ObjectiveMicrotube associated protein-2 （MAP-2）， alpha-tubulin （α-tubulin）， and synaptophysin （SYP） are important proteins in neuronal signal communication. This paper observed the effects of modified Zhigancao Tang on the expression of serum α-Synuclein （α-Syn） and its oligomers， MAP-2， α-tubulin， and SYP of patients with liver and kidney deficiency of Parkinson's disease （PD）， analyzed their correlation， and evaluated the therapeutic effect of modified Zhigancao Tang in patients with liver and kidney deficiency of PD based on α-Syn transmission pathway mediated by neuronal communication in vivo. MethodsA total of 60 patients with PD who met the inclusion criteria were randomly divided into a treatment group （30 cases） and a control group （30 cases）. Both groups were treated on the basis of PD medicine， and the treatment group was treated with modified Zhigancao Tang. Both groups were treated for 12 weeks. The changes in UPDRS score， TCM syndrome score， and expression of serum α-Syn and its oligomers， MAP-2， α-tubulin， and SYP were observed before and after 12 weeks of treatment in each group. The correlation between the above-mentioned serum biological indexes and the levels of serum α-Syn and its oligomers was analyzed. ResultsAfter treatment， the TCM syndrome score， UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ score of the treatment group were significantly decreased （P<0.05， P<0.01）. The UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ scores in the treatment group were significantly decreased compared with those in the control group after treatment （P<0.05）. After treatment， the total effective rate of the control group was 63.3% （19/30）， and that of the treatment group was 86.7% （26/30）. The clinical effect of the observation group was better than the control group （Z=-2.03， P<0.05）. The total effective rate of the observation group was better than that of the control group， and the difference was statistically significant （χ²=5.136， P<0.05）. After treatment， the oligomer level of serum α-Syn and MAP-2 level in the treatment group were significantly decreased （P<0.05， P<0.01）. The levels of serum α-Syn and its oligomers， as well as α-tubulin in the treatment group， were significantly decreased compared with those in the control group after treatment （P<0.05， P<0.01）. Serum α-Syn was correlated with serum MAP-2 and α-Syn oligomer in patients with PD （P<0.05， P<0.01） but not correlated with serum SYP . Serum α-Syn oligomers of patients with PD were correlated with serum MAP-2 and α-tubulin （P<0.05， P<0.01） but not correlated with serum SYP level. Serum SYP of patients with PD was correlated with serum MAP-2 （P<0.05）. ConclusionModified Zhigancao Tang has a therapeutic effect on patients with liver and kidney deficiency of PD by inhibiting the production of α-Syn oligomers and intervening α-Syn microtubule transport pathway in vivo.

Objective To understand the epidemiological characteristics of scrub typhus disease and to provide a scientific basis for the prevention and control of scrub typhus disease. Methods Descriptive epidemiological methods were used to analyze the population and regional distribution of scrub typhus. Seasonal characteristics were analyzed using concentration method and circular distribution method, and incidence trend was analyzed using joinpoint regression model. Results The annual incidence rate of scrub typhus was 0.95/100 000 from 2010 to 2022. The incidence rate of male was 0.77/100 000, lower than that of female 1.12/100 000 (χ²=18.89, P<0.05). The incidence rate of the 60-74 years old group was 3.38/100,000, and the total number of cases in the age group 45-74 years was 416 (74.95%). Occupational distribution was mainly among farmers, with 448 cases (80.72%). The top three regions with the highest number of reported cases (in order: Donghai County, Ganyu District, and Guannan County) reported a total of 416 cases, accounting for 74.95%. Concentration ratio was M=0.9408, and the incidence of scrub typhus disease was strictly seasonal. Circular distribution results showed a^-=-62.3728, S=20.8960. The circular distribution results indicated that the peak day was October 19th, and the peak period was between October 7 to December 19. The average annual percentage change (AAPC) of the incidence rate from 2010 to 2022 was 13.70%, 95% CI (-8.62%~41.48%), and the incidence rate showed an upward trend (t=1.15, P=0.249). Conclusion The incidence of scrub typhus disease is strictly seasonal, and the incidence rate over the years shows an upward trend. It is necessary to strengthen monitoring and take various intervention measures to reduce the risk of scrub typhus disease.

