Objective At the level of human induced pluripotent stem cell-derived cardiomyocytes(hiPSC-CMs)and neonatal rat cardiomyocytes(NRVMs),investigate the role of serum glucocorticoid regulated kinase 1(SGK1)in the myocardial injury caused by sunitinib and the potential protective effect of berberine.Methods Enzyme-linked immunosorbent assay was used to detect the effect of sunitinib and incubation with berberine on the level of NT-proBNP and cTn-I in hiPSC-CMs.The effect of sunitinib and incubation with berberine on the activity of SGK1 in hiPSC-CMs was quantitatively tested using kinase activity photometry.Western blot was used to detect the expression of SGK1 in NRVMs.And the above indicators were detected again after SGK1 blockade using SGK1 blocker.Results Sunitinib and SGK1 inhibitor significantly increased the NT-proBNP and cTn-I level of hiPSC-CMs(P<0.01),and incubation with berberine activated SGK1 could significantly protect hiPSC-CMs from the increase in NT-proBNP level caused by sunitinib(P<0.01),while the SGK1 inhibitor resisted the protective effect of berberine(P<0.01).Sunitinib and SGK1 inhibitor significantly decreased the activity of SGK1 in hiPSC-CMs(P<0.01),and incubation with berberine activated SGK1,which significantly protected hiPSC-CMs from the inhibition of SGK1 activity caused by sunitinib(P<0.01).Sunitinib and SGK1 inhibitors significantly reduced SGK1 protein expression in NRVMs(P<0.01),and incubating berberine to activate SGK1 significantly protected SGK1 protein expression decrease induced by sunitinib(P<0.01).Conclusions Sunitinib inhibits the activity of SGK1,leading to myocardial injury,while berberine activates SGK1 and has protective effects.

Objective:To observe the changes of central visual acuity and extracentral visual acuity in eyes with non-arteritic central retinal artery occlusion (NA-CRAO).Methods:A retrospective clinical study. From January 1, 2017 to December 31, 2024, 140 patients (140 eyes) diagnosed with NA-CRAO through ophthalmic examination at Department of Ophthalmology of First People's Hospital of Xianyang City were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), visual field, intraocular pressure, fundus color photography, optical coherence tomography (OCT), and fluorescein angiography (FFA) examinations. After a clear diagnosis, conservative treatment such as reducing intraocular pressure, relieving spasms, and dilating blood vessels should be given immediately. Simultaneously, intravenous and/or arterial thrombolysis therapy should be administered based on the patient's overall condition. Under the same treatment conditions as other treatments, 33 eyes were treated with hyperbaric oxygen therapy within 24 hours after seeking medical attention. The changes in central visual acuity (BCVA) and peripheral visual acuity of the affected eye one month after treatment were observed. BCVA improvement of ≥ 1 line was defined as the increase of no light sensitivity to light sensitivity or above, and the increase of light sensitivity to 0.01 or above. The visual acuity outside the center was determined by the 0 ° axis in front of the eyeball at eye level, and was 10 ° outside visual acuity on the temporal side. Multivariate analysis using logistic regression analysis.Results:Among the 140 cases (140 eyes), there were 84 males (84 eyes) and 56 females (56 eyes). The mean age was (63.89±10.78) years. The duration of illness from the onset of symptoms to the time of diagnosis was 48 (2-720) hours. 6, 1, 14, 47, 41, 16, and 15 eyes were diagnosed with BCVA without light perception, uncertain light perception, manual/anterior, digital/anterior, 0.01-0.10, and ≥ 0.10, respectively. FFA examination revealed delayed arm retinal circulation time and filling of the retinal artery trunk to the peak, with changes in the "arterial front" observed in 126 eyes. OCT examination showed extensive edema and unclear structure in the inner layer of the retina in all patients. Out of 140 eyes, 122 were treated with intravenous thrombolysis and 4 with arterial thrombolysis; 14 eyes did not receive thrombolytic therapy. After treatment, 38 eyes (27.1 %) showed an improvement of BCVA ≥ 1; 67 eyes (47.9%) did not show an improvement in BCVA, and the affected eye had a BCVA of approximately 0.6 without light perception; 17 eyes (12.1 %) showed improvement in peripheral vision, and the peripheral vision of the affected eyes ranged from 0.01 to 0.1, all of whom were patients undergoing intravenous thrombolysis, and prior to treatment, this group of patients had complete blindness in the coarse side visual field of the Amsler grid, and their out of center visual acuity could not be measured. Among the 33 eyes treated with hyperbaric oxygen therapy, 24 eyes (72.7%) showed an increase in BCVA after treatment; 9 eyes did not improve, among which 4 eyes (12.1%) showed improvement in out of center visual acuity. Among the 107 eyes that did not receive hyperbaric oxygen therapy, 49 eyes (45.8%) showed an increase in BCVA after treatment. There was no improvement in 58 eyes (54.2%), among which 13 eyes (12.1%) showed an improvement in out of center visual acuity. The results of logistic regression analysis showed that intravenous thrombolysis and hyperbaric oxygen therapy were independent predictive factors for the improvement of central and extra central visual acuity ( P<0.05). Conclusions:Hyperbaric oxygen therapy within 24 hours of seeking medical attention for patients with NA-CRAO disease course ≤ 1 month has a significant effect on the recovery of central and extra central vision. Intravenous thrombolysis and hyperbaric oxygen therapy are independent predictive factors for the improvement of central and extra central vision.

