Medical parasitology, as a course bridging basic medical sciences and clinical medicine, has an important disciplinary value in the medical education system. This study investigated the composition of parasitology teachers from multiple medical colleges and universities across China. The results showed that there was a significant difference in the proportion of teachers with clinical medicine background knowledge, and there was common dilemma that there were insufficient clinical medicine knowledge reserves among teachers in some medical colleges and universities, who encountered severe teaching challenges. Based on this issue, this study constructed a basic-clinical medicine collaborative problem-based learning (PBL) teaching model. This model integrated theoretical teaching, case analyses, and experimental operations, and combined transdisciplinary team building and multidimensional teacher training, which significantly improved the clinical teaching capability among parasitology teachers, and effectively compensated the impact of insufficient clinical medicine knowledge reserves on teaching. Following teaching reform, students' scores significantly improved, and their case analysis capability enhanced. This study provides a practical path to address the shortage of clinical medicine background knowledge among parasitology teachers, which facilitates the progress of educational reform of medical parasitology and improvement of teaching quality.

ObjectiveTo decipher the mechanism by which Zuoguiwan （ZGW） treat hyperthyroidism in rats with kidney-Yin deficiency based on the dopamine receptor D4 （DRD4）/nicotinamide adenine dinucleotide phosphate （NADPH） oxidase 4 （NOX4） signaling pathway. MethodsThe rat model of kidney-Yin deficiency was induced by unilateral intramuscular injection of dexamethasone （0.35 mg·kg^-1）. After successful modeling， the rats were randomized into model， methimazole （positive control， 5 mg·kg^-1）， low-， medium-， and high-dose （1.85， 3.70， 7.40 g·kg^-1， respectively） ZGW， and normal control groups. After 21 days of continuous gavage， the behavioral indexes and body weight changes of rats were evaluated. The pathological changes of the renal tissue were observed by hematoxylin-eosin staining. The serum levels of thyroid hormones ［triiodothyronine （T₃）， thyroxine （T₄）， thyroid-stimulating hormone （TSH）］， renal function indexes ［serum creatine （Scr） and blood urea nitrogen （BUN）］， energy metabolism markers ［cyclic adenosine monophosphate （cAMP） and cyclic guanosine monophosphate （cGMP）］， and oxidative stress-related factors ［superoxide dismutase （SOD）， malondialdehyde （MDA）， and NADPH）］ were measured by enzyme-linked immunosorbent assay （ELISA）. Western blot was employed to analyze the expression of DRD4， NOX4， mitochondrial respiratory chain complex proteins ［NADH：ubiquinone oxidoreductase subunit S4 （NDUFS4） and cytochrome C oxidase subunit 4 （COX4）］， and inflammation-related protein ［tumor necrosis factor-alpha （TNF-α）， interleukin-6 （IL-6）， p38 mitogen-activated protein kinase （MAPK）］ pathway in the renal tissue. ResultsCompared with the normal group， the model group showed mental malaise， body weight decreases （P<0.01）， inflammatory cell infiltration in the renal tissue， a few residual parotid glands in the thyroid， elevations in serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA， and NADPH （P<0.01）， down-regulation in protein levels of TSH， SOD， and DRD4 （P<0.05， P<0.01）， and up-regulation in expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.01）. Compared with the model group， ZGW increased the body weight （P<0.05， P<0.01）， reduced the infiltration of renal interstitial inflammatory cells， restored the thyroid structure and follicle size， lowered the serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA and NADPH （P<0.05， P<0.01）， up-regulated the expression of TSH， SOD and DRD4 （P<0.05， P<0.01）， and down-regulated the expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.05， P<0.01）. Moreover， high-dose ZGW outperformed methimazole （P<0.05）. ConclusionBy activating DRD4， ZGW can inhibit the expression of NOX4 mediated by the p38 MAPK pathway， reduce oxidative stress and inflammatory response， thereby ameliorating the pathological state of hyperthyroidism due to kidney-Yin deficiency. This study provides new molecular mechanism support for the clinical application of ZGW.

