OBJECTIVE To investigate the preventive effect of cucurbitacin B （CB） on sepsis-induced acute lung injury （ALI） and its mechanism. METHODS The mice were divided into control group， model group， dexamethasone group （positive control， 2 mg/kg）， CB low-dose and high-dose groups （25， 50 mg/kg）. Each group was given relevant medicine intraperitoneally， once a day， for 3 consecutive days. Twenty-four hours after the last administration， those groups were given lipopolysaccharide （10 mg/kg） intraperitoneally to establish sepsis-induced ALI model （finally， 8 mice per group were included in the experiment）， except for control group. Twenty-four hours after medication， blood routine indicators （total white blood cell count， neutrophils count， lymphocytes count）， lung function indicators （total lung resistance， pulmonary outflow resistance， lung dynamic compliance， peak expiratory flow rate， and maximum ventilation volume）， dry wet ratio of lung tissue were measured in each group. The lung tissue level of myeloperoxidase （MPO）， and the serum levels of tumor necrosis factor-α （TNF-α）， interleukin 1β （IL-1β）， IL-6， superoxide dismutase （SOD） and malondialdehyde （MDA） were all detected. The pathological changes of lung tissue were observed； immunohistochemistry was used to detect the positive expression of phosphorylation signal transducer and activator of transcription 3 （p-STAT3） in the lung tissue. Western blot assay was used to detect the expressions of proteins related to IL-6/JAK2/ STAT3 signaling pathway in the lung tissue. RESULTS Compared with control group， total pulmonary resistance， pulmonary flow resistance， dry wet ratio of lung tissue， the total white blood cell count， neutrophils count， lymphocytes count of whole blood， the lung tissue level of MPO and serum levels of MDA， IL-6， IL-1β and TNF-α， the p-STAT3 protein optical density value， the protein expressions of IL-6 and IL-6 receptor， and the phosphorylation levels of JAK2 and STAT3 protein were increased significantly in the model group （P＜0.01）， while lung dynamic compliance， peak expiratory flow rate， maximum ventilation volume and serum level of SOD were decreased significantly （P＜0.05 or P＜0.01）. Pulmonary tissue showed alveolar collapse and infiltration of inflammatory cells. Compared with the model group， the above indexes of mice were reversed significantly in dexamethasone group and CB groups （P＜0.05 or P＜0.01）， the pathological damage of lung tissue was reduced. CONCLUSIONS CB can prevent sepsis-induced ALI by inhibiting the activity of Δ 基金项目遵义市科技计划项目（No.202252） IL-6/JAK2/STAT3 signaling pathway and relieving ＊第一作者主治医师。研究方向：重症医学。E-mail：fjuanxui@ 163.com inflammatory reactions. # 通信作者 主任医师。研究方向：儿童呼吸系统疾病诊断与治

Objective:To investigate the diagnosis of dual-energy X-ray absorptiometry(DXA)for osteoporosis(OP)of postmenopausal patients with rheumatoid arthritis(RA)in Qinghai region and the risk factors of them.Methods:A total of 200 postmenopausal female RA patients who admitted to Qinghai Hospital of Traditional Chinese Medicine from May 2022 to April 2023 were selected.All patients were tested for bone mineral density(BMD)after admission,and lumbar spines L1-L4,whole lumbar,large trochanter,Ward's triangle area,whole body and whole forearm were measured by DXA.According to the results of BMD test,patients whose BMD T values of all body parts-2.5 SD were less or equal to-2.5 were included in the OP group(121 cases),and patients whose BMD T value of all body parts were larger than-2.5 SD were included in the non-OP group(79 cases).The BMD T value of different body parts between two groups of RA patients were compared and analyzed.The area under curve(AUC)of receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of BMD T value for OP.The logistic regression method was adopted to analyze the risk factors that postmenopausal RA patients of Qinghai region occurred OP.Results:The BMD T values of L1,L2,L3,L4,whole lumbar,large trochanter,Ward's triangular area,whole body and whole forearm of OP group were obviously lower than those of the non-OP group.In analysis of ROC curve,the sensitivities of BMD T values of L1,L2,L3,L4,whole lumbar,large trochanter,Ward's triangle area,whole body and forearm were respectively 96.20%,95.22%,90.16%,96.03%,92.01%,89.36%,99.26%,90.02% and 96.03% in diagnosing OP,and the specificities of them were respectively 81.00%,82.19%,85.22%,83.06%,83.06%,90.22%,80.06%,86.23%,83.09%,and the AUC values of them were respectively 0.908,0.905,0.896,0.906,0.903,0.879,0.918,0.901 and 0.906.The results of the logistic-regression analysis showed that advanced age,long disease course,rheumatic activity scores of 28 joints,erythrocyte sedimentation rate and Calcium supplementation were the risk factors of occurring OP in postmenopausal RA patients in Qinghai region.Conclusion:The DXA method that detects BMD of RA patients who occur OP can be used as gold standard to assess OP,and there are many risk factors that affect the occurrence of OP in postmenopausal RA patients of Qinghai region.The clinical work should combine with relative factors to formulate reasonable measure so as to reduce the incidence of OP.