Objective At the level of human induced pluripotent stem cell-derived cardiomyocytes(hiPSC-CMs)and neonatal rat cardiomyocytes(NRVMs),investigate the role of serum glucocorticoid regulated kinase 1(SGK1)in the myocardial injury caused by sunitinib and the potential protective effect of berberine.Methods Enzyme-linked immunosorbent assay was used to detect the effect of sunitinib and incubation with berberine on the level of NT-proBNP and cTn-I in hiPSC-CMs.The effect of sunitinib and incubation with berberine on the activity of SGK1 in hiPSC-CMs was quantitatively tested using kinase activity photometry.Western blot was used to detect the expression of SGK1 in NRVMs.And the above indicators were detected again after SGK1 blockade using SGK1 blocker.Results Sunitinib and SGK1 inhibitor significantly increased the NT-proBNP and cTn-I level of hiPSC-CMs(P<0.01),and incubation with berberine activated SGK1 could significantly protect hiPSC-CMs from the increase in NT-proBNP level caused by sunitinib(P<0.01),while the SGK1 inhibitor resisted the protective effect of berberine(P<0.01).Sunitinib and SGK1 inhibitor significantly decreased the activity of SGK1 in hiPSC-CMs(P<0.01),and incubation with berberine activated SGK1,which significantly protected hiPSC-CMs from the inhibition of SGK1 activity caused by sunitinib(P<0.01).Sunitinib and SGK1 inhibitors significantly reduced SGK1 protein expression in NRVMs(P<0.01),and incubating berberine to activate SGK1 significantly protected SGK1 protein expression decrease induced by sunitinib(P<0.01).Conclusions Sunitinib inhibits the activity of SGK1,leading to myocardial injury,while berberine activates SGK1 and has protective effects.

