ObjectiveTo decipher the mechanism by which Zuoguiwan （ZGW） treat hyperthyroidism in rats with kidney-Yin deficiency based on the dopamine receptor D4 （DRD4）/nicotinamide adenine dinucleotide phosphate （NADPH） oxidase 4 （NOX4） signaling pathway. MethodsThe rat model of kidney-Yin deficiency was induced by unilateral intramuscular injection of dexamethasone （0.35 mg·kg^-1）. After successful modeling， the rats were randomized into model， methimazole （positive control， 5 mg·kg^-1）， low-， medium-， and high-dose （1.85， 3.70， 7.40 g·kg^-1， respectively） ZGW， and normal control groups. After 21 days of continuous gavage， the behavioral indexes and body weight changes of rats were evaluated. The pathological changes of the renal tissue were observed by hematoxylin-eosin staining. The serum levels of thyroid hormones ［triiodothyronine （T₃）， thyroxine （T₄）， thyroid-stimulating hormone （TSH）］， renal function indexes ［serum creatine （Scr） and blood urea nitrogen （BUN）］， energy metabolism markers ［cyclic adenosine monophosphate （cAMP） and cyclic guanosine monophosphate （cGMP）］， and oxidative stress-related factors ［superoxide dismutase （SOD）， malondialdehyde （MDA）， and NADPH）］ were measured by enzyme-linked immunosorbent assay （ELISA）. Western blot was employed to analyze the expression of DRD4， NOX4， mitochondrial respiratory chain complex proteins ［NADH：ubiquinone oxidoreductase subunit S4 （NDUFS4） and cytochrome C oxidase subunit 4 （COX4）］， and inflammation-related protein ［tumor necrosis factor-alpha （TNF-α）， interleukin-6 （IL-6）， p38 mitogen-activated protein kinase （MAPK）］ pathway in the renal tissue. ResultsCompared with the normal group， the model group showed mental malaise， body weight decreases （P<0.01）， inflammatory cell infiltration in the renal tissue， a few residual parotid glands in the thyroid， elevations in serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA， and NADPH （P<0.01）， down-regulation in protein levels of TSH， SOD， and DRD4 （P<0.05， P<0.01）， and up-regulation in expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.01）. Compared with the model group， ZGW increased the body weight （P<0.05， P<0.01）， reduced the infiltration of renal interstitial inflammatory cells， restored the thyroid structure and follicle size， lowered the serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA and NADPH （P<0.05， P<0.01）， up-regulated the expression of TSH， SOD and DRD4 （P<0.05， P<0.01）， and down-regulated the expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.05， P<0.01）. Moreover， high-dose ZGW outperformed methimazole （P<0.05）. ConclusionBy activating DRD4， ZGW can inhibit the expression of NOX4 mediated by the p38 MAPK pathway， reduce oxidative stress and inflammatory response， thereby ameliorating the pathological state of hyperthyroidism due to kidney-Yin deficiency. This study provides new molecular mechanism support for the clinical application of ZGW.

Objective: To investigate the health-related quality of life and its influencing factors in elderly patients with metabolic syndrome (MS), so as to provide the evidence for improving health-related quality of life in older adults with chronic diseases. Methods: In 2021, elderly MS patients aged ≥60 years from four districts in Nanjing City were selected as the study subjects using a multi-stage random sampling method. Data on social demographic information, lifestyle, disease history and blood biochemical indicators were collected through questionnaire surveys, physical examination and laboratory tests. Health utility value and EuroQol Visual Analog Scale (EQ-VAS) score were assessed using the EuroQol 5-dimension 3-level questionnaire. Factors affecting health-related quality of life were identified with the Tobit regression model and multiple linear regression model. Results: A total of 3 378 elderly MS patients were included, with a median age of 67.00 (interquartile range, 7.00) years. There were 1 558 males (46.12%) and 1 820 females (53.88%). The median (interquartile range) of health utility value and EQ-VAS score were 1.00 (0.03) and 80.00 (15.00). Tobit regression and multiple linear regression analysis showed that gender (female, β=-0.034), education level (middle school, β=0.024; junior college and above, β=0.046), marital status (married, β=0.014), physical activity (sufficient, β=0.013), vegetable intake (meet standard, β=-0.009) and fruit intake (meet standard, β=0.016) were the influencing factors of health utility value. Residence (urban area, β=1.933) and alcohol consumption (yes, β=1.761) were influencing factors of EQ-VAS score. Age, cardiovascular and cerebrovascular diseases, malignant tumors and chronic respiratory diseases were the influencing factors of health utility value and EQ-VAS score. Conclusion Age, sex, marital status, residence, lifestyle and disease are mainly associatied with the health-related quality of life in elderly MS patients.

