ObjectiveTo explore the mechanism by which Yizhi Qingxin prescription improves mitochondrial dysfunction in Alzheimer's disease （AD） through regulating mitochondrial Ca²⁺ homeostasis and kinetic balance based on the protein kinase A （PKA）/calcineurin （CaN） signaling pathway. MethodsSixty three-month-old amyloid precursor protein （APP）/presenilin 1 （PS1） double transgenic mice were randomly divided into a model group， a donepezil group（0.65 mg·kg^-1）， a low-dose Yizhi Qingxin prescription group （YQF-L，2.6 g·kg^-1）， a medium-dose Yizhi Qingxin prescription group （YQF-M，5.2 g·kg^-1）， and a high-dose Yizhi Qingxin prescription group （YQF-H，10.4 g·kg^-1）， with 12 mice in each group. Twelve C57BL/6J mice with the same genetic background served as a normal group. Each treatment group received gavage administration daily， with the model and normal groups receiving equal volume of physiological saline. Intervention continued for 12 consecutive weeks. The learning and memory abilities of the mice were assessed using the novel object recognition （NOR） and Morris water maze （MWM） tests. Hematoxylin-eosin （HE）/Nissl staining was used to observe histopathological changes in the hippocampus. Transmission electron microscopy （TEM） was used to observe mitochondrial ultrastructure. Fluo-4 acetoxymethyl ester （Fluo-4 AM） Ca²⁺ probe was used to measure intracellular Ca²⁺ concentration in brain tissue. Western blot was used to determine the protein expression of PKA， CaN， sodium/calcium/lithium exchanger （NCLX）， mitochondrial calcium uniporter （MCU）， calmodulin （CaM）， dynamin-related protein 1 （Drp1）， and phosphorylated dynamin-related protein 1 （serine 637 site） ［p-Drp1（S637）］ in the hippocampus. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to measure the expression of PKA， CaN， CaM， NCLX， MCU， and Drp1 mRNAs. ResultsCompared with those in the normal group， the recognition index （RI） of the model group decreased （P0.01）， and the number of crossings through the original platform area， the duration of stay in the target quadrant， and the distance were reduced （P0.01）. The protein expression of PKA， NCLX， and p-DRP1 （ser637） significantly decreased （P0.05）， and the mRNA expression of PKA and NCLX significantly decreased （P0.05）. The escape latency （EL） was prolonged （P0.05）， and the intracellular Ca²⁺ level significantly increased （P0.01）. The protein expression of CaN， CaM， MCU， and Drp1， as well as the mRNA expression of CaN， MCU， and Drp1， significantly increased （P0.05）. After intervention with Donepezil and Yizhi Qingxin prescription， compared with that in the model group， the RI of the treatment group significantly increased （P0.05）， and the number of crossings through the platform and the duration of stay in the target quadrant significantly increased （P0.05）. The protein expression of PKA， NCLX， and p-Drp1 （ser637） and the mRNA expression of PKA and NCLX significantly increased （P0.05）. On the 4th and 5th days， the EL was shortened （P0.05）， and the intracellular Ca²⁺ level decreased （P0.05）. The protein expression of CaN， CaM， MCU， and Drp1 and the mRNA expression of CaN， MCU， and Drp1 significantly decreased （P0.05）. ConclusionYizhi Qingxin prescription regulates the PKA/CaN pathway， upregulates the expression of PKA， NCLX， and p-Drp1 （ser637） proteins， reduces the expression of CaN， CaM， MCU， and Drp1 proteins， and regulates Ca²⁺ homeostasis and mitochondrial dynamic balance， thereby enhancing the spatial learning and memory abilities of AD mice.

