ObjectiveTo investigate the potential mechanism of Danggui Buxuetang （DBT） in the treatment of vascular dementia （VAD）. MethodsSixty male SD rats were randomly assigned to the sham-operated group， model group， DBT low-， medium-， and high-dose groups， and the donepezil group. Except for the sham-operated group， rats in all other groups underwent bilateral common carotid artery ligation. After successful modeling， DBT was administered at doses of 9.2， 18.4， 36.8 g·kg^-1 for the low-， medium-， and high-dose groups， respectively， while the donepezil group received 3 mg·kg^-1 donepezil solution by gavage once daily. After 4 consecutive weeks of drug treatment， rats underwent the Morris water maze test， novel object recognition test， Nissl staining to observe hippocampal neurons， and immunofluorescence staining to detect the expression of neuronal nuclear protein （NeuN） in the hippocampus. Western blot was used to assess the expression of PTEN-induced kinase 1 （PINK1）， Parkin， microtubule-associated protein 1 light chain 3Ⅱ （LC3Ⅱ）， B-cell lymphoma-2 （Bcl-2）， and Bcl-2-associated X protein （Bax）. Transmission electron microscopy was used to observe hippocampal neuronal ultrastructure. Real-time PCR was used to detect the expression of NADPH oxidase subunits p22^phox and p47^phox in hippocampal tissues. The levels of malondialdehyde （MDA）， glutathione （GSH）， superoxide dismutase （SOD）， and total antioxidant capacity were measured to evaluate oxidative stress levels. ResultsIn the Morris water maze test， escape latency changed significantly over time in all groups except the model group. Compared with the sham-operated group， the model group showed significantly prolonged escape latency （P<0.01）. Compared with the model group， rats in the DBT groups and the donepezil group exhibited significantly shorter escape latency （P<0.05， P<0.01）. The number of crossings over the original platform was significantly reduced in the model group compared with the sham-operated group （P<0.01）， whereas rats in the DBT and donepezil groups showed significantly increased platform crossings compared with the model group （P<0.05， P<0.01）. Compared with the sham-operated group， exploration time of new objects was significantly reduced in the model group （P<0.01）. Compared with the model group， exploration time of new objects increased significantly in the medium- and high-dose DBT groups and the donepezil group （P<0.05， P<0.01）， while no significant change was observed in the low-dose DBT group. Compared with the high-dose DBT group， rats in the donepezil group had significantly prolonged escape latency and reduced platform crossings and new-object exploration time （P<0.05）. Nissl staining showed decreased density of healthy neurons in the CA1 and CA3 regions of the hippocampus in the model group， with loss of Nissl bodies and nuclear atrophy or disappearance. In the high-dose DBT group， neuronal density in CA1 and CA3 increased， with neurons arranged closely and displaying normal morphology. Immunofluorescence showed that compared with the sham-operated group， the hippocampal NeuN⁺ cell count in the VAD model group was significantly decreased（P<0.01）， compared with the VAD model group， the hippocampal NeuN⁺ cell count in the high-dose DBT group was significantly increased（P<0.01）. Compared with the sham-operated group， the expression of PINK1， Parkin， LC3Ⅱ， and Bax proteins was significantly increased（P<0.01）， while the expression of Bcl-2 was significantly decreased in the VAD model group（P<0.01）. Compared with the VAD model group， the high-dose DBT group showed significantly decreased expression of PINK1， Parkin， LC3Ⅱ， and Bax proteins（P<0.01）and significantly upregulated Bcl-2 expression（P<0.01）. The medium-dose DBT group exhibited significantly reduced expression of Parkin， LC3Ⅱ， and Bax proteins（P<0.05，P<0.01） and significantly increased Bcl-2 expression（P<0.01）， while no statistically significant differences were observed in the low-dose DBT group. Transmission electron microscopy showed mitochondrial pyknosis， thickened cristae， increased electron density， and the presence of mitochondrial autophagy in the model group. In contrast， hippocampal neurons in the high-dose DBT group contained abundant mitochondria with intact morphology， clear cristae， and uniform matrix. Compared with the sham-operated group， total antioxidant capacity， SOD activity， and GSH levels were significantly decreased， while MDA levels were significantly increased in the model group （P<0.01）. Compared with the model group， total antioxidant capacity and antioxidant levels （SOD， GSH） increased significantly， and MDA decreased significantly in the medium- and high-dose DBT groups （P<0.01）， while no significant changes were observed in the low-dose DBT group. Compared with the sham-operated group， mRNA expression of p22^phox and p47^phox was significantly increased in the model group （P<0.01）. Compared with the model group， expression of p22^phox and p47^phox was significantly decreased in the DBT groups （P<0.05， P<0.01）. ConclusionDBT may exert neuroprotective effects by regulating PINK1/Parkin-mediated mitochondrial autophagy， thereby improving learning and memory abilities and treating VAD.

