Objective To investigate the regulatory role of the programmed cell death protein 1 (PD-1) and its ligand programmed cell death protein ligand 1 (PD-L1) signaling on the subtypes and functions of natural killer (NK) cells at the maternal-fetal interface during the second trimester in mice following Toxoplasma gondii infection during the first trimester. Methods Twelve 6- to 8-week-old female mice of the C57BL/6J strain were divided into a control group and an infection group, of 6 mice in each group. On the 6.5th day of pregnancy (Gd6.5), each pregnant mouse in the infection group was intraperitoneally injected with 150 tachyzoites of the Toxoplasma gondii PRU strain, while mice in the control group were injected with an equal volume of physiological saline. On the 12.5th day of pregnancy (Gd12.5), uterus and placenta tissues were sampled from pregnant mice for pathological observations, and the mRNA expression levels of PD-1, PD-L1, and tumor necrosis factor-α (TNF-α) were quantified in uterus and placenta tissues. The PD-1 and DX5 expression was measured on NK cells at the maternal-fetal interface using flow cytometry. In addition, the in vitro JEG-3 trophoblast cells and NK-92MI cells co-culture system was established as the control group, and the addition of T. gondii tachyzoites in the co-culture system served as the infection group. The PD-1, PD-L1, and DX5 mRNA expression was quantified in cells using real-time fluorescence quantitative reverse transcription PCR (RT-qPCR) assay, and the TNF-α concentration was measured in the cell culture supernatant using enzyme-linked immunosorbent assay (ELISA). Results On Gd12.5, clear and intact cellular structures of placental decidual tissues were seen in pregnant mice in the control group, with no remarkable abnormal changes found in the uterine columnar epithelial cells, and inflammatory cell infiltration and blood stasis at varying degrees were found in uterine and placental tissues from pregnant mice in the infection group. The relative PD-1, PD-L1, and TNF-α mRNA expression was (1.004 ± 0.004), (1.001 ± 0.001), and (1.001 ± 0.001) in uterine tissues from pregnant mice in the control group and (2.480 ± 0.720), (3.355 ± 0.920), and (2.391 ± 0.073) in the infection group, respectively. The relative PD-1, PD-L1, and TNF-α mRNA expression was (1.007 ± 0.010), (1.006 ± 0.006), and (1.001 ± 0.001) in the uterine tissues in the control group and (6.948 ± 1.918), (3.225 ± 1.034), and (1.536 ± 0.150) in the infection group, respectively. The relative PD-1, PD-L1, and TNF-α mRNA expression was higher in both the uterine (t = 3.55, 4.43 and 33.02, all P values < 0.05) and placental tissues (t = 5.36, 3.72 and 6.18, all P values < 0.05) in the infection group than in the control group. Flow cytometry showed that the proportions of PD-1⁺ NK cells, PD-1⁺ DX5⁺ NK cells, and DX5⁺ NK cells were (12.200 ± 1.082)%, (9.373 ± 7.728)%, and (44.000 ± 4.095)% in uterine tissues from pregnant mice in the control group, and (21.733 ± 1.630)%, (18.767 ± 1.242)%, and (73.367 ± 0.611)% in the infection group, respectively. The proportions of PD-1⁺ NK cells, PD-1⁺ DX5⁺ NK cells, and DX5⁺ NK cells were (1.100 ± 0.510)%, (2.277 ± 1.337)%, and (96.167 ± 2.831)% in placental tissues from mice in the control group, and (26.867 ± 9.722)%, (23.433 ± 6.983)%, and (82.467 ± 2.248)% in the infection group, respectively. The proportions of PD-1⁺ NK cells (t = 8.45, P < 0.05) and DX5⁺ NK cells (t = 12.29, P < 0.05) were higher in uterine tissues from pregnant mice in the infection group than in the control group, and no significant difference was seen in the proportion of PD-1⁺ DX5⁺ NK cells (Z = -1.09, P > 0.05). The proportions of PD-1⁺ NK cells (t = 4.58, P < 0.05) and PD-1⁺ DX5⁺ NK cells (t = 5.15, P < 0.05) were higher in placental tissues from pregnant mice in the infection group than in the control group, while the proportion of DX5⁺ NK cells was lower in the infection group than in the control group (t = -6.56, P < 0.05). RT-qPCR assay revealed that the relative PD-1, PD-L1, and DX5 mRNA expression was (1.010 ± 0.005), (1.002 ± 0.003), and (1.001 ± 0.001) in the JEG-3 cells and NK92MI cells co-culture system and (3.638 ± 1.258), (0.397 ± 0.158), and (4.267 ± 1.750) in the control group, and ELISA measured that the TNF-α concentration was higher in the cell culture supernatant in the infection group [(22.056 ± 3.205) pg/mL] than in the control group [(12.441 ± 0.001) pg/mL] (t = 5.20, P < 0.05). The PD-1(t = 3.62, P < 0.05) and DX5 mRNA expression (t = 3.23, P < 0.05) was higher in the infection group than in the control group, and the PD-L1 mRNA expression was lower in the infection group than in the control group (t = -6.63, P < 0.05). Conclusions Following T. gondii infection, both PD-L1 expression and PD-1 expression on DX5⁺ NK cells at the maternal-fetal interface are upregulated in mice during the second trimester; however, the proportion of DX5⁺ NK cells decreases. These findings suggest that PD-1/PD-L1 signaling may suppress NK cell functions by modulating DX5⁺ NK cell subsets.

