Chronic heart failure （CHF） is a group of complex clinical syndromes caused by abnormal changes in the structure and/or function of the heart due to various reasons， resulting in disorders of ventricular contraction and/or diastole. CHF is a condition where primary diseases such as coronary heart disease， hypertension and pulmonary heart disease recur frequently and persist for a long time， presenting blood stasis in meridians and collaterals， stagnation of water and dampness， and accumulation of Qi in collaterals. Its pathogenesis is complex and may involve myocardial energy metabolism disorders， oxidative stress responses， myocardial cell apoptosis， autophagy， inflammatory responses， etc. According to the theory of restraining hyperactivity to acquire harmony， we believe that under normal circumstances， the adenosine monophosphate-activated protein kinase （AMPK） signaling pathway functions normally， maintaining human physiological activities and energy metabolism. Under pathological conditions， the AMPK signaling pathway is abnormal， causing energy metabolism disorders， inflammatory responses， and myocardial fibrosis. Traditional Chinese medicine （TCM） can regulate the AMPK signaling pathway through multiple mechanisms， targets， and effects， effectively curbing the occurrence and development of CHF. It has gradually become a research hotspot in the prevention and treatment of this disease. Guided by the theory of TCM， our research group， through literature review， summarized the relationship between the AMPK pathway and CHF and reviewed the research progress in the prevention and control of CHF with TCM active ingredients， TCM compound prescriptions， and Chinese patent medicines via regulating the AMPK pathway. The review aims to clarify the mechanism and targets of TCM in the treatment of CHF by regulating the AMPK pathway and guide the clinical treatment and drug development for CHF.

Background Aluminum (Al) is a lightweight metal that is widely present in the environment and the human body. It has been documented to cause various adverse health effects including the suppression of humoral immunity. Objective To investigate the role of oxidative stress in Al-induced humoral immunity suppression and to evaluate the possible protective effects of iron supplementation on this process. Methods Adult C57BL/6J mice were exposed to Al at concentrations of 0, 200, or 800 μg·mL⁻¹ via drinking water for three consecutive months. The expression of major histocompatibility complex class Ⅱ (I-A), proliferating cell markr-67 (Ki-67), and 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) in splenic B cells was evaluated through flow cytometry. Splenic B cells from the mice treated with 800 μg·mL⁻¹ Al or the control were sorted and treated in vitro with glutathione (GSH), N-Acetyl-L-cysteine (NAC), or a control vehicle. After 24 h, the expression of I-A was evaluated; and the hydroxyl radical (·OH)-generating potential, ·OH production, malondialdehyde (MDA) production, and iron content were assessed using commercial kits. Sixteen mice treated with 800 μg·mL⁻¹ Al received an intravenous injection of either a ferric chloride solution containing 0.3 g·L⁻¹ iron or a 0.9% sodium chloride solution, while eight control mice received 0.9% sodium chloride solution; the injection volume was 0.1 mL per mouse. Two and a half days after injection, I-A and Ki-67 expressions, ·OH-generating potential, ·OH production, and MDA production in splenic B cells were measured; and the concentrations of serum immunoglobulin (Ig) M and IgG were measured through (enzyme-linked immunosorbent assay) ELISA. The splenic B cells sorted from untreated mice were exposed to 0, 12.5, 25, or 50 μg·L⁻¹ Al in vitro. The splenic B cells treated with 50 μg·L⁻¹ Al and the splenic B cells sorted from 800 μg·mL⁻¹ Al-treated mice were additionally treated with GSH and NAC in vitro. The iron supplementation groups, which included the 50 μg·L⁻¹ Al-treated group and splenic B cells sorted from 800 μg·mL⁻¹ Al-treated mice, were treated with a culture medium containing 30 μmol·L⁻¹ iron in vitro. I-A and Ki-67 expressions, ·OH-generating potential, ·OH production, and MDA production in B cells were detected after a 24-h treatment period. Results In the in vivo mouse model, exposure to 800 μg·mL⁻¹ Al significantly inhibited the I-A and Ki-67 expressions (P<0.05), increased DCFH-DA expression and ·OH-generating potential (P<0.05, P<0.01), decreased iron content (P<0.01) and ·OH and MDA production (P<0.01, P<0.001) of splenic B cells, as well as serum IgM and IgG concentrations (P<0.05, P<0.01) in the mice. Exposure to 200 μg·mL⁻¹ Al showed a tendency to decrease the I-A and Ki-67 expressions, and to increase the DCFH-DA expression in splenic B cells, but these differences were not significant. In the in vitro splenic B-cell model, Al (12.5, 25, and 50 μg·L⁻¹) inhibited I-A and Ki-67 expressions (P<0.05, P<0.01) across all concentrations; 50 μg·L⁻¹ Al increased the ·OH-generating potential (P<0.05), and decreased ·OH and MDA production (P<0.01, P<0.05) in B cells. Treatment with GSH and NAC further suppressed I-A expression (P<0.05) in B cells. Iron supplementation increased the ·OH and MDA production (P<0.05), restored I-A and Ki-67 expressions (P<0.05, P<0.01) in B cells, and elevated the serum IgM and IgG concentrations (P<0.05) in Al-treated mice. Conclusion Al suppresses humoral immunity and ·OH production in B cells. The underlying mechanism may involve the decreased iron content and the subsequent retardation of the Fenton reaction in B cells. Supplementing with iron can restore the Fenton reaction in B cells and potentially reverse Al-induced impairment of humoral immunity.