ObjectiveTo explore the mechanism by which Yizhi Qingxin prescription improves mitochondrial dysfunction in Alzheimer's disease （AD） through regulating mitochondrial Ca²⁺ homeostasis and kinetic balance based on the protein kinase A （PKA）/calcineurin （CaN） signaling pathway. MethodsSixty three-month-old amyloid precursor protein （APP）/presenilin 1 （PS1） double transgenic mice were randomly divided into a model group， a donepezil group（0.65 mg·kg^-1）， a low-dose Yizhi Qingxin prescription group （YQF-L，2.6 g·kg^-1）， a medium-dose Yizhi Qingxin prescription group （YQF-M，5.2 g·kg^-1）， and a high-dose Yizhi Qingxin prescription group （YQF-H，10.4 g·kg^-1）， with 12 mice in each group. Twelve C57BL/6J mice with the same genetic background served as a normal group. Each treatment group received gavage administration daily， with the model and normal groups receiving equal volume of physiological saline. Intervention continued for 12 consecutive weeks. The learning and memory abilities of the mice were assessed using the novel object recognition （NOR） and Morris water maze （MWM） tests. Hematoxylin-eosin （HE）/Nissl staining was used to observe histopathological changes in the hippocampus. Transmission electron microscopy （TEM） was used to observe mitochondrial ultrastructure. Fluo-4 acetoxymethyl ester （Fluo-4 AM） Ca²⁺ probe was used to measure intracellular Ca²⁺ concentration in brain tissue. Western blot was used to determine the protein expression of PKA， CaN， sodium/calcium/lithium exchanger （NCLX）， mitochondrial calcium uniporter （MCU）， calmodulin （CaM）， dynamin-related protein 1 （Drp1）， and phosphorylated dynamin-related protein 1 （serine 637 site） ［p-Drp1（S637）］ in the hippocampus. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to measure the expression of PKA， CaN， CaM， NCLX， MCU， and Drp1 mRNAs. ResultsCompared with those in the normal group， the recognition index （RI） of the model group decreased （P0.01）， and the number of crossings through the original platform area， the duration of stay in the target quadrant， and the distance were reduced （P0.01）. The protein expression of PKA， NCLX， and p-DRP1 （ser637） significantly decreased （P0.05）， and the mRNA expression of PKA and NCLX significantly decreased （P0.05）. The escape latency （EL） was prolonged （P0.05）， and the intracellular Ca²⁺ level significantly increased （P0.01）. The protein expression of CaN， CaM， MCU， and Drp1， as well as the mRNA expression of CaN， MCU， and Drp1， significantly increased （P0.05）. After intervention with Donepezil and Yizhi Qingxin prescription， compared with that in the model group， the RI of the treatment group significantly increased （P0.05）， and the number of crossings through the platform and the duration of stay in the target quadrant significantly increased （P0.05）. The protein expression of PKA， NCLX， and p-Drp1 （ser637） and the mRNA expression of PKA and NCLX significantly increased （P0.05）. On the 4th and 5th days， the EL was shortened （P0.05）， and the intracellular Ca²⁺ level decreased （P0.05）. The protein expression of CaN， CaM， MCU， and Drp1 and the mRNA expression of CaN， MCU， and Drp1 significantly decreased （P0.05）. ConclusionYizhi Qingxin prescription regulates the PKA/CaN pathway， upregulates the expression of PKA， NCLX， and p-Drp1 （ser637） proteins， reduces the expression of CaN， CaM， MCU， and Drp1 proteins， and regulates Ca²⁺ homeostasis and mitochondrial dynamic balance， thereby enhancing the spatial learning and memory abilities of AD mice.

