Objective To investigate the potential mechanism by which dihydromyricetin(DHM)ameliorates diabetic nephropathy(DN),and to screen and validate its possible key molecular targets.Methods A DN model was established using db/db mice,and 100 mg/(kg·d)DHM was administered via gavage 5 d per week for totally 10 weeks.Renal morphological changes were observed after staining to evaluate the effects of DHM.GSE161885 and GSE270526 datasets were obtained from the Gene Expression Omnibus(GEO)database and analyzed in combination with the GeneCards database to screen for DN-related differentially expressed genes(DEGs).Protein-protein interaction(PPI)network and molecular docking were employed to predict potential DHM targets.Western blotting and immunofluorescence staining were performed to detect the effects of DHM on pyroptosis-related pathways in the renal tissues of db/db mice and in high glucose(HG)-induced human renal tubular epithelial cells(HK-2).The specific NLR family pyrin domain containing protein 3(NLRP3)inhibitor MCC950 was also used to validate the predicted mechanism.Results In vivo experiments showed that DHM significantly ameliorated renal pathological damage in db/db mice,alleviated glomerular hypertrophy and mesangial expansion,and markedly reduced Paller scores(P<0.001).Immunofluorescence staining revealed significantly weakened fluorescence signals for α-smooth muscle actin(α-SMA),fibronectin,and collagen Ⅰ in renal tissues.Western blot results showed that the expression levels of collagen Ⅰ,collagen Ⅲ,α-SMA,and transforming growth factor beta 1(TGF-β1)were significantly decreased(P<0.05).A total of 16 DN-related DEGs were identified.Enrichment analysis revealed that these genes were primarily enriched in pathways such as viral protein interactions,cytokine-cytokine receptor interaction,and the AGE-RAGE signaling pathway in diabetic complications,and were primarily involved in gene functions such as the positive regulation of lymphocyte-mediated immunity,positive regulation of adaptive immune response,and chemokine activity.Molecular docking confirmed NLRP3 as a potential target of DHM.In vivo validation showed that DHM significantly down-regulated gasdermin-D(GSDMD)fluorescence signals and inhibited the expression of pyroptosis-related proteins including NLRP3,Caspase 1,Cleaved-Caspase 1,interleukin 18(IL-18),and GSDMD(P<0.05).In vitro studies further confirmed that both DHM and the specific NLRP3 inhibitor MCC950 alleviate high glucose-induced fibrosis and pyroptosis in HIC-2 cells.Conclusion DHM can ameliorate the progression of DN,and its mechanism is related to inhibiting NLRP3 inflammasome-mediated pyroptosis,thereby alleviating renal inflammation and fibrosis.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Objective:To investigate the current state of oral health knowledge,attitude and practice(KAP)of plateau military personnels and to analyze the disease condition,aiming to explore new strategies for enhancing oral health.Methods:A question-naire was developed to survey 500 individuals at high altitudes(≥3 000 m)and 500 at low altitudes(≤1 000 m)regarding their oral health KAP,with 100 subjects randomly selected from each group for oral examinations.Logistic regression analysis was ap-plied to examine the correlation between KAP and disease status.Based on these findings,a survey of the oral health needs of mili-tary personnels was conducted in conjunction with their KAP.And an innovative training system,"Perception-Comprehension-Inte-gration"(PCI),was established to improve the competencies of primary healthcare providers,with its effectiveness being evaluated.Results:The high altitude group had significantly lower rates of overall oral health awareness(53.61％),positive attitude(55.00％)and positive practice(40.29％)compared with the low altitude group(P＜0.05);the incidence in high altitude group experiencing dental caries(73％),wedge-shaped defects(34％),pericoronitis(16％),gingival bleeding(74％),dental calculus(81％)and cheilitis(37％)were significantly higher than those in the low altitude group(P＜0.05).There was a significant nega-tive correlation between KAP scores and disease prevalence.The subjects in both groups showed a substantial demand(exceeding 70％)for oral health.The innovative PCI training system has markedly strengthened the health personnel's compre-hensive preventive and health care capabilities.Conclu-sion:The oral health status of plateau military personnels is in dire need of enhancement.And the PCI training sys-tem is poised to serve as a novel approach to tackling this critical concern.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Objective:To investigate the current state of oral health knowledge,attitude and practice(KAP)of plateau military personnels and to analyze the disease condition,aiming to explore new strategies for enhancing oral health.Methods:A question-naire was developed to survey 500 individuals at high altitudes(≥3 000 m)and 500 at low altitudes(≤1 000 m)regarding their oral health KAP,with 100 subjects randomly selected from each group for oral examinations.Logistic regression analysis was ap-plied to examine the correlation between KAP and disease status.Based on these findings,a survey of the oral health needs of mili-tary personnels was conducted in conjunction with their KAP.And an innovative training system,"Perception-Comprehension-Inte-gration"(PCI),was established to improve the competencies of primary healthcare providers,with its effectiveness being evaluated.Results:The high altitude group had significantly lower rates of overall oral health awareness(53.61％),positive attitude(55.00％)and positive practice(40.29％)compared with the low altitude group(P＜0.05);the incidence in high altitude group experiencing dental caries(73％),wedge-shaped defects(34％),pericoronitis(16％),gingival bleeding(74％),dental calculus(81％)and cheilitis(37％)were significantly higher than those in the low altitude group(P＜0.05).There was a significant nega-tive correlation between KAP scores and disease prevalence.The subjects in both groups showed a substantial demand(exceeding 70％)for oral health.The innovative PCI training system has markedly strengthened the health personnel's compre-hensive preventive and health care capabilities.Conclu-sion:The oral health status of plateau military personnels is in dire need of enhancement.And the PCI training sys-tem is poised to serve as a novel approach to tackling this critical concern.

