OBJECTIVES: To clarify the role of hippocampal glutamate system in regulating HPA axis in mediating the effect of electroacupuncture (EA) at the heart meridian for improving myocardial injury in rats with acute myocardial ischemia (AMI). METHODS: Male SD rats were randomized into sham-operated group, AMI group, EA group, and L-glutamic acid+EA group (n=9). Rat models of AMI were established by left descending coronary artery ligation, and EA was applied at the "Shenmen-Tongli" segment; the rats in L-glutamic acid+EA group were subjected to microinjection of L-glutamic acid into the bilateral hippocampus prior to AMI modeling and EA treatment. Cardiac functions of the rats were evaluated using echocardiography, and ECG and heart rate variation (HRV) were analyzed using PowerLab and LabChart. Pathological changes in the myocardial tissue was examined using HE staining, and serum levels of myocardial enzymes were detected with ELISA. Myocardial expressions of TH and GAP43 were detected with immunohistochemistry, and colocalization of VGLUT1, VGLUT2 and c-fos were observed using immunofluorescence staining; the expressions of VGLUT1, VGLUT2, NMDAR1 and NMDAR2B were detected using Western blotting. RESULTS: The rat models of AMI showed significantly decreased LVEF and LVFS and increased serum levels of myocardial enzymes in positive correlation with the HPA axis. Numerous TH- and GAP43-positive cells were observed in the hippocampus, where the expressions of NE and E, neurons colabeled with VGLUT1, VGLUT2 and c-fos, and expressions of VGLUT1, VGLUT2, NMDAR1, NMDAR2B and Glu increased significantly. All these changes were significantly improved by interventions with EA as compared with those in AMI and L-Glutamate+EA groups. CONCLUSIONS In rats with AMI, EA at the heart meridian can regulate excessive glutamate release in the hippocampus, thereby inhibiting HPA axis hyperactivity and reducing sympathetic nerve activity to protect the myocardial tissue.
Animals ; Electroacupuncture ; Male ; Rats, Sprague-Dawley ; Hippocampus/metabolism* ; Rats ; Glutamic Acid/metabolism* ; Myocardial Ischemia/physiopathology* ; Hypothalamo-Hypophyseal System/physiopathology* ; Pituitary-Adrenal System/physiopathology* ; Receptors, N-Methyl-D-Aspartate/metabolism*

Objective:To explore the impact of emergency response to public health emergencies on the efficiency of pre-hospital emergency work, and study the degree of impact on 120 ambulance dispatchers in Chongqing city during pre-periods and post-periods of the emergency intervention.Methods:Taking 120 phone answering and ambulance operation efficiency as the research subjects, we collected pre-hospital emergency case data from a city's emergency medical center, covering the period from November 10, 2021 to January 6, 2023. The cases were divided into groups according to the time periods of emergency response. A regression discontinuity design method was employed to compare the response of emergency intervention to the predictions (virtual cases) without the emergency intervention, obtaining the average intervention effect.Results:During the study period of 27 days, the number of 120 calls picked up within 10 seconds increased from 11 000 to 19 000, but the answering rate slightly decreased within 10 seconds. The vacancy rate of 120 ambulances during emergency response decreased from 0.39% to 0.20%, but the completion rate within 18 minutes decreased from 72% to 30%. In this particular emergency response period, the number of patient complaints (such as high fever and difficulty breathing) increased compared to the pre-period of emergency response.Conclusion:Emergency response significantly impacts pre-hospital emergency work such as emergency phone answering and ambulance operation efficiency. This study provides empirical research results and decision-making support for urban emergency medical services to respond to public health emergencies.