Objective To investigate the causes and factors affecting unplanned reoperation,and to provide a reference basis for reducing the incidence of unplanned return of the patient to the operating room for reoperation.Methods Surgical data from the hospital was extracted spanning from January to December 2022,and subjected to a descriptive analysis of the overall situation,departmental distribution,primary reasons,and patient referrals related to unplanned reoperations in the hospital,and analyzed factors contributing to unplanned reoperations in the hospital using binary logistic regression.Results In 2022,130 unplanned reoperations were reported in this hospital,corresponding to an incidence of 0.35％.Patients who required unplanned reoperation were predominantly male(63.08％).The majority had surgical incision grade of category 0(46.92％),and surgeries were classified as levels 3 and 4(80.77％).Furthermore,88.46％of the surgeries were performed by surgeons with advanced degrees or higher.The common causes were postoperative bleeding,failure to achieve the desired result,need for the condition,probing for the cause,and occurrence of leakage or fistula,collectively accounting for 50.00％of the cases.Key factors contributing to unplanned reoperations were sex,type of surgical incision,and incision healing grade;among which male patients(OR=1.733,P=0.006),patients with class Ⅰ surgical incision(OR=2.909,P=0.004),and patients with incision grade B healing(OR=6.565,P＜0.001)showed a higher propensity for unplanned reoperations.Conclusion Hos-pitals should emphasize monitoring and managing unplanned reoperations by improving perioperative supervision,conducting thorough root cause analyses,and focusing on continuous quality improvement to enhance surgical outcomes and patient safety.

Objective To investigate the protective effect and mechanism of the antioxidant Lutein in a mouse model of dry age-related macular degeneration(AMD)induced by hydroquinone.Methods Twenty-four specific pathogen-free(SPF)grade male C57BL/6 mice,aged 6-8 weeks,were randomly divided into 3 groups(n=8 per group).The control group was fed a standard diet and water for 3 months.The model group and the drug intervention group received 8 g·L-1 hydroquinone in drinking water combined with a high-fat diet for 2 months to establish the dry AMD mouse model.After modeling,the model group resumed a standard diet and water for 1 month.The drug group received oral gavage daily at 8:00 AM,administered Lutein at 0.1 g per kg body weight(dissolved in distilled water),for 1 month.At the experimental endpoint,all mice were euthanized,and samples were collected for analysis.The ultrastructure of retinal pigment epithelial(RPE)cells was observed by electron microscopy.Serum activities of superoxide dismutase(SOD),catalase(CAT),and glutathione peroxidase(GSH-Px)were measured using a microplate reader.mRNA expression levels of nuclear factor ery-throid 2-related factor 2(Nrf2),heme oxygenase-1(HO-1),and glutamate-cysteine ligase(GCL)in retinal tissue were de-tected by real-time quantitative PCR.Protein expression levels of Nrf2,HO-1,and GCL in retinal tissue were determined by Western blot.Results In the model group,mitochondria and intracellular organelles in RPE cells exhibited vacuolar de-generation,with compromised structural integrity;simultaneously,microvilli were disorganized and significantly reduced in number.In the drug group,the mitochondrial structure of RPE cells was relatively well-preserved,with morphology largely normal;microvilli structure was clear,and density showed some recovery compared to the model group.Compared to the control group,serum activities of SOD,CAT,and GSH-Px were significantly decreased in the model group(all P＜0.01).Compared to the model group,serum activities of SOD,CAT,and GSH-Px were significantly increased in the drug group(all P＜0.05).Compared to the control group,retinal mRNA expression levels of Nrf2,HO-1,and GCL were significantly decreased in the model group(all P＜0.01).Compared to the model group,retinal mRNA expression levels of Nrf2,HO-1,and GCL were significantly increased in the drug group(all P＜0.01).Compared to the control group,retinal protein ex-pression levels of Nrf2,HO-1,and GCL were decreased in the model group(all P＜0.05).Compared to the model group,retinal protein expression levels of Nrf2,HO-1,and GCL were increased in the drug group(all P＜0.05).Conclusion The antioxidant Lutein promotes the expression of downstream target genes HO-1 and GCL by activating the Nrf2 signaling pathway,which not only enhances the biosynthesis levels of antioxidant enzymes(SOD,CAT,GSH Px),but also effec-tively inhibits oxidative stress response by enhancing autophagic activity.