Objective: To investigate the clinicopathological characteristics and diagnostic-therapeutic strategies of oncocytic mucoepidermoid carcinoma (OMEC) of the parotid gland, and to enhance awareness of this rare variant among clinicians and pathologists. Methods: The clinical data, imaging findings, histopathological features, immunophenotype, and molecular characteristics of two patients with parotid OMEC were retrospectively analyzed, and the relevant literature was reviewed. Results: Case 1 was a 50-year-old man who presented with a painless mass behind the right earlobe for more than 2 years. The patient underwent extended parotidectomy with preservation of the facial nerve. Histopathological examination revealed that the tumor was predominantly composed of oncocytic cells with a small proportion of mucous cells. Immunohistochemically, the tumor cells were partially positive for cytokeratin 5/6, cytokeratin 7, and P63. Special staining with alcian blue, periodic acid-Schiff, and phosphotungstic acid hematoxylin yielded positive results. The diagnosis of right parotid OMEC was established. No recurrence or metastasis was observed during a 1 year follow-up. Case 2 was a 61-year-old man with a 3-month history of a mass beneath the left ear. After partial parotidectomy at an outside institution, pathological consultation at the Stomatological Hospital of Jilin University demonstrated that the tumor consisted almost entirely of oncocytic cells, exhibited infiltrative growth, and lacked typical mucous, epidermoid, and intermediate cells. Fluorescence in situ hybridization confirmed positive mastermind-like transcriptional activator 2 (MAML2) gene rearrangement, establishing the diagnosis of left parotid OMEC. The patient subsequently underwent total parotidectomy with preservation of the facial nerve, and no recurrence was detected during a short-term 3 months follow-up. A review of the literature indicated that OMEC most commonly arises in the parotid gland and is generally a low-grade malignancy with favorable prognosis. When tumors are composed exclusively of oncocytic cells, exhibit minimal cytological atypia, and lack the classical cellular components of mucoepidermoid carcinoma, they are highly prone to misdiagnosis as oncocytoma, nodular oncocytic hyperplasia, or other benign oncocytic lesions. Accurate differential diagnosis relies on recognition of infiltrative growth patterns, supportive immunophenotypic markers (e.g., P63 positivity), and detection of characteristic MAML2 gene rearrangement. Complete surgical excision remains the treatment of choice. Conclusion OMEC dominated by oncocytic cells carries a high risk of clinical misdiagnosis. Integrating the assessment Conclusion OMEC dominated by oncocytic cells carries a high risk of clinical misdiagnosis. Integrating the assessment of infiltrative histopathological features with immunohistochemistry and molecular detection of MAML2 rearrangement is crucial for accurate diagnosis, appropriate assessment of tumor behavior, and optimal surgical decision making.

Objective:Based on the best evidence, formulate the review indicators to promote the initiation and establishment of maternal lactation and carry out clinical review, analyze the barriers and promoting factors of the clinical application of evidence, and formulate countermeasures.Methods:Evidence-based nursing research was used to identify clinical problems, build evidence-based group, systematically search, evaluate and synthesize evidence. On September 1,2023 to December 31 in Affiliated Hospital of Jiangsu University document and delivery of maternal investigation, in Ottawa research application mode as a guide, based on the evidence to review indicators and review method, clear clinical status and evidence gap, combined with the stakeholders interview, using content analysis to analyze barriers and promoting factors, to formulate action countermeasures.Results:In this study, 140 pregnant women were finally included for clinical review, aged from 22 to 42 (30.13 ± 3.69) years. A total of 23 pieces of best evidence were incorporated, leading to the establishment of 29 review indicators. Among these, 20 review indicators showed compliance rates below 60%. The main obstacles based on the results of review and interviews with stakeholders: the evidence content covered perinatal stages but lacked specificity and practical applicability; nurses had insufficient knowledge and faced increased workloads; pregnant/postpartum women lacked essential knowledge and skills, with delayed resolution of lactation issues; the practice environment lacked evidence-based implementation protocols, specialized assessment tools, and professional lactation consultant teams, etc. Promoting factors: the project team had rich experience in evidence transformation; the reform aligned with national policies, high engagement from departmental leaders, and standardized management systems for evidence-based projects in the nursing department; strong motivation among pregnant/postpartum women; the hospital was an infant-friendly hospital with talents needed for evidence transformation.Conclusions:There is a big gap between the clinical status and the evidence of promoting the initiation and establishment of lactation, so nursing staff should make full use of the promoting factors and formulate countermeasures according to the obstacle factors, so as to provide reference for promoting the initiation of lactation and the establishment of relevant evidence to clinical transformation.