Objective:To observe the changes of central visual acuity and extracentral visual acuity in eyes with non-arteritic central retinal artery occlusion (NA-CRAO).Methods:A retrospective clinical study. From January 1, 2017 to December 31, 2024, 140 patients (140 eyes) diagnosed with NA-CRAO through ophthalmic examination at Department of Ophthalmology of First People's Hospital of Xianyang City were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), visual field, intraocular pressure, fundus color photography, optical coherence tomography (OCT), and fluorescein angiography (FFA) examinations. After a clear diagnosis, conservative treatment such as reducing intraocular pressure, relieving spasms, and dilating blood vessels should be given immediately. Simultaneously, intravenous and/or arterial thrombolysis therapy should be administered based on the patient's overall condition. Under the same treatment conditions as other treatments, 33 eyes were treated with hyperbaric oxygen therapy within 24 hours after seeking medical attention. The changes in central visual acuity (BCVA) and peripheral visual acuity of the affected eye one month after treatment were observed. BCVA improvement of ≥ 1 line was defined as the increase of no light sensitivity to light sensitivity or above, and the increase of light sensitivity to 0.01 or above. The visual acuity outside the center was determined by the 0 ° axis in front of the eyeball at eye level, and was 10 ° outside visual acuity on the temporal side. Multivariate analysis using logistic regression analysis.Results:Among the 140 cases (140 eyes), there were 84 males (84 eyes) and 56 females (56 eyes). The mean age was (63.89±10.78) years. The duration of illness from the onset of symptoms to the time of diagnosis was 48 (2-720) hours. 6, 1, 14, 47, 41, 16, and 15 eyes were diagnosed with BCVA without light perception, uncertain light perception, manual/anterior, digital/anterior, 0.01-0.10, and ≥ 0.10, respectively. FFA examination revealed delayed arm retinal circulation time and filling of the retinal artery trunk to the peak, with changes in the "arterial front" observed in 126 eyes. OCT examination showed extensive edema and unclear structure in the inner layer of the retina in all patients. Out of 140 eyes, 122 were treated with intravenous thrombolysis and 4 with arterial thrombolysis; 14 eyes did not receive thrombolytic therapy. After treatment, 38 eyes (27.1 %) showed an improvement of BCVA ≥ 1; 67 eyes (47.9%) did not show an improvement in BCVA, and the affected eye had a BCVA of approximately 0.6 without light perception; 17 eyes (12.1 %) showed improvement in peripheral vision, and the peripheral vision of the affected eyes ranged from 0.01 to 0.1, all of whom were patients undergoing intravenous thrombolysis, and prior to treatment, this group of patients had complete blindness in the coarse side visual field of the Amsler grid, and their out of center visual acuity could not be measured. Among the 33 eyes treated with hyperbaric oxygen therapy, 24 eyes (72.7%) showed an increase in BCVA after treatment; 9 eyes did not improve, among which 4 eyes (12.1%) showed improvement in out of center visual acuity. Among the 107 eyes that did not receive hyperbaric oxygen therapy, 49 eyes (45.8%) showed an increase in BCVA after treatment. There was no improvement in 58 eyes (54.2%), among which 13 eyes (12.1%) showed an improvement in out of center visual acuity. The results of logistic regression analysis showed that intravenous thrombolysis and hyperbaric oxygen therapy were independent predictive factors for the improvement of central and extra central visual acuity ( P<0.05). Conclusions:Hyperbaric oxygen therapy within 24 hours of seeking medical attention for patients with NA-CRAO disease course ≤ 1 month has a significant effect on the recovery of central and extra central vision. Intravenous thrombolysis and hyperbaric oxygen therapy are independent predictive factors for the improvement of central and extra central vision.

So far， there are still no specific treatment methods for severe hepatitis and liver failure， resulting in a mortality rate of over 70%， and they are the difficulties in the treatment of critical illness in China and globally. Liver transplantation is currently the most effective treatment method for end-stage liver disease， but only 1%‍ ‍—‍ ‍2% of patients can receive the opportunity for organ transplantation. The bioartificial liver support system utilizes external mechanical， physical， and biological devices to remove various harmful substances accumulated in the patient’s body， compensate for the metabolic functions of the liver， supplement necessary substances， improve internal environment， promote the recovery of liver function， help patients get through the critical period， and save time for liver transplantation， and therefore， it is considered one of the important methods for the treatment of end-stage liver disease. Since hepatocytes are the core element of bioartificial liver， this article summarizes the sources of liver seed cells， 3D culture methods， and corresponding bioreactor culture systems and hopes to gradually solve the core issue of large-scale in vitro preparation of hepatocytes to obtain hepatocytes with adequate quantity and quality， which urgently needs to be addressed in clinical application.