Objective:To explore the value of the "sandwich" feedback method based on the PDCA (plan, do, check, action) cycle in improving the ability of faculty in the department of radiology in teaching clinical radiological image interpretation during standardized residency training.Methods:The study involved six faculty members engaged in standardized residency training in the department of radiology from January 2023 to January 2024. The "sandwich" feedback method based on PDCA cycle was adopted to improve their ability in teaching clinical radiological image interpretation quarterly. The teaching ability was evaluated by residents and peer faculty members. A survey on teaching satisfaction was carried out.Results:Comparison of the teaching ability between PDCA cycles demonstrated a progressive increase in scores as rated by both residents and peer faculty members (scores from quarter 1 to quarter 4 were (77.00±2.53)/(80.33±3.26), (79.16±2.04)/(82.83±2.86), (81.83±1.17)/(85.16±1.17), (83.00±1.41)/(86.00±1.41). ANOVA of repeated measures indicated that quarter had a significant impact on both peer faculty member and resident evaluations ( P<0.001), and the results remained significant after Greenhouse-Geisser correction (G-G) and Huynh-Feldt correction (H-F). Moreover, a steady increase was observed in the scores of common deficiencies. The questionnaire survey showed that 88.88% (24/27) of the faculty members were "satisfied" or "very satisfied" with the feedback model. There were no significant differences in the scores of teaching feedback is necessary and aids in standardized teaching activities, creating an atmosphere before feedback is essential and effective "sandwich" feedback is helpful in improving the ability of faculty in teaching radiological image interpretation, and "sandwich" feedback can promote teaching reflection among faculty" between resident and peer faculty member evaluations ( P>0.05). Conclusions:The "sandwich" feedback method based on the PDCA cycle can effectively improve the ability of faculty in teaching clinical radiological image interpretation in the department of radiology and provide new ideas for achieving teaching homogeneity.

Objective:To explore the effects of vitamin D supplementation combined with suspended lumbar abdominal muscle training on rehabilitation and bone metabolism indexes of patients after OVCF.Methods:A total of 140 patients with osteoporotic vertebral compression fractures (OVCF) treated at Yantaishan Hospital from Jun. 2021 to Jun. 2024 were included in this study. Patients were randomly assigned to a control group and an observation group using a random number table, with 70 patients in each group. The control group received suspension lumbar and abdominal muscle training, while the observation group received vitamin D supplementation combined with suspension lumbar and abdominal muscle training. Outcomes evaluated included VAS scores, Oswestry Disability Index (ODI) , Cobb Angle, lumboabdominal muscle strength, and serum levels of 25-hydroxyvitamin D [25 (OH) D], bone mineral density T value, and bone metabolism markers [serum osteocalcin (OC) , calcitonin (CT) , total type I collagen amino-terminal propeptide (tPINP) , type I collagen carboxy-terminal peptide β special sequence (β-CTX) , intact parathyroid hormone (iPTH) , and bone-specific alkaline phosphatase (BALP) ] measured by chemiluminescence.Results:In comparison with the control group, the VAS and ODI scores in the observation group were lower after treatment ( t=13.66, t=9.87, P < 0.05) . Compared to the control group, the lumbar muscle strength score of the observation group, the 25 (OH) D level and bone mineral density T value was higher after treatment ( t=57.63, t=6.64, t=5.01, P < 0.05) , and the Cobb Angle was smaller ( t=9.21, P < 0.05) .Compared with the control group, the bone metabolism indexes OC, CT, tPINP, and BALP were higher in the observation group after treatment ( t=4.21, t=3.05, t=2.66, t=3.16, P < 0.05) , while the iPTH and β-CTX were lower ( t=7.28, t=3.50, P < 0.05) . Conclusions:Vitamin D supplementation combined with suspended lumbar and abdominal muscle training can promote postoperative rehabilitation of OVCF patients and improve the level of bone metabolism indexes after surgery.