Yunüjian （Jing Yue's Collected Works）， composed of Gypsum Fibrosum， Rehmanniae Radix Praeparata， Anemarrhenae Rhizoma， Ophiopogonis Radix， and Achyranthis Bidentatae Radix， is used for the treatment of "headache， toothache， consumptive thirst， and other diseases caused by heat and Yin deficiency in the stomach". In modern clinical settings， it has definite hypoglycemic efficacy， as it improves insulin resistance， inhibits oxidative stress and inflammatory response， and down-regulates estrogen level. It is often directly used， modified before use， combined with other formulae （Liuwei Dihuangtang， Shashen Maidongtang， Shenqi Sanjingtang， Huangqi Guizhi Wuwutang， Zengyetang， Zengye Baihutang， etc.）， or used together with western medicine （insulin， metformin， pioglitazone， glurenorm， etc.）. Modified Yunüjian can be applied for the treatment of type 2 diabetes mellitus， gestational diabetes， polycystic ovary syndrome with insulin resistance， pruritus induced by diabetes mellitus， diabetic peripheral neuropathy， diabetic nephropathy， diabetic ketoacidosis， diabetic retinopathy， and diabetic periodontitis. According to previous experiment， the protection for pancreatic islet β-cells is an important way of Yunüjian to improve diabetes mellitus. The formula can remove damaged proteins and organelles by increasing the expression of autophagy-related 2B （Atg2B）， ubiquitin-like-conjugating enzyme （Atg3）， γ-aminobutyric acid type A receptor-associated protein （GABARAP）， selective autophagy receptor （p62/SQSTM1）， etc. Moreover， it plays an active role in islet cell proliferation and apoptosis by regulating the expression of mammalian target of rapamycin （mTOR） and reducing the expression of islet β-cell autophagy gene （Beclin）. These are pivotal for maintaining the quantitative structure and functions of islet cells. The modulatory effect of Yunüjian on growth hormone-releasing peptide （ghrelin）， gastrin， and growth hormone secretagogue receptor （GHSR） mRNA expression is also the underlying mechanism for the formula to protect pancreatic β-cells. In this study， we summarized the clinical and experimental studies on the therapeutic effect of this formula on diabetes mellitus， discussed the mechanisms， and proposed suggestions on the problems， hoping to provide a reference for the clinical application and further development of Yunüjian. This study is of practical significance for the scientific interpretation of the modern connotation of Yunüjian and the expansion of its clinical application.

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.

Objective: To observe the effect of Tai Chi combined with conventional western medicine therapy for elderly patients with type2 diabetes mellitus. Methods: According to randomized controlled design, 108 patients were divided into two groups ,with 54 in each group. Patients in control group were treated with conventional western medicine therapy and regular walk (three times per week), while the patients in the observation group were treated with conventional western medicine therapy and Tai Chi (three times per week), both groups were treated for 12 weeks. Before and after treatments, diabetes symptoms scale was used to assess disease conditions, FPG and HbA1c were detected separately by methods of HK (hexokinase) and High Performance Liquid Chromatography (HPLC), Diabetes mellitus Specific Quality of Life scale (DSQL) were used to assess the quality of life, Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6G) was used to assess patients’ self-management ability, and Geriatric Depression Scale was used to assess patients' depression emotions. Results: After treatments, the clinical symptoms scores (1.79 ± 1.21 vs. 2.86 ± 1.66, t=-3.401), the DSQL scores (50.40 ± 10.88 vs. 56.00 ± 10.85, t=-2.156), the GDS scores (5.63 ± 0.71 vs. 6.08 ±0.91, t=-2.515) of observation group were significantly lower than that of control group (P<0.01 or P<0.05), and the SES6G scores (7.54 ± 0.59 vs. 6.89 ± 0.39, t=-5.987) of observation group were significantly higher than that of control group (P<0.01); after treatments, the D-value of FPG (-0.97 ± 1.54 mmol/L vs. -0.28 ± 1.74 mmol/L, t=-2.092) was significantly higher than that of control group (P<0.05). Conclusions The Tai Chi combined with conventional western medicine therapy could alleviate clinical symptoms and negative emotions, improve disease management and quality of life, regulate blood glucose of elderly patients with type 2 diabetes mellitus.

