OBJECTIVE To investigate the ameliorative effect and mechanism of short-acting exenatide on diabetic cognitive dysfunction. METHODS Spontaneously diabetic db / db mice were randomly divided into model group （normal saline） and exenatide group （50 μg/kg）， with db / m mice as the normal control group （normal saline）， with 8 mice in each group. Mice in each group were subcutaneously injected with corresponding drugs or normal saline twice daily for 8 consecutive weeks. Body weight and fasting blood glucose were measured at a fixed time every week. Cognitive function was evaluated by Morris water maze test. The levels of oxidative st ress indicators [malondialdehyde （MDA）， superoxide dismutase （SOD）， glutathione （GSH） ] ， cyclic adenosine monophosphate （cAMP） and protein kinase A （PKA） were detected in hippocampus tissue of mice. The hippocampal neuronal HT22 cells of mice were divided into control group （25 mmol/L glucose）， high glucose group （125 mmol/L glucose）， high glucose+exenatide group （125 mmol/L glucose+20 nmol/L exenatide）， high glucose+exenatide+H89 （PKA inhibitor） group （125 mmol/L glucose+20 nmol/L exenatide+10 μmol/L H89）， and high glucose+H89 group （125 mmol/L glucose+10 μmol/L H89）. After 48 h of intervention with corresponding solutions/culture medium， the levels of oxidative stress indicators， cAMP and PKA， the activities of mitochondrial respiratory enzymes Ⅱ and Ⅳ， and the phosphorylation level of dynamin-related protein 1 （Drp1） were measured. RESULTS Animal experiments showed that compared with the normal control group， the model group exhibited significantly increased body weight， fasting blood glucose and MDA level in the hippocampus （ P ＜0.05）， as well as significantly prolonged escape latency （ P ＜0.05）； swimming speed significantly slowed down， the time spent in the target quadrant， the number of platform crossings， and the levels of SOD， GSH， cAMP and PKA in the hippocampus were significantly decreased （ P ＜0.05）. Compared with model group， all the above indicators （except for swimming speed） in the exenatide group were significantly reversed （ P ＜0.05）. Cell experiments showed that compared with high glucose group， the high glucose+exenatide group had significantly decreased MDA level （ P ＜0.05）， and significantly increased levels of SOD， GSH， cAMP and PKA， the activities of mitochondrial respiratory enzymes Ⅱ and Ⅳ， and phosphorylation level of Drp1 （ P ＜0.05）. Compared with high glucose+exenatide group， the above indicators in the high glucose+exenatide+H89 group were significantly reversed （ P ＜0.05）. CONCLUSIONS Short-acting exenatide can activate the cAMP/PKA pathway， promote Drp1 phosphorylation， and increase the activities of mitochondrial respiratory enzymes， thereby maintaining mitochondrial stability， reducing oxidative stress injury， and ultimately improving diabetic cognitive dysfunction.

