Non-alcoholic fatty liver disease （NAFLD） is one of the most prevalent forms of liver diseases globally. Its progression can lead to cirrhosis and end-stage liver disease， and there is currently a lack of effective pharmacological treatments. Adenosine monophosphate-activated protein kinase （AMPK）， as a regulatory hub for maintaining cellular energy homeostasis， can coordinate key cellular processes such as adipogenesis， glucose metabolism， and mitochondrial functions. Its activation exerts metabolic regulatory effects through pathways including inhibiting lipogenesis， enhancing mitochondrial β-oxidation， regulating inflammation and oxidative stress， and promoting autophagy. Accordingly， AMPK emerges as a potential target for the prevention and treatment of NAFLD. Traditional Chinese Medicine （TCM）， with low toxicity， high accessibility， and multi-component， multi-target synergistic effects， has demonstrated unique value in NAFLD treatment， particularly showing notable advantages in regulating the AMPK signaling pathway. Sichuan is known as the treasure house of TCM， and the active components of its authentic medicinal materials such as Coptidis Rhizoma not only reflect regional characteristics in AMPK signaling regulation but also form a multi-level metabolic regulatory network through crosstalk with pathways such as sirtuin 1 （SIRT1） and peroxisome proliferator-activated receptor α （PPARα）. They can achieve specific regulation by directly activating AMPK and modulating upstream and downstream targets， exerting prominent effects in ameliorating hepatic steatosis and inflammation. This study systematically reviews the research findings on TCM for the prevention and treatment of NAFLD over the past five years， elaborating the mechanisms by which TCM treats NAFLD through regulating the AMPK signaling pathway. It aims to provide new perspectives and references for clinical diagnosis and treatment， basic research， and drug development.

Objective To study the expression and clinical significance of neural Wiskott-Alrdich syndrome protein(N-WASP)in pla-centas with preeclampsia.Methods This study included a total of 65 pregnant women:15 in the early-onset preeclampsia group,15 in the early-onset control group,15 in the late-onset preeclampsia group,and 20 in the late-onset control group.Real-time fluorescence quan-titative PCR(RT-qPCR)was used to detect the relative expression of N-WASP mRNA in placental tissues.Western blotting and immu-nohistochemistry were used to detect the expression and position of N-WASP protein in placental tissues from each group.Results RT-qPCR revealed significantly lower N-WASP mRNA expression levels in the placental tissue of the early-onset preeclampsia group compared to those in the early-onset control group(0.50±0.19 vs.0.93±0.73,P＜0.05).The N-WASP mRNA expression levels in late-onset preeclampsia placenta were significantly lower than those in the late-onset control group(0.83±0.34 vs.1.15±0.34,P＜0.05).Western blotting revealed significantly lower N-WASP protein expression in the placental tissue of early-onset preeclampsia compared to that in the early-onset control group(0.35±0.17 vs.0.72±0.21,P＜0.05).The N-WASP protein expression in late-onset preeclampsia placenta was significantly lower than that in the late-onset control group(0.39±0.16 vs.0.76±0.20,P＜0.05).The N-WASP mRNA expression in the placenta negatively correlated with the occurrence of early-onset(r =-0.37,P = 0.042)and late-onset preeclampsia(r =-0.39,P = 0.019).Immunohistochemistry revealed that N-WASP protein was localized in the cytoplasm of syncytiotrophoblasts,cytotrophoblasts,villous stromal cells,and vascular endothelial cells.Conclusion The low expression of N-WASP may be closely associated with preeclampsia.

