BACKGROUND:Repetitive trans-spinal magnetic stimulation(rTSMS)can inhibit inflammatory responses following spinal cord injury.rTSMS applies magnetic field stimulation to the spinal cord region to modulate neuronal excitability and synaptic transmission,thereby promoting plasticity and repair of the nervous system. OBJECTIVE:To observe the effects of rTSMS on the Toll-like receptor 4(TLR4)/nuclear factor(NF)-κB/NLRP3 signaling pathway after spinal cord injury and explore its mechanism in promoting motor function recovery. METHODS:Male C57BL/6J mice,SPF grade,were randomly divided into sham surgery group,spinal cord injury group,and rTSMS group.The latter two groups of mice were anesthetized and the T9 vertebral plate was removed using rongeur forceps to expose the spinal cord,and the spinal cord was clamped using a small aneurysm clip for 20 seconds to establish the spinal cord injury model.Mice in the rTSMS group underwent a 21-day rTSMS intervention starting on day 1 after spinal cord injury.The stimulation lasted 10 minutes per day,5 days per week with an interval of 2 days.Basso Mouse Scale scores were used to assess motor function recovery in mice after spinal cord injury at 1,3,7,14,and 21 days after spinal cord injury.Western blot was employed to detect the expression of AQP4,apoptotic factors Bax,Bcl-2,CL-Caspase-3,inflammatory factors tumor necrosis factor-α,interferon-γ,interleukin-6,interleukin-4,and the TLR4/NF-κB/NLRP3 signaling pathway related proteins in the injured spinal cord.Oxidative stress assay kit was used to measure the activity of superoxide dismutase,glutathione peroxidase,and malondialdehyde content at the site of spinal cord injury.Immunofluorescence staining was performed to detect the expression of neuronal nuclei(NeuN). RESULTS AND CONCLUSION:The Basso Mouse Scale score in the rTSMS group was significantly higher than that in the spinal cord injury group(P<0.05).Compared with the spinal cord injury group,the rTSMS group showed a reduction in spinal cord water content.The expression of AQP4 protein,malondialdehyde content,and expression of Bax,Bcl-2,CL-Caspase-3,tumor necrosis factor-α,interferon-γ,interleukin-6,and TLR4/NF-κB/NLRP3 signaling pathway related proteins were all decreased in the rTSMS group,while the activities of superoxide dismutase and glutathione peroxidase,as well as the expression of Bcl-2,interleukin-4,and NeuN,were all increased(P<0.05).These results suggest that rTSMS downregulates the expression of proteins related to the TLR4/NF-κB/NLRP3 signaling pathway,alleviating symptoms after spinal cord injury such as spinal cord edema,oxidative stress,apoptosis,and inflammation,exerting neuroprotective effects,and thereby promoting the recovery of hindlimb motor function after spinal cord injury.

Objective To systematically evaluate the efficacy and safety of proximal gastrectomy (PG) versus total gastrectomy (TG) for the treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG). Methods PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang, and VIP databases were searched for literature comparing the efficacy and safety of PG and TG for the treatment of Siewert type Ⅱ/Ⅲ AEG. The search period was from database inception to March 2023. Meta-analysis was performed using Review Manager 5.4 software. Results A total of 23 articles were included, including 16 retrospective cohort studies, 5 prospective cohort studies, and 2 randomized controlled trials. The total sample size was 2 826 patients, with 1 389 patients undergoing PG and 1 437 patients undergoing TG. Meta-analysis results showed that compared with TG, PG had less intraoperative blood loss [MD=−19.85, 95%CI (−37.20, −2.51), P=0.02] and shorter postoperative hospital stay [MD=−1.23, 95%CI (−2.38, −0.08), P=0.04]. TG had a greater number of lymph nodes dissected [MD=−6.20, 95%CI (−7.68, −4.71), P<0.001] and a lower incidence of reflux esophagitis [MD=3.02, 95%CI (1.24, 7.34), P=0.01]. There were no statistically significant differences between the two surgical approaches in terms of operative time, postoperative survival rate (1-year, 3-year, 5-year), and postoperative overall complications (P>0.05). Conclusion PG has advantages in terms of intraoperative blood loss and postoperative hospital stay, while TG has advantages in terms of the number of lymph nodes dissected and the incidence of reflux esophagitis. There is no significant difference in long-term survival between the two surgical approaches.

