ObjectiveTo investigate the effect of Danggui Shaoyaosan on ferroptosis in the rat model of non-alcoholic fatty liver disease （NAFLD） and explore the underlying mechanism based on the nuclear factor E₂-related factor 2 （Nrf2）/solute carrier family 7 member 11 （SLC7A11）/glutathione peroxidase 4 （GPX4） signaling pathway. MethodsThe sixty SD rats were randomly grouped as follows： control， model， Yishanfu （0.144 g·kg^-1）， and low-， medium-， and high-dose （2.44， 4.88， and 9.76 g·kg^-1， respectively） Danggui Shaoyaosan. A high-fat diet was used to establish the rat model of NAFLD. After 12 weeks of modeling， rats were treated with corresponding agents for 4 weeks. Then， the body weight and liver weight were measured， and the liver index was calculated. At the same time， serum and liver samples were collected. The levels or activities of total cholesterol （TC）， triglycerides （TG）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， and Fe²⁺ in the serum and TC， TG， free fatty acids （FFA）， malondialdehyde （MDA）， superoxide dismutase （SOD）， glutathione peroxidase （GPX）， and Fe²⁺ in the liver were measured. Hematoxylin-eosin staining and oil red O staining were employed to observe the pathological changes in the liver. Immunofluorescence was used to assess the reactive oxygen species （ROS） content in the liver. Mitochondrial morphology was observed by transmission electron microscopy. The protein levels of Nrf2， SLC7A11， GPX4， transferrin receptor 1 （TFR1）， and divalent metal transporter 1 （DMT1） in the liver were determined by Western blot. ResultsCompared with the control group， the model group showed increases in the body weight， liver weight， liver index， levels or activities of TC， TG， ALT， AST， and Fe²⁺ in the serum， levels of TC， TG， FFA， MDA， Fe²⁺， and ROS in the liver， and protein levels of TFR1 and DMT1 in the liver （P<0.01）， and decreases in the activities of SOD， GPX and the protein levels of Nrf2， SLC7A11， and GPX4 in the liver （P<0.05， P<0.01）. Meanwhile， the liver tissue in the model group presented steatosis， iron deposition， mitochondrial shrinkage， and blurred or swollen mitochondrial cristae. Compared with the model group， all doses of Danggui Shaoyaosan reduced the body weight， liver weight， liver index， levels or activities of TC， TG， ALT， AST， and Fe²⁺ in the serum， levels of TC， TG， FFA， MDA， Fe²⁺， and ROS in the liver， and protein levels of TFR1 and DMT1 in the liver （P<0.01）， while increasing the activities of SOD and GPX and the protein levels of Nrf2， SLC7A11， and GPX4 in the liver （P<0.01）. Furthermore， Danggui Shaoyaosan alleviated steatosis， iron deposition， and mitochondrial damage in the liver. ConclusionDanggui Shaoyaosan may inhibit lipid peroxidation and ferroptosis by activating the Nrf2/SLC7A11/GPX4 signaling pathway to treat NAFLD.

Objective:To discuss the infection status and clinical outcomes in the patients with bullous pemphigoid(BP),and to analyze the risk factors for infection in hospitalized BP patients,as well as to construct and evaluate the risk prediction model.Methods:A total of 126 patients first diagnosed with BP were selected.According to the occurrence of infection,the patients were divided into infection group(52 cases)and non-infection group(74 cases).The infection status and outcomes of the patients in two groups were recorded;statistical analysis was performed on the general data,laboratory examination results,FRAIL scale scores for frailty screening,NRS2002 scores,and skin lesion severity of the patients in two groups;multivariate Logistic regression model was used to identify the risk factors for infection in the patients;the goodness-of-fit test was used to evaluate the model;receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the model for infection.Results:Among the 126 hospitalized BP patients,52 cases had infection,with an infection rate of 41.27％.The mortality rate of the patients in infection group was higher than that in non-infection group(P＜0.05),and the remission rate of the patients in non-infection group was higher than that in infection group(P＜0.05).The FRAIL scale score for frailty screening,NRS2002 score,serum albumin level,prealbumin level,number of hospitalization,skin lesion severity,and time of hospital stay of the patients in infection group were significantly higher than those in non-infection group(P＜0.05).The multivariate Logistic regression analysis results derived the regression equation:Logistic(P)=-7.63+0.922× skin lesion severity+2.565×FRAIL scale score for frailty screening+1.214×NRS2002 score.The area under the curve of the Logistic regression model was 0.916.Conclusion:The FRAIL scale score for frailty screening,NRS2002 score,and skin lesion severity are the risk factors for infection in the hospitalized BP patients.The constructed infection risk prediction model based on these factors has good predictive value and may provide new ideas for the prevention and control of infection in the hospitalized BP patients.