OBJECTIVE To explore the potential mechanism by which drug-containing serum of Dianxianqing granules （DXQ） inhibits microglial ferroptosis. METHODS Male SD rats were given normal saline and Dianxianqing granules solution via intragastric administration to prepare normal serum and DXQ， respectively. Mice microglia BV2 cells were collected and successfully transfected with a negative control small interfering RNA （si-NC）， and then they were included in the si-NC group and cultured under normal conditions. Cells successfully transfected with small interfering RNA targeting glutathione peroxidase 4 （GPX4） （si-GPX4） were divided into the si-GPX4 group， the CsA group （treated with 1 μmol/L cyclosporine A）， and the DXQ- L， DXQ-M and DXQ-H groups （treated with 5%， 7% and 10% DXQ， respectively）. These groups were subsequently treated with their corresponding drug solutions and ferroptosis inducer Erastin （10 μmol/L）. The intracellular levels of total iron ions， glutathione （GSH）， reactive oxygen species （ROS）， and the expression of mitochondrial superoxide were determined in each group after 48 h of treatment. Additionally， mitochondrial membrane potential， the opening degree of mitochondrial permeability transition pore （MPTP）， and mRNA expressions of GPX4 and cyclophilin D （CypD） were detected. Furthermore， the expressions of ferroptosis-related proteins[GPX4， transferrin receptor 1 （TfR1） and ferritin heavy chain 1 （FTH1）]， as well as MPTP-related proteins [adenine nucleotide translocator （ANT）， cytochrome C （CytC）， mitochondrial calcium uniporter （MCU） and CypD] were assessed. RESULTS Compared with si-NC group， the levels of total iron ions and ROS， the expression level of mitochondrial superoxide， the opening degree of MPTP， protein and its mRNA expressions of CypD as well as protein expressions of TfR1 and MCU were increased or up-regulated significantly （P＜0.01）； however， GSH content， mitochondrial membrane potential， protein and mRNA expressions of GPX4， and protein expressions of FTH1， ANT and CytC were decreased or down-regulated significantly （P＜0.01）. Compared with the si-GPX4 group， the cells in the DXQ-M， DXQ-H groups showed a general improvement in the above quantitative indicators （P＜0.01 or P＜0.05）. CONCLUSIONS DXQ can enhance antioxidant capacity by activating the GSH/GPX4 pathway， regulate the expressions of TfR1 and FTH1 protein to correct iron ion homeostasis， inhibit excessive opening of MPTP to improve mitochondrial function， and ultimately suppress microglial ferroptosis.

This study was aimed at preliminarily investigating the genetic and antimicrobial resistance characteristics of Salmonella Alachua isolates through whole-genome analyses.Five Salmonella Alachua isolates from various sources(both hu-man and non-human)were collected and identified.Phenotype and serotype verification,antimicrobial susceptibility testing,and whole-genome sequencing were performed.Virulence genes,antimicrobial resistance genes,and plasmid replicons were predicted according to globally available Salmonella Alachua genomic data.A phylogenetic tree was constructed to explore the genetic background.The first report of Salmonella Alachua in China emerged in Shanghai in 2015,and patients presented pri-marily with diarrhea.The isolates have been found predominantly in the eastern and southern coastal regions.Among the five i-solates analyzed,four belonged to sequence type(ST)2061,and one belonged to ST1298.All isolates were susceptible to most commonly used clinical antibiotics.Whole-genome analyses revealed that two ST2061 strains carried the blaKPC-2 gene,and one ST1298 strain carried the fosA7 gene.Phylogenetic analysis of global Salmonella Alachua populations indicated that the ST2061 clone belonged to the C1 clade,which was closely related to strains from the UK,whereas the ST1298 clone was found in the C4 clade,a globally disseminated fosA 7-positive lineage.This study provides initial insights into the genetic and antimi-crobial resistance characteristics of Salmonella Alachua in China,highlighting the presence of strains carrying blaKPC-2 and fo-sA7 genes.These findings may provide a reference for future large-scale molecular epidemiological surveillance and source-trac-ing efforts,and they underscore the importance of enhanced resistance monitoring for Salmonella Alachua.