Objective:To investigate the situation of mild cognitive impairment (MCI) in elderly people in fluorosis areas, and analyze its potential influencing factors.Methods:From April to October 2020, a cluster random sampling method was used to select local elderly people aged 60 and older in areas of drinking-water-borne endemic fluorosis in Tianjin, and their general information was collected through face-to-face surveys. Terminal drinking water samples were collected from survey subjects. Water fluoride concentration was measured using ion-selective electrode method. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE), and survey subjects were categorized into MCI group and control group based on MMSE scores. Logistic regression and Chi-squared automatic interaction detection classification tree models were constructed to analyze the influencing factors of MCI.Results:A total of 677 subjects were included, including 160 cases in the MCI group and 517 cases in the control group, with a MCI detection rate of 23.63%. The detection rates of MCI in the high fluoride exposure group and non high fluoride exposure group were 30.82% (94/305) and 17.74% (66/372), respectively, with a statistically significant difference between the groups (χ 2 = 15.88, P < 0.001). The results of univariate analysis showed that MCI was associated with high fluoride exposure, age, per capita annual household income, sleep duration, personality, and interpersonal relationships (χ 2 = 15.88, 16.17, 12.32, 8.91, 14.03, 9.81, P < 0.05). The results of multiple logistic regression analysis showed that moderate interpersonal relationships ( OR = 2.13, 95% CI: 1.08, 4.20) and high fluoride exposure ( OR = 1.91, 95% CI: 1.03, 3.54) were both risk factors for MCI ( P < 0.05). The classification tree model analysis result showed that high fluoride exposure was the primary factor affecting MCI in elderly people in fluorosis areas, followed by per capita annual household income, personality, and age. Conclusions:The detection rate of MCI in the high fluoride exposure group of elderly people in fluorosis areas is higher than that in the non high fluoride exposure group. High fluoride exposure, interpersonal relationships, per capita annual household income, personality, and age are all influencing factors of MCI in elderly people in fluorosis areas.

Objective:To learn about the iodine nutrition status of pregnant women in Tianjin and analyze the influencing factors of moderate to severe iodine deficiency in pregnant women.Methods:From January 2022 to December 2024, a stratified random sampling method was adopted. Each year, five sampling areas were divided into the east, west, south, north and central directions in 16 districts of Tianjin. Ten pregnant women from one township/street in each area were selected for questionnaire surveys. Household salt samples and random urine samples were collected to measure salt iodine and urinary iodine levels. Multivariate logistic regression was used to analyze the influencing factors of moderate to severe iodine deficiency in pregnant women, and a restricted cubic spline model was used to analyze the dose-response relationship between the risk of moderate to severe iodine deficiency in pregnant women and salt iodine level.Results:A total of 2 532 pregnant women in Tianjin were surveyed, with an age of (30.70 ± 4.44) years. Among them, 53.20% (1 347/2 532) had received health education, and 52.45% (1 328/2 532) actively supplemented iodine. A total of 2 532 household salt samples of pregnant women were tested, with a median salt iodine level of 23.66 mg/kg. The coverage rate of iodized salt was 74.45% (1 885/2 532), the qualified rate of iodized salt was 87.59% (1 651/1 885), and the consumption rate of qualified iodized salt was 65.21% (1 651/2 532). A total of 2 532 urine samples of pregnant women were tested, with a median urinary iodine level of 151.68 μg/L. Among them, 652, 1 348 and 532 urine samples were collected from pregnant women in the early, middle, and late stages of pregnancy, respectively, with median urinary iodine levels of 150.80, 153.00 and 143.68 μg/L, respectively. Multivariate logistic regression analysis showed that consuming iodized salt was a protective factor for the moderate to severe iodine deficiency in pregnant women ( OR = 0.70, 95% CI: 0.58 - 0.86, P < 0.001). Restricted cubic spline analysis showed that there was a linear dose-response relationship between the risk of moderate to severe iodine deficiency in pregnant women and salt iodine level ( Poverall < 0.001, Pnonlinear = 0.065). Further stratified analysis revealed that there was a linear dose-response relationship between the risk of moderate to severe iodine deficiency in pregnant women who had received iodine supplementation and salt iodine level ( Poverall = 0.018, Pnonlinear = 0.554), while there was a nonlinear dose-response relationship between the risk of moderate to severe iodine deficiency in pregnant women who had not received iodine supplementation and salt iodine level ( Poverall < 0.001, Pnonlinear = 0.029). Conclusions:From 2022 to 2024, the overall iodine level of pregnant women in Tianjin is appropriate, but some pregnant women are at risk of iodine deficiency. Consuming iodized salt is a protective factor against the moderate to severe iodine deficiency in pregnant women. It is still necessary to further implement comprehensive prevention and control measures mainly based on iodized salt.