Objective To investigate the relationship between serum trimethylamine oxide(TMAO),neurofilament light chain protein(NfL),peroxisome proliferator-activated receptor γ coactivator-1α(PGC-1α)expression levels and short-term prognosis in aneurysmal subarachnoid hemorrhage(aSAH)patients.Method A total of 125 aSAH patients(aSAH group)and 125 healthy volunteers in the same period(control group)who were admitted in heji hospital affiliated to Changzhi Medical College from March 2020 to June 2023 were selected.The serum expression levels of TMAO,NfL and PGC-1α were compared between control group and aSAH group.The aSAH patients were followed up for 6 months after discharge.Their prognosis were evaluated using Glasgow Outcome Scale(GOS)and they were further divided into good prognosis and poor prognosis groups according to the GOS results.The serum expression levels of TMAO,NfL and PGC-1α were compared between the two groups.The poor prognosis influencing factors were analyzed by multivariate Logistic regression analysis,the serum TMAO,NfL and PGC-1α value in predicting poor prognosis were analyzed by receiver operating characteristic(ROC)curve.Result The expression levels of serum TMAO and PGC-1 α in the aSAH group were(2.63±0.36)μmol/L and(0.51±0.13)ng/mL,respectively,which were lower than those in the control group(3.18±0.57)μmol/L and(0.81±0.16)ng/mL(P<0.05).The expression level of serum NfL was significantly higher in the aSAH group(64.48±14.35 pg/mL)than in the control group(28.36±8.82 pg/mL)(P<0.05).Compared with the good prognosis group whose serum levels of TMAO and PGC-1 α were(2.80±0.80)μmol/L and(0.58±0.16)ng/mL,respectively,the poor prognosis group had significantly lower serum TMAO[(2.29±0.63)μmol/L]and PGC-1 α[(0.36±0.12)ng/mL](P<0.05).In contrast,poor prognosis group had a significantly higher level of NfL(76.70±15.61)pg/mL compared to good prognosis group(58.52±10.52)pg/mL(P<0.05).The proportion of patients with hypertension,patients with diabetes,patients with large or giant aneurysms,patients with Hunt Hess grade Ⅲ-Ⅳ,patients with onset to hospital time>12 h,and the level of C-reactive protein(CRP)were higher in the poor prognosis group than in the good prognosis group(P<0.05).Hunt Hess grade Ⅲ-Ⅳ,elevated serum CRP and NfL were independent risk factors for poor prognosis in aSAH patients(P<0.05),while elevated TMAO and PGC-1 α were protective factors(P<0.05).The area under the curve(AUC)of serum TMAO,NfL,PGC-1 α,and their combined prediction of poor prognosis in aSAH patients were 0.726,0.830,0.862,and 0.956,respectively.The AUC of the combined detection was greater than that of each indicator detected separately.Conclusion Serum TMAO and PGC-1α are lowly expressed in aSAH patients,and serum NfL is highly expressed,which are related to the occurrence of short-term poor prognosis,the combined detection of the three indicators has a high predictive value for short-term poor prognosis in aSAH patients.

Objective:To explore the value of the "sandwich" feedback method based on the PDCA (plan, do, check, action) cycle in improving the ability of faculty in the department of radiology in teaching clinical radiological image interpretation during standardized residency training.Methods:The study involved six faculty members engaged in standardized residency training in the department of radiology from January 2023 to January 2024. The "sandwich" feedback method based on PDCA cycle was adopted to improve their ability in teaching clinical radiological image interpretation quarterly. The teaching ability was evaluated by residents and peer faculty members. A survey on teaching satisfaction was carried out.Results:Comparison of the teaching ability between PDCA cycles demonstrated a progressive increase in scores as rated by both residents and peer faculty members (scores from quarter 1 to quarter 4 were (77.00±2.53)/(80.33±3.26), (79.16±2.04)/(82.83±2.86), (81.83±1.17)/(85.16±1.17), (83.00±1.41)/(86.00±1.41). ANOVA of repeated measures indicated that quarter had a significant impact on both peer faculty member and resident evaluations ( P<0.001), and the results remained significant after Greenhouse-Geisser correction (G-G) and Huynh-Feldt correction (H-F). Moreover, a steady increase was observed in the scores of common deficiencies. The questionnaire survey showed that 88.88% (24/27) of the faculty members were "satisfied" or "very satisfied" with the feedback model. There were no significant differences in the scores of teaching feedback is necessary and aids in standardized teaching activities, creating an atmosphere before feedback is essential and effective "sandwich" feedback is helpful in improving the ability of faculty in teaching radiological image interpretation, and "sandwich" feedback can promote teaching reflection among faculty" between resident and peer faculty member evaluations ( P>0.05). Conclusions:The "sandwich" feedback method based on the PDCA cycle can effectively improve the ability of faculty in teaching clinical radiological image interpretation in the department of radiology and provide new ideas for achieving teaching homogeneity.

