ObjectiveThis paper aims to investigate the differential mechanisms underlying the staged therapeutic effects of Qijia Rougan formula on liver fibrosis using proteomic technology. MethodsThe staged rat model of liver fibrosis was established by subcutaneous injection of carbon tetrachloride （CCl₄） and olive oil. One hundred and four SD rats were randomized into thirteen groups：a normal group，a two-week model group，a four-week model group，a six-week model group，an eight-week model group，a two-week Qijia Rougan formula group，a four-week Qijia Rougan formula group，a six-week Qijia Rougan formula group，an eight-week Qijia Rougan formula group，a two-week compound Biejia Ruangan tablet group，a four-week Compound Biejia Ruangan Tablet group，a six-week Compound Biejia Ruangan Tablet group，and an eight-week compound Biejia Ruangan tablet group. After two weeks of drug intervention，liver tissue and abdominal aortic blood samples were collected from the rats for testing. Hematoxylin-eosin （HE） staining，Masson staining，and Picro Sirius red staining were used to observe pathological damage and collagen fiber deposition in liver tissues. Immunohistochemistry （IHC） was employed to detect the contents of fibrosis markers in liver tissues. The contents of liver function indicators in the serum were measured using a fully automated biochemical analyzer，and the levels of liver fibrosis indicators in the serum were assessed by enzyme-linked immunosorbent assay （ELISA）. Liver tissues from the normal group，each model group，and each Qijia Rougan formula group were subjected to label-free quantitative proteomic analysis to identify differential proteins among the groups，with key proteins validated by Western blot. Finally，bioinformatics analysis was performed on the differential proteins. Results（1） The staged rat model of liver fibrosis constructed with CCl₄ and olive oil showed pathological results at the 2^nd，4^th，6^th，and 8^th weeks of modeling that were consistent with the Metavir standards for the F1，F2，F3，and F4 stages. Compared with those in the normal control group，the protein expressions of α-smooth muscle actin （α-SMA） and Collagen Ⅰ were significantly increased in each stage （P<0.05）. The levels of liver function indicators in the serum，including alanine aminotransferase （ALT），aspartate aminotransferase （AST），alkaline phosphatase （ALP），direct bilirubin （DBIL），and total bilirubin （TBil） in each model group，were significantly elevated in each stage （P<0.01）. The levels of liver fibrosis indicators in the serum，including procollagen Ⅲ peptide （PⅢP），type Ⅳ collagen（Ⅳ-C），hyaluronic acid （HA），and laminin （LN） in each model group，were significantly increased in each stage （P<0.05，P<0.01）. This study successfully established a staged rat model of liver fibrosis. （2） Compared with the model groups at each stage，the administration groups showed a reduction in hepatocyte ballooning degeneration，a more orderly arrangement of hepatocytes，and a decrease of inflammatory cell infiltration. The blue-stained collagen fibers became significantly thinner and finer，with reduced and narrowed fibrous septa. The areas of collagen fibers and Picro Sirius red staining were reduced （P<0.05）. The positive areas of α-SMA and Collagen Ⅰ expression were significantly decreased （P<0.05）. The levels of ALT，AST，ALP，DBIL，and TBil in the rats of the model groups at each stage were significantly reduced （P<0.05，P<0.01）. The levels of PⅢP，Ⅳ-C，HA，and LN in the rats of the model groups at each stage were significantly decreased （P<0.05）. Among these，the improvements in all indicators were most significant in the F3 stage （P<0.01）.（3） The proteomic results show that a total of 165 differential proteins exhibit a callback trend when comparing the model groups at four stages with the normal group，and when comparing the Qijia Rougan formula group with the model group. Western blot analysis reveals that the levels of NAD（P）H：quinone oxidoreductase 1 （NQO1），mitogen-activated protein kinase 1 （MAPK1），arginase 1 （Arg1），and glutathione S-transferase α1 （GSTA1） were consistent with the proteomic results. Bioinformatics results reveal that 165 differentially expressed proteins are enriched in multiple signaling pathways. Notably，signaling pathways such as drug metabolism-cytochrome P450，arginine biosynthesis，and the peroxisome proliferator-activated receptor （PPAR） signaling pathway were found to be closely associated with liver fibrosis，suggesting that the Qijia Rougan formula may exert its staged regulatory effects on liver fibrosis by regulating these pathways. ConclusionThe Qijia Rougan formula may achieve staged regulation of liver fibrosis by regulating drug metabolism-cytochrome P450，arginine biosynthesis，and the PPAR signaling pathway.