BACKGROUND:In the follow-up after unicompartmental knee arthroplasty,some patients have knee pain,among which postmenopausal obese women are the most common. As an important index to measure the degree of body obesity,whether body mass index is related to the curative effect after unicompartmental knee arthroplasty and whether obesity will affect the function of knee joint after operation are worthy of further study.OBJECTIVE:To evaluate the clinical efficacy of postmenopausal obese women undergoing medial unicompartmental knee arthroplasty,and to determine the influence of body mass index on the quality of life after unicompartmental knee arthroplasty.METHODS:Female postmenopausal patients who underwent medial unicompartmental knee arthroplasty for the first time due to medial knee pain from January 2017 to January 2019 in the Fourth Clinical Medical College of Xinjiang Medical University were enrolled. A total of 270 cases were included according to inclusion and exclusion criteria,and were divided into 4 groups according to preoperative body mass index:There were 42 cases in normal group (body mass index 18.5-22.9 kg/m2),58 cases in overweight group (body mass index 23.0-24.9 kg/m2),122 cases in obese group (body mass index 25.0-29.9 kg/m2),and 48 cases in severely obese group (body mass index ≥30 kg/m2). Hospital for Special Surgery score,Western Ontario and McMaster Universities Osteoarthritis Index score,knee range of motion,visual analog scale score,and hip-knee-ankle angle were compared before,after and at the last time in each group. Patients were followed up to record the time of use of prostheses after surgery and reasons for failure or revision. The effective utilization rate of prostheses was calculated and compared in each group. Survival curve was used for statistical analysis of the effective utilization rate of prostheses.RESULTS AND CONCLUSION:(1) There was no significant difference in postoperative follow-up time,knee joint range of motion,visual analog scale score,and hip-knee-ankle angle between the groups (P>0.05). (2) The Hospital for Special Surgery score and Western Ontario and McMaster Universities Osteoarthritis Index score of each group in final follow-up were significantly improved compared with those before surgery (P<0.05),and the postoperative effect was obvious in each group (P<0.05). Regarding Hospital for Special Surgery score,the improvement effect was worse in the severely obese group. (3) The comparison of hip-knee-ankle angle between all groups immediately after surgery and the last follow-up showed that there were significant differences between the other groups at two time points (P<0.05) except the normal group (P>0.05). (4) The effective utilization rate of prosthesis in normal,overweight,obesity,and severely obese groups was 100％,95％,94％,and 94％,respectively,and there was no significant difference between the groups (x2=2.532,P=0.469). (5) It is indicated that body mass index of postmenopausal obese women had no significant effect on the effective utilization rate of medial unicompartmental prosthesis. Obesity is an important factor affecting the postoperative knee function score and the effective utilization rate of prosthesis.Weight should be properly controlled before and after unicompartmental knee arthroplasty. At the same time,female body mass index ≥ 30 kg/m2 is not the best indication for unicompartmental knee arthroplasty. It is suggested that female patients undergoing unicompartmental knee arthroplasty should controlbody mass index below 30 kg/m2.

Objective:To address the critical issue of missing dynamic border molding information in edentulous direct digital impression technology, this study explores innovative digital solutions and conducts preliminary application validation.Methods:Based on the myostatic line theory, a methodology was established: intraoral scanner (IOS) high-frequency video was utilized to dynamically capture functional molding data of soft tissues, integrated with a self-developed mobility gradient recognition algorithm to achieve dynamic threshold segmentation between the muscle dynamic zone and myostatic zone, termed "optical digital molding technology". Ten edentulous patients with well-fitting complete dentures, treated at the Department of Prosthodontics, Peking University School and Hospital of Stomatology from January 2024 to December 2024, were enrolled. The standard deviation between the muscle static line (generated by mobility gradient algorithm with thresholds of 0.3-0.7 mm) and the denture border curve was analyzed to optimize the dynamic threshold, followed by single-case clinical validation.Results:Among the mobility thresholds of 0.3-0.7 mm, the 0.5 mm threshold yielded the smallest standard deviation between the myostatic line and denture border. Clinical validation demonstrated that dentures designed with this threshold exhibited no displacement during dynamic functional tests, with marginal sealing meeting clinical standards.Conclusions:The optical digital border molding technique for edentulous soft tissue boundaries translates the myostatic line theory into quantifiable parameters for the first time. Based on data from 10 cases, a mobility threshold of 0.5 mm is recommended for clinical application.