Objective To investigate the inhibiting effect of CGP77675 (CGP),a Src inhibitor,on epithelial-mesenchymal transition (EMT) of human retinal pigment epithelial (RPE) cells induced by transformation growth factor-β1 (TGF-β1).Methods Human RPE cell line (ARPE19 cells) was cultured in vitro and divided into control group,TGF-β1 group and TGF-β1 +CGP group.Corresponding agent was added into culture medium based on grouping.The morphology of the cells were examined under the optical microscope 3 days after culture.The expressions of EMT-related genes and proteins in the cells were detected by real-time quantitative PCR and Western blot,respectively,including fibronectin 1 (FN 1),and plasminogen activation inhibitor 1 (PAI1),and the expressions of zonula occludens protein 1 (ZO1) and cytoskeleton protein filamentous actin (F-actin) were detected by immunofluorescence staining.MTT assay was employed to evaluate the cell proliferation rate.The migration distance of the cells was measured by scratch test.Results The ARPE19 cells in the control group showed an epithelial-like morphology and F-actin and ZO-1 were expressed along cell membrane.In the TGF-β1 group,the cells appeared to be fibrous-like,and the fluorescence staining of F-actin was disordered and ZO-1 was discontinuous on the cell membrane.The cells in the TGF-β1 +CGP group remained to be an epithelial-like in shape with clear and complete expressions of F-actin and ZO-1.The relative expressions of FN1 mRNA and PAI1 mRNA in the cells were 0.211 ± 0.080 and 0.116±0.073,1.000±0.001 and 1.000±0.001,0.368±0.097 and 0.362±0.048 in the control group,TGF-β1 group and TGF-β1 +CGP groups,showing significant differences among the groups (F=33.14,82.92;both at P＜0.01),with the highest expressions ofFN1 mRNA and PAI1 mRNA in the TGF-β1 group (all at P＜0.05).The relative expressions of FN1 and PAI1 proteins were 0.166±0.055 and 0.327±0.066,1.000±0.001 and 1.000± 0.001,0.143 ± 0.030 and 0.260 ± 0.077 in the control group,TGF-β1 group and TGF-β1 + CGP group,with significant differences among three groups (F=181.90,48.85;both at P＜0.01),and the expressions FN1 and PAI1 proteins were significantly higher in the TGF-β1 than those in the control group and TGF-β1 +CGP group (all at P＜0.05).The cell proliferative rate in the TGF-β1+CGP group was (79.30±3.44) ％ and (54.80±7.39) ％ at the third day and seventh day after culture,which were significantly reduced in comparison with (99.50 ± 1.00)％ and (99.10±0.50)％ in the control group as well as (95.10±4.20)％ and (92.10±4.50)％ in the TGF-β1 group (all at P＜0.05).The migration distance was disappeared in the TGF-β1 group,and the scratch width was not obviously changed in the TGF-β1 +CGP group.Conclusions Src inhibitor can inhibit EMT process of ARPE19 cells induced by TGF-β1,indicating that Src signaling pathway may play a critical role in EMT of RPE cells.

Objective To explore the value of prenatal MRI signs in diagnosis of placenta accreta.Methods MRI data of 163 pregnant women with suspected placenta accreta were retrospectively reviewed.According to the results of cesarean section,they were divided into placenta accreta group (n =136) or without placenta accreta group (n =27).The differencesof MRI signs between the two groups were compared.Taking cesarean section results as the gold standard,the sensitivity,specificity,positive and negative predictive value of MRI signs were calculated,respectively.Results Uterine bulging,abnormal vessels and hypointense T2WI bands at junction of placental and myometrium,as well as uterine recess had statistical differences between the two groups (all P＜0.05).No statistical difference of placental heterogeneity,focal interruptions in myometrial wall,uterine penetration and parametrium implantation nor protrusion of placenta into cervix was found between the two groups (all P＞0.05).The MRI signs of uterine penetration and parametrium implantation,uterine recess,protrusion of placenta into cervix yielded a specificity and positive predictive value of 100％,respectively.Conclusion Prenatal MRI has high efficacy in the diagnosis of placenta accrete.Placenta accrete should be highly suspected especially in the presence of uterine penetration and parametrium implantation,uterine recess and protrusion of placenta into the cervix.