Aim To investigate the intestinal protection and possible mechanism of magnolol(MG)in newborn rats with necrotizing enterocolitis(NEC).Methods The rats were randomly divided into control group(Ctrl group),model group(NEC group)and treatment group(MG group).The NEC model was induced by hypoxia,cold stimulation,deep formula milk and LPS intragastric administration in 7-day-old rats for four days.They were killed after five days of treatment with MG(20 mg·kg-1).HE staining was used to observe the intestinal pathological injury.Western blot was used to detect the expressions of IL-1 β,TNF-α,NL-RP3,ASC,caspase-1 and tight junction protein in the distal ileum of rats.Colon contents were collected for 16S rDNA sequencing to understand the gut microbio-ta.Results MG improved the body mass and intesti-nal injury of NEC neonatal rats.The expressions of in-testinal IL-1β,TNF-α,NLRP3,ASC and caspase-1 proteins were down-regulated,and the expressions of Claudin,Occludin and ZO-1 proteins were up-regula-ted.16S rDNA showed that MG increased the diversity of intestinal flora,and at the phylum level,MG in-creased the abundance of firmicutes and bacteroides in NEC model,and decreased the abundance of pro-teobacteria.At the genus level,MG treatment in-creased the abundance of Lactobacillus,unclassified_Muribaculaceae,Racteroides,but decreased the abun-dance of Escherichia_Shigella,Rodentibacter and Fuso-bacterium.Conclusion MG intervention can protect the intestinal tract of NEC rats by potentially improving barrier function,and regulating the intestinal microbiota through the NLRP3/ASC/caspase-1 signaling pathway.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective:To analyze the effectiveness of different localization methods in colostomy localization among rectal cancer patients with colostomy.Methods:A total of 158 rectal cancer patients who underwent laparoscopic Dixon operation combined with temporary ileostomy from January 2020 to December 2022 at the Peking University Third Hospital were retrospectively selected for the study. Patients were divided into a traditional localization group ( n=86) and a modified localization group ( n=72) based on preoperative colostomy localization methods. The preoperative colostomy localization adoption rate and the incidence of peristoma fecal dermatitis were compared between the two groups. Results:The preoperative colostomy localization adoption rate in modified localization group was higher than that in traditional localization group, and the incidence of peristoma fecal dermatitis was lower than that in traditional localization group, with statistically significant differences ( P<0.05) . Conclusions:The modified rectangular area localization method is accurate for colostomy localization and reduces the risk of colostomy complications in postoperative patients.

Cervical spine health issues not only seriously affect patients' quality of life but also impose a heavy burden on the social healthcare system. Existing guidelines lack sufficient clinical guidance on lifestyle and work habits, such as exercise, posture, daily routine, and diet, making it difficult to meet practical needs. To address this, relying on the China Association of Chinese Medicine, Wangjing Hospital of China Academy of Chinese Medical Sciences took the lead and joined hands with more than ten institutions to form a multidisciplinary guideline development group. For the first time, the group developed the Guidelines for Cervical Spine Health Intervention based on evidence-based medicine methods, strictly following the standardized procedures outlined in the World Health Organization Handbook for Guideline Development and the Guiding Principles for the Formulation/Revision of Clinical Practice Guidelines in China (2022 Edition). This proposal systematically explains the methods and steps for developing the guideline, aiming to make the guideline development process scientific, standardized, and transparent.
Humans ; Practice Guidelines as Topic/standards* ; Cervical Vertebrae ; China

In most types of erectile dysfunction, particularly in advanced stages, typical pathological features observed are reduced parenchymal cells coupled with increased tissue fibrosis. However, the current treatment methods have shown limited success in reversing these pathologic changes. Recent research has revealed that changes in autophagy levels, along with alterations in apoptosis and fibrosis-related proteins, are linked to the progression of erectile dysfunction, suggesting a significant association. Autophagy, known to significantly affect cell fate and tissue fibrosis, is currently being explored as a potential treatment modality for erectile dysfunction. However, these present studies are still in their nascent stage, and there are limited experimental data available. This review analyzes erectile dysfunction from a pathological perspective. It provides an in-depth overview of how autophagy is involved in the apoptotic processes of smooth muscle and endothelial cells and its role in the fibrotic processes occurring in the cavernosum. This study aimed to develop a theoretical framework for the potential effectiveness of autophagy in preventing and treating erectile dysfunction, thus encouraging further investigation among researchers in this area.
