Cerebral ischemia reperfusion injury （CIRI） is a secondary brain injury that may occur in patients with ischemic stroke during the process of blood flow recovery. NOD-like receptor protein 3 （NLRP3） inflammasome plays an important role in the occurrence and development of CIRI. Regulating the activity of NLRP3 inflammasome can induce cell pyroptosis， induce neuroinflammatory response， promote macrophage/microglial polarization， destroy the blood-brain barrier， affect angiogenesis and neurogenesis， thereby affecting CIRI. Traditional Chinese medicine has obvious advantages in the treatment of CIRI. In this paper， with NLRP3 inflammasome as the core， we systematically elucidated the mechanism of action of traditional Chinese medicines on CIRI， and found that traditional Chinese medicines monomers （such as baicalin， polygalasaponin F） and traditional Chinese medicines compound formulas （such as Huangqi guizhi wuwu decoction， Yiqi shengqing formulation） can inhibit NLRP3 inflammasome activity， reduce inflammatory response and oxidative stress， and improve neuronal injury， thereby reducing CIRI.

Cerebral ischemia reperfusion injury （CIRI） is a secondary brain injury that may occur in patients with ischemic stroke during the process of blood flow recovery. NOD-like receptor protein 3 （NLRP3） inflammasome plays an important role in the occurrence and development of CIRI. Regulating the activity of NLRP3 inflammasome can induce cell pyroptosis， induce neuroinflammatory response， promote macrophage/microglial polarization， destroy the blood-brain barrier， affect angiogenesis and neurogenesis， thereby affecting CIRI. Traditional Chinese medicine has obvious advantages in the treatment of CIRI. In this paper， with NLRP3 inflammasome as the core， we systematically elucidated the mechanism of action of traditional Chinese medicines on CIRI， and found that traditional Chinese medicines monomers （such as baicalin， polygalasaponin F） and traditional Chinese medicines compound formulas （such as Huangqi guizhi wuwu decoction， Yiqi shengqing formulation） can inhibit NLRP3 inflammasome activity， reduce inflammatory response and oxidative stress， and improve neuronal injury， thereby reducing CIRI.

ObjectiveTo investigate the association of serum exosomal microRNAs （miRNAs） with hepatic inflammatory injury and histological outcomes in patients with chronic hepatitis B （CHB）. MethodsPeripheral serum samples were collected from six healthy adults and six patients with CHB， and size exclusion chromatography was used to extract exosomes. Small RNA sequencing and transcriptomic analysis were used to identify the serum exosomal miRNAs associated with liver inflammatory injury and fibrosis， and quantitative real-time PCR was used for validation in a mouse model of acute liver injury induced by lipopolysaccharide/D-galactosamine， a rat model of liver fibrosis induced by carbon tetrachloride， and 84 CHB patients undergoing liver biopsy twice before and after treatment. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； an analysis of variance was used for comparison between multiple groups， and the Tukey test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the Kruskal-Wallis H test was used for comparison between multiple groups， and the Dunn test was used for further comparison between two groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The univariate and multivariate Logistic regression analyses were used to investigate influencing factors. ResultsAbnormal expression of serum exosomal miR-122-5p was observed in patients with CHB， and it was downregulated in patients with confluent necrosis and advanced fibrosis. In the mouse model of acute liver injury and the rat model of liver fibrosis， compared with the control group， the model group had a significant reduction in the expression level of miR-122-5p in the liver （P=0.048 and 0.014）， and compared with the patients with mild liver injury， the patients with severe confluent necrosis and advanced fibrosis showed a significant reduction in the expression level of miR-122-5p in liver tissue （P<0.05）. Among the 84 CHB patients， the patients with severe hepatic confluent necrosis or advanced liver fibrosis had a significantly lower expression level of serum exosomal miR-122-5p than those with mild liver injury （P<0.001 and P=0.003）. The multivariate Logistic regression analysis showed that the expression level of miR-122-5p was an independent influencing factor for confluent necrosis （odds ratio ［OR］=0.001， 95% confidence interval ［CI］： 0.000‍ ‍—‍ ‍0.037， P=0.005） and liver fibrosis degree （OR=0.568， 95%CI： 0.331‍ ‍—‍ ‍0.856， P=0.019）. In addition， compared with the patients with low expression of miR-122-5p， the patients with high expression of miR-122-5p before treatment had a significantly higher reversal rate of liver fibrosis after 72 weeks of antiviral therapy （64.3% vs 38.1%， P=0.029）. ConclusionSerum exosomal miR-122-5p in CHB patients is closely associated with the progression of hepatic confluent necrosis and fibrosis， and the reduction in the expression level of miR-122-5p may aggravate hepatic confluent necrosis， promote the progression of fibrosis， and affect the histological outcome of CHB patients after antiviral therapy.