Objective To explore the potential molecular mechanism of Maitong Jun'an decoction(MTJA)in the treatment of coronary heart disease based on network pharmacology,molecular docking and animal experiments.Methods The main active components and corresponding protein targets of MTJA were screened in Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP)and SwissTargetPrediction combined with literatures.Genes associated with myocardial infarction and heart failure in coronary heart disease were searched in DisGeNET,Genecards and Online Mendelian Inheritance in Man(OMIM)databases.The intersection of compound targets and disease targets was obtained,and"medicine-composition-target-disease"network was constructed.The overlapping targets were imported into STRING database to construct protein-protein interaction(PPI)network.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were performed on the targets,and molecular docking studies were further conducted on the core targets and active compounds.The rat model of myocardial infarction was established.The morphological and pathological changes of heart tissue were observed by hematoxylin-eosin staining,and the expression of core target protein was detected by Western blotting.Results There were 264 nodes and 1 193 interrelationships in the"medicine-composition-target-disease"network.Quercetin and kaempferol were the key components as ranked by degree value.The proteins with high degree in PPI network were interleukin(IL)-6,IL-1β and protein kinase B 1(Akt1).GO and KEGG analyses showed that the mechanism of MTJA in the treatment of coronary heart disease mainly involved lipids and atherosclerosis,advanced glycation end product(AGE)-receptor for advanced glycation end product(RAGE)signaling pathway in diabetes complications,fluid shear stress and atherosclerosis,IL-17 signaling pathway,etc.The results of molecular docking showed that the important compounds of MTJA had strong binding ability with the core target.The results of animal experiments showed that MTJA could significantly alleviate the myocardial injury in rats with myocardial infarction,and reduce the expression levels of IL-1β and IL-6 proteins in apical tissue of rats with coronary heart disease.Conclusion MTJA may play a role in the treatment of coronary heart disease by reducing the expression levels of IL-1β and IL-6 proteins.

Comprehensive improvement in course teaching quality is an important link in deepening the reform of undergraduate education and teaching. Since 2018, West China Medical School, Sichuan University, has implemented the collective lesson preparation system of "two meetings, seven decisions, and three preparation sessions" for undergraduate clinical courses, thereby effectively implementing subject cooperation, organizational guidance, and resource integration among clinical teachers and determining the key elements of the course through "teaching, learning, and exam preparations" before class. In the process of course operation, the concept of quality control based on plan-do-check-act cycle is deeply integrated with the collective lesson preparation system, and active implementation of the whole-process quality control loop of planning (plan), organization and implementation (do), inspection of results (check), and treatment and improvement (action) has effectively improved the teaching quality of undergraduate clinical courses.

Regional odontodysplasia(ROD)is a localized developmental anomaly involving deciduous and perma-nent dentition,with a significant impact on patients.The affected teeth display unique ghost-like radiological characteris-tics,clinically manifesting as delayed tooth eruption,abnormal tooth morphology,and recurrent swelling of gingiva.In this paper,we report a case of a 2-year-old patient with ROD whose chief complaint was facial cellulitis.We analyze the medical history,clinical examination,radiographic findings,and histologic findings,and review the pathological fea-tures,pathogenesis,multidisciplinary diagnosis,and treatment of ROD.This rare case,which offers clinical samples for its further study,can provide a deeper study of ROD.