ObjectiveBased on traditional quality evaluation of Gardeniae Fructus（GF） recorded in historical materia medica， this study systematically compared the quality differences between wild and cultivated GF from morphological characteristics， microscopic features， and contents of primary and secondary metabolites. MethodsVernier calipers and analytical balances were used to measure the length， diameter and individual fruit weight of wild and cultivated GF， and the aspect ratio was calculated. A colorimeter was used to determine the chromaticity value of wild and cultivated GF， and the paraffin sections of them were prepared by safranin-fast green staining and examined under an optical microscope to observe their microstructure. Subsequently， the contents of water-soluble and alcohol-soluble extracts of wild and cultivated GF were detected by hot immersion method under the general rule 2201 in volume Ⅳ of the 2020 edition of the Pharmacopoeia of the People's Republic of China， the starch content was measured by anthrone colorimetric method， the content of total polysaccharides was determined by phenol-sulfuric acid colorimetric method， the sucrose content was determined by high performance liquid chromatography coupled with evaporative light scattering detection（HPLC-ELSD）， and the contents of representative components in them were measured by ultra-performance liquid chromatography（UPLC）. Finally， correlation analysis was conducted between quality traits and phenotypic traits， combined with multivariate statistical analysis methods such as principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）， key differential components between wild and cultivated GF were screened. ResultsIn terms of traits， the wild GF fruits were smaller， exhibiting reddish yellow or brownish red hues with significant variation between batches. While the cultivated GF fruits are larger， displaying deeper orange-red or brownish red. The diameter and individual fruit weight of cultivated GF were significantly greater than those of wild GF， while the blue-yellow value（b^*） of wild GF was significantly higher than that of cultivated GF. In the microstructure， the mesocarp of wild GF contained numerous scattered calcium oxalate cluster crystals， while the endocarp contained stone cell class round， polygonal or tangential prolongation， undeveloped seeds were visible within the fruit. In contrast， the mesocarp of cultivated GF contained few calcium oxalate cluster crystals， or some batches exhibited extremely numerous cluster crystals. The stone cells in the endocarp were predominantly round-like， with the innermost layer arranged in a grid pattern. Seeds were basically mature， and only a few immature seeds existed in some batches. Regarding primary metabolite content， wild GF exhibited significantly higher total polysaccharide level than cultivated GF（P<0.01）. In category-specific component content， wild GF exhibited significantly higher levels of total flavonoids and total polyphenols compared to cultivated GF（P<0.01）. Analysis of 12 secondary metabolites revealed that wild GF exhibited significantly higher levels of Shanzhiside， deacetyl asperulosidic acid methyl ester， gardenoside and chlorogenic acid compared to cultivated GF（P<0.01）. Conversely， the contents of genipin 1-gentiobioside， geniposide and genipin were significantly lower in wild GF（P<0.01）. ConclusionThere are significant differences between wild and cultivated GF in terms of traits， microstructure， and contents of primary and secondary metabolites. At present， the quality evaluation system of cultivated GF remains incomplete， and this study provides a reference for guiding the production of high-quality GF medicinal materials.

Numerous techniques for C2 screw fixation have been recently reported. However, concerns remain regarding the risk of spinal cord or vertebral artery injury and inadequate biomechanical stability. To our knowledge, the specific transforaminal “in-out-in” screw fixation technique has not been previously reported. This study aimed to investigate the feasibility and preliminary clinical outcomes of a transforaminal “in-out-in” multi-cortical purchase screw for posterior C2 screw fixation. Between October 2022 and March 2023, 10 patients underwent posterior atlantoaxial internal fixation. All patients had severe hypoplasia of the C2 pedicle on at least one side, precluding the use of standard C2 pedicle screws. A transforaminal “in-out-in” screw was used as an alternative. No spinal cord injury, vascular injury, or other major complications were observed. No implant failure was noted at the final follow-up. In conclusion, the transforaminal “in-out-in” screw may achieve rigid three-column fixation with multiple cortical purchases. It represents a safe and effective alternative for posterior C2 fixation in patients with severely narrow C2 pedicles where traditional pedicle screw placement is not feasible.

