ObjectiveHeadspace solid-phase microextraction-gas chromatography-mass spectrometry（HS-SPME-GC-MS） and GC-triple quadrupole MS（GC-QqQ-MS） in combination with non-targeted and targeted metabolomics were employed to systematically analyze the chemical composition differences of Xihuangwan prepared with natural musk and artificial musk， and establish an identification system for them. MethodsThe volatile components of 9 batches of Xihuangwan samples from 8 manufacturers were analyzed by HS-SPME-GC-MS non-targeted metabolomics， and identified by comparing their MS data with the National Institute of Standards and Technology（NIST） spectral library. Orthogonal partial least squares-discriminant analysis（OPLS-DA） was used to identify differential volatile components of Xihuangwan prepared with natural musk and artificial musk. Additionally， GC-QqQ-MS targeted metabolomics was applied to quantify the levels of α-pinene， β-elemene， muscone， dehydroepiandrosterone， bornyl acetate， and octyl acetate in 27 batches of samples from 9 manufacturers. Cluster analysis， principal component analysis（PCA）， and partial least squares-discriminant analysis（PLS-DA） were conducted to further explore the differences in volatile components between Xihuangwan samples prepared with natural musk and artificial musk. ResultsNon-targeted metabolomics identified 291 volatile compounds in Xihuangwan， including alkanes， esters， alkanes， alcohols， ketones， naphthalenes and others. OPLS-DA analysis revealed distinct separation between Xihuangwan samples containing artificial musk（A1， C1， D1， E1， F1， G1， I1） and those containing natural musk（H1， H3）. A total of 30 differential metabolites were identified. The relative contents of these 30 differential metabolites were visualized using a radar chart， revealing significant differences in the levels of octanol， borneol acetate and muscone. Cluster analysis and PCA results from targeted metabolomics indicated that Xihuangwan could be classified into two distinct groups：one composed of natural musk（H1， H3） and the other of artificial musk， sample H2. PLS-DA identified muscone， octyl acetate， and dehydroepiandrosterone as key differential volatile components. Although no significant difference was observed in the content of octyl acetate between the two groups， statistically significant differences were found for muscone and dehydroepiandrosterone（P<0.05）. ConclusionMuscone and dehydroepiandrosterone can be used for the differentiation of Xihuangwan samples containing natural musk from those containing artificial musk. This study systematically and comprehensively analyzed the differences in the types and contents of major volatile components in Xihuangwan prepared with natural musk and artificial musk， providing a scientific basis for quality evaluation and control of Xihuangwan.

ObjectiveHeadspace solid-phase microextraction-gas chromatography-mass spectrometry（HS-SPME-GC-MS） and GC-triple quadrupole MS（GC-QqQ-MS） in combination with non-targeted and targeted metabolomics were employed to systematically analyze the chemical composition differences of Xihuangwan prepared with natural musk and artificial musk， and establish an identification system for them. MethodsThe volatile components of 9 batches of Xihuangwan samples from 8 manufacturers were analyzed by HS-SPME-GC-MS non-targeted metabolomics， and identified by comparing their MS data with the National Institute of Standards and Technology（NIST） spectral library. Orthogonal partial least squares-discriminant analysis（OPLS-DA） was used to identify differential volatile components of Xihuangwan prepared with natural musk and artificial musk. Additionally， GC-QqQ-MS targeted metabolomics was applied to quantify the levels of α-pinene， β-elemene， muscone， dehydroepiandrosterone， bornyl acetate， and octyl acetate in 27 batches of samples from 9 manufacturers. Cluster analysis， principal component analysis（PCA）， and partial least squares-discriminant analysis（PLS-DA） were conducted to further explore the differences in volatile components between Xihuangwan samples prepared with natural musk and artificial musk. ResultsNon-targeted metabolomics identified 291 volatile compounds in Xihuangwan， including alkanes， esters， alkanes， alcohols， ketones， naphthalenes and others. OPLS-DA analysis revealed distinct separation between Xihuangwan samples containing artificial musk（A1， C1， D1， E1， F1， G1， I1） and those containing natural musk（H1， H3）. A total of 30 differential metabolites were identified. The relative contents of these 30 differential metabolites were visualized using a radar chart， revealing significant differences in the levels of octanol， borneol acetate and muscone. Cluster analysis and PCA results from targeted metabolomics indicated that Xihuangwan could be classified into two distinct groups：one composed of natural musk（H1， H3） and the other of artificial musk， sample H2. PLS-DA identified muscone， octyl acetate， and dehydroepiandrosterone as key differential volatile components. Although no significant difference was observed in the content of octyl acetate between the two groups， statistically significant differences were found for muscone and dehydroepiandrosterone（P<0.05）. ConclusionMuscone and dehydroepiandrosterone can be used for the differentiation of Xihuangwan samples containing natural musk from those containing artificial musk. This study systematically and comprehensively analyzed the differences in the types and contents of major volatile components in Xihuangwan prepared with natural musk and artificial musk， providing a scientific basis for quality evaluation and control of Xihuangwan.