OBJECTIVE To explore the effects and mechanisms of cycloartenol on myocardial ischemia-reperfusion injury in mice.METHODS In vitro experiments,primary cardiomyocytes were extracted from 1-3 days SD mice.The hypoxia/reoxygenation model was established by incubating cells in a hypoxic culture box for 3 hours followed by reoxygenation in a normal culture box for 3 hours.The primary cardiomyocytes were divided into Control group,H/R group,low-dose(3 μmol·L-1)and high-dose(10 μmol·L-1)cycloartenol groups,and SB203580 group.CCK-8 was used to detect cell viability,the apoptosis rate was detected by flow cytometry,and Western blot was used to detect the expression levels of p38 MAPK and p-p38 MAPK in each group.In an in vi-vo experiment,7-week-old male C57BL/6J mice were randomly divided into a Control group,an I/R group,and three doses of cyclo-artenol(0.2,0.5,1.0 mg·kg-1)groups.The mice were continuously administered for seven days before the surgery.The model was prepared by ligation of the left anterior descending coronary artery(LAD)for 30 minutes,followed by reperfusion for 24 hours to in-duce myocardial ischemia-reperfusion injury.Left ventricular ejection fraction(LVEF),cardiac output(CO),left ventricular fractional shortening(LVFS)of each group of mice were detected by small animal ultrasound.TTC staining was used to detect the changes of is-chemic infarct size in each group.The changes of myocardial tissue in each group were observed by HE staining.The expression levels of p38 MAPK,p-p38 MAPK,IL-6 and TNF-α in myocardial tissue of mice were detected by Western blot.Serum levels of creatine ki-nase isoenzyme(CK-MB),lactate dehydrogenase(LDH),cardiac troponin I(cTnI),interleukin-6(IL-6),and tumor necrosis fac-tor-α(TNF-α)were measured using ELISA kits.RESULTS In vitro experiments demonstrated that compared with the H/R group,both the cycloartenol and SB203580 pretreatment groups showed a significant increase in myocardial cell viability and the apoptosis rate decrease,which can downregulate the protein expression level of p-p38 MAPK and decrease the ratio of p-p38 MAPK/p38 MAPK(P<0.05).In vivo experiments confirmed that compared with the I/R group,cycloartenol pretreatment significantly improved LVEF,LVFS,and CO values(P<0.05),reduce myocardial ischemic infarct size,thereby enhancing myocardial function.The protein ex-pression level of p-p38 MAPK in myocardial tissue was down-regulated,the ratio of p-p38 MAPK/p38 MAPK was decreased,and the expression levels of IL-6 and TNF-α were decreased.Additionally,cycloartenol pretreatment reduced the levels of CK-MB,LDH,cT-nI,IL-6,and TNF-α in mouse serum(P<0.05).CONCLUSION Pre-treatment with cycloartenol can protect mouse cardiac func-tion and alleviate myocardial ischemia-reperfusion injury.Its mechanism of action may be related to the inhibition of p38 MAPK phos-phorylation,reducing inflammatory reactions.

Objective·To investigate the effects of sennoside A(SA)on the formation of atherosclerotic plaque and the expression of 5-hydroxytryptamine(5-HT)and its receptor in mice with diabetes mellitus type 2(T2DM).Methods·Twelve mice with knocked-out apolipoprotein E gene were randomly divided into two groups,namely the model group and the model+SA group,with six mice in each group.Six C57BL/6J mice with the same genetic background were used as the control group.The control group was fed with normal diet,and the model group and the model+SA group were given intraperitoneal injection of streptozotocin(30 mg/kg)daily on the basis of high-fat diet to establish a model of T2DM.The model+SA group was given SA daily by gavage for 8 weeks,and the control group and the model group were given equal volume of distillation-distillation H2O by gavage.The body weight,fasting blood glucose(FBG)and 2-h postprandial blood glucose of mice were compared before and after modeling and treatment.The area of aortic plaque was observed by oil red O staining and hematoxylin-eosin(H-E)staining,and the level of 5-HT in serum and thoracic aorta was measured by ELISA kit.Western blotting was used to detect the expression of 5-hydroxytryptamine receptor 2B(HTR2B)and serotonin transporter(SERT)in thoracic aorta of mice.Results·Compared with the control group,the body weight,FBG and 2-h postprandial blood glucose in the model group increased,and glucose metabolism was disordered.The expression of HTR2B and SERT protein in thoracic aorta increased,while the concentration of 5-HT in thoracic aorta decreased.The serum 5-HT concentration increased(all P<0.05).After treatment with SA,compared with the model group,the body weight of the model+SA group decreased,and FBG and 2-h postprandial blood glucose were significantly improved.The area of aortic plaque and the expression of HTR2B and SERT protein in thoracic aorta significantly decreased,while the concentration of 5-HT increased.The serum 5-HT concentration decreased(all P<0.05).Conclusion·SA can reduce atherosclerotic plaque area in T2DM mice,which may be related to lowering blood glucose and inhibiting the expression of 5-HT and its receptor.