ObjectiveTo investigate the current awareness and optimization recommendations on pneumonia with unknown etiology (PUE) surveillance among Shanghai healthcare professionals, and to provide evidence for the improvement of the surveillance system. MethodsIn December 2024, healthcare professional participants from diverse medical and health institutions were randomly selected within each stratum using a stratified cluster sampling method in all 16 districts of Shanghai for questionnaire surveys on their knowledge and suggestions for optimization of the PUE surveillance system. Descriptive statistics analyses, multivariate logistic regressions, and content analyses were used for data analyses. ResultsA total of 385 survey subjects were involved in the study, including 119 professional staffs from disease prevention and control centers and 266 from medical institutions. Those who understood the case definition for PUE correctly accounted for 67.01% (258/385). Multivariate regression model analyses showed that female gender (aOR=2.22, 95%CI: 1.36‒3.66), professionals from disease control institutions (aOR=2.02, 95%CI: 1.12‒3.72), and those who self-assessed as being familiar with the monitoring system (aOR=2.18, 95%CI:1.23‒3.89) had better understanding of the definition. Overall, 89.61% (345/385) of the survey subjects acknowledged the necessity of the surveillance system. Small number of cases meeting the case definition (54.46%, 214/379), insufficient diagnostic awareness (39.84%, 151/379), and lack of incentives for case reporting (29.29%, 111/379) were major problems for the current surveillance system, with variations observed across different types of institutions. Suggested segments for optimizing the surveillance system included monitoring purpose, case definition, form of monitoring and reporting procedure, organization mechanism, and epidemiological investigation and response. ConclusionThe necessity of PUE surveillance is commonly recognized among healthcare workers. However, the existing system falls short in terms of mastery of case definition and overall surveillance adaptability. There is an urgent need for optimization and improvement to enhance the capacity for preventing and controlling emerging and sudden respiratory infectious diseases.

(rsFC)and their relationship with negative symptoms in schizophrenia patients with predominant negative symptoms(PNS).Methods Fifty-four schizophrenia patients with PNS and sixty-one healthy controls underwent resting-state functional magnetic resonance imaging(fMRI)scans.Data were collected on general demographic information,the Positive and Negative Syndrome Scale(PANSS),the Scale for the Assessment of Negative Symptoms(SANS),and the Temporal Experience of Pleasure Scale(TEPS).Twelve striatal subregions were selected as regions of interest(ROIs)to analyze the rsFC between each ROI and whole-brain voxels.The rsFC values of areas with significant differences were extracted for Pearson correlation analysis with negative symptoms.Results Compared with healthy controls,schizophrenia patients with PNS exhibited decreased rsFC between the right dorsal caudal putamen(DCP)and right insula,left middle frontal gyrus(MFG),right median cingulate and paracingulate gyri(MCC);between the left DCP and right putamen,left insula,left MFG;between the right dorsal rostral putamen(DRP)and bilateral MFG,left insula,right MCC;between the left DRP and right insula,left rolandic operculum;between the right ventral rostral putamen(VRP)and bilateral putamen,left MFG,right MCC;between the left VRP and right insula,left putamen,bilateral MFG,right MCC,left inferior parietal gyrus,excluding supramarginal and angular gyri.Decreased rsFC was also observed between the left ventral caudate/nucleus accumbens(inferior)and right insula,left anterior cingulate cortex,supracallosal,bilateral precuneus(a threshold of P<0.001 in voxel-level with P<0.05 in cluster-lever,corrected for family-wise error,PFWE<0.05/12=0.004).No regions showed increased rsFC in schizophrenia patients with PNS relative to healthy controls.And no significant correlations were found between striatal rsFC and negative symptoms(PBonferroni>0.05).Conclusion Schizophrenia patients with PNS exhibited widespread cortical-striatal functional connectivity abnormalities,particularly reduced rsFC between the putamen and the MFG,MCC and insula.