Objective:To explore the effects of vitamin D supplementation combined with suspended lumbar abdominal muscle training on rehabilitation and bone metabolism indexes of patients after OVCF.Methods:A total of 140 patients with osteoporotic vertebral compression fractures (OVCF) treated at Yantaishan Hospital from Jun. 2021 to Jun. 2024 were included in this study. Patients were randomly assigned to a control group and an observation group using a random number table, with 70 patients in each group. The control group received suspension lumbar and abdominal muscle training, while the observation group received vitamin D supplementation combined with suspension lumbar and abdominal muscle training. Outcomes evaluated included VAS scores, Oswestry Disability Index (ODI) , Cobb Angle, lumboabdominal muscle strength, and serum levels of 25-hydroxyvitamin D [25 (OH) D], bone mineral density T value, and bone metabolism markers [serum osteocalcin (OC) , calcitonin (CT) , total type I collagen amino-terminal propeptide (tPINP) , type I collagen carboxy-terminal peptide β special sequence (β-CTX) , intact parathyroid hormone (iPTH) , and bone-specific alkaline phosphatase (BALP) ] measured by chemiluminescence.Results:In comparison with the control group, the VAS and ODI scores in the observation group were lower after treatment ( t=13.66, t=9.87, P < 0.05) . Compared to the control group, the lumbar muscle strength score of the observation group, the 25 (OH) D level and bone mineral density T value was higher after treatment ( t=57.63, t=6.64, t=5.01, P < 0.05) , and the Cobb Angle was smaller ( t=9.21, P < 0.05) .Compared with the control group, the bone metabolism indexes OC, CT, tPINP, and BALP were higher in the observation group after treatment ( t=4.21, t=3.05, t=2.66, t=3.16, P < 0.05) , while the iPTH and β-CTX were lower ( t=7.28, t=3.50, P < 0.05) . Conclusions:Vitamin D supplementation combined with suspended lumbar and abdominal muscle training can promote postoperative rehabilitation of OVCF patients and improve the level of bone metabolism indexes after surgery.

Aim To investigate the correlation between serum solube growth stimulation expressed gene 2 protein(sST2)and early reperfusion arrhythmia(ERA)after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 202 STEMI patients who under-went emergency PCI from November 2020 to August 2022 in the Cardiac Center of Liaoning Provincial People's Hospital were divided into two groups based on the occurrence of ERA within 48 hours after PCI:ERA group and non-ERA group.Serum sST2 level and clinical data were compared between the groups.Univariable and multivariable Logistic regression analysis were used to explore the association between serum sST2 level and ERA occurrence,and restricted cubic spline model was applied to identify independent risk factors for ERA.Results There were 83(41.1％)patients experi-enced ERA within 48 hours after PCI.Compared with the non-ERA group,the patients in ERA group had shorter time from chest pain to reperfusion and higher serum sST2 level(P＜0.001).Multivariate Logistic regression analysis showed that for STEMI patients,elevated serum sST2 level(sST2≥45.03 μg/L),early reperfusion time(chest pain to successful reperfusion time≤5.23 h),high thrombosis burden,and right coronary artery as the infarct related artery(IRA)were in-dependent risk factors for ERA after emergency PCI.The restricted cubic spline model suggested that the serum sST2 lev-el of STEMI patients was nonlinearly correlated with the risk of ERA after PCI(P＜0.01),and the cutoff point was 45.12 μg/L.ROC curve analysis showed that the area under the ROC curve of serum sST2 level in predicting ERA oc-currence after PCI was 0.827(95％CI:0.771～0.883).Conclusion The high serum sST2 level before PCI is an independent risk factor for ERA occurrence after PCI in patients with STEMI.When serum sST2＞45.12 μg/L,its level is positively correlated with the risk of ERA.