Objective:To investigate the chain mediation effect of psychological flexibility and dyadic coping between perceived social support and family function in parents of pediatric liver transplant recipients.Methods:Totally 320 parents of pediatric liver transplant recipients who were treated at the Department of Pediatric Organ Transplantation, Tianjin First Central Hospital from April to October 2023 were selected by convenience sampling. The participants were surveyed using a general information questionnaire, the Perceived Social Support Scale (PSSS), the Acceptance and Action Questionnaire-Ⅱ (AAQ-Ⅱ), the Dyadic Coping Inventory (DCI), and the Family APGAR Index (APGAR). Pearson correlation analysis was used to examine the relationships between perceived social support, psychological flexibility, dyadic coping, and family function in these parents. Structural equation modeling (SEM) was performed using Amos 26.0 to analyze the chain mediation effect of psychological flexibility and dyadic coping between perceived social support and family function, with the Bootstrap method used for model testing.Results:A total of 320 questionnaires were distributed, with 312 valid responses, yielding a response rate of 97.50% (312/320). The scores for the 312 parents were as follows: PSSS (59.29±15.64), AAQ-Ⅱ (20.35±9.07), DCI (124.64±32.65), and APGAR (6.98±2.74). Family function was positively correlated with perceived social support and dyadic coping ( P<0.01), and perceived social support was positively correlated with dyadic coping ( P<0.01). Psychological flexibility was negatively correlated with family function, perceived social support, and dyadic coping ( P<0.01). SEM results showed that psychological flexibility and dyadic coping had a significant chain mediation effect between perceived social support and family function, with a mediation effect value of 0.059. The chain mediation effect of psychological flexibility and dyadic coping accounted for 13.81% of the total effect (0.059/0.427) . Conclusions:Perceived social support directly affects family function in parents of pediatric liver transplant recipients and also indirectly influences family function through the chain mediation effect of psychological flexibility and dyadic coping.

Objective:To investigate the application status of emergency radiology in China, and to provide data support for the standardized development, scientific management and big data research of emergency radiology.Methods:From August 12th to October 19th, 2022, a questionnaire survey was conducted through WeChat"Questionnaire Star"to send targeted questionnaires to investigate the relevant data of the current status of emergency radiology in China, mainly including digital radiography (DR) and computed tomography (CT). This study was initiated by the Chinese Emergency Radiology Database Collaboration Group, and comprehensively investigated emergency imaging personnel, equipment, workload, critical value reporting process, and artificial intelligence (AI) application status.Results:There were 123 hospitals in the study. The survey showed that emergency DR/CT reports were mainly completed by residents and above (69.1%). There were 21 DR brands, 10 CT brands and 8 MR brands used for emergency imaging examinations. The median number of DR examinations in tertiary hospitals and secondary hospitals investigated from January to June 2022 was 4 642 and 2 015 cases respectively, and the median number of CT examinations was 16 512 and 3 762 cases respectively. The average single-shift workload of DR in the emergency radiology department during the day and night shift in tertiary hospitals was mainly ≤20 copies and 21-50 copies, and the average single-shift workload of CT in the emergency radiology department during the day and night shift was mainly 21-50 copies and 51-100 copies, while the average single-shift workload of DR/CT in the emergency radiology department during the day/night shift in secondary hospitals was mainly ≤20 copies. In terms of critical value reporting process, 74.8% of emergency imaging doctors and 84.6% of emergency imaging technicians took the way of phone/text message to notify the clinical doctor or the patients′ family. The overall deployment rate of AI in emergency imaging was about 60.2%. 75% of the respondents believed that in the future, AI can improve emergency radiology work from aspects such as emergency screening, aided diagnosis and process optimization.Conclusions:The emergency medical imaging mainly based on DR and CT has the current situations such as generally low seniority of doctors, diverse brands of imaging equipments, large volume of examinations and intense workload per doctor, especially in tertiary hospitals, and dependence on traditional means for critical value reporting. At present, AI is emerging in the field of emergency imaging, and there is still a long way to go to play the huge potential of AI in the intelligent whole process of emergency imaging in the future.

Recently,with the rapid growth of the global population and the exhaustion of resources,exploration activities in extreme environments such as the polar regions,the outer space,the deep sea,the deep underground and highlands are becoming increasingly more frequent.This in-depth exploration of the external environment and the consequent dramatic changes in lifestyles impact on sleep,a basic life activity of humans,in ways that cannot be overlooked.the basic life activity of human beings.Sleep,a basic life activity and the result of the evolution of organisms to adapt to their environment,is closely associated with sleep homeostasis and endogenous rhythms.However,external environmental changes and lifestyle shifts in extreme environments have had a significant impact on the patterns and the quality of sleep in humans.Furthermore,this impact can lead to many physiological and psychological problems,posing a great threat to human health.In this review,we delved into the specific effects of different extreme natural environments and enclosed environments on sleep,elaborating on how these environments alter the patterns and the quality of sleep in humans.In addition,we summarized the changes in human sleep under extreme environments to help gain a better understanding of the mechanisms by which these specific environments impact human sleep.It is expected that this review will provide a solid theoretical foundation for optimizing long-term survival strategies in extreme environments and help humans adapt to and overcome the challenges posed by extreme environments more effectively.