Male ; Humans ; Autophagy/physiology* ; Apoptosis/physiology* ; Erectile Dysfunction/physiopathology* ; Fibrosis ; Penis/pathology* ; Animals ; Endothelial Cells/pathology* ; Myocytes, Smooth Muscle/pathology*

Objective:To explore the efficacy and safety of the ballistic-ultrasound-negative pressure three-in-one energy platform (Trilogy) for micro-channel percutaneous nephrolithotomy (mini-PCNL).Methods:A retrospective analysis was conducted on the clinical data of 140 patients with upper urinary tract stones treated at Tianjin Medical University Second Hospital from February to October 2024. All patients underwent mini-PCNL and were divided into the holmium laser group and the Trilogy group based on the stone fragmentation equipment used during the procedure. There were 69 patients in the holmium laser group and 71 in the Trilogy group. The two groups had similar mean ages (55.1±10.2 years vs. 53.4±10.8 years), male patient proportions (50 cases, 72.5% vs. 50 cases, 70.4%), body mass indices (25.2±3.6 kg/m 2 vs. 25.3±4.0 kg/m 2), incidence rates of hypertension (29 cases, 42.0% vs. 31 cases, 43.7%), diabetes (15 cases, 21.7% vs. 12 cases, 16.9%), mean cumulative stone lengths (39.2±12.6 mm vs. 35.9±14.8 mm), total stone volumes preoperatively (6 184.3±3 653.5 mm 3 vs. 5 644.9±4 173.8 mm 3), mean CT values for stones (1 138.2±264.3 HU vs. 1 151.3±208.0 HU), stone locations (ureter 14 cases, 20.3% vs. 22 cases, 31.0%; kidney 48 cases, 69.6% vs. 39 cases, 54.9%; both ureter and kidney 7 cases, 10.1% vs. 10 cases, 14.1%), preoperative mean urinary white blood cell counts [9.6(3.6, 31.2) cells/HPF vs. 11.9(3.8, 34.5) cells/HPF], proportions of patients with preoperative urinary white blood cells (+ + + ; 23 cases, 33.3% vs. 25 cases, 35.2%), nitrite positivity rates (4 cases, 5.8% vs. 3 cases, 4.2%), and urine culture positivity rates (12 cases, 17.4% vs. 18 cases, 25.4%) showed no statistically significant differences. The proportion of patients with moderate or higher hydronephrosis in the holmium laser group was lower than that in the Trilogy group (32 cases, 46.4% vs. 47 cases, 66.2%, P=0.018). The holmium laser group utilized holmium laser lithotripsy, where stone fragments were either flushed out with a vortex or retrieved with a stone basket. The Trilogy group employed a three-in-one energy platform to break the stones. This device incorporated pneumatic ballistic, ultrasound, and negative pressure suction capabilities within the same metallic probe, allowing the stone to be fragmented into small pieces while simultaneously performing ultrasonic negative pressure stone clearance. The parameters for the three-in-one energy platform were adjusted based on intraoperative conditions, typically setting negative pressure at 30%-50%, ultrasound power at 80%-100%, ballistic power at 80%, and frequency at 8 Hz. During the stone fragmentation process, the ballistic device fragmented the stones while ultrasound further reduced larger fragments and removed them. Some fragments that were difficult to break could also be flushed out or retrieved with a stone basket. The efficiency of stone clearance (volume of stones cleared per unit time) was compared between the two groups, as well as the stone-free rates on postoperative day 1 and day 30. Stone clearance time was defined as the duration from the start of fragmentation to the placement of the nephrostomy tube. Changes in postoperative white blood cells, hemoglobin, and albumin levels compared to preoperative levels, as well as the incidence of Clavien-Dindo complications, were compared between the two groups. Equipment failure incidents were recorded (fiber fracture in the holmium laser group indicating it could not be used; probe fracture in the Trilogy group). Patients were sub-grouped based on stone CT values into CT ≥ 1 000 HU and CT < 1 000 HU categories to compare stone clearance efficiency between the two devices within each sub-group. In the CT≥1 000 HU sub-group, there were 51 cases in the holmium laser group and 54 in the Trilogy group, there were no significant differences in preoperative total stone volume (6 785.0±3 902.3 mm 3 vs. 5 678.1±4 297.7 mm 3). In the CT < 1 000 HU sub-group, there were 18 cases in the