Objective To investigate the relationships of the mRNA expression levels of mitochon-drial ribosomal large subunit protein 13(MRPL13),BCL2-associated protein A1(BCL2A1)and TP53 apoptosis-inducing protein 1(TP53AIP1)in the serum of breast cancer patients with their chemotherapy efficacy as well as immune function.Methods A total of 148 triple-negative breast cancer patients undergoing chemotherapy were selected as the study subjects.Based on chemotherapy efficacy,they were divided into responsive group(97 cases)and non-responsive group(51 cases).Sixty healthy individuals undergoing physical examinations during the same period were selected as the control group.The mRNA expression levels of MRPL13,BCL2A1 and TP53AIP1 in the serum of patients were detected.The concentrations of immunoglobulin M(IgM),immunoglobulin G(IgG)and im-munoglobulin A(IgA)in the serum of patients were measured,and the proportions of CD4+and CD8+cells in whole blood were determined.The mRNA expression levels of MRPL13,BCL2A1 and TP53AIP1 were compared between the breast cancer group and the control group.The mRNA ex-pression levels of MRPL13,BCL2A1 and TP53AIP1 were compared between the responsive and non-responsive groups.The differences in immune function indicators before and after chemotherapy be-tween the responsive and non-responsive groups,were compared.The correlations of the mRNA ex-pression levels of MRPL13,BCL2A1 and TP53AIP1 with immune indicators were analyzed.Factors influencing chemotherapy efficacy were screened.Results The mRNA expression levels of MRPL13 and BCL2A1 in the breast cancer group were higher than those in the control group,while the mRNA expression level of TP53AIP1 was lower,with statistically significant differences(P＜0.05).In the responsive group,the mRNA expression levels of MRPL13 and BCL2A1 were lower than those in the non-responsive group,while the mRNA expression level of TP53AIP1 was higher,with statistically significant differences(P＜0.05).After chemotherapy,the IgM concentration in the responsive group was higher than that in the non-responsive group,with a statistically significant difference(P＜0.05).The proportion of CD8+cells in the responsive group was lower than that in the non-responsive group,with a statistically significant difference(P＜0.05).The mRNA expres-sion level of MRPL13 was positively correlated with IgM,IgG and CD8+(r=0.672,0.716,0.824,P＜0.05).The mRNA expression level of BCL2A1 was positively correlated with IgA and CD4+(r=0.654,0.862,P＜0.05).The mRNA expression level of TP53AIP1 was negatively cor-related with CD4+and CD8+(r=-0.846,-0.792,P＜0.05).High expressions of MRPL13 and BCL2A1 were independent risk factors for chemotherapy efficacy in breast cancer patients(P＜0.05),while high expression of TP53AIP1 was protective factor(P＜0.05).Conclusion The mRNA expression levels of MRPL13,BCL2A1 and TP53AIP1 in the serum of triple-negative breast cancer patients undergoing chemotherapy are correlated with the levels of IgM,IgG and IgA,the proportions of CD4+and CD8+T cells,and chemotherapy efficacy.High expression of MRPL13 and BCL2A1 are independent risk factors for poor chemotherapy efficacy,while high expression of TP53AIP1 is a protective factor.