Objective To investigate the protective effect and mechanism of the antioxidant Lutein in a mouse model of dry age-related macular degeneration(AMD)induced by hydroquinone.Methods Twenty-four specific pathogen-free(SPF)grade male C57BL/6 mice,aged 6-8 weeks,were randomly divided into 3 groups(n=8 per group).The control group was fed a standard diet and water for 3 months.The model group and the drug intervention group received 8 g·L-1 hydroquinone in drinking water combined with a high-fat diet for 2 months to establish the dry AMD mouse model.After modeling,the model group resumed a standard diet and water for 1 month.The drug group received oral gavage daily at 8:00 AM,administered Lutein at 0.1 g per kg body weight(dissolved in distilled water),for 1 month.At the experimental endpoint,all mice were euthanized,and samples were collected for analysis.The ultrastructure of retinal pigment epithelial(RPE)cells was observed by electron microscopy.Serum activities of superoxide dismutase(SOD),catalase(CAT),and glutathione peroxidase(GSH-Px)were measured using a microplate reader.mRNA expression levels of nuclear factor ery-throid 2-related factor 2(Nrf2),heme oxygenase-1(HO-1),and glutamate-cysteine ligase(GCL)in retinal tissue were de-tected by real-time quantitative PCR.Protein expression levels of Nrf2,HO-1,and GCL in retinal tissue were determined by Western blot.Results In the model group,mitochondria and intracellular organelles in RPE cells exhibited vacuolar de-generation,with compromised structural integrity;simultaneously,microvilli were disorganized and significantly reduced in number.In the drug group,the mitochondrial structure of RPE cells was relatively well-preserved,with morphology largely normal;microvilli structure was clear,and density showed some recovery compared to the model group.Compared to the control group,serum activities of SOD,CAT,and GSH-Px were significantly decreased in the model group(all P＜0.01).Compared to the model group,serum activities of SOD,CAT,and GSH-Px were significantly increased in the drug group(all P＜0.05).Compared to the control group,retinal mRNA expression levels of Nrf2,HO-1,and GCL were significantly decreased in the model group(all P＜0.01).Compared to the model group,retinal mRNA expression levels of Nrf2,HO-1,and GCL were significantly increased in the drug group(all P＜0.01).Compared to the control group,retinal protein ex-pression levels of Nrf2,HO-1,and GCL were decreased in the model group(all P＜0.05).Compared to the model group,retinal protein expression levels of Nrf2,HO-1,and GCL were increased in the drug group(all P＜0.05).Conclusion The antioxidant Lutein promotes the expression of downstream target genes HO-1 and GCL by activating the Nrf2 signaling pathway,which not only enhances the biosynthesis levels of antioxidant enzymes(SOD,CAT,GSH Px),but also effec-tively inhibits oxidative stress response by enhancing autophagic activity.

