ObjectiveTo investigate whether the effect of Danggui Shaoyaosan （DSS） on cognitive impairment is related to its promotion of ketone body metabolism in the brain and regulation of glutamate/α-amino-3-hydroxy-5-methyl-4-isox-azolepropionic acid receptor （AMPAR） pathway. MethodsMale APP/PS1 mice were randomized into model， low-dose （3.2 g·kg^-1） DSS， medium-dose （6.4 g·kg^-1） DSS， high-dose （12.8 g·kg^-1） DSS， ketogenic diet， and inhibitor （talampanel， 5 mg·kg^-1） groups. C57BL/6J wild-type mice were selected as the normal group. The talampanel group was intragastrically administered for 2 consecutive weeks from the 6th week， and the other groups were continuously treated for 8 weeks before behavioral testing. The ultrastructure of synapses in hippocampal CA1 region was observed by transmission electron microscopy， and calcium/calmodulin-dependent kinase Ⅱ （CaMKⅡ） expression was detected by immunohistochemistry （IHC）. The levels of β-hydroxybutyrate （BHB） and lactic acid （LAC） were measured by biochemical kits， and those of glutamate （Glu）， glutamine （Gln）， γ-aminobutyric acid （GABA）， and synaptophysin （SYP） by enzyme-linked immunosorbent assay （ELISA）. The mRNA levels of glutamine synthetase （GS）， glutaminase （GLS）， glutamate decarboxylase （GAD）， CaMKⅡ， and AMPAR subunits GluA1 and GluA2 were quantified by Real-time quantitative polymerase chain reaction （Real-time PCR）， and the protein levels of GS， GLS， GAD， GluA1， and GluA2 by Western blot. ResultsCompared with the normal group， the model group exhibited decreased recognition index， spontaneous alternation rate， and residence time in the target quadrant （P<0.01）， increased escape latency and ratio of the time in the opposite side of the target quadrant to the time in the target quadrant （P<0.05， P<0.01）， damaged synaptic ultrastructure of hippocampal CA1 region， increased positive expression of CaMKⅡ， no significant difference in BHB level， elevated LAC and Glu levels （P<0.01）， declined SYP， Gln， and GABA levels （P<0.01）， downregulated mRNA and protein levels of GS， GAD， and GluA2 （P<0.05， P<0.01）， and upregulated mRNA and protein levels of GLS and GluA1 （P<0.05， P<0.01） and mRNA level of CaMKⅡ （P<0.01）. Compared with the model group， DSS intervention improved the behavioral indexes of mice （P<0.05， P<0.01）， enhanced the synaptic ultrastructure plasticity in hippocampal CA1 region， decreased the positive expression of CaMKⅡ， raised the BHB level （P<0.01）， reduced the LAC and Glu levels （P<0.01）， elevated the SYP， Gln， and GABA levels （P<0.01）， upregulated the mRNA and protein levels of GS， GAD， and GluA2， and downregulated the mRNA and protein levels of GLS and GluA1 （P<0.05， P<0.01） and the mRNA level of CaMKⅡ （P<0.01）. ConclusionDSS can improve the learning and memory and enhance the synaptic plasticity of APP/PS1 mice. Its neuroprotective effect is coupled with the promotion of ketone body formation and remodeling of brain energy metabolism， and is related to the regulation of glutamate/AMPAR pathway.