BackgroundSchizophrenia is a complex， chronic and severe mental disorder， and the pathogenesis of which has not been fully elucidated. The abnormalities in lipid metabolism and circulating metabolomes have already been implicated in the pathophysiology of schizophrenia. However， available studies have mainly focused on a few liposomes and circulating metabolites， failing to systematically reveal the mediating role of circulating metabolomes in the causal relationship between liposomes and schizophrenia. ObjectiveTo uncover mediating role of circulating metabolomes in the causal relationship between liposomes and schizophrenia， thereby providing biomarkers and potential therapeutic targets for the prevention and treatment of schizophrenia. MethodsData from Genome-Wide Association Studies （GWAS） were analyzed， taking data on 179 liposomes as exposure variables， data on 123 circulating metabolites as intermediate variables， and data on schizophrenia as outcome variable. A two-step， two-sample Mendelian randomization analysis was conducted using the inverse-variance weighted （IVW）， MR- Egger， Weighted median， and Weighted mode methods to study the causal relationship of liposomes with schizophrenia and the mediating role of circulating metabolomes in the relationship. ResultsIVW model identified 8 lipids associated with schizophrenia without reverse causality. There were 5 circulating metabolomes strongly associated with schizophrenia. Acetate played a significant mediating role in the causal relationship between phosphatidylinositol （18：0_18：2） and schizophrenia （P=0.023， 95% CI： 0.036~0.532）， accounting for 28.4% of the causal relationship. ConclusionThis study demonstrates a causal relationship between liposomes and schizophrenia， with phosphatidylinositol being a risk factor in the progression of schizophrenia， and acetate playing a mediating role in this process. ［Fund by National Natural Science Foundation of China General Program （number， 82271546）； Shanxi Merit Funding for Overseas Students Sci-Tech Activities Project （number， 20240041）； Shanxi Province Science and Technology Innovation Leading Talent Team Project （number， 202304051001049）； Shanxi Scientific Research Foundation for the Returned Overseas Chinese Scholars （number， 2022-190）； "Six Measures for Health Care Prosperity" Specialized Research Program （number， Y2024008）］

OBJECTIVE To observe the effects of measures dominated by intensifying link quality on prevention and control of carbapenem-resistant Klebsiella pneumoniae(CRKP)among general ICU patients.METHODS The conventional intervention measures were taken from Jan.2016 to Oct.2020,which was assigned as the pre-inter-vention period;the intervention measures dominated by enhancement of link quality were taken for the general ICU patients(the study group)from Nov.2020 to Oct.2021,which was set as the intervention period,the inter-vention measures were taken for the neurosurgery ICU patients and the surgery ICU patients(the control group).A two-group interrupted time series of a quasi-experimental study was analyzed,and whether or not the intervention measures could reduce the incidence of CRKP hospital-associated infection among the general ICU patients was evaluated.RESULTS A total of 23 713 case-times of patients from three ICU wards were enrolled in the study.The incidence of CRKP hospital-associated infection among the general ICU patients was 4.49 cases per thousand patient-days during intervention period,3.71 cases per thousand patient-days during pre-intervention pe-riod,and there was no significant difference(u=-1.412,P=0.079);it was lower than 7.06 cases per thousand patient-days during nearly one year before the intervention period(from Nov.2019 to Oct.2020),and there was significant difference(u=3.128,P=0.002).The result of analysis of the interrupted time series showed that there was significant difference in the slope change between the study group and the control group after the inter-vention(P=0.035),indicating that the intervention measures could reduce the incidence of CRKP hospital-associ-ated infection in the study group,and there was significant difference in the changing trend between the study group and the control group.CONCLUSIONS The prevention and control measures for CRKP dominated by the link quality management can effectively reduce the incidence of CRKP hospital-associated infection among the gen-eral ICU patients.The prevention and control strategies may provide reference for prevention and control of CRKP in ICUs of other medical institutions.

