BACKGROUND:The inflammatory response of microglia is closely related to neuronal survival,regeneration,and functional recovery after spinal cord injury.Peroxiredoxin 1 is not only involved in the regulation of oxidative stress,but also has an important effect on cell proliferation,apoptosis,and inflammatory response.OBJECTIVE:To investigate the role and mechanism of peroxiredoxin 1 in the inflammatory response of microglia following spinal cord injury.METHODS:(1)Twelve female C57BL/6 mice were randomly divided into sham-operated(n=6)and spinal cord injury(n=6)groups.The sham-operated group was not modeled and acute spinal cord injury models were constructed in the spinal cord injury group using the modified Allen's method.Spinal cord tissue at the injured site was taken at 7 days after modeling and transcriptome sequencing was performed to identify differentially expressed genes.The expression of peroxiredoxin 1 in spinal cord tissues was verified using western blot and RT-qPCR.(2)Mouse microglia BV2 were divided into two groups:the control group was stimulated with lipopolysaccharide for 6 hours,and in the knockout group,lipopolysaccharide stimulation was applied for 6 hours at 24 hours after peroxiredoxin 1 was knocked down in the cells.RT-qPCR was performed to detect mRNA expression of peroxiredoxin 1,inflammatory factors(interleukin 1β,interleukin 6,inducible nitric oxide synthase,tumor necrosis factor α,C-C motif chemokine ligand 2,and C-X-C motif chemokine ligand 2),and western blot was performed to detect the expression of peroxiredoxin 1,inducible nitric oxide synthase,and reactive oxygen/mitogen-activated protein kinase signaling pathway proteins.Mouse microglia BV2 were treated in two groups:the control group was stimulated by hydrogen peroxide for 4 hours,and the knockout group was stimulated by hydrogen peroxide for 4 hours at 24 hours after knockdown of peroxiredoxin 1.The level of reactive oxygen species was detected by 2,7-dichlorodihydrofluorescein diacetate probe.RESULTS AND CONCLUSION:(1)Results from transcriptome sequencing,western blot and RT-qPCR confirmed that peroxiredoxin 1 expression levels in mouse spinal cord tissues were significantly higher in the spinal cord injury group than the sham-operated group(P＜0.05).(2)Peroxiredoxin 1 knockdown in microglial cells led to decreased expression of peroxiredoxin 1 mRNA and protein(P＜0.05),increased mRNA expression of interleukin 1β,interleukin 6,inducible nitric oxide synthase,tumor necrosis factor α,C-C motif chemokine ligand 2,and C-X-C motif chemokine ligand 2(P＜0.05),increased protein expression of inducible nitric oxide synthase,P-P38,P-JNK and P-ERK proteins(P＜0.05),and increased level of reactive oxygen species(P＜0.05).To conclude,peroxiredoxin 1 regulates microglial inflammation by targeting the reactive oxygen species/mitogen-activated protein kinase signaling pathway.