Objective To analyze the similarities and differences between four-point hand-knee position and hand-foot kneeling positions in trunk muscle activation and co-contraction, explore the possibility of hand-foot kneeling position as core stabilization exercises, so as to provide suggestions for actual training.Methods Nineteen healthy volunteers randomly performed exercises of four-point hand-knee position (4 motions) and hand-foot kneeling position (3 motions), while surface electromyography (sEMG) signals were collected from bilateral rectus abdominis, external oblique, erector spine, and multifidus muscles. The average sEMG and muscle co-contraction index (CCI) based on the sEMG signals were analyzed and compared.Results Significant differences were found in the sEMG and CCI within and between the two positions. Under four-point hand-knee position with the right hand and left leg lifting, the activation of all muscles was higher than that in the starting position. In four-point hand-knee position with the left leg lifting, the activation of ipsilateral multifidus muscle was significantly higher than that in hand-foot kneeling position. The activation degree of external oblique muscle and rectus abdominis was higher in hand-foot kneeling position with right hand lifting. A total of 28 muscle matching methods were obtained by pair-to-pair matching of 8 muscles. The starting posture in four-point hand-knee position fluctuated the least, indicating that the spine was the most stable, while the index of other exercises fluctuated in a larger range.Conclusions The possibility of hand-foot kneeling position as core stabilization exercises was proved from two aspects, namely, muscle activation and CCI. The hand-foot kneeling position and four-point hand-knee position can be used for strengthening abdominal muscles and back muscles, respectively. The four-point hand-knee position with contralateral upper and lower limbs lift is a more advanced exercise for trunk muscles, but sports injuries should be avoided.

OBJECTIVE：To investigate the clini cal features of thrombocytopenia induced by antidepressants ，and to provide reference for the rational use of clinical drugs. METHODS ：Retrieved from CNKI ，Wanfang database ，VIP，PubMed and Web of Science，during Jan. 1st in 1985 to Aug. 31st in 2020，case reports about antidepressants-induced thrombocytopenia was collected and analyzed descriptively in terms of demographic characteristics ，medication，clinical manifestations ，treatment and outcome. RESULTS：A total of 17 literatures were retrieved ，and 19 patients were included ，involving 10 male and 9 female，aged from 5 to 95 years old ，with an average of （48±24）years old. Nine kinds of drugs were involved ，including 4 cases of escitalopram ，3 cases of citalopram ，3 cases of fluoxetine ，3 cases of mirtazapine ，2 cases of amitriptyline ，1 case of sertraline ，1 case of paroxetine，1 case of mianserin and 1 case of imipramine. There were 9 cases of single drug and 10 cases of drug combination. All 19 patients suffered from thrombocytopenia at 3 d-10 years after medication ，14 of them had hemorrhage tendency. Main clinical manifestations included mucocutaneous hemorrhage ，gingival bleeding ，black stool ，hematochezia，vaginal bleeding ，ocular hemorrhage，alveolar hemorrhage. No bleeding was found in 5 cases. After drug withdrawal/changing drugs and other symptomatic treatment， platelet count of 19 patients recovered to normal ， and bleeding symptoms disappeared. CONCLUSIONS ： Thrombocytopenia caused by antidepressants has no obvious clinical features and is not easy to be found ，but it may lead to severe； bleeding symptoms if it is not found in time. The changes of platelet count should be closely monitored in clinical application of such drugs to ensure the safety of drug use.