Objective: To assess the nutritional supply status of school meals for primary and secondary school students in Henan Province, so as to provide a basis for scientific guidance of school meals. Methods: During 2021-2023, 115 lunch and dinner samples were collected from 25 primary and secondary schools in Zhoukou, Anyang and Luoyang of Henan Province by a direct selection method, and 13 nutrients were determined for each sample. The nutrient supply was evaluated based on Nutrition Guidelines of School Meals and Reference Intake of Dietary Nutrients for Chinese Residents (2023 Edition). Mann-Whitney U test was used to compare the differences of nutritional supply between urban and rural schools. Results: The median values for energy (709.77 kcal,1 kcal=4.18 kJ), fat energy supply ratio (0.27) and carbohydrate energy supply ratio (0.55) in the 66 lunches and dinners from primary school were within the recommended range. The supply of protein (28.39 g) and sodium (1 464.59 mg) was excessive. The median values of zinc (2.62 mg) and dietary fiber (5.19 g) were lower than the reference values. No statistically significant differences were observed in the supply of 13 nutrients between urban and rural primary schools( U = 427.00 -633.00, P > 0.05 ). Among 49 samples from secondary schools, the median value of energy supply (930.02 kcal), carbohydrate energy ratio ( 0.54 ) and fat energy supply ratio(0.25) were within the recommended range; and the median values of protein (38.82 g) and sodium (2 556.80 mg) were higher than the standard; and the median values of calcium (250.32 mg) and vitamin B1 (0.16 mg) were lower than the standard. Additionally, the differences in the level of vitamin B2 ( U =372.00) and zinc ( U =375.00) between the urban and rural secondary schools were statistically significant ( P <0.05). Conclusion Nutrient supply of primary and secondary school meals in three cities of Henan Province is inadequate and imbalanced, and the recipe need to be further optimized and improved.

Objective To investigate the effect of tritiated water on the immune system of zebrafish and its potential molecular mechanism. Methods Zebrafish embryos (2.5 to 3 hours post-fertilization [hpf]) were exposed to 3.7 × 10⁴ Bq/mL tritiated water (tritiated water group), and those exposed to E3 culture medium were used as the control group. The mortality rate, hatching rate, deformity rate, heart rate, body length, yolk sac area, neutrophil count in the tail, immune-related gene expression, and immune-related protein expression of zebrafish in the two groups were determined. Then transcriptome technology was used to further analyze the possible mechanism of tritiated water affecting the immune system of zebrafish. Results Compared with the control group, zebrafish at 72 hpf in the tritiated water group had no significant changes in the mortality rate, hatching rate, deformity rate, body length, and yolk sac area((t = 0.9045, 0.5000, 1.0000, 0.7238, 0.0337, P = 0.4169, 0.6433, 0.3739, 0.4785, 0.9735), but had significantly increased heart rate(t = 4.575，P = 0.002). At 4 days post-fertilization (dpf), the neutrophil count in the tail of zebrafish in the tritiated water group was significantly increased(t = 2.563，P = 0.0196), the mRNA expression of TNF-α was significantly decreased(t = 2.891, P = 0.045), the protein expression of nuclear factor-kappa B (NF-κB) was significantly increased(t = 3.848, P = 0.018), and the protein expression of NLRP3 was significantly decreased(t = 14.98, P = 0.001). At 7 dpf, the neutrophil count in the tail and the protein expression levels of NF-κB, NLRP3, and interleukin-1β were significantly decreased(t = 3.772, 7.048, 15.620, 4.423, P = 0.014, 0.002, 0.0001, 0.012). Transcriptome sequencing revealed that differentially expressed genes were mainly enriched in the “neutrophil activation” and “platelet activation pathways” at 4 dpf and in the “neutrophil apoptosis”, “ferroptosis”, and “necroptosis” pathways at 7 dpf. Conclusion Tritiated water exposure induces a temporally dynamic immune response in zebrafish, potentially affecting immune homeostasis by regulating neutrophil activation and apoptosis, as well as the expression of NF-κB and NLRP3.