Objective:To investigate the prevalence of dental fluorosis in children in Tianjin and study its influencing factors.Methods:From January to December 2023, 5 affected villages were selected from each of the drinking water-borne endemic fluorosis (drinking water-borne fluorosis for short) areas of 10 agricultural areas in Tianjin, and 50 children aged 8 - 12 years (gender and age balanced) were selected from each affected village for questionnaire survey and dental fluorosis examination. At the same time, water samples from affected villages and children's one random urine sample were collected to test for fluoride levels in water and urine. Multivariate logistic regression was used to analyze the influencing factors of dental fluorosis prevalence in children, and a restricted cubic spline model was used to analyze the dose-response relationship between the years of water improvement and dental fluorosis prevalence.Results:A total of 50 water samples were collected, with water fluoride levels ranging from 0.05 to 0.85 mg/L. All affected villages had completed the water improvement and the water fluoride levels were qualified. A total of 2 439 urine samples were collected from children, with urinary fluoride levels ranging from 0.05 to 12.56 mg/L and a geometric mean of 0.82 mg/L. A total of 2 439 children were examined for dental fluorosis, with a detection rate of 22.67% (553/2 439). The results of multivariate logistic regression analysis showed that age ( OR = 1.26, 95% CI: 1.15 - 1.37, P < 0.001), father's education level of junior high school or below ( OR = 1.57, 95% CI: 1.04 - 2.38, P = 0.033), and high urinary fluoride (0.74 - 1.58 mg/L: OR = 1.59, 95% CI: 1.19 - 2.13, P = 0.002; 1.59 - 12.56 mg/L: OR = 2.00, 95% CI: 1.48 - 2.70, P < 0.001) were risk factors for dental fluorosis prevalence in children. The total annual household income with 40 000 to 80 000 yuan ( OR = 0.76, 95% CI: 0.58 - 0.99, P = 0.041), father's occupation was self-employed and other occupation ( OR = 0.69, 95% CI: 0.51 - 0.92, P = 0.013), the years of water improvement in affected villages ≥10 years ( OR = 0.39, 95% CI: 0.30 - 0.50, P < 0.001), and the material of the drinking water container at home was stainless steel products ( OR = 0.58, 95% CI: 0.40 - 0.85, P = 0.005), ceramic or glass products ( OR = 0.66, 95% CI: 0.48 - 0.90, P = 0.010) were protective factors for dental fluorosis prevalence in children. By constructing a restricted cubic spline model, it was found that there was a linear dose-response relationship between the prevalence of dental fluorosis in children and the years of water improvement in affected villages ( Poverall < 0.001, Pnonlinear = 0.059). The longer the years of water improvement, the lower the risk of dental fluorosis prevalence. Conclusions:The detection rate of dental fluorosis in children in Tianjin is relatively high. The fluoride reduction and water improvement measures implemented in drinking water-borne fluorosis areas can effectively reduce the risk of dental fluorosis prevalence. Factors such as age, urinary fluoride, economic conditions, and lifestyle also have important impacts on the prevalence of dental fluorosis.