Objective To summarize the clinical characteristics and pathogenesis of severe acute respiratory syn-drome coronavirus 2(SARS-CoV-2)infection-related encephalitis,aiming to provide new theoretical basis for clini-cal diagnosis and treatment.Methods Clinical characteristics as well as diagnosis and treatment process of 25 pa-tients with SARS-CoV-2 infection-related encephalitis in the Second Affiliated Hospital of Shandong First Medical University were analyzed,and the pathogenesis was evaluated.Results The main prodromal symptoms were fever(80.0％),the initial symptoms were consciousness disturbance(56.0％),epileptic seizures(52.0％),and mental symptoms(36.0％).The subsequent symptoms were mainly autonomic nerve dysfunction(88.0％),epileptic sei-zures(68.0％),cognitive dysfunction(68.0％),motor impairment(64.0％),and language dysfunction(52.0％).The auxiliary examination results were mainly increase of content of cerebrospinal fluid(CSF)protein and increase ofC-reactive protein(CRP);electroencephalogram(EEG)showed slowing down of a non-specific background rhythm,followed by abnormal discharges;the most common manifestation of magnetic resonance imaging(MRI)was abnormal high signal in the insular cortex and medial temporal lobe,followed by diffuse or focal microbleeds.The first-line treatment agents were glucocorticoid combined with immunotherapy,and the second-line treatment agent was monoclonal antibody.The prognosis was poor.Conclusion Patients with a history of exposure to SARS-CoV-2 infection,consciousness disturbance,epileptic seizures and mental symptoms should be vigilant to the possi-bility of encephalitis.CSF,EEG,and MRI auxiliary examination should be given.Once diagnosed,early interven-tion is necessary.The main pathogenesis include direct invasion,cytokine storm,excessive immune inflammation,specific lymphocyte response,etc.

Objective:To analyze the predictive value of residual lipoprotein cholesterol (RLP-C) combined with three-dimensional spot tracking (3D-STE) technology for myocardial ischemia in patients with coronary heart disease (CHD).Methods:A total of 158 patients with suspected CHD myocardial ischemia admitted to the First Affiliated Hospital of Xi′an Jiaotong University from March 2021 to August 2023 were selected and divided into the observation group (patients with myocardial ischemia) and the control group (patients with non-myocardial ischemia) according to the results of coronary angiography (CAG). The levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and total cholesterol (TC) of the patients were detected by the fully automatic biochemical analyzer, and the level of RLP-C was calculated. The 3D-STE technique was adopted to analyze the global long axis strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) of the left ventricle of the patients. The differences of each index between the two groups were compared, the related influencing factors of myocardial ischemia in patients with CHD were analyzed, and the predictive value of RLP-C combined with 3D-STE technology for myocardial ischemia in patients with CHD was evaluated.Results:CAG revealed 39 patients (24.68%) with myocardial ischemia, with a total of 52 myocardial perfusion abnormalities, including 22 right coronary artery supply areas, 12 left coronary artery circumflex supply areas, and 18 anterior descending branch areas. The levels of cardiac function classification, GCS, GRS, GLS and RLP-C in the observation group were all better than those in the control group (all P<0.05). Binary logistic regression analysis showed that cardiac function classification grade Ⅳ, GCS, GRS, GLS, and RLP-C were the influencing factors of myocardial ischemia in patients with CHD (all P<0.05). Analysis of the receiver operating characteristic curve results showed that the sensitivities of cardiac function classification grade Ⅳ, GCS, GRS, RLP-C, GLS and the combination of the five in predicting myocardial ischemia in patients with CHD were 69.23%, 71.79%, 74.36%, 76.92%, 74.36% and 89.74%, respectively. The specificities were 68.91%, 71.43%, 75.63%, 77.31%, 76.47% and 88.24% respectively. The combined diagnosis of myocardial ischemia in patients with CHD with cardiac function classification grade Ⅳ, GCS, GRS, RLP-C and GLS had a relatively high value (all P<0.05). Conclusions:Cardiac function classification grade Ⅳ, GLS, GCS, GRS, and RLP-C are influencing factors of myocardial ischemia in patients with CHD. Combined detection is helpful to improve the diagnostic accuracy of myocardial ischemia.