Objective To propose a whole-life cycle management model for valvular heart disease (VHD), systematically elucidate its underlying logic and implementation pathways, and concurrently review and analyze its preliminary application outcomes. Methods Since 2020, West China Hospital of Sichuan University has established a management system encompassing "assessment-decision-intervention-follow-up", including: (1) a risk-stratified, tiered management pathway; (2) six core functions ("promotion, screening, prevention, diagnosis, treatment, and rehabilitation") coordinated by disease-specific managers; (3) an intelligent decision support information platform; and (4) a collaborative network of multidisciplinary teams and regional academic alliances. To evaluate the effectiveness of this management model, we retrospectively included three cohorts: (1) the population screened by echocardiography from 2020 to 2024, analyzing the detection rate of aortic valve disease and risk stratification; (2) patients enrolled in the whole-life cycle management from April 2021 to December 2024, assessing follow-up outcomes, hospital satisfaction, and changes in quality of life; (3) patients who underwent transcatheter aortic valve replacement (TAVR) from January 2022 to January 2024, evaluating the one-year all-cause mortality rate, perioperative complications, and improvements in New York Heart Association (NYHA) classification. Results Between 2020 and 2024, a total of 583 874 individuals underwent echocardiographic screening. A total of 48 089 patients with aortic valve disease were identified, including 3 401 (7.1%) high-risk patients, 18 657 (38.8%) moderate-risk patients, and 26 031 (54.1%) low-risk patients. Among them, 2 417 patients were enrolled in whole-life cycle management. Patient satisfaction scores showed a yearly increase, rising from 73.89 points before 2020 to 93.74 points in 2024. The 1-year mortality rate in the TAVR cohort decreased to 5.3%, significantly lower than the 8.2% observed under early standard management between 2014 and 2019 (P<0.01). Conclusion Through process optimization and resource integration, the VHD whole-life cycle management model has demonstrated significant effectiveness in standardizing diagnostic and follow-up procedures, enhancing patient satisfaction and quality of life, and reducing mortality. These outcomes highlight its practical value for broader implementation in China.

Objective:To explore Nursing Management course design and teaching management reform under the guidance of the concept of Plan-Do-Check-Act (PDCA).Methods:The PDCA cycle was implemented in four stages and eight steps throughout the course design and teaching management of Nursing Management. With each class as a small cycle and the whole course as a big cycle, the teaching objectives, teaching content, teaching methods, teaching implementation, classroom quality, and learning effects were dynamically controlled. The implementation effects were evaluated through assessments and feedbacks.Results:The qualitative analysis showed that the teaching design was reasonable, the teaching objectives were specific, and the teaching content was clear in hierarchy and appropriate in arrangement and organization; and peers and experts rated classroom performance excellent. The quantitative analysis showed that the students' process assessment score was (88.14±1.23), written test score was (80.21±6.25), and average overall score was (82.60±4.43), all with significant improvements in horizontal and vertical comparisons; and the students had improvements in management awareness, management ability, practical application ability, and self-confidence, with a high degree of satisfaction with the course.Conclusions:PDCA-guided whole-process management can optimize the course teaching design of Nursing Management, which is conducive to developing students' management practice abilities and improving teaching quality.