Background Previous studies have demonstrated that the vagus nerve stimulation improves upper limb function in patients with stroke sequelae(six month-two years).This study aimed to investigate whether the auricular intradermal acupuncture(AIA)acted on the auricular branch of the vagus nerve can facilitate the recovery of upper limb motor function and expedite the effects and characteristics of rehabilitation processes in flaccid phase after stroke in Phase Brunnstrom Ⅰ.Methods This study utilized a randomized controlled single-blinded clinical design.Patients with ischemic stroke in Phase Brunnstrom Ⅰ were randomly assigned to the auricular intradermal acupuncture(AIA)group(AIA,standard rehabilitation,conventional acupuncture)or the sham auricular intradermal acupuncture(sham AIA)group(the sham AIA,standard rehabilitation,conventional acupuncture)for 6 days of 1 week(6 times).Primary outcome measures:Brunnstrom(Ueda Assessment),Fugl-Meyer assessment of the upper extremity(FMA-UE)and its subtype score(FMA-UEFS,FMA-UEES),Wolf motor function test scale(WMFT).Secondary outcome measures:Upper limb active range of joint motion(AROM),manual muscle test(MMT)of upper limb muscles,Barthel index(BI).Results Of the 332 patients who were screened,70 patients met the criteria and were recruited.There were 35 patients in the AIA group,1 patient was fall off,34 patients were actually completed;35 patients in the sham AIA group had no falling off case.Primary outcome measures:The upper Ueda assessment of the AIA group were better than those of the sham AIA group after treatment on days 3 and 6(P<0.05,P<0.001,respectively).The FMA-UEFS score on days 6 of the AIA group were significantly better than those of the sham AIA group(P<0.05).FMA-UEES of the AIA group was more associated with FMA-UE than FMA-UEFS with FMA-UE after treatment on day 6(FMA-UEFS:r=0.728,P<0.001;FMA-UEES:r=0.744,P<0.001).After 3 days and 6 days of treatment,the AIA group of the WMFT were significantly improved in the sham AIA group(P<0.05,P<0.001,respectively).Secondary outcome measures:AROM:After 6 days of treatment,the AIA group of shoulder abduction were more improved than in the sham AIA group(P<0.05).MMT:The muscle strength of elbow flexion,and elbow extension muscle improved more in the AIA group than in the sham AIA group(P<0.05).Barthel index(BI):After 6 days of treatment,there was a significant improvement in the group compared with before treatment(P<0.05),but no difference compared with the group(P>0.05).Conclusions AIA combined with conventional rehabilitation and acupuncture,can effectively improve the upper limb motor function of patients with post-ischemic stroke flaccid hemiplegia and accelerates the rehabilitation process of upper limb motor function.Clinical Trial Registration The study protocol is registered withhttp://www.chictr.org.cn(accession number:ChiCTR2200058141).

Purpose To investigate the changes in quadriceps femoris microcirculatory perfusion level after low-load blood flow restriction training and its relationship with muscle strength.Materials and Methods Twenty-five healthy subjects were prospectively recruited in the First Affiliated Hospital of Kunming Medical University from September to November 2022.A 200 mmHg pressure cuff was applied at the root of the left thigh for blood flow restriction,and the subjects completed regular knee extension training within 4 weeks.Before the first training session and within 24 hours after the last training session,all subjects underwent scanning with the 3.0T MRI intravoxel incoherent motion sequence and the multi-echo steady-state acquisition three-dimentional imaging sequence.After image post-processing,the quadriceps femoris cross-sectional area,perfusion fraction and pseudo-diffusion coefficient were obtained,and the peak torque was measured using an isokinetic dynamometer.The MRI and muscle strength test parameters before and after training were compared,and correlation analyses were performed between the change of peak torque and the change of perfusion fraction,cross-sectional area,and pseudo-diffusion coefficient respectively.Results After low-load blood flow restriction training,the cross-sectional area of the left quadriceps femoris in subjects increased(t=-4.515,P<0.05).Among its components,the cross-sectional area of the left rectus femoris,vastus intermedius and vastus lateralis all increased(t=-3.302,-2.877,-3.207,all P<0.05).The perfusion fraction value of the left quadriceps femoris increased(t=-5.447,P<0.05);the perfusion fraction values of the left rectus femoris,vastus intermedius,vastus lateralis and vastus medialis all increased(t=-5.723,-4.621,-3.767,-4.682,all P<0.05);the muscle strength of the left quadriceps femoris increased(t=-3.983,P<0.05).There was a highly positive correlation between change of perfusion fraction and peak torque of the left quadriceps femoris in subjects(r=0.708,P<0.05).Conclusion After low-load blood flow restriction training,the changes in quadriceps femoris muscle microperfusion quantified by intravoxel incoherent motion are related to muscle strength,which is helpful for formulating rehabilitation training strategies for young patients.