Objective:To explore the effects of adenosine on learning and memory in rats thromboembolic stroke(TS)and its mechanism based on PI3K/Akt/CREB signaling pathway.Methods:36 male SD rats were randomly di-vided into sham group(Sham),TS group,TS+adenosine(TS+Ade)group and TS+adenosine+Akt inhibitor(TS+Ade+MK-2206)group.Preparation of rat TS model used autologous thrombus intravascular formation method.Mor-ris water maze(MWM)test was used to observe the learning and memory ability of rats.The morphological changes of hippocampal neurons were observed by Nissl staining.The expression of glutamate transporter 1(GLT-1)and glial fi-brillary acidic protein(GFAP)in CA1 region was determined by immunofluorescence.The protein expressions of PI3K,p-PI3K,Akt,p-Akt,CREB and p-CREB were determined by Western blot.Results:Through the rat TS mod-el,adenosine was able to improve the learning and memory ability,improve the hippocampal neuron cell morphological abpormality and vacuolation,nucleolar condensation and other phenomena in rats.Immunofluorescence results showed that GLT-1 and GFAP were co-localized,and adenosine could significantly enhance the fluorescence intensity of GFAP and GLT-1.Western blot results showed that adenosine can enhance the expression of p-PI3K,p-Akt,and p-CREB proteins,but the use of Akt inhibitors can to some extent inhibit the phosphorylation of PI3K,Akt,and CREB.Conclusion:Adenosine may enhance the expression of GLT-1 in astrocytes and increase the clearance of glutamate through activation of PI3K/Akt/CREB signaling pathway,thereby reducing the excitotoxicity and improving recognition and memory function.However,this effect is partially blocked by Akt inhibitors.

BACKGROUND:Bone tissue,as a highly mineralized and structurally complex connective tissue,plays a pivotal role in maintaining the form and function of living organisms.Traditional imaging techniques have been insufficient to meet the demands for in-depth observation of bone.The advent of tissue clearing technology has enabled researchers to more clearly observe the intricate structures within bones,such as trabecular bone,bone marrow cavities,and neural and vascular networks interacting with bone tissue.This has opened new perspectives for research and clinical applications in orthopedics.OBJECTIVE:To comprehensively summarize the applications of tissue clearing technology in the field of orthopedics and to explore its potential in the study of bone tissue structure and function,elucidation of disease mechanisms,and innovation in treatment strategies.Additionally,it provides an outlook on innovative directions.METHODS:The review encompassed a search of the CNKI and PubMed databases using search terms"tissue clearing,tissue optical,bone"in English and"tissue clearing,bone,bone defect"in Chinese,combined with Boolean logic to optimize the search strategy.The inclusion criteria were scholarly articles and dissertations directly related to tissue clearing technology and orthopedic research,excluding literature with weak relevance,duplication,or incomplete data.A total of 82 articles were finally analyzed,focusing on the efficacy of clearing techniques,their scope of application,and their contributions to orthopedic research.RESULTS AND CONCLUSION:(1)Tissue clearing technology has demonstrated unique advantages in various domains,including the analysis of bone structure,the study of bone metabolism,the pathological characteristics of bone tumors,the process of fracture healing,the mechanisms of bone infection,and the evaluation of biocompatibility of bone grafts and implant materials.(2)The application of this technology has not only accelerated the progress of basic research in the field of orthopedics but also provides new strategies and methods for clinical treatment,indicating a broad application prospect in orthopedic research.