Objective:To investigate the changes of nitric oxide(NO),endothelin-1(ET-1),thromboxane B2(TXB2)levels in patients with chronic heart failure(CHF)and their correlation with plasma brain natriuretic peptide(BNP).Methods:We enrolled 110 CHF patients admitted in the Second Hospital of Qinhuangdao between January and December 2022.According to the New York Heart Association(NYHA)cardiac function classification,the patients were divided into cardiac function class Ⅱ group(n=22),cardiac function class Ⅲ group(n=50),and cardiac function class Ⅳ group(n=38).Baseline data,levels of NO,ET-1,TXB2,BNP and other related laboratory indexes were compared among three groups.Pearson correlation analysis was used to analyze the association of NO,ET-1,TXB2 with plasma BNP in CHF patients.Multivariate linear regression was employed to analyze related factors of elevated BNP in CHF patients.Results:Compared with patients in class Ⅱ group and class Ⅲ group,those in class Ⅳ group had significant higher uric acid[(467.39±32.60)μmol/L vs.(367.25±22.39)μmol/L vs.(421.42±28.34)μmol/L],total bilirubin[(17.36±3.10)μmol/L vs.(10.65±1.39)μmol/L vs.(11.12±2.01)μmol/L],BNP[(897.60±50.11)ng/L vs.(381.37±31.25)ng/L vs.(527.60±47.84)ng/L],NO[(50.12±5.95)μmol/L vs.(25.36±2.14)μmol/L vs.(37.92±4.84)μmol/L],ET-1[(114.10±10.53)pg/L vs.(80.25±7.38)pg/L vs.(97.03±8.40)pg/L],TXB2[(417.98±29.35)pg/ml vs.(302.63±19.63)pg/ml vs.(381.29±26.44)pg/ml](P＜0.001 all).Compared with those in class Ⅱ group,those in class Ⅲ group had significant higher above-mentioned indexes(except total bilirubin)(P＜0.001 all).Pearson correlation analysis indicated that plasma NO,ET-1,TXB2 were positively associated with BNP(r=0.828,0.750,0.720,P＜0.001 all).Multivariate linear regression analysis indicated that uric acid,total bilirubin,plasma NO,ET-1 and TXB2 levels were independent risk factors for elevated BNP level in CHF patients(B=0.555～20.550,P＜0.05 or＜0.01),while the use of angiotensin converting enzyme inhibitors(ACEI)/angiotensin Ⅱ receptor blockers(ARB)was an independent protective factor(B=-46.222,P=0.027).Conclusion:The levels of NO,ET-1,and TXB2 are closely related to the occurrence and development of CHF,and they show an increasing trend with the progression of CHF,and is closely related to BNP.

Objective To explore the thoughts and experiences of exercise adherence in breast cancer patients undergoing endocrine therapy,aims to provide reference for targeted intervention.Methods Employing purposive sampling,a descriptive qualitative study was conducted from Octomber 2023 to November 2024,and 24 breast cancer patients receiving endocrine therapy who visited a tertiary-level hospital in Tianjin,China,were selected for semi-structured in-depth interviews.The data was analyzed through traditional content analysis to extract themes.Results 3 primary themes and 6 sub-themes were identified,including sense of benefits from exercise(including physical benefits and psychological well-being),factors influencing exercise adherence(barriers and facilitators),and supportive needs for exercise adherence(including professional support and guidance,as well as emotional support and companionship).Conclusion Healthcare providers should consider the influencing factors,supportive needs of behavior change,and exercise experiences of breast cancer patients receiving endocrine therapy.Developing targeted exercise rehabilitation programs to address these needs could enhance exercise adherence.