ObjectiveTo explore the possible mechanism of Chuanxiong （Rhizoma Chuanxiong） & Tianma （Rhizoma Gastrodiae） herbal pair in treating migraines based on AMP-activated protein kinase （AMPK）/transient receptor potential A1 channel （TRPA1） pathway. MethodsForty-eight healthy male SD rats were randomly divided into control group， model group， and Chuanxiong Tianma medication group， with 16 rats in each group. The control group and model group were given 10 ml/kg of normal saline by gavage， while the Chuanxiong Tianma medication group was given 0.675 g/kg of Chuanxiong Tianma herbal pair by gavage， once daily for 8 consecutive days in both groups. Migraime model was performed before the last administration， with subcutaneous injection of 10 ml/kg of normal saline in the control group， and subcutaneous injection of 10 ml/kg of nitroglycerin in the model group and Chuanxiong Tianma medication group. The Von Frey filament was used to measure the periorbital mechanical pain threshold of rats. The enzyme-linked immunosorbent assay （ELISA） was used to determine the levels of calcitonin gene-related peptide （CGRP） in rat serum and cerebrospinal fluid. The nitric oxide （NO） assay kit was used to determine the NO level in serum and cerebrospinal fluid. RT-PCR was usedto detect the mRNA expression levels of immediate-early genes in the trigeminal ganglion of rats （c-Fos）， CGRP， transient receptor potential V1 channel （TRPV1）， AMPK alpha subunit （PRKAA）， and TRPA1. Immunofluorescence was used to detect the number of c-Fos-positive cells in the trigeminal cervical complex （TCC） and the protein expression levels of phosphorylated AMPK （pAMPK） and TRPA1 in the trigeminal ganglion. ResultsCompared to those in the control group， the mechanical stimulation threshold and pAMPK protein expression in the model group decreased， while the levels of CGRP and NO in serum， c-Fos， CGRP， TRPV1 and TRPA1 mRNA levels in the trigeminal ganglion， TRPA1 protein expression， and the number of c-Fos-positive cells in the TCC significantly increased （P＜0.05）. Compared to those in the model group， the mechanical stimulation threshold and pAMPK protein expression in the Chuanxiong Tianma medication group significantly increased， while the levels of CGRP and NO in serum， c-Fos， CGRP， TRPV1 and TRPA1 mRNA levels in the trigeminal ganglion， TRPA1 protein expression， and the number of c-Fos-positive cells in the TCC significantly decreased （P＜0.05）. ConclusionChuanxiong Tianma herbal pair may improve migraine symptoms by regulating the AMPK/TRPA1 pathway in the trigeminal ganglion and increasing the mechanical pain threshold.

Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.

Objective To explore the application effect of a new lighted surgical aspirator in deep brain hematoma removal operation.Methods Totally 153 patients of non-traumatic basis festival area cerebral hemorrhage were randomly divided into a control group and a treatment group.Both the groups underwent clearance of intracranial hematoma and decompressive craniectomy surgical operation in the operating room,with the common aspirator involved in the control group and the lighted one in the treatment group.Results There was no significant difference between the rates of hematomal removal in the groups (P＞0.05).The treatment group had the operating time less by 59.85 min and the hospital stay decreased by 15.23 d than those in the control group (P＜0.05).The GOS score and daily viability of the treatment group was also statistically higher than those of the control group (P＜0.05),and the effective rate in the treatment group was also more than that in the control group by 24.9％ (P＜0.05).Conclusion The new aspirator solves the problems in visual field and light source,decreases the operating time and improves the disease prognosis.

Objective To explore the feasibility of low concentration contrast medium and low-voltage combined with adaptive statistical iterative reconstruction(ASRI)technique in enhanced CT imaging of solitary pulmonary nodules. Methods A total of 40 patients with solitary pulmonary nodules who underwent routine exam-inations and were pathologically confirmed from February 2015 to February 2017 were collected and divided into conventional group(conventional dose,high osmolar contrast,using filtered back projection reconstruction)and low dose group(low voltage,low concentration isotonic contrast,iterative reconstruction). Results Subjective scoring of conventional group(3.97 ± 0.57)and low dose group(4.01 ± 0.54)indicated no statistical significance (P > 0.05). No significant difference was found regarding to reconstructed image quality,SNR and CNR in both two groups.The dose length product(DLP)and effective dose(ED)in low dose group were lower than those in the conventional group[(283.52 ± 11.50)mGy/cm vs(370.74 ± 29.56)mGy/cm;(3.65 ± 0.32)mSV vs(5.11±0.25) mSV],and the difference was statistically significant(P < 0.05). Conclusions Low concentration isotonic con-trast agent(iodixanol 270 mgI/L)and low voltage(100 kV)combined with ASIR technology could satisfy the clini-cal need in enhanced CT imaging of solitary pulmonary nodule.