Objective To observe the effect of preoperative enteral nutritional support combined with modified Ivor-Lewis surgery for esophageal cancer on lung function and mRNA expression of GATA-binding protein 3(GATA3)and forkhead protein P3(Foxp3)in peripheral blood.Methods Sixty esophageal cancer patients who underwent modified Ivor-Lewis surgery in our hospital from January 2022 to October 2023 were selected and divided into two groups by simple random method.The control group was given conventional diet before operation,and the observation group was given enteral nutrition support before operation.The two groups were compared in terms of nutritional support.Results Both groups showed significantly decreases in one-second exertion expiratory volume/exertion lung volume(FEV1/FVC)(P<0.05),FVC(P<0.05),FEV1(P<0.05)and the levels of peripheral blood GATA3(P<0.05),Foxp3 mRNA(P<0.05)expression compared with those at admission(P<0.05),but no significant differences in pulmonary function(P>0.05),peripheral blood GATA3(P>0.05),and Foxp3 mRNA(P>0.05)expression between them at 1 week postoperatively.Both groups exhibited significantly lower levels of albumin,prealbumin,haemoglobin,transferrin,PNI and body mass and body mass index at admis-sion as compared to those at one week after surgery(P<0.05).The observation group showed significantly higher levels of albumin,prealbumin,haemoglobin,transferrin,and PNI at 1 week postoperatively(P<0.05),but no significant differences in ventilation time,defecation time,drain retention time,hospitalisation time,and compli-cation rate as compared to the control group(P>0.05).Conclusion Preoperative enteral nutritional support combined with modified Ivor-Lewis surgery for esophageal cancer improves postoperative nutritional status,and ren-ders less effect on postoperative lung function and peripheral blood GATA3 and Foxp3 mRNA expression.

BACKGROUND:The occurrence and development of osteoarthritis is strongly associated with immune abnormalities,and the importance of various immune cells and immune mediators in the pathogenesis of osteoarthritis has been continuously elucidated. OBJECTIVE:To review the role of immune cells and related cytokines in osteoarthritis disease,and provide new ideas for future research and prevention of osteoarthritis. METHODS:Taking"osteoarthritis,knee,macrophages,T cells,B cells,natural killer cells,dendritic cells,cytokines,inflammatory factors,immune cells"as search terms,relevant published literature was searched on CNKI,WanFang,VIP,PubMed and Web of Science databases.After reading the title and abstract for preliminary screening,98 articles were selected for review after reading the full text again. RESULTS AND CONCLUSION:In the past,it was believed that the pathogenesis of osteoarthritis was associated with cartilage wear.In recent years,studies have suggested that osteoarthritis is a chronic inflammatory state in which immune cells are widely involved.With the in-depth study of the pathogenesis of osteoarthritis,scholars believe that the pathogenesis of osteoarthritis is driven by early innate immune response,which will gradually catalyze degenerative changes and eventually lead to changes in the joint microenvironment.Various immune cells and cytokines are the key factors affecting the repair of osteoarthritis.Macrophages and natural killer cells participate in synovial inflammatory reaction,and T cell immune reaction participates in the degradation of osteoarthritis cartilage and aggravates the condition of osteoarthritis.Interleukin-1β secreted by immune cells,interleukin-6,tumor necrosis factor α,interleukin-17 and interleukin-37 play an important role in the pathophysiology of osteoarthritis,among which interleukin-1β is the most important inflammatory factor causing articular cartilage damage.Assessing immunological risk factors at the early stage of osteoarthritis can effectively treat the disease at an early stage,which can significantly reduce disability,morbidity and costs associated with osteoarthritis.At present,the immunomodulatory effect of stem cells and their derived secretions and biomaterials on the treatment of osteoarthritis has been confirmed in different experimental models,but there is still a lot of research to be done before they are used in clinical practice.With the discovery of new therapeutic targets,targeted treatment will bring new hope for the repair of clinical osteoarthritis.