BACKGROUND:The inflammatory response of microglia is closely related to neuronal survival,regeneration,and functional recovery after spinal cord injury.Peroxiredoxin 1 is not only involved in the regulation of oxidative stress,but also has an important effect on cell proliferation,apoptosis,and inflammatory response.OBJECTIVE:To investigate the role and mechanism of peroxiredoxin 1 in the inflammatory response of microglia following spinal cord injury.METHODS:(1)Twelve female C57BL/6 mice were randomly divided into sham-operated(n=6)and spinal cord injury(n=6)groups.The sham-operated group was not modeled and acute spinal cord injury models were constructed in the spinal cord injury group using the modified Allen's method.Spinal cord tissue at the injured site was taken at 7 days after modeling and transcriptome sequencing was performed to identify differentially expressed genes.The expression of peroxiredoxin 1 in spinal cord tissues was verified using western blot and RT-qPCR.(2)Mouse microglia BV2 were divided into two groups:the control group was stimulated with lipopolysaccharide for 6 hours,and in the knockout group,lipopolysaccharide stimulation was applied for 6 hours at 24 hours after peroxiredoxin 1 was knocked down in the cells.RT-qPCR was performed to detect mRNA expression of peroxiredoxin 1,inflammatory factors(interleukin 1β,interleukin 6,inducible nitric oxide synthase,tumor necrosis factor α,C-C motif chemokine ligand 2,and C-X-C motif chemokine ligand 2),and western blot was performed to detect the expression of peroxiredoxin 1,inducible nitric oxide synthase,and reactive oxygen/mitogen-activated protein kinase signaling pathway proteins.Mouse microglia BV2 were treated in two groups:the control group was stimulated by hydrogen peroxide for 4 hours,and the knockout group was stimulated by hydrogen peroxide for 4 hours at 24 hours after knockdown of peroxiredoxin 1.The level of reactive oxygen species was detected by 2,7-dichlorodihydrofluorescein diacetate probe.RESULTS AND CONCLUSION:(1)Results from transcriptome sequencing,western blot and RT-qPCR confirmed that peroxiredoxin 1 expression levels in mouse spinal cord tissues were significantly higher in the spinal cord injury group than the sham-operated group(P＜0.05).(2)Peroxiredoxin 1 knockdown in microglial cells led to decreased expression of peroxiredoxin 1 mRNA and protein(P＜0.05),increased mRNA expression of interleukin 1β,interleukin 6,inducible nitric oxide synthase,tumor necrosis factor α,C-C motif chemokine ligand 2,and C-X-C motif chemokine ligand 2(P＜0.05),increased protein expression of inducible nitric oxide synthase,P-P38,P-JNK and P-ERK proteins(P＜0.05),and increased level of reactive oxygen species(P＜0.05).To conclude,peroxiredoxin 1 regulates microglial inflammation by targeting the reactive oxygen species/mitogen-activated protein kinase signaling pathway.

Photodynamic immunotherapy is a promising strategy for cancer treatment. However, the dysfunctional tumor vasculature results in tumor hypoxia and the low efficiency of drug delivery, which in turn restricts the anticancer effect of photodynamic immunotherapy. In this study, we designed photosensitive lipid nanoparticles. The synthesized PFBT@Rox Lip nanoparticles could produce type I/II reactive oxygen species (ROS) by electron or energy transfer through PFBT under light irradiation. Moreover, this nanosystem could alleviate tumor hypoxia and promote vascular normalization through Roxadustat. Upon irradiation with white light, the ROS produced by PFBT@Rox Lip nanoparticles in situ dysregulated calcium homeostasis and triggered endoplasmic reticulum stress, which further promoted the release of damage-associated molecular patterns, enhanced antigen presentation, and stimulated an effective adaptive immune response, ultimately priming the tumor microenvironment (TME) together with the hypoxia alleviation and vessel normalization by Roxadustat. Indeed, in vivo results indicated that PFBT@Rox Lip nanoparticles promoted M1 polarization of tumor-associated macrophages, recruited more natural killer cells, and augmented infiltration of T cells, thereby leading to efficient photodynamic immunotherapy and potentiating the anti-primary and metastatic tumor efficacy of PD-1 antibody. Collectively, photodynamic immunotherapy with PFBT@Rox Lip nanoparticles efficiently program TME through the induction of immunogenicity and oxygenation, and effectively suppress tumor growth through immunogenic cell death and enhanced anti-tumor immunity.

In response to the new requirements for course instruction outlined in the revised training program for medical imaging program, this study integrated medical imaging technology courses based on the principle of outcome-oriented education and by leveraging self-developed digital resources, with imaging methods as the entry point. The core elements of the course teaching were re-optimized and reorganized to transcend the temporal and spatial limitations of course delivery, enabling the rational application of diverse teaching methods. This approach facilitated the integration of knowledge across three specialized courses, namely medical imaging physics, medical imaging equipment, and medical imaging examination techniques, and achieved full-dimensional and whole-process teaching evaluation. While reducing the number of hours allocated to theoretical instruction, the teaching objectives were achieved with high quality, providing a reference for the integration of digital technologies into the teaching of medical imaging and related disciplines.