Objective:To investigate the feasibility of flight fatigue being detected via photoplethysmography (PPG) and regional cerebral oxygen saturation (rScO 2) in order to address the challenges posed by flight fatigue during prolonged or multiple consecutive flights. Methods:A total of 16 healthy male volunteers were enrolled. A wireless cerebral oximetry monitor headband was employed to collect PPG and rScO 2 data from the forehead while a multi-lead physiological data acquisition system was used concurrently to record three-lead electrocardiograms (ECGs). After 18 h of sleep deprivation, each volunteer performed a flight-simulating task, which was divided into 4 stages: the baseline period (T1), relaxation period (T2), early fatigue period (T3) and severe fatigue period (T4). Five-minute data was collected from each stage for analysis using AcqKnowledge 6.0. Heart rate (HR) and 3 HR variability (HRV) metrics, namely standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), and low frequency to high frequency power ratio (LF/HF), were computed independently from both ECG and PPG traces. The mean rScO 2 value for each stage was used to represent the cerebral oxygen saturation during that stage. The intra-class correlation coefficient (ICC) was employed to assess the consistency of the measurements, and the differences in HR and HRV indicators of the volunteers in the 4 stages of the experiment were analyzed. Results:The HR measured by ECG and PPG was highly consistent across the 4 stages among the 14 volunteers ( ICC=0.951, 0.963, 0.962, 0.963, P=0.013, 0.011, 0.021, 0.015), so were SDNN, RMSSD and LF/HF values ( ICC=0.935-0.983, all P<0.05). HR values calculated with either method showed significant differences across the 4 stages in the 14 volunteers ( F=21.63, 20.52, P=0.007, 0.008). HR gradually declined from T1 to T4, and was significantly lower at T4 than at T1 ( P=0.011, 0.009). There were significant differences in SDNN ( F=22.31, 24.26, P=0.006, 0.003), RMSSD ( F=22.30, 22.26, P=0.006, 0.006), and LF/HF ( F=20.37, 25.13, P=0.009, 0.002) across the 4 stages among the 14 volunteers. SDNN and RMSSD kept increasing as fatigue was intensified, while LF/HF decreased correspondingly. Statistically significant differences were found in SDNN, RMSSD and LF/HF values between T4 and T1 (all P<0.01). rScO 2 measured during the flight-simulating trial also differed significantly across the 4 stages ( F=21.39, P=0.007). rScO? at both T3 and T4 was significantly lower than at T1 ( P=0.009, 0.007). Conclusions:PPG can replace ECG for monitoring HR and HRV indicators under flight fatigue. Furthermore, the combination of PPG with rScO 2 monitoring allows for earlier detection of flight fatigue. This study is expected to offer a user-friendly and non-invasive approach to management of pilot fatigue.

Aim To investigate the correlation between serum solube growth stimulation expressed gene 2 protein(sST2)and early reperfusion arrhythmia(ERA)after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 202 STEMI patients who under-went emergency PCI from November 2020 to August 2022 in the Cardiac Center of Liaoning Provincial People's Hospital were divided into two groups based on the occurrence of ERA within 48 hours after PCI:ERA group and non-ERA group.Serum sST2 level and clinical data were compared between the groups.Univariable and multivariable Logistic regression analysis were used to explore the association between serum sST2 level and ERA occurrence,and restricted cubic spline model was applied to identify independent risk factors for ERA.Results There were 83(41.1％)patients experi-enced ERA within 48 hours after PCI.Compared with the non-ERA group,the patients in ERA group had shorter time from chest pain to reperfusion and higher serum sST2 level(P＜0.001).Multivariate Logistic regression analysis showed that for STEMI patients,elevated serum sST2 level(sST2≥45.03 μg/L),early reperfusion time(chest pain to successful reperfusion time≤5.23 h),high thrombosis burden,and right coronary artery as the infarct related artery(IRA)were in-dependent risk factors for ERA after emergency PCI.The restricted cubic spline model suggested that the serum sST2 lev-el of STEMI patients was nonlinearly correlated with the risk of ERA after PCI(P＜0.01),and the cutoff point was 45.12 μg/L.ROC curve analysis showed that the area under the ROC curve of serum sST2 level in predicting ERA oc-currence after PCI was 0.827(95％CI:0.771～0.883).Conclusion The high serum sST2 level before PCI is an independent risk factor for ERA occurrence after PCI in patients with STEMI.When serum sST2＞45.12 μg/L,its level is positively correlated with the risk of ERA.