Objective:To investigate the impact of circular RanGTPase activating protein 1 (circRANGAP1) on the biological behavior of trophoblast cells in preeclampsia and its potential mechanisms.Methods:Placental tissues were collected from preeclampsia patients and age- and gestational age- matched control pregnant women admitted to Shengjing Hospital of China Medical University from August 2020 to December 2022 (eight cases each in the early-onset preeclampsia group and early-onset control group, and 24 cases each in the late-onset preeclampsia group and late-onset control group). The expression levels of circRANGAP1 and eukaryotic translation initiation factor 4A3 (EIF4A3) mRNA in placental tissues were detected by real-time quantitative polymerase chain reaction (RT-qPCR), and EIF4A3 protein expression was assessed by Western blotting. In HTR-8/Svneo cells, the proliferation, migration, and invasion abilities were evaluated by cell counting assay, scratch assay, Transwell invasion assay, and the regulatory effect of EIF4A3 on circRANGAP1 was examined by RNA binding protein immunoprecipitation (RIP). Changes of circRANGAP1 expression in HTR-8/Svneo cells were detected by RT-qPCR after EIF4A3 knockdown. Statistical analysis was performed using independent sample t-test, non-parametric Chi-square test, or Pearson correlation analysis. Results:(1) There was no significant difference in circRANGAP1 expression between the early-onset preeclampsia group and the early-onset control group. However, circRANGAP1 expression was higher in the late-onset preeclampsia group compared to the late-onset control group [(3.764±3.297) vs. (0.960±0.720), t=4.07, P<0.001]. In late-onset preeclampsia patients, circRANGAP1 expression was positively correlated with both systolic and diastolic blood pressure (systolic: r=0.639, P<0.01; diastolic: r=0.800, P<0.001). There was no significant difference in EIF4A3 mRNA and protein expression between the early-onset preeclampsia group and the early-onset control group, but EIF4A3 mRNA and protein expression were higher in the late-onset preeclampsia group compared to the late-onset control group [mRNA: (2.963±3.081) vs. (1.149±0.667), t=2.30, P=0.028; protein: (2.504±1.008) vs. (0.258±0.180), t=4.39, P=0.005]. (2) After small interfering (si) RNA knockdown, there was no significant difference in mRANGAP1 expression, but circRANGAP1 expression decreased [(1.000±0.004), (0.465±0.031), and (0.621±0.030)], with si-1 showing the highest knockdown efficiency ( t=23.59, P=0.002). Specific knockdown of circRANGAP1 resulted in increased proliferation [(1.297±0.058) vs. (1.456±0.030), t=－5.97, P<0.001], invasion [(94.400± 6.504) vs. (219.000±19.870), t=－13.32, P<0.001], and migration [(25.493±3.498)% vs. (58.456±3.277)%, t=－15.38, P<0.001] abilities of trophoblast cells. (3) There are six binding sites for EIF4A3 in the upstream region of circRANGAP1 pre-mRNA. EIF4A3 can bind through regions a and b, but not region c. After siRNA knockdown, EIF4A3 expression decreased [(1.003±0.101), (0.276±0.060), (0.398±0.074), and (0.184±0.017)], with si-3 showing the highest knockdown efficiency. After EIF4A3 knockdown, circRANGAP1 expression in trophoblast cells decreased [(1.004±0.118) vs. (0.480±0.039), t=5.96, P=0.027]. Conclusion:circRANGAP1, regulated by EIF4A3, inhibits the proliferation, migration, and invasion abilities of trophoblast cells, thereby participating in the pathogenesis of preeclampsia.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Patients with novel coronavirus infection still have many functional disorders during the recovery period. The timely intervention of rehabilitation treatment has important clinical significance in improving the patients’ functions and their ability of daily living. Based on the current evidence of evidence-based medicine and clinical practice, this paper summarizes the rehabilitation treatment and precautions of patients with simple novel coronavirus infection and different groups with previous dysfunction and novel coronavirus infection (such as neurological dysfunction, chronic pain, and bone and joint diseases) with a view to providing clinical reference for the rehabilitation treatment of patients with novel coronavirus infection during the recovery period.