Objective To analyze the changes in the expression of Toll-like receptors 4 (TLR4) and 7 on the surface of murine bone marrow-derived dendritic cells following dengue virus type 2 (DEN2) infection.Methods DEN2 NGC strain was infected into BALB/c suckling mice through intracranial injection and injected into C6/36 cells to induce the in vivo and in vitro proliferation of DEN2, respectively.RT-PCR was performed to identify DEN2 RNA.Reed-Muench method was used to determine the 50% tissue culture infective dose (TCID50) of DEN2.Dendritic cells (DCs) were prepared by stimulating bone marrow cells isolated form C57BL/6 mice with IL-4 and GM-CSF and then identified by flow cytometry.The prepared murine bone marrow-derived DCs were infected with DEN2 and observed with direct immunofluorescence assay.Dynamic changes in the expression of CD11c, CD86 and I-A/I-E molecules on DCs after DEN2 infection were detected by flow cytometry.Levels of DEN2 RNA and the expression of TLR4 and TLR7 at mRNA level were dynamically detected by real-time quantitative PCR.Results The TCID50 of DEN2 to C6/36 cells was 10-5.8.Murine bone marrow-derived DCs were acquired with a purity of 70% and could be infected with DEN2 in vitro.The percentages of CD86 and I-A/I-E molecules on the surface of DCs infected with 1×105 TCID50 of DEN2 were statistically different from those of the negative control group.Neither of the two groups showed a significant difference in the percentages of membrane molecules over time.However, the percentages of membrane molecules on DCs increased with increasing viral load.Compared with the negative control group, the levels of DEN2 RNA in infection groups were increased with increasing virus load, while the expression of TLR4 and TLR7 on DEN2 infected-DCs at mRNA level was decreased with increasing viral load.Conclusion DEN2 infection promotes the maturation of DCs.Expression of TLR4 and TLR7 on DEN2 infected-DCs at mRNA level decreases with increasing viral load, which suggests that TLR4 and TLR7 are closely related to viral infection and play a certain role in the pathogenesis of DEN infection.

Purpose To explore the expression of Toll-like receptor 4 (TLR4), PI3K, AKT and NF-κB in cervical lesions, and to in-vestigate their association with human papillomavirus ( HPV) 16 infection. Methods Immunohistochemical SP staining was performed to detect the expression of TLR4, PI3K, AKT, NF-κB in paraffin-embedded cervical tissue specimens from Uighur women with chroni-cal cervicitis, cervical intraepithelial neoplasia ( CIN) and cervical squamous cell carcinoma ( CSCC) . The HPV 16 DNA was detected by PCR. Results The positive expression rates of TLR4, PI3K, AKT, NF-κB in chronical cervicitis, CIN and cervical cancer were 32. 0%, 59. 4%, 77. 8%, 28. 0%, 56. 3%, 73. 0%, 24. 0%, 56. 3%, 79. 4%, and 8. 0%, 48. 4%, 81. 0%, respectively. The expression of them was higher in cervicitis than in CIN and cevical cancer ( P<0. 05 ) . The positive expression rates of HPV 16 in three groups were 8. 0%, 48. 4% and 81. 0% (P<0. 05). The expression of TLR4, PI3K, NF-κB and HPV 16 was related to cervi-cal cancer differentiation (P<0. 05). PI3K and AKT were significantly correlated with FIGOs’ stages (P<0. 05). NF-κB was corre-lated with lymph node metastasis. The expression of TLR4 was significantly associated with HPV 16 infection in CIN and CSCC ( r=0. 303, P=0. 015, r=0. 633, P=0. 000), and correlation with PI3K in CIN and CSCC (r=0. 254, P=0. 045, r=0. 386, P=0. 003). PI3K was associated with AKT only in CSCC (r=0. 298, P=0. 018). Conclusions The expression of TLR4 can be up-regulated by HPV 16 infection. High expression of PI3K/AKT signal pathway mediated by TLR4 may play important roles in the devel-opment and progression of CIN and CSCC, and HPV 16 infection may be a trigger factor affecting the molecular signal pathway.