OBJECTIVE T o explore the effectiveness and safety of azvudine in prevention of SARS-CoV-2 infection among the population of close contact with families with symptomatic SARS-CoV-2 infection.METHODS A total of 64 people who were closely contact with the families with symptomatic SARS-CoV-2 infection and were trea-ted in Ma'anshan People's Hospital from Jan.2023 to Oct.2023 were enrolled in the study and randomly divid-ed into the group A with 22 cases,the group B with 17 cases and the group C with 25 cases.The group A was giv-en 5mg of azvudine,the group B was given 3mg of azvudine plus 2mg of placebo,and the group C was given 5 mg of azvudine;all the three groups were treated for 7 days in total.The incidence of SARS-CoV-2 infection and the levels of interleukin-6(IL-6),C-reactive protein(CRP),immunoglobulin G(IgG)and immunoglobulin M(IgM)were observed among the three groups of research subjects after the drug therapies;the adverse reactions were re-corded during the research period.RESULTS The incidence rate of SARS-CoV-2 infection was 4.55％in the group A,11.76％in the group B,12.00％in the group C,and there was no significant difference(x2=0.921,P=0.631).There were no significant differences in the levels of IL-6,CRP,IgG and IgM among the three groups be-fore and after the drug therapies.The incidence of adverse reactions such as fatigue,cough,hypertriglyceridemia and gastrointestinal tract reactions was 9.09％in the group A after the drug therapies,11.76％in the group B,12.00％in the group C,and there was no significant difference.CONCLUSION There is no significant difference in the effectiveness of azvudine in prevention of SARS-CoV-2 infection among the population of close contact with families with symptomatic SARS-CoV-2 infection,with the safety and tolerance favorable.

Isoflavones which mainly distributed in leguminous plants have plenty of health benefits.Isoflavone synthase(IFS)is a membrane-associated cytochrome P450 enzyme(CYP450)which carries out the unique aryl-ring migration and hydroxylation.So far,few crystal structures of plant P450s have been obtained.We determined the crystal structure of IFS from Medicago truncatula at 1.9 ? by MAD method using a selenomethionine substituted crystal and conducted molecular docking and mutagenesis study.The structure of IFS complexed with imidazole exhibits the helix Ⅰa-loop-helix Ⅰβ motif which cor-responds to helix Ⅰ of other P450s.Compared with structures of common P450s,IFS/imidazole structure contains an extra domain,i.e.,the γ-domain.The structure reveals a homodimer in which the γ-domain of one molecule interacts with the β-domain of another.The plane of heme group makes an angle of ap-proximately 40° with the helix Ⅰa-loop-helix Ⅰβ motif.Molecular docking combined with mutagenesis study suggested that Trp-128 and Asp-300 might play important roles in substrate binding and recogni-tion.Phe-301,Ser-303 and Gly-305 from the helix Ⅰa-loop-helix Ⅰβ motif may play important roles in the aryl-ring migration.These novel structural features reveal insights into the unique reaction mechanism of IFS and provide a basis for engineering IFS in leguminous crops for health purpose.