OBJECTIVE To investigate the current status and existing issues of hospital-associated infection manage-ment in non-public medical institutions,so as to provide data for the formulation of hospital-associated infec-tion management policies and the construction of a quality evaluation system for hospital-associated infection man-agement in non-public medical institutions.METHODS A qualitative research method was employed.In Dec.2023,semi-structured interviews were conducted with 38 directors of hospital-associated infection management depart-ments in primary,secondary and tertiary non-public medical institutions.The interview data were coded and ana-lyzed by Nvivo 12.0 software to refine themes.RESULTS Three themes were refined:the organizational system for hospital-associated infection management in non-public medical institutions had been basically established,but the division of functions and responsibilities was not yet fully clear,hospital-associated infection management had achieved certain results,including collaborating with other departments to standardize and implement infection control measures,enhancing staff awareness of infection control,and promoting the establishment of organization-al systems.There were issues in infection control works such as insufficient funding,personnel allocation not meeting requirements,and difficulties in implementing infection control measures.The most urgent assis-tance needed was to address the training and professional title promotion for full-time and part-time infection con-trol personnel.CONCLUSION Non-public medical institutions should strengthen staffing and training,enhance the pro-fessional capabilities of infection control personnel,and establish hospital-associated infection management standards that are tailored to the characteristics of non-public medical institutions at all levels.

Objective To investigate the causes and factors affecting unplanned reoperation,and to provide a reference basis for reducing the incidence of unplanned return of the patient to the operating room for reoperation.Methods Surgical data from the hospital was extracted spanning from January to December 2022,and subjected to a descriptive analysis of the overall situation,departmental distribution,primary reasons,and patient referrals related to unplanned reoperations in the hospital,and analyzed factors contributing to unplanned reoperations in the hospital using binary logistic regression.Results In 2022,130 unplanned reoperations were reported in this hospital,corresponding to an incidence of 0.35％.Patients who required unplanned reoperation were predominantly male(63.08％).The majority had surgical incision grade of category 0(46.92％),and surgeries were classified as levels 3 and 4(80.77％).Furthermore,88.46％of the surgeries were performed by surgeons with advanced degrees or higher.The common causes were postoperative bleeding,failure to achieve the desired result,need for the condition,probing for the cause,and occurrence of leakage or fistula,collectively accounting for 50.00％of the cases.Key factors contributing to unplanned reoperations were sex,type of surgical incision,and incision healing grade;among which male patients(OR=1.733,P=0.006),patients with class Ⅰ surgical incision(OR=2.909,P=0.004),and patients with incision grade B healing(OR=6.565,P＜0.001)showed a higher propensity for unplanned reoperations.Conclusion Hos-pitals should emphasize monitoring and managing unplanned reoperations by improving perioperative supervision,conducting thorough root cause analyses,and focusing on continuous quality improvement to enhance surgical outcomes and patient safety.

OBJECTIVE To investigate the current status and existing issues of hospital-associated infection manage-ment in non-public medical institutions,so as to provide data for the formulation of hospital-associated infec-tion management policies and the construction of a quality evaluation system for hospital-associated infection man-agement in non-public medical institutions.METHODS A qualitative research method was employed.In Dec.2023,semi-structured interviews were conducted with 38 directors of hospital-associated infection management depart-ments in primary,secondary and tertiary non-public medical institutions.The interview data were coded and ana-lyzed by Nvivo 12.0 software to refine themes.RESULTS Three themes were refined:the organizational system for hospital-associated infection management in non-public medical institutions had been basically established,but the division of functions and responsibilities was not yet fully clear,hospital-associated infection management had achieved certain results,including collaborating with other departments to standardize and implement infection control measures,enhancing staff awareness of infection control,and promoting the establishment of organization-al systems.There were issues in infection control works such as insufficient funding,personnel allocation not meeting requirements,and difficulties in implementing infection control measures.The most urgent assis-tance needed was to address the training and professional title promotion for full-time and part-time infection con-trol personnel.CONCLUSION Non-public medical institutions should strengthen staffing and training,enhance the pro-fessional capabilities of infection control personnel,and establish hospital-associated infection management standards that are tailored to the characteristics of non-public medical institutions at all levels.