Objective:To investigate the subacute toxicity and target organs of triethylenediammonium perchlorate ammonium complex salt (DAP-4) .Methods:In August 2024, 40 SPF-grade SD rats were selected, with 10 rats in each group, half male and half female. There were 45, 140, and 420 mg/kg DAP-4 groups and a control group. Rats in each dose DAP-4 group were orally administered the corresponding amount of DAP-4 solution, while the control group was given the same dose of 1% sodium carboxymethyl cellulose. SD rats were given intragastric administration once a day for 28 consecutive days. The behaviors, histopathological changes, and blood physiological and biochemical indicators of rats were detected at the corresponding time points respectively. One-way analysis of variance was used for the comparison of quantitative data between groups.Results:Compared with the control group, the body weight, food intake and food utilization rate of female and male rats in the 420 mg/kg DAP-4 group were significantly decreased ( P<0.05), while no abnormalities were observed in the other dose groups. Compared with the control group, the white blood cell count of female rats in the 420 mg/kg DAP-4 group decreased, while the hemoglobin and hematocrit decreased and the total serum protein increased of male rats ( P<0.05). Compared with the control group, fibrinogen was increased in both female and male rats in the 420 mg/kg DAP-4 group, and the thrombin time of female rats was shortened ( P<0.05). In each dose group, the livers of female and male rats showed varying degrees of vacuolar degeneration, and the renal tubules of female rats were swollen. Conclusion:420 mg/kg DAP-4 can cause damage to the liver and kidney of rats, and the maximal no effect level of DAP-4 for rats is 140 mg/kg.

OBJECTIVE To observe the effects of measures dominated by intensifying link quality on prevention and control of carbapenem-resistant Klebsiella pneumoniae(CRKP)among general ICU patients.METHODS The conventional intervention measures were taken from Jan.2016 to Oct.2020,which was assigned as the pre-inter-vention period;the intervention measures dominated by enhancement of link quality were taken for the general ICU patients(the study group)from Nov.2020 to Oct.2021,which was set as the intervention period,the inter-vention measures were taken for the neurosurgery ICU patients and the surgery ICU patients(the control group).A two-group interrupted time series of a quasi-experimental study was analyzed,and whether or not the intervention measures could reduce the incidence of CRKP hospital-associated infection among the general ICU patients was evaluated.RESULTS A total of 23 713 case-times of patients from three ICU wards were enrolled in the study.The incidence of CRKP hospital-associated infection among the general ICU patients was 4.49 cases per thousand patient-days during intervention period,3.71 cases per thousand patient-days during pre-intervention pe-riod,and there was no significant difference(u=-1.412,P=0.079);it was lower than 7.06 cases per thousand patient-days during nearly one year before the intervention period(from Nov.2019 to Oct.2020),and there was significant difference(u=3.128,P=0.002).The result of analysis of the interrupted time series showed that there was significant difference in the slope change between the study group and the control group after the inter-vention(P=0.035),indicating that the intervention measures could reduce the incidence of CRKP hospital-associ-ated infection in the study group,and there was significant difference in the changing trend between the study group and the control group.CONCLUSIONS The prevention and control measures for CRKP dominated by the link quality management can effectively reduce the incidence of CRKP hospital-associated infection among the gen-eral ICU patients.The prevention and control strategies may provide reference for prevention and control of CRKP in ICUs of other medical institutions.