Objective:To observe the proteomic changes in vitreous fluid samples from patients with rhegmatogenous retinal detachment combined with choroidal detachment (RRDCD).Methods:A prospective cross-sectional clinical study. Vitreous fluid samples were collected from 35 patients with RRDCD (RRDCD group) and 40 patients with rhegmatogenous retinal detachment (RRD group) who were diagnosed at Wuhan Aier Eye Hospital between November 2021 and December 2023. Prior to vitrectomy, 0.3-0.5 ml of vitreous fluid was collected from the affected eyes. Differentially expressed proteins were analyzed using Data-Independent Acquisition (DIA). Three of these proteins were randomly selected for validation using enzyme-linked immunosorbent assay (ELISA). Bioinformatics analyses, including gene ontology functional enrichment and kyoto encyclopedia of genes and genomes pathway enrichment, were performed to explore the functions of the differentially expressed proteins.Results:Significant differences were observed between the RRDCD and RRD groups in intraocular pressure ( t=-12.795), the number of retinal tears ( t=4.601), the extent of retinal detachment ( χ2=39.642), axial length ( t=0.840), postoperative proliferative vitreoretinopathy incidence ( χ2=4.730), single-surgery reattachment rate ( χ2=7.717), and best-corrected visual acuity ( t=7.033) at 6 months postoperatively ( P<0.05). A total of 237 differentially expressed proteins were identified between the RRDCD and RRD groups, with 63 upregulated and 174 downregulated. These proteins were involved in pathways such as extracellular matrix-receptor interaction, complement activation, coagulation, and lysosomal pathways. ELISA validation results showed that the expression trends of the three selected proteins in the RRDCD and RRD groups were consistent with the DIA proteomic analysis. Compared to the RRD group, proteins such as fibrin, coagulation factors, cathepsins, and trypsin inhibitors were significantly upregulated in the RRDCD group. Conclusions:The protein expression profile in vitreous fluid samples from RRDCD patients show significant alterations compared to the RRD group. These differential changes suggest that RRDCD is closely associated with complement and coagulation cascade activation, lysosomal pathways, and extracellular matrix remodeling.

OBJECTIVE To compare the efficacy and safety of new oral anticoagulants （NOACs） and warfarin in the treatment of left ventricular thrombus （LVT）， and to provide evidenced-based reference for rational drug use in clinic. METHODS Retrieved from PubMed， Cochrane Library， Embase， Ovid Medline， CNKI， Wanfang and VIP during the inceptions to March 2022， after screening the literature and extracting data， the quality of randomized controlled trials （RCTs） was evaluated by using bias risk evaluation tool recommended by Cochrane systematic evaluator manual. Newcastle Ottawa Scale was used to evaluate the quality of cohort studies， and RevMan 5.3 software was used for meta-analysis and bias risk analysis. RESULTS A total of 13 studies were included in the analysis， including 2 RCTs， 11 cohort studies and 2 261 patients； results of meta-analysis showed that there was no statistical significance in the incidence of complete LVT resolution [OR＝1.05， 95%CI（0.81，1.37）， P＝0.71]， the incidence of stroke/systemic embolism [OR＝0.89， 95%CI（0.67，1.18）， P＝0.42]， the incidence of massive haemorrhage [OR＝ 0.61， 95%CI（0.19，1.97）， P＝0.41]， the incidence of rehospitalization [OR＝0.84， 95%CI（0.49，1.46）， P＝0.54] or all-cause mortality [OR＝0.93， 95%CI（0.56，1.56）， P＝0.79] between 2 groups. The incidence of any bleeding event in trial group was significantly lower than that control group[OR＝ 025-80863493。0.65， 95%CI（0.45，0.93）， P＝0.02]. Subgroup analysis showed that complete LVT resolution of patients with follow-up ≤6 months in trial group was significantly higher than control group， and the incidence of any bleeding event was significantly lower in patients with follow-up ＞6 months and in the European region than control group （P＜0.05）. There was no statistically significant difference in the rate of complete LVT resolution in patients with follow-up＞6 months， the incidence of any bleeding event in patients from Asia and America， or the incidence of any bleeding event in the two groups included in the RCT or the cohort study （P＞0.05）. The publication bias analysis showed that publication bias was less likely in the rate of complete LVT resolution but more likely in the incidence of any bleeding event. CONCLUSIONS NOACs can eliminate thrombus faster in the early stage， but with the prolongation of anticoagulation time， the efficacy of NOACs is comparable to warfarin， and the safety of NOACs in any bleeding event is better than warfarin.