Objective:To observe the clinical and imaging features of patients with retinal vein occlusion (RVO) complicated with retinal artery occlusion (RAO).Methods:A retrospective clinical study. Fifteen patients with 15 eyes with RVO combined with RAO and macular edema diagnosed by ophthalmology examination in the Department of Ophthalmology, First People's Hospital of Xianyang City during 2 years from February 1, 2022 to January 31, 2024 were included in the study. Branch retinal vein occlusion (BRVO) combined with branch retinal artery occlusion (BRAO) occurred in 3 cases and 3 eyes. Central retinal vein occlusion (CRVO) complicated with central retinal artery occlusion (CRAO) in 12 eyes. Best corrected visual acuity (BCVA), intraocular pressure, scanning laser ophthalmoscope, optical coherence tomography (OCT), fluorescein fundus angiography (FFA) and serum homocysteine were all performed. OCT angiography (OCTA) was performed in 6 eyes. All eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drugs. After the initial 1 treatment, dosage was assessed as needed. Follow-up was performed every month for 12 months after treatment. FFA inspection was performed at 3 months. During follow-up, it was found that there were no perfusion areas of capillaries, and retinal laser photocoagulation therapy was given in time. Fundus manifestations, FFA, OCT, OCTA characteristics and causes of disease were analyzed retrospectively.Results:There were 15 eyes in 15 cases, 9 eyes in 9 males; 6 women with 6 eyes. Age was (61.0±9.7) years. All complained of painless vision loss in one eye. All eyes were positive for relative afferent pupillary disorder. Contralateral congenital optic disc defect was in 1 case; hypertension was in 6 cases; hyperhomocysteinemia was in 2 cases; cerebral infarction was in 3 cases; coronary heart disease was in 1 case. CRVO combined with CRAO was in 12 eyes BCVA light sensitivity-0.25. The BCVA of BRVO combined with BRAO were 0.1, 0.4 and 0.25, respectively. All the patients had retinal edema in the posterior pole of the eye, venous sinuous, dilated, thin arteries and stiff shape. The retina presents with flaky or flame-like bleeding. Posterior polar retinal lint patch was in 13 eyes. In 12 eyes with CRVO combined with CRAO, optic disc edema was observed and the boundary was not clear. In 3 eyes with BRVO combined with BRAO, no obvious abnormality was found in the optic disc, and the boundary was clear. FFA examination showed no or prolonged arterial filling, delayed retinal vein laminar flow, relatively slow or even no capillary filling, macular arteriole atretosis to varying degrees, arch ring structure destruction, optic disc telangiectasia and fluorescein leakage. OCT examination showed that the middle and inner layers of the retina were thickened to varying degrees, the diffuse reflex was enhanced, the interlayer structure was unclear, and the reflex of the lower retinal tissue was weakened. The blood flow density of superficial capillary plexus and deep capillary plexus (DCP) decreased in 6 eyes undergoing OCTA examination. Decreased or interrupted blood flow in the vascular bed of DCP. During the follow-up period, there were 13 eyes with no perfusion area of retinal capillary. The time of occurrence was (1.14±0.95) (0-2) months, and the area was 10-75 disc area. Optic nerve atrophy occurred in 5 eyes. At the last follow-up, visual acuity increased, unchanged and decreased in 12, 2 and 1 eyes, respectively.Conclusions:The pathogenesis of RVO-RAO is complicated. Most RVO and RAO occurred simultaneously, and a few RVO occurred several days after RAO. Although the RAO manifestations are not typical, the radiographic features are both RVO and RAO. Compared with BVRO combined with BRAO, the prognosis of visual acuity in CRAO patients with CRVO is worse.

Objective: To provide the mechanism-based pharmacotherapy of the Huatan Qushi formula (HTQS formula), for the health management and treatment of non-alcoholic fatty liver disease (NAFLD). Methods: A rat model of NAFLD was employed to examine the efficacy and safety of the HTQS formula. In vivo active components and potential mechanisms of the HTQS formula were identified using UPLC‒MS/MS combined with network pharmacology. The influence of the HTQS formula on the dominating proteins in PI3K/Akt pathway was validated in vivo using western blot. Finally, 16S rRNA sequencing of the gut microbiome was conducted followed by targeted metabolomics detecting fecal short-chain fatty acids (SCFAs) and bile acids to determine the impact of the HTQS formula on gut microbiota. Results: The HTQS formula reduced weight gain and hepatic steatosis in NAFLD rats and decreased serum total cholesterol (TC), triglycerides, blood glucose, and insulin resistance (IR) without causing liver or kidney injury. We detected 28 components using UPLC‒MS/MS and identified 439 shared targets between NAFLD and the HTQS formula. Primarily, we focused on the PI3K/Akt signaling pathway based on protein‒protein interaction network analysis. We validated that the HTQS formula inhibited liver steatosis and inflammation by increasing the phosphorylation levels of PI3K, AKT, P27, GSK3β in the PI3K/Akt signaling pathway. 16S rRNA sequencing revealed that the HTQS formula reduced the abundance of the genus Family_XIII_AD3011_group, which was positively correlated with IR and taurodeoxycholic acid. In addition, Lachnospiraceae_UCG_010 inversely correlated with TC and five bile acids, which could be essential to the therapeutic effect of the HTQS formula against NAFLD. Conclusions The HTQS formula proved to be an effective pharmacotherapy for NAFLD without causing liver or kidney injury. Multiple potent components of the HTQS formula could alleviate liver steatosis and lipid metabolism disorder by modulating the PI3K/Akt signaling pathway and restoring gut microbiota composition.