Objective To build the relationship model of childhood aubuse, personality, insecurity and dissociative trait in medical students. Methods Through stratified sampling,262 medical students were investiga?ted by the Personal Report of Childhood Abuse( PRCA) ,Dissociative Trait Scale( DTS) ,Self?Rating Feeling of In?security Scale( SRFIS) ,Revised NEO Five?Factor Inventory( NEO?FFI?R) . A path analysis was applied by AMOS (Analysis of Moment Structures) version 7.0. Results ①Childhood abuse was positively related to insecurity, dissociative trait and neuroticism( r=0.248~0.361, P<0.01) ,but was passively related to extraversion,agreeable?ness and conscientiousness( r=-0.168~-0.250, P<0.01). Insecurity was positively related to dissociative trait and neuroticism( r=0.479~0.522, P<0.01) ,but was passively related to extraversion,agreeableness and conscien?tiousness( r=-0.234~-0.324, P<0.01). Dissociative trait was positively related to neuroticism( r=0.597, P<0.01) ,but was passively related to openness, extraversion, agreeableness and conscientiousness ( r=-0. 133~-0.453, P<0.05). ②The path analysis showed that childhood abuse was directly related to insecurity(B=0.339, P<0.01)and personality(B=-0.226, P<0.01)of medical students. Personality was directly related to insecurity and dissociative( B=-0.609~-0.363, P<0.01) . Insecurity was directly related to dissociative trait( B=0.448, P<0.01) . Personality and insecurity mediated entirely the relationship between childhood abuse and dissociative trait of medical students. The model fit indexes were χ2/ df =1.151<3.000, P=O.080>0.05,RMSEA=0.024<0.050, GFI=0.935,AGFI=0.909,NFI=0.923,RFI=0.902,IFI=0.989,TLI=0.986 and CFI=0.989. Conclusion Per?sonality and insecurity as mediated variable mediate the relationship between childhood abuse and dissociative trait of medical students. Childhood abuse has no direct effect on dissociative trait of medical students.

Objective To evaluate the spot urine sample collection method and value of urinary albumin measurement in population survey. Methods Six hundred and fifty-nine Beijing residents were requested to collect 24 h urine for detection of UAER, as well as random spot urine samples and morning urine samples in the next day. Rapid semi-quantitative urinary albumin-specific dipstick and ACR were measured in each spot urine specimen. The 24 h UAER was measured as golden standard to generate ROC curves and evaluate the sensitivity, specificity and AUC of each method. Results The value of ACR in the morning spot urine samples and random spot urine samples were 9. 36(5. 12-33.29) mg/g and 11.29(6. 34-41.29) mg/g respectively and there was no significant difference between these two groups (t = - 1. 382,P＞0.05). The correlation was significant in the two groups (r = 0.932, P ＜ 0.01). The correlation coefficient between ACR in the morning spot urine samples and UAER was 0. 853 (P ＜ 0. 01). The correlation coefficient between ACR in the random spot urine samples and UAER was 0. 874 (P ＜0. 01).The sensitivity and specificity of ACR for diagnosis of albuminuria in the random urine samples were 77. 9% and 91.0%. The sensitivity and specificity of ACR for diagnosis of albuminuria in the morning urine samples were 78. 4% and 95.7%. Concerning the semi-quantitative urinary albumin-specific dipstick, sensitivity and specificity were 90. 3% and 41.1% , respectively. The specificity was much lower than that of ACR. The area under the ROC curves of ACR in the random urine specimens and the morning urine specimens was 0. 918 ±0. 012, 0. 929 ± 0. 015, respectively. There was no statistical difference between these two groups (χ2 =2. 13, P＞0. 05). The area under the ROC curves of semi-quantitative urinary albumin-specific dipstick in the random urine specimens was 0.661 ±0.021, lower than that of ACR (χ2 = 248.41, P＜0.01).Conclusion Measurement of ACR in random urine samples is a reasonable method with simplicity and accuracy for the detection of albuminuria in general population screening program.