The new type of coronavirus pneumonia referred to as coronavirus disease 2019 (COVID-19), became pandemic globally, causing tens of millions of infections. The establishment of a sound prevention and control system is particularly important for disease prevention and control. In the process of admission and treatment of COVID-19 patients, we have established an effective rapid prevention and control system for special infections in the hospital. Through the establishment of a hospital-level emergency response and first aid training system, the closed-loop communication between hospitals, departments and medical care is quick to respond. We categorize treatment according to patients’ condition, provide rapid feedback and return, implement the specific responsibility system for special personnel, improve the rapid prevention and control system for special infections, and apply it to the prevention and control of the epidemic of COVID-19 patients in the region, and achieve the effectiveness of the anti-epidemic through comprehensive management measures. The control has achieved zero infection among medical staff and within the hospital, ensuring that the hospital can quickly resume daily work at the end of the epidemic, and has certain promotion and demonstration value.

OBJECTIVE：To sy stematically evaluate the efficacy and safety of a spirin combined with clopidogrel in the treatment of progressing stroke. METHODS ：Retrieved from the Cochrane library ，PubMed，Embase，Clinical trials.gov ，CBM， VIP，Wanfang database and CNKI databases ，randomized controlled trials （RCTs）about aspirin combined with clopidogrel （trial group）versus aspirin or clopidogrel alone （control group ）in the treatment of progressing stroke were collected. After literature screening and data extraction ，the quality of literatures were evaluated with bias risk assessment tool recommended by Cochrane system evaluator manual 5.2. Meta-analysis was performed by using Rev Man 5.3 software. RESULTS ：A total of 27 RCTs involving 2 854 patients were enrolled. The results of Meta-analysis showed that response rate of trial group was significantly higher than aspirin group [RR ＝1.31，95％CI（1.26，1.37），P＜0.000 01]；Neurological deficit score （NDS）of trial group was significantly lower than control group [MD ＝－3.80，95％CI（－5.30，－2.30），P＜0.000 01]；National Institutes of Health Stroke Scale Score in trial group was significantly lower than aspirin group [MD ＝－3.72，95％CI（－5.25，－2.20），P＜0.000 01] and clopidogrel group [MD ＝－2.44，95％CI（－4.14，－0.73），P＝0.005]. Results of subgroup analysis showed that NDS score of trial group was significantly lower than control group after 14 d of treatment [MD ＝－2.19，95％CI（－3.11，－1.27），P＜0.000 01]，15 d of treatment [MD ＝－5.73，95％CI（－10.65，－0.81），P＝0.02] and 28 d of treatment [MD ＝－3.45，95％CI（－4.24，－2.67），P＜ 0.000 01]. Compared with trial group ，there was no statistical significance in response rate with clopidogrel group ，the incidence of ADR with clopidogrel group ，the incidence of bleeding event with clopidogrel group ，and mortality with control group （P＞0.05）. CONCLUSIONS：Aspirin combined with clopidogrel in the ； treatment of progressive stroke ，can improve the efficacy and improve neurological deficit symptoms in the short term ，but can not reduce the incidence of ADR or the mortality during E-mail：wuyanzi89@126.com the treatment.

Objective:To discuss the implementation and experience of the quality control circle ( QCC) activi-ty in shortening the interval time of consecutive operation and speeding up the turnover of operating table. Method:We formed a QCC team and explored the influential factors of the interval time of consecutive operation using quali-ty control technique. We found out the real reason, put forward corresponding countermeasures, and organized the implementation. Results: Before the implementation of QCC, the average interval time of consecutive operation was 24. 6 minutes, whereas it decreased to 16. 2 minutes after the implementation of QCC with the progress rate of 64. 87%. Through the QCC activities, the problem-solving ability, responsibility, communication and coordina-tion ability, motivation, confidence, team cohesion, and the use of quality control technique of the QCC members has improved significantly. Conclusion:Through the quality management tools of QCC, the interval time of con-secutive operation has greatly shorten, the turnover of operation table has improved, and doctors′ and operating room nurses′satisfaction has improved significantly.