Psoraleae Fructus （PF） is a non-toxic Chinese herbal medicine， while the liver injury caused by PF has aroused wide concern in recent years. At present， animal experiments and in vitro studies have been carried out to explore the mechanism， targets， and toxic components of PF in inducing liver injury， which， however， have differences compared with the actual conditions in clinical practice， and there are still some potential hepatotoxic components and targets of PF that have not been discovered. With the continuous progress in systems biology， establishing the drug-induced liver injury model and the liver injury prediction model based on network toxicology can reduce the cost of animal experiments， improve the toxicity prediction efficiency， and provide new tools for predicting toxic components and targets. To systematically explain the characteristics of liver injury in the application of PF and explore the potential hepatotoxic components and targets of PF， we reviewed the related articles published by China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， and PubMed from 1962 to 2021 and analyzed the characteristics and influencing factors of liver injury caused by PF in the patients. Furthermore， we summarized the chemical components of PF and the components entering blood. By reviewing the mechanism， targets， and components of PF in inducing liver injury that were discovered by in vivo and in vitro experiments， we summarized the known compounds in PF that may cause liver injury. Finally， the current methods for building the prediction model of PF-induced liver injury were summarized， and the predicted toxic components and targets were introduced. The possible factors of PF in causing liver injury were explained from three aspects： clinical characteristics， preclinical studies， and computer-assisted network prediction， which provide a reference for predicting the risk of PF-induced liver injury.

ObjectiveBased on ultra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS^E） technique， we identified qualitatively the metabolites of aristolochic acid（AAs） in rat in order to analyze the metabolic differences between water extract of Aristolochiae fructus（AFE） and Aristolochic acid Ⅰ（AAⅠ）. MethodSD rats were selected and administered AFE（110 g·kg^-1·d^-1） or AAⅠ（5 mg·kg^-1·d^-1） by oral for 5 days， respectively. Serum， urine and feces were collected after administration. Through sample pretreatment， ACQUITY UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm） was used with the mobile phase of 0.01% formic acid methanol（A）-0.01% formic acid water（B， containing 5 mmol·L^-1 ammonium acetate） for gradient elution（0-1 min， 10%B； 1-7 min， 10%-75%B； 7-7.2 min， 75%-95%B； 7.2-10.2 min， 95%B； 10.2-10.3 min， 95%-10%B； 10.3-12 min， 10%B） at a flow rate of 0.3 mL·min^-1. Positive ion mode of electrospray ionization（ESI⁺） was performed in the scanning range of m/z 100-1 200. In combination with UNIFI 1.9.4.053 system， the Pathway-MS^E was used to qualitatively analyze and identify the AAs prototype and related metabolites in biological samples（serum， urine and feces）， and to compare the similarities and differences of metabolites in rats in the subacute toxicity test between AFE group and AAⅠ group. ResultCompared with AAⅠ group， 6， 10， 13 common metabolites and 14， 20， 30 unique metabolites were identified in biological samples（serum， urine and feces） of AFE group， respectively. Moreover， the main AAs components always followed the metabolic processes of demethylation， nitrate reduction and conjugation. Compared with common metabolites in AAⅠ group， prototype components of AAⅠ in serum and most metabolic derivatives of AAⅠ［AAⅠa， aristolochic lactam Ⅰ（ALⅠ）a， 7-OHALⅠ and its conjugated derivatives］ in biological samples were significantly increased in AFE group（P<0.05， P<0.01）， except that the metabolic amount of ALⅠ in feces of AFE group was remarkably lowed than that of AAⅠ group（P<0.01）. In addition， a variety of special ALⅠ efflux derivatives were also identified in the urine and feces of the AFE group. ConclusionAlthough major AAs components in AFE all show similar metabolic rules as AAⅠ components in vivo， the coexistence of multiple AAs components in Aristolochiae Fructus may affect the metabolism of AAⅠ， and achieve the attenuating effect by increasing the metabolic effection of AAⅠ and ALⅠ.

In order to cultivate qualified oral clinicians, strengthen examination management, and strictly implement process assessment, Special Training Base of Oral and Maxillofacial Radiology in West China Hospital of Stomatology, Sichuan University, has implemented a whole-process and diversified assessment reform. In the part of process assessment, firstly the students were asked to fill in the workload form to give timely feedback on training and truly reflect attendance records; secondly, the performance of trainees in class was comprehensively evaluated in clinical training and theoretical teaching to improve their ability of comprehensive thinking of clinical problems. In the part of result assessment, the traditional theoretical assessment method was weakened, and the ability of comprehensive clinical research was strengthened. Trainees were guided to choose the topic flexibly and use standardized PPT format, and a comprehensive score was determined after assessment. Experts were invited to give their advice, so as to enhance the clinical confidence and scientific research confidence of trainees and help them expand their learning depth and breadth within the limited training time. The analysis of examination methods and assessment results shows that the "whole-process and diversified" assessment mode can truly reflect the training results of trainees and lay a solid foundation for further improvement and implementation of standardized training.