Objective:To explore the distribution of Traditional Chinese Medicine constitution among patients with impaired awareness of hypoglycemia (IAH) and identify risk factors for IAH in patients with diabetes mellitus, to develop a risk prediction model. The aim is to validate the models′ predictive accuracy to facilitate early prevention and treatment of IAH.Methods:A case control study employing convenience sampling model was conducted on 1351 hospitalized patients with diabetes mellitus in the endocrinology departments of Changshu Hospital Affiliated to Nanjing University of Chinese Medicine and Affiliated Hospital of Jiangsu University, between August 2021 and December 2023. Traditional Chinese medicine constitution types were determined using the Traditional Chinese Medicine Constitution Classification and Judgment (ZYYXH/T157-2009). Data were divided into training and test sets at a ratio of 7∶3. Two prediction models were developed: Model 1, a conventional IAH prediction model for patients with diabetes mellitus, and Model 2, an IAH prediction model for patients with diabetes mellitus incorporating traditional Chinese medicine constitution. Nomograms were drawn for both models. The Hosmer-Lemeshow goodness-of-fit test, calibration curve, receiver operating characteristic (ROC) curve, and area under the curve (AUC) were calculated to evaluate the effectiveness of models 1 and 2. The improvement in prediction performance between Models 1 and 2 was assessed using Delong test, AUC, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).Results:The study included 1 283 patients with diabetes mellitus, including 578 males and 705 females, aged (59.61 ± 14.09) years. The incidence of IAH among patients with diabetes mellitus was 20.50% (263/1283), with yang deficiency constitution being the most prevalent traditional Chinese medicine constitution type, at 47.53% (125/263). Multivariate analysis revealed that age, body mass index, course of diabetes, neurological hypoglycemia symptoms, hypoglycemia symptoms and severe hypoglycemia history were the influencing factors of Model 1 (all P<0.05); age, body mass index, neurological hypoglycemic symptoms, hypoglycemic symptoms, history of severe hypoglycemia, and traditional Chinese medicine constitution were the influencing factors of Model 2 (all P<0.05). The Hosmer-Lemeshow goodness-of-fit test showed a good fit of Model 2 [training set ( χ2=8.48, P>0.05), test set ( χ2=3.92, P>0.05)]. The Delong test results showed that the AUC for Model 2 was 0.96 for both the training and test sets, significantly higher than the AUCs of the 0.90 and 0.91 for Model 1 ( Z=-7.27, -3.70, both P<0.01). Furthermore, NRI was 0.66 ( 95%CI 0.53-0.79, P<0.01) and IDI was 0.02 (95% CI 0.01-0.03, P<0.05) for Model 2. Comparative analysis of clinical utility demonstrated that the net benefit of Model 2 for predicting IAH in patients with diabetes mellitus surpassed that of Model 1 across threshold probabilities ranging from 5% to 100%. Conclusions:The study constructed a nomogram prediction model included traditional Chinese medicine constitution with good predictive performance for IAH in patients with diabetes mellitus, and is of significant clinical value for identifying high-risk IAH populations.IAH patients mainly have a biased constitution, indicating that medical staff can reduce the incidence of IAH by improving the patients′ constitution.

In response to the new requirements for course instruction outlined in the revised training program for medical imaging program, this study integrated medical imaging technology courses based on the principle of outcome-oriented education and by leveraging self-developed digital resources, with imaging methods as the entry point. The core elements of the course teaching were re-optimized and reorganized to transcend the temporal and spatial limitations of course delivery, enabling the rational application of diverse teaching methods. This approach facilitated the integration of knowledge across three specialized courses, namely medical imaging physics, medical imaging equipment, and medical imaging examination techniques, and achieved full-dimensional and whole-process teaching evaluation. While reducing the number of hours allocated to theoretical instruction, the teaching objectives were achieved with high quality, providing a reference for the integration of digital technologies into the teaching of medical imaging and related disciplines.