Cerebral ischemia-reperfusion injury(CIR1)refers to the recovery of blood supply after cerebral ischemia,which leads to further damage and the dysfunction of brain tissue.Modern medicine has made some progress in the prevention and treatment of CIRI,but it still faces some challenges and limitations.Therefore,it is of great clinical value to find effective interventions to prevent and treat CIRI.AMP-activated protein kinase(AMPK)and its downstream proteins are important targets for the treatment of CIRI and play key roles in the regulation of cellular energy homeostasis.Traditional Chinese medicine for CIRI has multi-target and multi-pathway activities and multiple effects.It can activate a cascade of reactions in the AMPK signaling pathway and can be used to treat CIRI by regulating autophagy,oxidative stress,inflammatory response,and apoptosis,and has achieved certain result.Therefore,this paper summarizes the structure and mechanisms of the AMPK-related signaling pathway,elaborates on its relationship with CIRI,and systematically summarizes the research status of traditional Chinese medicine's ability to regulate the AMPK signaling pathway in the prevention and treatment of CIRI.This paper aims to provide new ideas for the prevention and treatment of CIRI using traditional Chinese medicine and the development of new drugs.

Objective:To analyze the epidemiological and etiological characteristics of a death case of meningococcal meningitis in Hengyang city, Hunan Province in 2024.Methods:Epidemiological investigation of the death case was performed, and samples from the patient and close contacts were collected. Following cultivation and isolation, Neisseria meningitidis ( Nm) strains were analyzed by antimicrobial susceptibility testing, pulsed field gel electrophoresis (PFGE), and whole-genome sequencing for analyzing epidemiological and etiological characteristics. Phylogenetic analysis was carried out using core genomic multilocus sequence typing (cgMLST). Results:The case was a 16-year-old high school boarding student with fulminant meningococcal meningitis. He had shock symptoms, and died within 24 h of the onset of symptoms. Six Nm strains were isolated from the patient and his roommates, belonging to two distinct clades. Isolate 144569 from the patient was highly homologous to isolate 144572 from a close contact, both belonging to the highly pathogenic sublineage L44.1 of CC4821. The typical molecular features was C: P1.7-2, 14: F5-101: ST4821 (CC4821). The two strains carried the antimicrobial resistance genes of gyrA-71 and penA-552, indicating reduced susceptibility to quinolone and penicillin, which was with their resistance phenotype. The isolates from four close contacts clustered within the same clade, characterized by the molecular features of B: P1.18-25, 9-18: ST5829 (UA). Conclusions:The death case is caused by Nm serogroup C from highly pathogenic sublineage L44.1 of CC4821. The spread of this isolate has the potential risk of outbreaks of invasive meningococcal disease. It is necessary to enhanced the molecular epidemiological surveillance, particularly focusing on the transmission of multiple serogroups of Nm among adolescents and the increasing exposure risk.

Objective:To compare the diagnostic efficacy of 22 G fine needle aspiration (FNA) needles and 22 G end-cutting fine needle biopsy (FNB) needles for solid pancreatic lesion using both cytological and histological examination.Methods:Clinical data of 116 patients who underwent endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/FNB) at the Digestive Endoscopy Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from June 2022 to March 2023 were retrospectively analyzed. Sixty-three patients sampled with 22 G FNA needles were the FNA group, and 53 sampled with 22 G FNB needles were the FNB group. The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and cytological and histological diagnostic yield of FNA needles and FNB needles for solid pancreatic lesions were compared.Results:There were no significant differences in age, gender, lesion location, lesion size, or the number of passes between the FNA group and the FNB group ( P>0.05). There were no significant differences in the diagnostic accuracy [93.7% (59/63) VS 90.6% (48/53), P=0.730], sensitivity [93.0% (53/57) VS 90.2% (46/51), P=0.732], specificity [100.0% (6/6) VS 100.0% (2/2), P=1.000], positive predictive value [100.0% (53/53) VS 100.0% (46/46), P=1.000] and negative predictive value [60.0% (6/10) VS 28.6% (2/7), P=0.335] of combined cytology and histology in distinguishing benign and malignant lesions between the two groups. In the FNA group, the diagnostic accuracy of combined cytology and histology was higher than cytology alone [93.7% (59/63) VS 81.0% (51/63), P=0.008], and was higher than histology alone without statistical significance [93.7% (59/63) VS 87.3% (55/63), P=0.125]. In the FNB group, the diagnostic accuracy of combined cytology and histology was higher than cytology alone [90.6% (48/53) VS 69.8% (37/53), P=0.001], but not than histology alone [90.6% (48/53) VS 90.6% (48/53)， P=1.000]. For solid masses located in pancreatic body/tail, the diagnostic accuracy for malignancy by histology using FNB needles tended to be higher than that of FNA needles [100.0% (17/17) VS 81.3% (26/32), P=0.080]. Conclusion:Both FNA needles and FNB needles exhibit adequate diagnostic yield for solid pancreatic masses when combining cytology and histology. FNB needles may offer a higher histological diagnostic yield.