Objective To explore the characteristic changes in white matter microstructure in Parkinson's disease(PD)patients via automated fiber quantification(AFQ)technology,providing a basis for the identification and diagnosis of PD,and to analyze the feasibility of combining the AFQ method with support vector machine(SVM)in the diagnosis of PD.Methods Forty patients with primary PD(PD group)and 20 healthy controls(HC)(HC group)were prospectively selected.The AFQ technology was applied for white matter fiber tract analysis.Statistical analyses were performed using FSL(v6.0)software and SPSS 27.0 software.Independent-sample t-tests were conducted for comparisons between groups in AFQ analysis.The AFQ method was used to analyze the relationship between diffusion tensor imaging(DTI)parameters and Montreal Cognitive Assessment(MoCA)scores.Results(1)The results of AFQ analysis revealed that compared with the HC group,the PD group exhibited significantly lower fractional anisotropy(FA)values in the right cingulum bundle,left cingulum bundle hippocampus,and left uncinate fasciculus,with no differences in the FA values of the remaining 17 fiber tracts.Moreover,PD group demonstrated higher mean diffusivity(MD)values in the left cingulum bundle,left cingulum bundle hippocampus,left inferior frontal occipital fasciculus,left inferior longitudinal fasciculus,left superior longitudinal fasciculus,and left uncinate fasciculus.These differences were statistically significant(P<0.05),while no significant differences were found in the MD values of the remaining 14 fiber tracts.Furthermore,the MD values of the left inferior frontal occipital fasciculus,and left inferior longitudinal fasciculus were negatively correlated with the MoCA scores.(2)The classification results of SVM showed that the best results were achieved when combining the differential nodes of FA and MD as classification features,with an area under the curve(AUC)of 0.922,an accuracy of 84.81%,a sensitivity of 87.50%,and a specificity of 82.05%.Conclusion The DTI parameters in PD patients can serve as potential biomarkers for diagnosis.The AFQ methods provides an effective approach for detecting alterations white matter tract integrity,offering important insights for the identification and diagnosis of PD.The best results are achieved when combining the differential nodes of FA and MD as classification features.

Objective:To construct and evaluate a radiomics model for predicting perineural invasion in patients with intrahepatic cholangiocarcinoma (ICC).Methods:Clinical data of 144 patients with ICC undergoing surgery in the People’s Hospital of Zhengzhou University ( n=113) and the Affiliated Cancer Hospital of Zhengzhou University ( n=31) from January 2018 to June 2023 were retrospectively analyzed, including 80 males and 64 females, aged (58.8±10.1) years. The patients were randomly divided into a training set ( n=100) and a test set ( n=44) at a ratio of 7: 3. The former set was used to build the model for predicting perineural invasion, and the latter was used to evaluate the model. Enhanced CT images and clinical data of the patients were collected, and features related to perineural invasion were screened. A light gradient boosting machine was used to construct an imaging genomics model. The model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results:Univariate and multivariate logistic regression analysis showed that none of the clinical features were associated with neural invasion in ICC patients (all P>0.05). Six, 25, 32, and 37 radiomics features were obtained by screening the intratumoral, 2 mm peritumoral, 5 mm peritumoral, and 8 mm peritumoral regions, respectively. The area under the ROC curve for predicting perineural invasion in ICC patients was 0.849 (95% CI: 0.774-0.923) in the training set and 0.745 (95% CI: 0.597-0.894) in the test set for the intratumoral model, 0.966 (95% CI: 0.938-0.995) and 0.750 (95% CI: 0.604-0.896) for the 5mm peritumoral model, 0.936 (95% CI: 0.892-0.980) and 0.792 (95% CI: 0.644-0.939) for the 2mm peritumoral model, and 0.961 (95% CI: 0.929-0.992) and 0.689 (95% CI: 0.526-0.853) for the 8mm peritumoral model. The area under the ROC curve, accuracy, sensitivity, and specificity of the combined intratumoral and 5mm peritumoral model for predicting perineural invasion were 0.927 (95% CI: 0.878-0.976), 88.0%, 84.5%, and 89.8% in the training set, and 0.849 (95% CI: 0.737-0.960), 77.3%, 85.2%, and 72.0% in the test set, respectively. The calibration curve showed a deviation between the calibration curve of the combined intratumoral and 5mm peritumoral model and the ideal line, but it could achieve basic consistency. DCA showed that when the threshold was between 0.18 and 0.70, the combined intratumoral and 5mm peritumoral model could bring clinical net benefit to patients when predicting neural invasion. Conclusion:The intratumoral and 5mm peritumoral imaging genomics model based on enhanced CT features can effectively predict neural invasion and offer clinical benefits in patients with ICC.