Objective:To investigate the subacute toxicity and target organs of triethylenediammonium perchlorate ammonium complex salt (DAP-4) .Methods:In August 2024, 40 SPF-grade SD rats were selected, with 10 rats in each group, half male and half female. There were 45, 140, and 420 mg/kg DAP-4 groups and a control group. Rats in each dose DAP-4 group were orally administered the corresponding amount of DAP-4 solution, while the control group was given the same dose of 1% sodium carboxymethyl cellulose. SD rats were given intragastric administration once a day for 28 consecutive days. The behaviors, histopathological changes, and blood physiological and biochemical indicators of rats were detected at the corresponding time points respectively. One-way analysis of variance was used for the comparison of quantitative data between groups.Results:Compared with the control group, the body weight, food intake and food utilization rate of female and male rats in the 420 mg/kg DAP-4 group were significantly decreased ( P<0.05), while no abnormalities were observed in the other dose groups. Compared with the control group, the white blood cell count of female rats in the 420 mg/kg DAP-4 group decreased, while the hemoglobin and hematocrit decreased and the total serum protein increased of male rats ( P<0.05). Compared with the control group, fibrinogen was increased in both female and male rats in the 420 mg/kg DAP-4 group, and the thrombin time of female rats was shortened ( P<0.05). In each dose group, the livers of female and male rats showed varying degrees of vacuolar degeneration, and the renal tubules of female rats were swollen. Conclusion:420 mg/kg DAP-4 can cause damage to the liver and kidney of rats, and the maximal no effect level of DAP-4 for rats is 140 mg/kg.

In the treatment process of proton radiation therapy,the patient needs to be positioned and immobilized before being moved into the treatment position.In this study,the patient was primarily positioned using the 6R robotic treatment couch as the patient support system(PSS).A simplified three-dimensional model of the treatment room was developed based on the relative motion within the treatment room.The forward and inverse kinematics of the 6R robotic treatment couch were analyzed using an improved Denavit-Hartenberg(D-H)representation.A collision interference model was created based on the actual treatment process.The motion path of the treatment couch was planned and simulated in MATLAB using an improved artificial potential field method for obstacle avoidance.The results indicate that the robotic treatment couch can smoothly navigate around obstacles to reach the target point,satisfying the positioning requirements for proton therapy.

OBJECTIVE To study the effects of SR9009 and LXH0225,nuclear receptor subfamily 1 group D member(REV-ERB)agonists,on mood disorders and cognitive impairment in over-training mice.METHODS Male C57BL/6J mice were randomly divided into the normal control,over-training model,model+fluoxetine(15 mg?kg-1),model+SR9009(100 mg?kg-1)and model+LXH0225(50 mg?kg-1)groups.Mice in the normal control group were ip given15%cremophor without extra stress while those in other groups were ip given 15%cremophor or different drugs respectively 30 min before daily forced swimming stress.When stressed,mice were forced to swim in 19-21℃water for 20 min per day for 18 d.After that,locomotor activity was assessed.Rotarod test and weight-loaded swimming test were performed to measure physical strength,while open field test and stair-climbing test were performed to measure anxiety-like behavior.Tail suspension test and forced swimming test were used to measure depression-like behavior while novel object recognition test and Y maze test were conducted to measure recogni-tion function.ELISA was used to measure serum corticosterone contents.RESULTS Compared with the normal control group,the locomotor activity of mice in the model group was significantly increased(P<0.01).There were anxiety-like behaviors with a significant increase in the number of times of stair-climb-ing and rearing(P<0.01).Depression-like behaviors were observed with a significant increase immobile time in forced swimming test(P<0.01).Cognitive impairment was manifested as decreased accuracy of Y-maze spontaneous alternation response(P<0.01).The corticosterone content was significantly elevated(P<0.01)in forced swimming mice.Compared with the model group,the accuracy of Y-maze spontaneous alternations was higher(P<0.01)and the content of serum corticosterone was lower(P<0.01)in the model+fluoxetine group.The immobile time was shorter(P<0.01),the spontaneous alternation response of Y maze was was less accurate(P<0.05)and serum corticosterone content was lower(P<0.01)in the model+SR9009 group than in the model group.The latency to fall off the rotarod was longer(P<0.05),the immobile time was shorter(P<0.01)and the content of serum corticosterone was lower(P<0.01)in the model+LXH0225 group compared with the model group.CONCLUSION The REV-ERBs agonists SR9009 and LXH0225 may protect against forced swimming over-training induced mood disorders and cognitive impairment.