Objective:To explore the distribution of Traditional Chinese Medicine constitution among patients with impaired awareness of hypoglycemia (IAH) and identify risk factors for IAH in patients with diabetes mellitus, to develop a risk prediction model. The aim is to validate the models′ predictive accuracy to facilitate early prevention and treatment of IAH.Methods:A case control study employing convenience sampling model was conducted on 1351 hospitalized patients with diabetes mellitus in the endocrinology departments of Changshu Hospital Affiliated to Nanjing University of Chinese Medicine and Affiliated Hospital of Jiangsu University, between August 2021 and December 2023. Traditional Chinese medicine constitution types were determined using the Traditional Chinese Medicine Constitution Classification and Judgment (ZYYXH/T157-2009). Data were divided into training and test sets at a ratio of 7∶3. Two prediction models were developed: Model 1, a conventional IAH prediction model for patients with diabetes mellitus, and Model 2, an IAH prediction model for patients with diabetes mellitus incorporating traditional Chinese medicine constitution. Nomograms were drawn for both models. The Hosmer-Lemeshow goodness-of-fit test, calibration curve, receiver operating characteristic (ROC) curve, and area under the curve (AUC) were calculated to evaluate the effectiveness of models 1 and 2. The improvement in prediction performance between Models 1 and 2 was assessed using Delong test, AUC, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).Results:The study included 1 283 patients with diabetes mellitus, including 578 males and 705 females, aged (59.61 ± 14.09) years. The incidence of IAH among patients with diabetes mellitus was 20.50% (263/1283), with yang deficiency constitution being the most prevalent traditional Chinese medicine constitution type, at 47.53% (125/263). Multivariate analysis revealed that age, body mass index, course of diabetes, neurological hypoglycemia symptoms, hypoglycemia symptoms and severe hypoglycemia history were the influencing factors of Model 1 (all P<0.05); age, body mass index, neurological hypoglycemic symptoms, hypoglycemic symptoms, history of severe hypoglycemia, and traditional Chinese medicine constitution were the influencing factors of Model 2 (all P<0.05). The Hosmer-Lemeshow goodness-of-fit test showed a good fit of Model 2 [training set ( χ2=8.48, P>0.05), test set ( χ2=3.92, P>0.05)]. The Delong test results showed that the AUC for Model 2 was 0.96 for both the training and test sets, significantly higher than the AUCs of the 0.90 and 0.91 for Model 1 ( Z=-7.27, -3.70, both P<0.01). Furthermore, NRI was 0.66 ( 95%CI 0.53-0.79, P<0.01) and IDI was 0.02 (95% CI 0.01-0.03, P<0.05) for Model 2. Comparative analysis of clinical utility demonstrated that the net benefit of Model 2 for predicting IAH in patients with diabetes mellitus surpassed that of Model 1 across threshold probabilities ranging from 5% to 100%. Conclusions:The study constructed a nomogram prediction model included traditional Chinese medicine constitution with good predictive performance for IAH in patients with diabetes mellitus, and is of significant clinical value for identifying high-risk IAH populations.IAH patients mainly have a biased constitution, indicating that medical staff can reduce the incidence of IAH by improving the patients′ constitution.

A method capable of retinal vessel segmentation and three-dimensional(3D)reconstruction is proposed for the early diagnosis of diabetic retinopathy.The 3D reconstruction can avoid the misjudgments of blood vessel length,curvature and branch angle after segmentation,which will affect the early diagnosis.IAAnet algorithm for retinal image segmentation combines traditional Unet with Inception V3,atrous spatial pyramid pooling and AttentionGates to reduce information loss and avoid over-fitting,thereby improving the network's ability to extract features.The projection reconstruction method is used to restore the 3D information of blood vessels,and supports the adjustments of brightness and contrast,so that doctors can better observe the real state of blood vessels.The proposed algorithm has an accuracy,recall rate,F1 score,intersection over union and area under ROC curve of 97.68%,96.07%,97.26%,92.79%and 94.00%,respectively.Compared with other networks,IAAnet algorithm exhibits higher segmentation accuracy,and can obtain more vascular information in 3D image after 3D projection reconstruction to assist in the early diagnosis.