The COVID-19 epidemic has spread to the whole world for three years and has had a serious impact on human life, health and economic activities. China's epidemic prevention and control has gone through the following stages: emergency unconventional stage, emergency normalization stage, and the transitional stage from the emergency normalization to the "Category B infectious disease treated as Category B" normalization, and achieved a major and decisive victory. The designated hospitals for prevention and control of COVID-19 epidemic in Tianjin has successfully completed its tasks in all stages of epidemic prevention and control, and has accumulated valuable experience. This article summarizes the experience of constructing a hospital infection prevention and control system during the "Category B infectious disease treated as Category A" period in designated hospital. The experience is summarized as the "Cluster" hospital infection prevention and control system, namely "three rings" outside, middle and inside, "three districts" of green, orange and red, "three things" before, during and after the event, "two-day pre-purification" and "two-director system", and "one zone" management. In emergency situations, we adopt a simplified version of the cluster hospital infection prevention and control system. In emergency situations, a simplified version of the "Cluster" hospital infection prevention and control system can be adopted. This system has the following characteristics: firstly, the system emphasizes the characteristics of "cluster" and the overall management of key measures to avoid any shortcomings. The second, it emphasizes the transformation of infection control concepts to maximize the safety of medical services through infection control. The third, it emphasizes the optimization of the process. The prevention and control measures should be comprehensive and focused, while also preventing excessive use. The measures emphasize the use of the least resources to achieve the best infection control effect. The fourth, it emphasizes the quality control work of infection control, pays attention to the importance of the process, and advocates the concept of "system slimming, process fattening". Fifthly, it emphasizes that the future development depends on artificial intelligence, in order to improve the quality and efficiency of prevention and control to the greatest extent. Sixth, hospitals need to strengthen continuous training and retraining. We utilize diverse training methods, including artificial intelligence, to ensure that infection control policies and procedures are simple. We have established an evaluation and feedback mechanism to ensure that medical personnel are in an emergency state at all times.

Objective To systematically evaluate the efficacy and safety of single and bilateral lung transplantation in the treatment of end-stage chronic obstructive pulmonary disease (COPD). Methods Chinese and English databases were searched by computer, including PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, Wanfang database, VIP database and CBM. Case-control studies on single lung transplantation or bilateral lung transplantation for COPD were collected from the inception to July 31, 2022. We evaluated the quality of the literature via Newcastle-Ottawa Scale (NOS). All results were analyzed using Review Manager V5.3 and STATA 17.0. Results A total of 8 studies were included covering 14076 patients, including 8326 patients in the single lung transplantation group and 5750 patients in the bilateral lung transplantation group. NOS scores were≥6 points. The results of meta-analysis showed that there was no statistical difference in the postoperative 1-year survival between the two groups (P=0.070). The 2-year survival rate (P=0.002), 3-year survival rate (P<0.001), 5-year survival rate (P<0.001), overall survival rate (P＜0.001), postoperative forced expiratory volume in one second/predicted value (P<0.001), postoperative forced vital capacity (P<0.001), and postoperative 6-minute walking distance (P=0.002) were lower or shorter than those in the bilateral lung transplantation group, the postoperative intubation time (P=0.030) was longer than that in the bilateral lung transplantation group. Bilateral lung transplantation group showed better surgical results. There was no statistical difference in the mortality, obliterative bronchiolitis, length of hospitalization, primary graft dysfunction, or postoperative adverse events (P>0.05). Conclusion Bilateral lung transplantation is associated with better long-term survival and postoperative lung function compared with single lung transplantation. In-hospital mortality and postoperative complications are similar between them.