Denitrification is an indispensable part of most sewage treatment systems. The biological denitrification process has attracted much attention in the past decades due to the advantages such as cost-effectiveness, process simplicity, and absence of secondary pollution. This review summarized the advances on biological denitrification processes in recent years according to the different physiological characteristics and denitrification mechanisms of denitrification microorganisms. The pros and cons of different biological denitrification processes developed based on nitrifying bacteria, denitrifying bacteria, and anaerobic ammonia-oxidizing bacteria were compared with the aim to identify the best strategy for denitrification in a complex wastewater environment. The rapid development of synthetic biology provides possibilities to develop highly-efficient denitrifying strains based on mechanistic understandings. Combined with the applications of automatic simulation to obtain the optimal denitrification conditions, cost-effective and highly-efficient denitrification processed can be envisioned in the foreseeable future.
Aerobiosis ; Denitrification ; Nitrification ; Nitrogen ; Waste Water

【Objective】 To investigate the effects of 80 kVp combined with multi-model adaptive statistical iterative reconstruction algorithm （ASiR-V） on the image quality of CT angiography （CTA） of iliac artery in kidney transplantation candidates before operation. 【Methods】 Totally 50 kidney transplantation candidates underwent “one-stop” scanning combined CTA for coronary and iliac arteries were recruited consecutively. After the scanning， images were reconstructed with different ASiR-V levels on the iliac artery from 50% to 100% at a 10% interval， and 6 groups of images were obtained. We evaluated and compared all image qualities， DLP and CTDI in the patients’ examination were recorded， and the effective dose （ED） was calculated. 【Results】 All of the image quality objective scores of different ASiR-V levels on the iliac artery were above 3 points （3.32±0.24）， and the average CT value was （344.30±74.53）HU. The ED received by the patient throughout the examination was （2.71±0.42)mSv. The image noise decreased while SNR and CNR increased monotonically as the ASiR-V levels increased， among which 80% ASiR-V image quality score was the highest with 3.41±0.26. 【Conclusion】 For patients who need to have both coronary and iliac arteries evaluated before kidney transplantation operation， low tube voltage （80 kVp） combined with 80% ASiR-V can obtain high-quality iliac artery images under the premise of reducing the ED dose， which can provide practical basis for further reducing the dose in personalized scanning scheme for such patients. It has good feasibility and clinical application value.

BACKGROUND:Choosing internal fixator implants with good strength and stiffness is the key to repair femoral neck combined with ipsilateral subtrochanteric fractures. OBJECTIVE:To compare the biomechanical properties of different implant fixation for femoral neck combined with ipsilateral subtrochanteric fractures. METHODS:Totaly 24 adult antiseptic cadaver specimens were used to produce fracture models with femoral neck fracture combined with 5 cm of ipsilateral subtrochanteri medical cortical defect, and were divided into femoral proximal locking plate group, lengthening proximal femur anti-rotation intramedulary nail group and lengthening proximal femoral nail group according to the random number table method. The results of axial compression test, torsion test and axial compression failure rest in three groups were compared. RESULTS AND CONCLUSION: The axial compressive stiffness and failure load in lengthening proximal femur anti-rotation intramedulary nail group were significantly greater than those in femoral proximal locking plate group and lengthening proximal femoral nail group, and those in lengthening proximal femoral nail group were significantly greater than those in femoral proximal locking plate group (P < 0.05). The torsional stiffness in femoral proximal locking plate group was significantly greater than that in lengthening proximal femur anti-rotation intramedulary nail group and lengthening proximal femoral nail group, and that in lengthening proximal femur anti-rotation intramedulary nail group was significantly greater than that in lengthening proximal femoral nail group (P < 0.05). The indexes of biomechanical properties of specimens at the 4thand 8th weeks after fixation in three groups were slightly increased compared with those in 0 week after surgery, but the difference was no statisticaly significant (P > 0.05). These results demonstrate that to a certain extent, compared with the femoral proximal locking plate and lengthening lengthening proximal femoral nail, lengthening proximal femur anti-rotation intramedulary nail fixation for repair of femoral neck combined with ipsilateral subtrochanteric fractures has more biomechanical advantages.