value of 0.892(95%CI:0.809-0.975),0.785(95%CI:0.666-0.904)and 0.841(95%CI:0.756-0.926),respectively.Conclusion The combination of BOLD imaging with mDixon Quant enables noninvasive and quantitative assessment of alterations in renal oxygen metabolism and iron content in early-stage T2DM patients.The diagnostic performance of this combined approach surpasses that of individual methods.

Objective Watch the proprioceptive neuromuscular facilitation(PNF)in the treatment of patients with shoulder-hand syndrome,and to explore its relevant therapeutic mechanisms.Methods Sixty patients with shoulder-hand syndrome were split into two groups at random:thirty cases each for observation and control.The control group received both standard medication and training in rehabilitation.Intradermal needles were inserted at the Jianjing,Jianyu,Binao,Qing Lengyuan,Shouwuli,and Quchi points and left in place for 48 hours for the treatment group.The PNF treatment was administered for thirty minutes every day,five times a week,whereas the control group underwent four weeks of traditional drug treatment and rehabilitation training.Before and after therapy,the following measures were used:the Disability of the Arm,Shoulder and Hand(DASH),the Activity of Daily Living Scale(ADL),the Simplified Fugl-Meyer Scale(FMA),and the Visual Analog Scale(VAS).In order to measure changes in endothelin-1(ET-1),nitric oxide(NO),and bradykinin(BK),serum was collected.Result Scale score:①Within-group comparison,compared with before treatment,VAS and DASH scores were significantly lower,FMA,a significant rise in ADL scores,differences were statistically significant(P<0.01).②Comparison between groups,compared with the control group,observation group of DASH score significantly lower after treatment(P<0.05),a significant rise in FMA and ADL scores(P<0.05),VAS score has no obvious difference(P>0.05).Laboratory index test:①Intra-group comparison:compared with before treatment,BK and ET-1 expression levels increased,NO and CGRP expression levels decreased,the differences were statistically significant(P<0.01).②Comparison between groups:Following treatment,the observation group showed increases in BK and ET-1 expression degrees as well as decreased NO and CGRP expression degrees.This difference was statistically significant(P<0.01).Conclusions Intradermal needle combined with PNF can promote shoulder pain symptoms,increase upper limb mobility,also improve quality of life in patients with shoulder-hand syndrome.One of the mechanisms may be to upregulate the expression level of BK and ET-1,and downregulate the expression level of NO and CGRP,so as to improve the microcirculation function and reduce the neurogenic inflammatory response.

Objective:To investigate the current status of knowledge, attitude, and practice in career planning among medical students and its influencing factors, and to facilitate the education of medical career planning.Methods:The convenience sampling method was used to distribute a self-made questionnaire, and related data were gathered from 295 medical students in Wuhan, China. SPSS 26.0 was used to perform analyses of related categorical variables, including descriptive statistics, univariate tests, rank-sum tests, and the binary logistic regression analysis.Results:The results showed that the medical students with good performance of career planning knowledge, attitude, and practice accounted for 68.48%, 87.12%, and 54.92%, respectively. Major, grade, professional satisfaction, and professional learning objectives were influencing factors for career planning knowledge among the medical students ( P<0.05); the intention for laboratory participation, the basis for major selection, and professional learning objectives were influencing factors for career planning attitude ( P<0.05); grade, internship experience, and professional learning objectives were influencing factors for career planning practice ( P<0.05). Conclusions:Related measures should be adopted to strengthen career planning education for medical talents, such as perfecting the whole-process and multi-agent career planning guidance system, stimulating the enthusiasm of students, and clarifying professional learning objectives.

BACKGROUND:In the occurrence and development of demyelinating diseases of the central nervous system,neuroinflammation caused by microglia is the main pathological feature,so inhibiting the inflammatory response is very important to alleviate demyelination.Hydroxysafflor yellow A can protect the blood-brain barrier,inhibit neuronal apoptosis,and improve neurological function.OBJECTIVE:To explore the mechanism of hydroxysafflor yellow A inhibiting bicyclohexanone oxalyl dihydrazone-induced demyelination in mice.METHODS:(1)In vivo:Thirty healthy male C57BL/6 mice were randomly divided into three groups:normal group,cuprizone group,and hydroxysafflor yellow A group.The mice in the cuprizone group and the hydroxysafflor yellow A group were fed with 0.2％cuprizone diet for 6 weeks to establish mouse models of demyelination.The mice in the normal group were fed with normal diet.At the end of the 4th week,the mice in the hydroxysafflor yellow A group were intraperitoneally injected with hydroxysafflor yellow A 20 mg/kg per day.The mice in the normal and cuprizone groups were intraperitoneally injected with normal saline for 2 weeks.The behavioral changes of mice were evaluated by open field test and elevated plus maze test.The loss of myelin sheath in corpus callosum was detected by black gold staining,myelin basic protein and degraded myelin basic protein immunofluorescence staining.The activation of microglia and the expression of inflammatory factors were detected by I ba-1 immunofluorescence staining and ELISA,respectively.The protein expression levels of Toll-like receptor 4,myeloid differentiation factor 88,and nuclear factor κB p65 in the brain of mice in each group were detected by western blot assay.(2)In vitro experiment:The inflammation model of BV2 microglia was established by lipopolysaccharide induction.BV2 cells were divided into normal group,lipopolysaccharide group(1 μg/mL),and lipopolysaccharide(1 μg/mL)+hydroxysafflor yellow A(25 μmol/L)group.The expression levels of tumor necrosis factor α and interleukin 6 in the supernatant were detected by ELISA.RESULTS AND CONCLUSION:(1)Compared with the normal group,the mice in the cuprizone group had severe anxiety,abnormal autonomic movement ability,and a large amount of myelin sheath loss in the corpus callosum.The average fluorescence intensity of myelin basic protein was significantly reduced,and the average fluorescence intensity of degraded myelin basic protein was significantly increased.The number of lba1+microglia increased,the contents of interleukin 1β,tumor necrosis factor α,and interleukin 6 in the brain increased,and the protein expression levels of Toll-like receptor 4,myeloid differentiation factor 88,and nuclear factor κB p65 increased significantly.The above symptoms and indexes of mice were reversed after hydroxysafflor yellow A treatment.(2)Hydroxysafflor yellow A significantly inhibited the expression of inflammatory factors such as tumor necrosis factor α,and interleukin 6 induced by lipopolysaccharide in BV2 microglia.(3)The above results demonstrate that hydroxysafflor yellow A can significantly improve cuprizone-induced demyelination in mice.The mechanism of action is related to the inhibition of microglial activation-mediated inflammatory response through the Toll-like receptor 4/myeloid differentiation factor 88/nuclear factor κB p65 signaling pathway.