Objective Experimental model of experimental autoimmune Myasthenia Gravis (EAMG) were established to explore the effect of Zini-Huangqi-Gegen decoction and Peiyuan-Guben powder on EAMG rats model.Methods Experimental animals were randomly divided into the control group (n=10) and the model group (n=30).The model rats were induced by murine AChR-α97-116 peptide immunostaining for EAMG rats model.After the first immunization,the general condictions and body weight of rats were observed,and the Lennon score was used to evaluate the rats.The second immunization was performed on the 1 1th day after the first immunization.On the 15th day after the first immunization,the rats were randomly divided into the model group(n=8),Huangqi-Gegen decoction and Peiyuan-Guben powder group (abbreviated Huangpei group,n=8) and Prednisone group (n=8) according to the Lennon score.Huangpi group rats were treated with Huangqi-Gegen decoction (21.5 g/kg) combined with Peiyuan-Guben powder (0.8 g/kg),prednisone group with 0.005 4 g/kg prednisone aqueous solution,the control group and the model group oral volume of distilled water.The rats were administered with a body weight of 10 ml/kg once a day for a total of 56 days.At the 70th day after the first immunization,serum was extracted from the rats.The Anti-AChR-α97-116 IgG and its subtype in serum were detected by ELISA.The IL-4,IL-10,IL-17 in serum were detected by ELISA.Results Compared with the model group,the weight of the rats in the Huangpei group and the prednisone group significantly increased after the 28th day of the first immunization (P＜0.05).After the 36nd day of the first immunization,the Lennon score of the Huangpei group significantly decreased (P＜0.05).At the end of the administration,the amplitude of EMG amplitude attenuation (41.83％ ± 7.45％ vs.67.76％ ± 4.32％) in the Huangpei group significantly decreased (P＜0.05),and the serum IgG (1.15 ± 0.07 vs.1.24 ± 0.08),IgG1 (0.17 ± 0.01 vs.0.25 ± 0.03),IL-4 (16.54 ± 1.66 pg/ml vs.25.64 ± 1.74 pg/ml),IL-10 (113.65 ± 12.87 pg/ml vs.121.54 ± 10.44 pg/ml),IL-17 (43.58 ± 3.54 pg/ml vs.65.76 ± 3.59 pg/ml) in the rat serum significantly decreased (P＜0.05).Conclusions Huangqi-Gegen decoction and Peiyuan-Guben powder can increase the body weight of rats,decrease the concentration of AChR-Ab in serum,the concentrations of IL-4,IL-10 and IL-17 in serum,and effectively improve the symptoms of EAMG rats.

Objective To assess the effectiveness of iterative metal artifact reduction (IMAR) on metal artifacts reduction in thorax scan.Methods Thoracic phantom with two pedicle screws implanted in both sides of the T5 vertebrae was used,with the scan parameters of 130 kV and CARE Dose 4D,the phantom was scanned with and without the screws respectively.Images without screws were reconstructed with FBP.Images with screws were reconstructed with FBP and IMAR respectively.Three ROIs were selected on tissues including aorta,pulmonary and paravertebral soft tissue on image slice adjacent to the screws.The CT value and standard deviations (noise) of ROIs were measured,and the deviation of CT value (△HU) was calculated as the difference between CT values in images with and without screws.Twenty-six cases who received chest CT examination and with pedicle screw implant in scanning range were collected.The scanning parameters and image reconstruction methods were the same as phantom scan.The CT value (HU) of metal artifacts adjacent to vertebrae and dorsal soft tissue was measured,and the image quality of reconstructed image by two skilled radiologists independently was evaluated.Results In the phantom after implanted screws,the noise were significantly reduced by IMAR compared to FBP in all the three ROIs of aorta,pulmonary and paravertebral soft tissue (P＜0.05),and the △HU was significantly smaller in IMAR compared to that with FBP (P＜0.01).In 26 patients,there were significant differences in CT value of vertebral bone tissue and dorsal soft tissue between FBP and IMAR (P＜0.05),and the subjective evaluation scores of the two image reconstruction methods showed a statistically significant difference (P＜0.05).Conclusion IMAR can significantly reduce streak artifacts of metal implant and adjuste the CT values of artifact affected tissues to make it more close to the true value without metal implant.