Objective:To investigate the changes of nitric oxide(NO),endothelin-1(ET-1),thromboxane B2(TXB2)levels in patients with chronic heart failure(CHF)and their correlation with plasma brain natriuretic peptide(BNP).Methods:We enrolled 110 CHF patients admitted in the Second Hospital of Qinhuangdao between January and December 2022.According to the New York Heart Association(NYHA)cardiac function classification,the patients were divided into cardiac function class Ⅱ group(n=22),cardiac function class Ⅲ group(n=50),and cardiac function class Ⅳ group(n=38).Baseline data,levels of NO,ET-1,TXB2,BNP and other related laboratory indexes were compared among three groups.Pearson correlation analysis was used to analyze the association of NO,ET-1,TXB2 with plasma BNP in CHF patients.Multivariate linear regression was employed to analyze related factors of elevated BNP in CHF patients.Results:Compared with patients in class Ⅱ group and class Ⅲ group,those in class Ⅳ group had significant higher uric acid[(467.39±32.60)μmol/L vs.(367.25±22.39)μmol/L vs.(421.42±28.34)μmol/L],total bilirubin[(17.36±3.10)μmol/L vs.(10.65±1.39)μmol/L vs.(11.12±2.01)μmol/L],BNP[(897.60±50.11)ng/L vs.(381.37±31.25)ng/L vs.(527.60±47.84)ng/L],NO[(50.12±5.95)μmol/L vs.(25.36±2.14)μmol/L vs.(37.92±4.84)μmol/L],ET-1[(114.10±10.53)pg/L vs.(80.25±7.38)pg/L vs.(97.03±8.40)pg/L],TXB2[(417.98±29.35)pg/ml vs.(302.63±19.63)pg/ml vs.(381.29±26.44)pg/ml](P＜0.001 all).Compared with those in class Ⅱ group,those in class Ⅲ group had significant higher above-mentioned indexes(except total bilirubin)(P＜0.001 all).Pearson correlation analysis indicated that plasma NO,ET-1,TXB2 were positively associated with BNP(r=0.828,0.750,0.720,P＜0.001 all).Multivariate linear regression analysis indicated that uric acid,total bilirubin,plasma NO,ET-1 and TXB2 levels were independent risk factors for elevated BNP level in CHF patients(B=0.555～20.550,P＜0.05 or＜0.01),while the use of angiotensin converting enzyme inhibitors(ACEI)/angiotensin Ⅱ receptor blockers(ARB)was an independent protective factor(B=-46.222,P=0.027).Conclusion:The levels of NO,ET-1,and TXB2 are closely related to the occurrence and development of CHF,and they show an increasing trend with the progression of CHF,and is closely related to BNP.

Objective To explore the brain damage of SD rats under different time points of hypobaric hypoxia exposure.Methods A rat high-altitube cerebral edema(HACE)model was constructed by simulating an altitude of 6 000 m in a hypobaric hypoxia animal experimental chamber.Thirty-six SD male rats were randomly divided into the control group and the hypobaric hypoxia exposure 3,7 and 14 d groups,with 9 rats in each group.Except for the control group,the rats in each group were continuously exposed to hypobaric hypoxia for 3,7,and 14 d.At the end of the modeling period,serum was collected by blood sampling via the abdominal aorta,and brain tissue samples were taken.The wet-to-dry ratio(W/D)of brain tissue was calculated,and the levels of relevant oxidative enzymes in serum and brain tissue were measured.The expression levels of hypoxia-inducible factor-1α(HIF-1α)and aquaporin 4(AQP4)mRNAs in brain tissue were detected by real-time fluorescence quantitative polymerase chain reaction.Results The W/D of brain tissues in the control group and the group exposed to hypobaric hypoxia for 3,7 and 14 d were 4.46±0.12,4.98±0.16,5.07±0.18 and 4.95±0.07;the superoxide dismutase contents were(111.86±2.45),(90.73±1.48),(79.64±2.56)and(55.33±1.45)U·g-1;the glutathione contents were(126.91±5.18),(125.26±1.53),(56.20±2.17)and(122.73±1.78)μg·mL-1;the malondialdehyde contents were(230.94±2.00),(362.65±3.28),(407.34±3.47)and(237.50±1.59)nmol·g-1;the relative expression levels of HIF-1 α mRNA were 1.00±0,2.99±0.49,4.72±0.49 and 1.91±0.28;the relative expression levels of AQP4 mRNA were 1.00±0,2.62±0.34,8.38±0.84 and 5.27±0.42,respectively.Statistically significant differences were found between the above indexes in the 3,7 and 14 d of hypobaric hypoxia exposure group compared with the control group(P＜0.05,P＜0.01).Conclusion Different time of hypobaric hypoxia exposure can up-regulate the expression of AQPs proteins in HACE rats and cause the disruption of the blood-brain barrier,and the HACE model constructed in the hypobaric hypoxia chamber with 6 000 m intervention for 7 d was more stable.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.