Objective:To observe the effect of shift work on the stability of the circadian clock and insulin sensitivity in non-overweight/obese individuals with normal blood glucose, and explore underlying connection.Methods:Female shift working nurses in the Department of Blood Transplantation and non-shift working nurses in the Health Management Center in the First Affiliated Hospital of Zhengzhou University were divided into shift worker group (SW group) and non-shift worker group (NSW group). Serum inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α)], adipokines (adiponectin, leptin, chemerin, visfatin), and melatonin levels were measured using enzyme linked immunosorbent assay (ELISA). Realtime fluorescence quantitative PCR was performed to detect peripheral blood circadian clock genes circadian locomotor output cycles protein kaput(Clock) and brain and muscle ARNT-like protein 1(Bmal1). Cortisol and fasting insulin were measured by chemiluminescent microparticle immunoassay, and HbA 1C was measured by capillary electrophoresis. In addition, visceral fat area (VFA) was assessed with bioelectrical impedance analyzer, and mid-sleep time composite phase deviations (CPD) was calculated based on the International Physical Activity Short Questionnaire. Results:SW group had lower serum level of melatonin ( P=0.023) and higher cortisol ( P=0.001) than the NSW group, and altered mRNA expression of Clock and Bmal1 ( P=0.034, P=0.047). Fasting blood glucose and HbA 1C in the SW group, although in the normal range, had been higher than in the NSW group ( P=0.011, P=0.033). Although body mass index was normal in SW group, VFA had been higher than that of the NSW group ( P=0.010). And homeostasis model assessment for insulin resistance (HOMA-IR), IL-6, TNF-α, leptin, chemerin, and visfatin were significantly higher in the SW group than NSW group ( P=0.033, P=0.012, P=0.001, P=0.011, P=0.021, P=0.007). In addition, adjusting for body mass index and activity factors revealed a significant positive correlation between CPD and VFA ( r=0.434, P=0.049), inflammatory factors IL-6 ( r=0.514, P=0.017) and TNF-α ( r=0.700, P<0.001) and pro-inflammatory adipokines leptin ( r=0.473, P=0.030), chemerin ( r=0.439, P=0.047), visfatin ( r=0.521, P=0.015). Conclusion:Shift work can affect circadian clock, with increased visceral adiposity, pro-inflammatory adipokines, inflammatory factors and decreased insulin sensitivity in women without overweight/obese.

Objective To observe the influence of nursing intervention based on International Classification of Functioning, Disability and Health (ICF) in the course of dysphagia for stroke patients. Methods A total of 60 stroke patients were chosen with dysphagia in the Second Affiliated Hospital of Xi'an Jiaotong University for the study.These patients were randomly divided into the control group and the intervention group with 30 cases in each group,two groups were directly treated with routine training, oral care, menthol popsicle stimulation, balloon dilatation treatment, swallowing electrical stimulation, basic training of swallowing and health education. The intervention group was assessed and intervened based on 34-item dysphagia ICF core project which Dongyi refined in addition to conventinal nursing.The grade was measured by the Kubota Toshio's drinking test,and the Surface Electromyography(sEMG)was performed to compare the swallowing duration and maximum amplitude in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention, after 4 weeks and after 8 weeks. Results The average grade in Kubota Toshio′s drinking test before intervention,after 4 weeks and after 8 weeks in the control group and the intervention group were 4.12±0.23,3.34±0.57,2.76±0.46 and 4.29± 0.25,2.82 ± 0.39,1.81 ± 0.41, intra group comparison was statistically significant (F=67.19, 368.56, P<0.01).Comparison between two groups in 4 weeks,8 weeks after intervention was statistically significant (t=4.81, 7.22,P<0.01). In the control group, intra group comparison of swallowing duration in the masseter,the orbicularis oris,submental,and the lower hyoid muscles before intervention,after 4 weeks and after 8 weeks was statistically significant(F=18.40-34.65,P<0.01).In the intervention group,intra group comparison of swallowing duration in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention,after 4 weeks and after 8 weeks was statistically significant(F=127.82-174.93, P<0.01). There were significant differences in swallowing duration in the masseter, the orbicularis oris,submental,and the lower hyoid muscles in 4 weeks,8 weeks after intervention between the two groups(t=-5.32-10.14,P<0.01).In the control group,intra group comparison of maximum amplitude in the masseter,the orbicularis oris,submental,and the lower hyoid muscles before intervention,after 4 weeks and after 8 weeks was statistically significant(F=28.11-90.54,P<0.01).In the intervention group,intra group comparison of the maximum amplitude in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention,after 4 weeks and after 8 weeks was statistically significant(F=60.91-178.31,P<0.01).There were significant differences in the maximum amplitude in 4 weeks,8 weeks after intervention between the two groups(t=-8.82--4.06,P<0.01). Conclusions Nursing intervention based on ICF has obvious curative effect on stroke patients with dysphagia.