A 68-year-old patient with non-small cell lung squamous carcinoma who received 6 cycles of sintilimab combination chemotherapy and sintilimab 200 mg,ivd,monotherapy developed severe diarrhea,abdominal pain,blood in the stool and other discomforts,and ultrasound and colonoscopy demonstrated extensive congestion and inflammation in the intestinal tract,and the pathologic biopsy was comprehensively considered to be an acute immune enteritis.Immunotherapy was suspended,adequate glucocorticoids and symptomatic treatment were given,and the patient's diarrhea and blood in stool improved after 2 days,and the symptoms were relieved and returned to normal after 6 days.The association between the patient's immune enteritis and sintilimab was assessed as probably relerant.This article reviews the literature on the case of immune-associated enteritis caused by sintilimab,describes how to use experimental methods and enteroscopy to detect the pathological changes in the clinic;and combines them with the clinical manifestations of diarrhea and blood in the stools to make the diagnosis and differentiation;and then refers to the guideline grading for timely management;and discusses the case to improve the clinicians'ability to recognize and deal with the relevant scenarios.

Objective Meta-analysis was used to summarize the current status of medication adherence in patients with type 2 diabetes mellitus and to clarify the characteristics of people with low medication adherence.Methods Relevant literatures were searched in Pubmed,Cochrane Library,Web of Science,Embase,CINAHL,CBM,China National Knowledge Infrastructure,Wanfang Data,and VIP.Two researchers conducted literature screening,data extraction and quality evaluation.Stata 16.0 software was used for subgroup analysis,sensitivity analysis,offset analysis.Results A total of 42 papers were included,and the overall medication adherence of middle-aged and elderly type 2 diabetes patients ranged from 18.37%-96.53%.The medication adherence was higher among those with high education level(63%),married(61%),not living alone(50%),monthly income>3000 RMB/month(64%),having medical insurance(49%),good psychological status(61%),no chronic co-morbidities(66%),having knowledge about the disease(53%),taking≤3 types of medication(58%),convenient access to medical care(58%),and good doctor-patient relationship(50%).Conclusion The medication adherence of patients with type 2 diabetes mellitus varies greatly among different subgroups.In the future,the specific influencing factors should be further explored to formulate targeted policies and intervention measures to improve patients'medication adherence and improve their health and quality of life.

Objective To systematically review the current status and influencing factors of potentially inappropriate medication(PIM)in elderly outpatients in China,and to provide a theoretical basis for reducing the risk of medication in elderly outpatients.Methods PubMed,Web of Science,Cochrane Library,Embase,CNKI,Wanfang and VIP databases were searched by matching subject words and free words for studies on the status and influencing factors of PIM in elderly outpatients in China.The retrieval time was from January 2000 to August 2023.Two to three people completed the literature screening,data extraction and quality evaluation process.Stata 16.0 was used for Meta-analysis.Results A total of 37 literatures were included in this study.The total number of prescriptions was 1 153 750,and the total number of PIM was 219 538.The highest quality score of literature was 9 points,and the lowest was 5 points,and no low-quality literature was found.The results of Meta-analysis showed that the incidence of PIM in elderly outpatients in China was 23.2％.Age(OR=1.21,95％CI:1.16-1.27),insomnia(OR=3.47,95％CI:1.43-8.41),merging coronary heart disease(OR=1.86,95％CI:1.43-2.35),merging disease number(OR=1.37,95％CI:1.24-1.52),number of medications(OR=1.95,95％CI:1.59-2.38),physician's professional title(OR=1.29,95％CI:1.23-1.36)were the influence factors of elderly patients with outpatient PIM happened in China.Conclusion The incidence of PIM in elderly outpatients in China is different.Age,merging coronary heart disease,merging disease number,number of medications and physician's professional title are the promoting factors of PIM.

Objective To systematically evaluate the efficacy and acceptability of non-pharmaceutical intervention(NPI)for depression in patients with mild cognitive impairment(MCI).Methods Randomized controlled trials of NPI in treatment of depression patients with MCI published in PubMed,Embase,Web of Science,CINAHL,Cochrane Library,CNKI,Wanfang Data,VIP and CBM databases were searched from self-built databases to January 6,2024,and performed a network Meta-analysis using Stata 14.0 software.Results A total of 55 literatures were included,involving 10 NPIs.According to the surface under the cumulative ranking curve(SUCRA),the top 3 curative effects were cognitive behavioral therapy(CBT),Chinese traditional sport(CTS)and art therapy,the top 3 acceptability were CBT,CTS,and health education.Conclusion CBT and CTS may be effective and acceptable NPI for improving depression in patients with MCI,and individualized interventions can be tailored to the patient's situation to achieve the best results.