Objective: To investigate the clinicopathological features, diagnosis, and differential diagnosis of gallbladder sarcomatoid carcinoma. Methods: The clinical manifestations and the microscopic and immunohistochemical characteristics of six patients with gallbladder sarcomatoid carcinoma were analyzed with a follow-up period. Related literature was reviewed. Results:Immunohistochemical markers of gallbladder sarcomatoid carcinoma with spindle cell morphology were epithelial and mesenchymal positivity. Conclusion: Gallbladder sarcomatoid carcinoma could be firmly diagnosed by microscopic morphology and immunohistochemistry. Radical resection is currently used to treat such patients. However, more cases with longer follow-up period are needed to discover better treatments and improve the survival of these patients.

Objective To explore the influence of integrin redistribution on hepatoma cell alignment and migration and the influence of cytoskeleton reassembly on integrin redistribution by the method of mechanical loading unloading and fibronection(FN) coating. Method By using immuneofluescence staining, cofocal laser scanning microscopy and quantitative morphological analysis, integrin distribution change and crtoskeleton assembly adjustment were observed and the deformation of cell movement was tested and analyzed quantitatively. Results (1) cells with different forms have different integrin expressions and distribution features. The β1 integrin expression for spreading cells was higher than that for round (nonspreading) cells. For spreading cells, the strongest staining was found towards the attachment surface. While for round (nonspreading) cells, the integrin staining on the free surface towards medium was stronger than that towards the attachment surface. (2) After 5 hours of mechanical stretch, the β1 integrin expression for both spreading and round cells increased, and distribution peaks towards the attachment surface broadened. At 1 hour after unloading, the β1 integrin expression decreased and the distribution of integrin staining showed the tendency of dispersion, especially for round cells. (3) After coating the substrates with FN, the β1 integrin expression increased. The integrin staining for either spreading or round cells was more towards the attachment surface to reduce the migration of hepatoma cells. 4) After 5 hours of mechanical stretch, 60% of cells showed their orientation of major axes distributed between 70°～110° towards the stretching direction, and the cytoskeleton aligned vertically to the stretching direction. Cytoskeletons were found significantly depolymerized at 1 hour of unloading. Conclusions The change of integrin distribution is affected by cytoskeleton aligned and the number of ligand. The distribution feature of the whole integrin expression on the surface of individual round cells is related to their stronger invasion and metastasis capability.

Objective To investigate patients'cognition of social status of physicians and nurses,and find out the influence factors of it. Methods 286 patients were asked to finish serf-designed scale of social status of physicians and nurses. Results Most patients thought social status of nurses was above the middle level in our country.The majority of patients considered doctors " social status was higher than nurses'(approval rate 75.5% ).The nurses'economic treatment was lower than doctors' (approval rate 62.2% );About 14 items among 15 items on the occupational reputation,doctors" occupation cognition rate was higher than the nurses,the nurses' occupation cognition rate was higher than the doctors' occupation only on the item of labor intensity.The influence factors of the social status differences between physicians and nurses were economic treatment,the important degree of occupation,the professional authority,the requirement of specialized skills for workers. Conclusions To study the influence factors of the social status difference of physicians and nurses is beneficial for us to study the strategy of improving the nurses' social status in order to fulfil the viewpoint of science development,keep nurse troops developing continuously and set up the harmonious physician-nurse relationship.

OBJECTIVE:To evaluate the utilization of traditional Chinese medicine(TCM) in our hospital and to provide reference for TCM pharmacy and rational use of TCM in the clinic.METHODS:1 052 outpatient prescriptions of TCM in our hospital from May to Oct.in 2009 were analyzed statistically by Microsoft Excel program.RESULTS:Prescriptions of respiratory system diseases in our hospital were mainly TCM prescription.TCM in middle-aged and aged group was a universal phenomenon.The ingredients in every prescription were excessive with high dosage.CONCLUSION:Clinicians and pharmacists should attach great importance on the application of TCM prescriptions to ensure safety and effectiveness of drug use.