People with AIDS are highly prone to opportunistic infections,among which pulmonary infections are the most common,with high incidence and fatality rates.How to effectively prevent or reduce the occurrence of HIV-related lung infections(HRLI)is of great practical significance.From the perspective of traditional Chinese medicine(TCM),HRLI and AIDS share common pathological mechanisms,including qi deficiency,spleen defi-ciency,phlegm-heat or phlegm-dampness obstructing the lungs.Based on the TCM theory of"preventing disease before it occurs",the three-level prevention approach includes:the first step"preventing disease before it occurs"emphasizes strengthening the body's defense mechanisms by tonifying the spleen and benefiting qi,and nourishing the lungs and kidneys to strengthen the exterior and protect the body;the second step"preventing the progression of disease once it occurs"emphasizes the removal of pathogenic factors while strengthening the body's defenses.Based on the principles of syndrome differentiation and treatment in TCM,focuses are kept on the spleen tonifying and phlegm resolving,pathogenic factors dispelling and dampness eliminating,while protecting the spleen and nourishing other organs.The third step"preventing relapse after recovery"emphasizes replenishing deficiencies and enhancing immunity.Adopting the three-level prevention approach and early intervention can reduce the inci-dence of HRLI,which is a new idea for the prevention and treatment of HRLI with TCM.

Objective:To investigate the short-term efficacy of robotic versus laparoscopic-assisted right hemicolectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 99 patients of right colon cancer who were admitted to Tianjin Medical University General Hospital from January 2020 to December 2023 were collected. There were 50 males and 49 females, aged 69(range, 26?89)years. Of the 99 patients, 41 patients undergoing robotic-assisted right hemicolectomy were divided into the robotic group, and 58 patients undergoing laparoscopic-assisted right hemicolectomy were divided into the lapa-roscopic group. Patients received robotic-assisted or laparoscopic-assisted right hemicolectomy operated by the same major surgeon. Observation indicators:(1) propensity score matching status and com-parison of clinical data of patients between the two groups after matching; (2) intraoperative and postoperative conditions.Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶1 nearest neighbor matching method. The caliper value was set as 0.1. Results:(1) Propensity score matching status and comparison of clinical data of patients between the two groups after matching. Of the 99 patients, 82 patients were successfully matched, with 41 cases in each of the robotic group and the laparoscopic group. After propensity score matching, the elimination of history of abdominal operation confounding bias ensured comparability. (2) Intraoperative and postoperative conditions. After propensity score matching, the operation time of the robotic group was 215(range, 130?340)minutes, the volume of intraoperative blood loss was 50(range, 10?400)mL, the number of lymph node dissected was 21(range, 5?55), the number of intensive care unit stay was 15, time to postoperative first flatus was 3(range, 1?12)days, time to postoperative first food intake was 4(range, 2?14)days, duration of postoperative hospital stay was 8(range, 5?25)days. The above indicators of the laparoscopic group were 210(range, 140?370)minutes, 50(range, 5?150)mL, 19(range, 5?34),20, 3(range, 0?9)days, 5(range, 2?10)days, 8(range, 6?17)days, respectively. There was no significant difference in the above indicators between patients of the two groups ( Z=?0.94, ?1.87, ?1.32, χ2=1.25, Z=0.13, ?0.83, ?0.65, P>0.05). There was no patient converted to open operation in the robotic group, versus 1 patient converted to open operation in the laparoscopic group, showing no significant difference between patients of the two groups ( P>0.05). There were 6 cases in the robotic group and 4 cases in the laparoscopic group with complications, showing no significant difference between the two groups ( χ2=0.46, P>0.05). Both groups of patients achieved R 0 resection and had no readmission 30 days after surgery. The hospital expense was (11.0±1.8)×10 4 yuan of the robotic group, versus (9.0±1.7)×10 4 yuan of the laparoscopic group, showing a significant difference between the two groups ( t=?5.27, P<0.05). Conclusion:Robot-assisted right hemicolectomy is non inferior to laparoscopic-assisted right hemicolectomy in safety and efficacy, but with higher hospitalization costs.