Objective To investigate the electroencephalography(EEG)signal characteristics in patients with neuropathic pain(NP)associated with spinal cord injury(SCI).Methods A total of 90 patients with SCI from January,2018 to November,2023 were selected from the EEG database of the Department of Rehabilitation Medicine,Xijing Hospital,and divided into NP group(n=46)and non-NP group(n=44)according to their symptoms.The resting-state EEG power and reactivity to eye-opening were compared between two groups.Results Compared with non-NP group,EEG power increased in frontal lobe in α and β1 bands,central lobe in δ,θ,α1 and β1 bands,parietal lobe in α and β1 bands,temporal lobe in α and β1 bands,left occipital lobe in α2 band,and occipital lobe in α1 and β1 bands(|Z|>1.998,P<0.05)in NP group during eye-opening;during eye-closing,EEG power increased in prefrontal lobe in α1 and β1 bands,right frontal lobe in θ band,frontal lobe in α and β1 bands,left frontal lobe in β2 band,central lobe in δ,α1 and β1 bands,parietal lobe in α1 and β1 bands,left pari-etal lobe in α2 and β2 bands,right temporal lobe in θ band,temporal lobe in α and β bands,occipital lobe in α1 and β1 bands,and left occipital lobe in β2 band(|Z|>1.970,P<0.05);while the reactivity to eye-opening de-creased in right prefrontal lobe in β1 band,frontal lobe in θ,α and β bands,right central lobe in β1 band,parietal lobe in α1 and β1 bands,right parietal lobe in β2 band,right temporal lobe in δ and θ band,temporal lobe in α1 and β bands,left occipital lobe in α1 band,and occipital lobe in β1(|Z|>1.967,P<0.05).Conclusion Resting-state EEG power characteristically elevates in NP patients after SCI,and the reactivity to eye-open-ing reduces.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Objective To investigate the electroencephalography(EEG)signal characteristics in patients with neuropathic pain(NP)associated with spinal cord injury(SCI).Methods A total of 90 patients with SCI from January,2018 to November,2023 were selected from the EEG database of the Department of Rehabilitation Medicine,Xijing Hospital,and divided into NP group(n=46)and non-NP group(n=44)according to their symptoms.The resting-state EEG power and reactivity to eye-opening were compared between two groups.Results Compared with non-NP group,EEG power increased in frontal lobe in α and β1 bands,central lobe in δ,θ,α1 and β1 bands,parietal lobe in α and β1 bands,temporal lobe in α and β1 bands,left occipital lobe in α2 band,and occipital lobe in α1 and β1 bands(|Z|>1.998,P<0.05)in NP group during eye-opening;during eye-closing,EEG power increased in prefrontal lobe in α1 and β1 bands,right frontal lobe in θ band,frontal lobe in α and β1 bands,left frontal lobe in β2 band,central lobe in δ,α1 and β1 bands,parietal lobe in α1 and β1 bands,left pari-etal lobe in α2 and β2 bands,right temporal lobe in θ band,temporal lobe in α and β bands,occipital lobe in α1 and β1 bands,and left occipital lobe in β2 band(|Z|>1.970,P<0.05);while the reactivity to eye-opening de-creased in right prefrontal lobe in β1 band,frontal lobe in θ,α and β bands,right central lobe in β1 band,parietal lobe in α1 and β1 bands,right parietal lobe in β2 band,right temporal lobe in δ and θ band,temporal lobe in α1 and β bands,left occipital lobe in α1 band,and occipital lobe in β1(|Z|>1.967,P<0.05).Conclusion Resting-state EEG power characteristically elevates in NP patients after SCI,and the reactivity to eye-open-ing reduces.

Objective:To analyze the relationship between 24-hour urinary calcium (24 h UCa) level and the risk of end-stage kidney disease (ESKD), cardiovascular disease (CVD), and all-cause mortality.Methods:In the Chinese Cohort Study of Chronic Kidney Disease, we examined 3 375 patients aged 18-74 years with CKD stages 1-4. Kaplan-Meier survival and Cox proportional hazard regression models were used to test a time-to-event association between levels of 24 h UCa and incidence of ESKD, CVD, and all-cause mortality.Results:During a follow-up of 4.17 (3.37, 5.20) years, 179, 145, 104 and 38 ESKD events occurred in <0.60, 0.60-, 1.20-, ≥2.32 mmol 24 h UCa groups. Higher levels of 24 h UCa (1.20-,≥2.32 mmol) were independently associated with a lower incidence of ESKD events in patients with CKD, with HR (95% CI) of 0.71 (0.54-0.93) and 0.43 (0.29-0.64), respectively. No significant associations with CVD and all-cause mortality endpoints were detected. Conclusion:Among patients with CKD, levels of 24 h UCa displayed an association with the risk of ESKD among patients with CKD stages 1-4.