Objective With the complex evolution of the social system,patients experience varying degrees of delay in obtaining medical and health services under the combined drive of internal and external environment.In order to alleviate the dilemma of seeking medical treatment in crisis situations,it analyzes the causes of the public's use behavior of Internet medical and health services after delayed medical treatment and the ways to improve it.Methods It employs the method of QCA analysis to explore the crisis management strategies adopted by 183 public.Based on Anderson medical treatment model as the theoretical guidance,conditional variables were constructed.Through deductive logic,it analyzes the complex linkage effect of seven variables,including accessibility level,traumatic life events,panic mood and satisfaction with Internet medical use,on the use of Internet medical services.Results it found that panic has a decisive role in promoting the public's use of Internet medical services.Five behavioural models of Internet medical use are proposed to reveal the potential driving mechanism of the public's adoption of Internet medical strategies.Conclusion By analyzing the synergistic effects between variables,it proposes comprehensive strategies,providing a new perspective for public health emergency management,and offering empirical evidence for policymakers to optimize smart medical services.

Objective With the complex evolution of the social system,patients experience varying degrees of delay in obtaining medical and health services under the combined drive of internal and external environment.In order to alleviate the dilemma of seeking medical treatment in crisis situations,it analyzes the causes of the public's use behavior of Internet medical and health services after delayed medical treatment and the ways to improve it.Methods It employs the method of QCA analysis to explore the crisis management strategies adopted by 183 public.Based on Anderson medical treatment model as the theoretical guidance,conditional variables were constructed.Through deductive logic,it analyzes the complex linkage effect of seven variables,including accessibility level,traumatic life events,panic mood and satisfaction with Internet medical use,on the use of Internet medical services.Results it found that panic has a decisive role in promoting the public's use of Internet medical services.Five behavioural models of Internet medical use are proposed to reveal the potential driving mechanism of the public's adoption of Internet medical strategies.Conclusion By analyzing the synergistic effects between variables,it proposes comprehensive strategies,providing a new perspective for public health emergency management,and offering empirical evidence for policymakers to optimize smart medical services.

ObjectiveTo investigate the relationship among spontaneous turning direction, balance ability and fall risk in patients with stroke during walking. MethodsFrom December, 2021 to November, 2022, 94 patients with stroke were recruited from Beijing Bo'ai Hospital. They were assessed with simple Timed 'Up and Go' Test (TUGT, TUGT1), TUGT with a cup in hand (TUGT2), and TUGT with calculation task (TUGT3). The spontaneous turning directions at the turn point were recorded, and the patients were divided into no-same group (n = 34) and same group, and the same group was further divided into affected group (n = 33) and unaffected group (n = 27), according to the spontaneous turning direction. After a spontaneous turning of each TUGT, the patients were asked to finish another TUGT turning to the opposite direction. And then, they were assessed with single leg standing test, Functional Reach Test (FRT), 360° turning test and the Morse Fall Scale (MFS). ResultsThere were the most patients with left hemiplegia in the affected group (χ² = 7.995, P < 0.05). The time of TUGT1, TUGT2 and TUGT3 was the most in the affected group and the least in the unaffected group (F > 4.009, P < 0.05), and it was more in the affected group than in the unaffected group as post-hoc test (P < 0.05). The one leg standing time (H = 9.403, P = 0.009) and FRT distance (F = 4.300, P = 0.016) were the least in the affected group and the most in the unaffected group, and it was less in the affected group than in the unaffected group as post-hoc test (P < 0.05). The turning time (F = 4.134, P = 0.019) and turning steps (F = 5.611, P = 0.003) were the most in the affected group and the least in the unaffected group, and it was more in the affected group than in the unaffected group as post-hoc test (P < 0.05). The score of MFS was the most in the affected group and the least in the unaffected group (H = 8.192, P = 0.017), and it was more in the affected group than in the unaffected group as post-hoc test (P < 0.05). ConclusionThe stroke patients spontaneously turning to the affected side during walking usually are poorer in balance function, and in a risk of fall.