The construction of a medical safety system based on the medical core quality and safty systems is the foundation of the hospital. Multi-campus operation coordinated development is key to the high-quality development of public hospitals and the balanced distribution of high-quality medical resources. Building a medical safety system that comfoms to the specialized layout and operation of branch districts is very important the construction of multi-campus hospitals. In January 2023, Xidan Campus of Peking Union Medical College Hospital established a medical safety system that was compatible with its development, based on the construction of the medical core quality and safty system. The system covered four dimensions: early identification, early assessment, early intervention, and fast response. It included high-risk surgical evaluation and filing, early warning of nursing rooms, periodic medical safety rounds, and rapid response teams and cross hospital transportation of critical care rapid response teams. As of June 2024, the hospital had recorded 570 high-risk surgeries with no unplanned secondary surgeries or unplanned readmissions; Reported nursing warnings 68 times, initiated 93 emergency treatments and cross hospital transfers. All emergency patients received early warning assessments and completed graded and classified transfers and management, effectively ensuring patient safety. This practice could provide references for other multi-campus hospitals to promote the construction and development of medical safety systems.

Objective:To explore the value of intraoperative multimodal monitoring in superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in evaluating hemodynamic parameters and blood-brain barrier disruption, as well as their correlations with postoperative perfusion changes.Methods:A retrospective case series study was performed; 60 patients with ischemic cerebrovascular diseases admitted to Department of Neurosurgery, Lianyungang Clinical Medical College of Nanjing Medical University (Lianyungang First People's Hospital) from March 2023 to October 2024 were selected, including 17 patients with moyamoya disease and 43 patients with chronic internal carotid artery occlusion and/or chronic symptomatic MCA stenosis/occlusion. All patients were confirmed by CTA or DSA and underwent STA-MCA M4 segment bypass surgery. Intraoperatively, microvascular Doppler ultrasound (MDU), sodium fluorescein angiography, and indocyanine green angiography combined with Flow800 (ICG-Flow800) were used to monitor the blood-brain barrier disruption grade, as well as the peak systolic velocity (PSV) and blood flow direction of the STA and recipient artery before and after arterial anastomosis. Cerebral blood perfusion improvement was reexamined by CT perfusion (CTP) 7 days and 1 month after surgery. These 60 patients were divided into a group with blood flow into the sylvian fissure (inflow group, n=27) and a group with blood flow out of the sylvian fissure (outflow group, n=33) according to the direction of recipient artery blood flow before arterial anastomosis, and further subdivided into subgroups with PSV≤10 cm/s and >10 cm/s based on the recipient artery PSV. Clinical and imaging data of these patients were collected and analyzed as follows: (1) CTP parameters such as cerebral blood volume, cerebral blood flow, mean transit time, and time to peak before surgery, 7 days after surgery, and 1 month after surgery were compared; (2) differences between the recipient artery PSV before arterial anastomosis and recipient artery exiting sylvian fissure velocity (RA.EXV) or recipient artery entering sylvian fissure velocity (RA.ESV) of the recipient artery after anastomosis were compared; (3) differences in ICG-Flow800 fluorescence intensity curve parameters such as delay time, rise time, curve slope, time to peak, and maximum fluorescence intensity of the cerebral surface veins before and after arterial anastomosis were compared; (4) spearman rank correlation was used to analyze the correlation of recipient artery PSV before arterial anastomosis with preoperative CTP parameters in all patients, the correlations of RA.ESV in the inflow group or RA.EXV in the outflow group with CTP parameters 7 days after surgery, and the correlations of blood-brain barrier disruption grade with