Objective:To study and verify the molecular mechanism of Duzhong Pills for osteoporosis (OP) by means of network pharmacology and molecular docking.Methods:The main chemical components of Duzhong Pills were mined by TCMSP database and the related targets were predicted. The potential targets of osteoporosis in GeneCards, DisGeNET and OMIM databases were searched and the common targets of both were obtained. The STRING platform was used for protein interaction analysis and PPI network diagram was made. The common targets were imported into the David database for enrichment analysis of GO and KEGG pathways, and molecular docking of the main components and core targets was performed. Eighteen Sprague-Dawley rats were divided into control group, model group and Duzhong Pills group according to random number table method, with 6 rats in each group. Ovariectomy was used to make osteoporosis model in model group and Duzhong Pills group. Duzhong Pills group was intragaxed with Duzhong Pills extract of 5 g/kg, and control group and model group were intragaxed with normal saline of the same volume, once a day for 8 weeks. Serum levels of TNF-α, IL-6 and IL-1β were detected by ELISA, and femur PI3K and Akt were detected by Western blot.Results:34 active components were obtained from Duzhong Pills, corresponding to 243 targets, and 1 059 targets for osteoporosis. The core targets included TNF-α, IL-6, AKT1, TP53, IL-1β and others regulated osteoporosis through PI3K-Akt and TNF pathway. The experimental results indicated that compared with model group, the levels of serum TNF-α, IL-6 and IL-1β in Duzhong Pills group decreased ( P<0.05), and the expressions of PI3K and Akt in femur decreased ( P<0.05). Conclusion:Through β-sitosterol, quercetin, kaempferol and other active components, Duzhong Pills can act on TNF, IL-6, AKT1, TP53, IL-1β and other targets, regulating PI3K-Akt signaling pathway, TNF signaling pathway and other signaling pathways to play a role in the treatment of osteoporosis.

Background Natural product sanguinarine chloride (SC) can significantly alleviate liver fibrosis and acute liver injury in mice, but whether it has a protective effect on mouse liver injury caused by sodium arsenite (SA) has not been studied. Objective To verify if SC may present preventive and therapeutic effects on SA-induced liver injury in mice. Methods A total of 140 SPF male Kunming mice were randomly divided into two sub-studies, which included a prevention sub-study and a treatment sub-study. In each sub-study, a blank group (normal saline), a model group (5 mg·kg⁻¹ SA), and a positive control group (11.375 mg·kg⁻¹ bicyclol and 182 mg·kg⁻¹ glutathione), as well as SC low, medium, and high dose groups (25, 50, and 100 mg·kg⁻¹) were arranged with 10 mice in each group. In the prevention sub-study, the blank group was given normal saline, the model group was given SA, and the other groups (the SC low, medium, and high dose groups and the positive control group) were given the corresponding treatment 30 min before gavage of SA, once a day, for 28 d. In the treatment sub-study, except for the blank group which was given normal saline, the other groups were given SA for 28 d, then the model group was given normal saline, and the other groups were given the corresponding treatment every day for 28 d. After the experiment, the mice were sacrificed to evaluate selected physiological and biochemical indicators in serum and liver tissue and to observe histopathological changes after HE staining. Results In either sub-study of preventive effect or treatment effect: compared with the blank group, body weight, liver weight, liver coefficient, as well as serum alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), malondialdehyde (MDA), glutathione peroxidase (GSH), and superoxide dismutase (SOD) among all SC groups were not significantly different (P>0.05); but compared with the model group, the SC groups showed increased body weight (P<0.01), decreased liver weight and liver coefficient (P<0.01), reduced ALT, AST, TBIL, and MDA (P<0.05 or P<0.01), and increased GSH and SOD with (P<0.05 or P<0.01) or without significance; compared with the positive control group, no differences were found in the above indicators (P＞0.05). The result of histopathological evaluation showed that the SC groups had a clear liver lobule structure, neatly arranged hepatic cords, and less infiltration of inflammatory cells. Conclusion SC has both preventive and therapeutic effects on SA-induced liver injury in mice.