Background and purpose:Relapsed or refractory diffuse large B-cell lymphoma(DLBCL)can be treated with chimeric antigen receptor T-cell(CAR-T)therapy.Imaging-based biomarkers may help identify patients likely to achieve clinical response to this immunotherapy.In this study,an 18-f1uoro-2-deoxy-D-glucose positron emission tomography-computed tomography(18F-FDG PET/CT)based model was developed to assess the progression-free survival(PFS)and overall survival(OS)of patients with relapsed or refractory(R/R)DLBCL who received CAR-T therapy.Methods:We retrospectively analyzed clinical and imaging data from patients with DLBCL who underwent CAR-T therapy at the First Affiliated Hospital of Soochow University between March 2017 and January 2022.Inclusion criteria:① age≥18 years old;② pathologically confirmed R/R DLBCL;③ 18F-FDG PET/CT performed before CAR-T cell therapy;④ complete clinicopathologic data;⑤ patients must have measurable lesions.Exclusion criteria:① patients with incomplete clinical or imaging data;② patients with other types of malignant tumors;③ patients who have received granulocyte colony-stimulating factor treatment within 1 month prior to PET/CT scan.This study was reviewed by the Ethics Committee of the First Affiliated Hospital of Soochow University(ID:2025256).Receiver operating characteristic(ROC)curves were used to determine the optimal thresholds for maximum standardized uptake value(SUVmax),tumor metabolic volume(MTV),and total glycolysis(TLG),and the patients were classified into high-risk and low-risk groups.Univariate and multivariate Cox regression analyses were used to identify potential prognostic factors and construct predictive models,which were visualized by drawing nomogram.Area under the ROC curve was used to assess the performance of each model.Results:A total of 61 patients(37 male patients and 24 female patients,aged 26-75 years)with DLBCL who underwent 18F-FDG PET/CT prior to CAR-T infusion were included.The median follow-up was 14 months;36 patients(59.02%)had disease progression and 25 patients(40.98%)died.Multivariate analysis showed that grade of cytokine release syndrome(CRS)[Hazard ratio(HR)=3.671;P=0.003]and MTV(HR=0.171,P=0.004)were independent prognostic factors for OS;Eastern Cooperative Oncology Group(ECOG)score(HR=2.411,P=0.019),grade of CRS(HR=2.499;P=0.027),and MTV(HR=0.338,P=0.007)were independent prognostic factors for PFS.The combined model(MTV,ECOG score,grade of CRS)was better than the clinical model(ECOG score,grade of CRS),and metabolic parameter model(MTV)in predicting PFS and OS.Conclusion:18F-FDG PET/CT metabolic parameter MTV in combination with traditional clinical risk factors(ECOG score,Grade of CRS)could identify patients with ultra-high risk of DLBCL.

BACKGROUND:In the follow-up after unicompartmental knee arthroplasty,some patients have knee pain,among which postmenopausal obese women are the most common. As an important index to measure the degree of body obesity,whether body mass index is related to the curative effect after unicompartmental knee arthroplasty and whether obesity will affect the function of knee joint after operation are worthy of further study.OBJECTIVE:To evaluate the clinical efficacy of postmenopausal obese women undergoing medial unicompartmental knee arthroplasty,and to determine the influence of body mass index on the quality of life after unicompartmental knee arthroplasty.METHODS:Female postmenopausal patients who underwent medial unicompartmental knee arthroplasty for the first time due to medial knee pain from January 2017 to January 2019 in the Fourth Clinical Medical College of Xinjiang Medical University were enrolled. A total of 270 cases were included according to inclusion and exclusion criteria,and were divided into 4 groups according to preoperative body mass index:There were 42 cases in normal group (body mass index 18.5-22.9 kg/m2),58 cases in overweight group (body mass index 23.0-24.9 kg/m2),122 cases in obese group (body mass index 25.0-29.9 kg/m2),and 48 cases in severely obese group (body mass index ≥30 kg/m2). Hospital for Special Surgery score,Western Ontario and McMaster Universities Osteoarthritis Index score,knee range of motion,visual analog scale score,and hip-knee-ankle angle were compared before,after and at the last time in each group. Patients were followed up to record the time of use of prostheses after surgery and reasons for failure or revision. The effective utilization rate of prostheses was calculated and compared in each group. Survival curve was used for statistical analysis of the effective utilization rate of prostheses.RESULTS AND CONCLUSION:(1) There was no significant difference in postoperative follow-up time,knee joint range of motion,visual analog scale score,and hip-knee-ankle angle between the groups (P>0.05). (2) The Hospital for Special Surgery score and Western Ontario and McMaster Universities Osteoarthritis Index score of each group in final follow-up were significantly improved compared with those before surgery (P<0.05),and the postoperative effect was obvious in each group (P<0.05). Regarding Hospital for Special Surgery score,the improvement effect was worse in the severely obese group. (3) The comparison of hip-knee-ankle angle between all groups immediately after surgery and the last follow-up showed that there were significant differences between the other groups at two time points (P<0.05) except the normal group (P>0.05). (4) The effective utilization rate of prosthesis in normal,overweight,obesity,and severely obese groups was 100％,95％,94％,and 94％,respectively,and there was no significant difference between the groups (x2=2.532,P=0.469). (5) It is indicated that body mass index of postmenopausal obese women had no significant effect on the effective utilization rate of medial unicompartmental prosthesis. Obesity is an important factor affecting the postoperative knee function score and the effective utilization rate of prosthesis.Weight should be properly controlled before and after unicompartmental knee arthroplasty. At the same time,female body mass index ≥ 30 kg/m2 is not the best indication for unicompartmental knee arthroplasty. It is suggested that female patients undergoing unicompartmental knee arthroplasty should controlbody mass index below 30 kg/m2.