preoperative CTP parameters, recipient artery PSV before arterial anastomosis, and RA.ESV or RA.EXV after arterial anastomosis in all patients. Results:(1) The blood flow direction of all recipient arteries became bidirectional after surgery. Cerebral blood perfusion improved to varying degrees after surgery: the mean transit time 7 days and 1 month after surgery, and cerebral blood flow 1 month after surgery were significantly higher compared with those before surgery ( P<0.05). (2) Regardless of the blood flow direction (into or out of the sylvian fissure), the RA.ESV or RA.EXV after anastomosis was significantly higher than the recipient artery PSV before anastomosis when the recipient artery PSV≤10 cm/s ( P<0.05). (3) For all patients, the ICG-Flow800 fluorescent intensity curve parameters of cerebral surface veins after anastomosis improved significantly compared with that before anastomosis ( P<0.05). (4) Preoperative recipient artery PSV was positively correlated with preoperative CBF in all patients ( rs=0.445, P=0.020). In the inflow group, postoperative RA.ESV was positively correlated with Tmax 7 days after surgery ( rs=0.490, P=0.009). The blood-brain barrier disruption grade was positively correlated with preoperative Tmax in all patients ( rs=0.478, P=0.012). Conclusion:Intraoperative multimodal monitoring in STA-MCA bypass surgery can provide surgeons with detailed hemodynamic parameters and blood-brain barrier disruption data, enabling real-time evaluation of surgical outcomes to optimize operative decision-making.

Objective:To evaluate the effect of superficial temporal artery to middle cerebral artery (STA-MCA) bypass on cognitive function, cerebral perfusion, and integrity of white matter tracts by comparing cognitive function scores, fractional anisotropy (FA), time to maximum (T max), and cerebral blood flow (CBF) at different time points before and after STA-MCA bypass, and analyze the relations of cognitive function with cerebral perfusion and white matter tract integrity so as to provide evidences for treatment of moyamoya disease (MMD) patients with mild cognitive impairment. Methods:A retrospective analysis was performed; 30 MMD patients with mild cognitive impairment received STA-MCA bypass at Department of Neurosurgery, Lianyungang Hospital Affiliated to Xuzhou Medical University (Lianyungang First People's Hospital) from January 2023 to August 2024 were enrolled. Before and 1, 3, and 6 months after STA-MCA bypass, all patients accepted Montreal cognitive assessment (MoCA), CT perfusion imaging, and diffusion tensor imaging (DTI). Differences in MoCA score, CBF, T max, and FA at different time points before and after surgery were compared. Spearman rank correlation was used to analyze the correlation of MoCA score with cerebral perfusion parameters and FA. Results:(1) In these MMD patients with mild cognitive impairment, CBF 3 and 6 months after STA-MCA bypass was significantly increased compared with that before STA-MCA bypass, and CBF 6 months after STA-MCA bypass was significantly higher than that 1 and 3 months after STA-MCA bypass ( P<0.05); T max 1, 3 and 6 months after STA-MCA bypass was significantly shortened compared with that before STA-MCA bypass, and T max 6 months after STA-MCA bypass was significantly shortened than that 1 and 3 months after STA-MCA bypass ( P<0.05); FA 6 months after STA-MCA bypass was significantly increased compared with that before, and 1 and 3 months after STA-MCA bypass ( P<0.05); MoCA score 6 months after STA-MCA bypass was significantly increased compared with that before and 1 month after STA-MCA bypass ( P<0.05). (2) In MMD patients with mild cognitive impairment, the preoperative MoCA score was positively correlated with preoperative CBF and FA ( r s=0.428, P=0.018; r s=0.438, P=0.015) and negatively correlated with preoperative T max ( r s=-0.380, P=0.039); 6 months after STA-MCA bypass, the MoCA score was positively correlated with CBF and FA ( r s=0.365, P=0.047; r s=0.400, P=0.028) and negatively correlated with T max ( r s=-0.371, P=0.043). Conclusion:STA-MCA bypass can improve cerebral perfusion, white matter fiber tract repair and cognitive function in MMD patients with mild cognitive impairment, and improvement of cognitive function is related to cerebral perfusion and white matter fiber tract repair.