holmium laser group and 17 in the Trilogy group. There were no significant differences between the groups in preoperative total stone volume (4 482.2±2 110.6 mm 3 vs. 5 530.9±3 845.3 mm 3). Results:The overall stone clearance efficiency in the Trilogy group was higher than that in the holmium laser group (87.9±35.7 mm 3/min vs. 77.1±24.3 mm 3/min, P=0.038). There were no significant differences in residual stone volume before discharge [5.5(0, 84.0) mm 3 vs. 5.3(0, 175.0) mm 3], stone clearance time (79.4±43.2 min vs. 66.6±49.7 min), or the proportion of patients using stone baskets during the procedure (33 cases, 47.8% vs. 36 cases, 50.7%). Postoperative changes in white blood cells, hemoglobin, and albumin compared to preoperative levels were not significantly different [(4.1±2.9)×10 9/L vs. (3.3±2.2)×10 9/L; (-2.9±10.5) g/L vs. (-1.6±9.3) g/L; (-2.5±3.6) g/L vs. (-1.8±5.0) g/L] Furthermore, there were no statistically significant differences in equipment failure rates (1 case, 1.4% vs. 4 cases, 5.6%), stone-free rates (postoperative day 1: 43 cases, 62.3% vs. 47 cases, 66.2%; postoperative day 30: 50 cases, 72.5% vs. 53 cases, 74.6%), or Clavien-Dindo complication rates (grade Ⅰ: 11 cases, 15.9% vs. 8 cases, 11.3%; grade Ⅱ: 2 cases, 2.8% vs. 0 cases; grade Ⅲ: 1 case, 1.4% vs. 0 cases). In the CT ≥ 1 000 HU sub-group, the clearance time for the holmium laser was longer than that for Trilogy (93.3±41.0 min vs. 74.6±51.9 min, P=0.044), there were no significant differences in residual stone volume before discharge [6.3(1.6, 173.8) mm 3 vs. 4.5(0, 69.0) mm 3] between the two groups. In the CT < 1 000 HU sub-group, the overall stone clearance efficiency of the Trilogy group exceeded that of the holmium laser group (134.2±38.0 mm 3/min vs. 105.5 ± 7.1 mm 3/min, P=0.004), there were no significant differences between the groups in residual stone volume before discharge [0(0, 51.1) mm 3 vs. 16.3(0, 957.2) mm 3], or stone clearance time (40.2±18.1 min vs. 39.1±27.5 min). Conclusions:In mini-PCNL surgery, the stone fragmentation efficiency of the three-in-one lithotripsy energy platform is superior to that of the holmium laser, while the overall complication rate is comparable to that of the holmium laser.

Object:To explore the feasibility of using artificial intelligence for quality control of echocardiographic images.Methods:Retrospectively，5 000 two-dimensional echocardiographic video images within the period from 2021 to 2023 were randomly retrieved from the echocardiography database of Nanjing Drum Tower Hospital，Affiliated Hospital of Medical School，Nanjing University. Among these selected images，1 559 of them were apical views. The physician team formulated the scoring rules，which specifically included four scoring criteria：gain，scaling ratio，cardiac axis angle，and structure. Subsequently，the data were labeled with view classification and image quality scores. The labeled data were further partitioned into the training set（ n = 643），the validation set（ n = 276），and the test set（ n = 640）. The training and validation sets were utilized for constructing the models for view classification and quality assessment，while the test set was employed to verify the models' effectiveness. The view classification module was implemented using the SlowFast model，and the quality assessment module involved algorithms such as ResNet，Video Swin Transformer，SSD，and U-Net. Results:The average accuracy，precision，recall rate and F1 score of the classification model in identifying each apical view were 0.987 1，0.983 0，0.987 1 and 0.984 9 respectively，and the inference time was（333.4 ± 105.4）ms. The average accuracies of the quality assessment module in terms of gain，scaling ratio，cardiac axis angle and display of main structures were 0.915 1，0.928 2，0.938 7 and 0.965 6 respectively，and the overall scoring accuracy was 0.912 7.Conclusions:The echocardiogram quality control system developed in this research can effectively classify and evaluate the quality of two-dimensional images of the apical views in echocardiograms. Moreover，it guarantees the objectivity，timeliness and high-efficiency of quality control，which has reference value for the establishment of the echocardiogram quality control system.