Objective:To analyze the level and clinical significance of IL-18 and IL-18-binding protein (BP) in the bone marrow of patients with myelodysplastic syndrome (MDS) .Methods:A total of 43 newly diagnosed patients with MDS who were admitted to the Department of Hematology, Tianjin Medical University General Hospital, from July 2020 to February 2021 were randomly selected. The control group consisted of 14 patients with acute myeloid leukemia (AML) and 25 patients with iron-deficiency anemia (IDA). The levels of IL-18 and IL-18 BP in the bone marrow supernatant were measured, and their correlations with MDS severity, as well as the functionality of CD8 + T cells and natural killer cells, was analyzed. Results:The levels of IL-18, IL-18 BP, and free IL-18 (fIL-18) in the bone marrow supernatant of patients with MDS were higher than in the IDA group. The level of fIL-18 was linearly and negatively correlated with the MDS-International Prognostic Scoring System (IPSS) score. IL-18 receptor (IL-18Rα) expression on CD8 + T cells in the MDS group was lower than in the IDA group, and the levels of fIL-18 and IL-18Rα were positively correlated with CD8 + T-cell function in the MDS group. Conclusion:IL-18 BP antagonizes IL-18, leading to a decrease in fIL-18 in the bone marrow microenvironment of patients with MDS, affecting CD8 + T-cell function, which is closely related to MDS severity; therefore, it may become a new target for MDS treatment.

Abstract: Objective　To compare the different effects of body mass index (BMI) and lean body mass index (LBMI) on the risk of all-cause death among elderly Chinese individuals. For the more scientific, accurate and convenient measurement of the elderly physique, analysis and evaluation of the health risk factors of the elderly in China. Methods　This study is based on follow-up data from 2014 to 2018, involving 5 990 participants who met the inclusion criteria in the Chinese Longitudinal Healthy Longevity Survey. Participants were grouped according to their BMI and LBMI, and both univariate and multivariate Cox proportional hazard models were established to compare the effects of BMI and LBMI on the risk of death in the elderly. According to gender, age, activities of daily living, and comorbidities, subgroup analysis was conducted to study the influence of LBMI in different subgroups. Results　The study population predominantly comprised females (52.9%, 3 167/5 990), with an average age of (84.7 ± 10.1) years, and most participants lived in rural areas (55.1%, 3 298/5 990). A majority were non-smokers (82.7%, 4 952/5 990) and non-drinkers (84.3%, 5 050/5 990). The prevalence of hypertension was 32.8% (1 966/ 5 990), diabetes 5.6% (334/5 990), and heart disease 12.9% (774/5 990). In the analysis of the impact of BMI on all-cause death in the elderly, univariate analysis showed that an increase in BMI was associated with a reduced risk of mortality. After adjusted by multiple factors (age, gender, living environment, marital status, average arterial pressure, number of children, smoking, drinking, hypertension, diabetes, heart disease, cerebrovascular disease, tumor, ADL/IADL, number of complications), compared to the normal group, the emaciated group (BMI<18.5 kg/m2) had the highest risk of death (HR=1.15,95%CI: 1.01-1.30); the overweight group (24.0 kg/m2≤BMI<28.0 kg/m2) had a lower risk of death (HR=0.78, 95%CI: 0.67-0.91). In the analysis of the impact of LBMI on the risk of death in the elderly, compared to moderate LBMI, lower LBMI was associated with a higher risk of death. Multivariate analysis showed that compared with moderate LBMI, a decrease in LBMI increased the risk of death, whereas an increase in LBMI did not show statistically significant differences in mortality risk in the elderly. Conclusion　In measuring fitness and quality of life in the elderly, LBMI has better representativeness and practical value.