Objective:To investigate the awareness of prevention and treatment knowledge of drinking water-borne endemic fluorosis among children in Tianjin, explore its influencing factors, analyze the needs of children's health education methods, and provide a basis for carrying out health education in school.Methods:From January to December in 2024, a stratified sampling method was employed to select two endemic villages from each of the 10 areas with drinking water-borne endemic fluorosis in Tianjin as survey sites. In each village, no fewer than 50 children aged 8 - 12 (gender and age balanced) were recruited to conduct a questionnaire survey. Multivariate logistic regression analysis was used to analyze the influencing factors of children's awareness of prevention and treatment knowledge.Results:A total of 1 678 valid questionnaires were collected. The overall awareness rate of prevention and control knowledge of drinking water-borne endemic fluorosis among children in Tianjin was 67.62% (11 346/16 780). Children had the highest awareness of the hazards of drinking water-borne endemic fluorosis (83.61%, 1 403/1 678), while their awareness of the clinical manifestations of dental fluorosis was the lowest (44.87%, 753/1 678). Multivariate logistic regression analysis showed that children in higher grades [grades 5 to 6, OR (95% CI) = 1.66 (1.36, 2.03), P < 0.001], with a larger number of permanent residents in the family [≥6 people, OR (95% CI) = 1.58 (1.13, 2.23), P = 0.008], whose mothers had a college education or above [ OR (95% CI) = 1.45 (1.08, 1.95), P = 0.014], and who had received health education [ OR (95% CI) = 1.46 (1.19, 1.78), P < 0.001] had a higher awareness rate of the prevention and control knowledge of drinking water-borne endemic fluorosis. There were statistically significant differences in the demand rates for access to prevention and control knowledge via school teachers, promotional videos, and online/WeChat official accounts among children of different grades ( P < 0.05). Conclusions:The awareness rate of prevention and treatment knowledge of drinking water-borne endemic fluorosis among children in Tianjin is relatively low. Special attention should be paid to children with a small number of permanent residents in the family, mothers with low educational levels, and who have not received health education. At the same time, detailed health publicity services should be carried out for children of different grades.

Yang being solid is an important summary of the normal functional state of yang qi in The Yellow Emperor's Inner Classic.Based on the theory of yang being solid and able to hold on,it is proposed that yang being solid is essential to maintain the state of tightness,thoroughness and quietness for maintaining the health of the human body.Yang losing its solidity is the core patho-genesis of the onset and progression of malignant tumors,which manifests as yang deficiency,yang depression and yang restlessness.If yang is not solid due to its deficiency,yang will lose its warmth and defense and the evil qi will be retained;if yang is not solid due to its depression,yang will lose its warmth and circulation and phlegm and stasis will gather;if yang is not solid due to its restlessness,yang will lose its tranquility,burn yin and consume essence.Aiming at the core pathogenesis of yang losing its solidity,the treatment methods of warming yang and replenishing qi to treat the disease before it occurs,unblocking yang and removing turbidity to disperse the staleness,and clearing and resolving restless yang to fight cancer and detoxify are used in clinical practice.Restoring the solidity of yang is taken as the goal of treating malignant tumors,which provides ideas for the clinical practice of treating malignant tumors with traditional Chinese medicine.

BACKGROUND:At present,there are many clinical studies on dysphagia,but little is known about the stress of bones and hyoid muscles caused by dysphagia.OBJECTIVE:To establish a three-dimensional model of swallowing musculoskeletal system to investigate the stress changes of hyoid and suprahyoid muscles during swallowing.METHODS:A healthy adult male was selected for head and neck CT scanning.A three-dimensional model was constructed by image extraction method.According to hyoid motion,the lowest and highest positions of hyoid were set,and the muscle strength of suprahyoid muscles was successively loaded to observe the stress influence of suprahyoid muscles on hyoid under physiological state.By changing the material properties of muscles,we simulated different degrees of dysphagia and observed the stress changes of suprahyoid muscle group under the condition of dysphagia.RESULTS AND CONCLUSION:(1)The finite element models including C2-C4 vertebrae,partial temporal bone,mandible,hyoid,and mylohyoid-geniohyoid muscle were established,which could reflect the displacement of hyoid and stress changes during swallowing.(2)Under physiological conditions,among suprahyoid muscles,mylohyoid muscle had the greatest influence on hyoid stress,followed by digastric muscle,geniohyoid muscle,and stylohyoid muscle.(3)By simulating different degrees of dysphagia,it was found that with the increase of the severity of dysphagia,the stress of suprahyoid muscles gradually increased.(4)These findings conclude that among suprahyoid muscles,mylohyoid muscle and digastric muscle have the greatest influence on hyoid stress,which suggests the importance of specific muscle stimulation.The aggravation of dysphagia was positively correlated with the stress change of suprahyoid muscles,which could provide a biomechanical reference for the mechanism study and clinical diagnosis and treatment of dysphagia.