Objective To explore the process and main behavior characteristics of behavioral characteristics of patients with recurrent hypoglycemia in the degeneracy of blood glucose management.Methods A mixed-method convergent design was used to collect data.From June 2022 to April 2023,382 patients with recurrent hypoglycemia were admitted to the endocrine department of a tertiary hospital in Jiangsu were recruited to score of ego depletion.K-means clustering was conducted to analyze the distribution characteristics of patients'characteristics in blood glucose management.At the same time,19 patients who were selected from the participants of the quantitative study were recruited to attend semi-structured interviews.Results Quantitative results analysis:the average score of blood glucose management loss was(49.20±6.58),and the average scores of cognitive control,behavioral control and emotional control were(17.90±4.12),(15.49±3.64)and(15.81±3.58),respectively.The results of cluster analysis showed that behavioral characteristics could be divided into 3 groups:a cognitive depletion group,an emotional depletion group and a self-control group.Qualitative data analysis:the process of deterioration of management in patients included 3 major themes,including the antecedents of ego depletion,the process of ego depletion and the aftereffects of ego depletion.Analysis of the mixed results showed that the status of ego depletion is serious;patients ignore the behavioral elements of active participation in blood glucose management,show many irrational decision-making behaviors,and the degradation behavior characteristics of patients'blood glucose management are different.Conclusion The degeneration behavior of blood glucose management was serious and affected by single or multiple factors,continuously consuming self-control energy and causing ego depletion.To promote the long-term maintenance of blood glucose management,priority should be given to take actions to enhance patients'perceptions,emotion and behaviors,help them learn about the possible blood glucose changes,improve their understanding and recognition of the value of scientific management.

Objective:To understand the incidence trend of meningococcal meningitis from 1990 to 2023 and major pathogenic serogroups of Neisseria ( N.) meningitidis from 2006 to 2023 in China and the time trend of the incidence of meningococcal meningitis caused by main pathogenic serogroups, and provide reference for the prevention and control of meningococcal meningitis. Methods:The study used the data from "National Epidemic Data Compile" from 1990 to 2003 and the data from China Notifiable Infectious Disease Reporting System from 2004 to 2023 to analyze the incidence trend of meningococcal meningitis in China from 1990 to 2023 by Joinpoint regression method. Based on the data of the national meningococcal meningitis surveillance information reporting and management system from 2006 to 2023, the incidence of meningococcal meningitis caused by different serogroups of N. meningitidis was described and analyzed, and the trend χ2 test was performed to analyze the change of the incidence of meningococcal meningitis caused by N. meningitidis A, B, and C. Results:The overall incidence of meningococcal meningitis in China showed a downward trend from 1990 to 2023 [average annual percent change (AAPC)=-14.80%, P<0.001], with the most obvious decline from 2005 to 2012 [annual percent change (APC)=-31.01%, P<0.001]. The incidence of meningococcal meningitis decreased in both men and women (AAPC=-14.69% and -15.05%, both P<0.001). A total of 1 178 serogroup specific cases of meningococcal meningitis were reported in China from 2006 to 2023, the proportion of serogroup C was highest (32.5%), followed by unclassified (22.3%), B (20.1%), A (18.4%), W (4.5%), Y (2.0%) and X (0.2%). The results of trend χ2 test indicated that the incidence of meningococcal meningitis caused by N. meningitidis A and C showed downward trends (both P<0.001) and the incidence of meningococcal meningitis caused by N. meningitidis B showed an upward trend in general population and young children (0-4 years old group) from 2006 to 2023 (both P<0.05). Conclusion:The incidence of meningococcal meningitis showed a downward trend in China from 1990 to 2023, but it is still necessary to pay more attention to the incidence of meningococcal meningitis caused by N. meningitidis B in age group aged 0-4 years and by multi serogroups at same time in general population.