Objective:To study the influence of the severity of diabetic retinopathy (DR) on the visual function of patients with type 2 diabetes, to provide scientific basis for the early prevention and control of DR.Methods:This study was designed as a cross-sectional study, recruiting already-diagnosed type 2 diabetes patients in four community health service centers in Guizhou Province between February and September 2022. Employing the Chinese version of the Visual Function Index-14 (VF-14), assess the participants′ near vision, visual adaptation, subjective visual perception, and stereo vision, with higher scores indicating poorer visual function. Categorize the severity of each eye′s damage into no diabetic retinopathy (DR), mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR), and use a 5-level DR grading system to evaluate the overall severity of diabetic retinopathy in both eyes. Employing linear regression analysis to investigate the linear relationship between DR and visual function index. Local weighted regression evaluates the nonlinear relationship between the DR composite score and the scores of visual function, with a steeper slope indicating poorer visual function for that level.Results:A total of 542 patients with type 2 diabetes were investigated, including 244 (45.02%) males, 298 (54.98%) females, and 162 (29.89%) patients with DR. After adjusting for confounders, compared with those without DR, patients with binocular DR Had overall scores ( β=0.136, P=0.003), near vision ( β=0.163, P<0.001), visual adaptation ( β=0.092, P=0.042), subjective vision ( β=0.120, P=0.009) and stereo vision ( β=0.094, P=0.044) were higher than those without DR. There were no differences in visual functions between DR And monocular DR. The local weighted regression curve showed that near vision (slope: 23.78) and overall score (slope: 58.37) increased sharply from mild to moderate NPDR in both eyes. Visual adaptation (slope: 5.37, 7.72), subjective vision (slope: 6.53, 7.93), stereovision (slope: 0.74, 0.91) increased slowly in mild to moderate NPDR in both eyes and in moderate to severe NPDR/PDR in both eyes. Conclusion:Binocular DR is associated with impaired visual function, but there is no difference between monocular DR And non-DR visual function. The early damage of DR To visual function is mainly manifested in near vision. In the prevention and control of DR, more attention should be paid to visual function, especially the change of near vision, and retinal damage should not be assessed solely by visual status.

Objective:To study the clinical value of serum adenosine deaminase (ADA) combined with whole blood microRNA (miR)-197-3p in the diagnosis of human brucellosis.Methods:From January 2020 to September 2023, 120 patients with brucellosis were selected from the Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jining Medical University (referred to as this hospital) and assigned to the brucellosis group, including 89 patients in the acute stage, 19 patients in the chronic stage, and 12 patients in the latent infection. In addition, 60 healthy volunteers from the animal husbandry industry were selected as the control group from the physical examination population in this hospital during the same period; sixty critically ill patients with community-acquired pneumonia were selected from the Department of Pulmonary and Critical Care Medicine of this hospital as the infection control group. Patients in the brucellosis group and infection control group were given standardized treatment. Fasting elbow venous blood samples were collected in the morning before and after treatment in the brucellosis group and infection control group, at enrollment in the control group, and serum ADA and whole blood miR-197-3p levels were tested. Multivariate logistic regression analysis was used to study the risk factors affecting the occurrence of brucellosis. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of ADA, miR-197-3p, and their combination for brucellosis.Results:Before treatment, the levels of serum ADA (U/L: 12.35 ± 2.89, 18.33 ± 4.57, 29.75 ± 6.46, 22.20 ± 4.78, 14.15 ± 3.03) and whole blood miR-197-3p (1.09 ± 0.33, 2.25 ± 0.41, 2.68 ± 0.59, 2.43 ± 0.51, 1.18 ± 0.40) in the control, infection control, acute stage, chronic stage, and latent infection groups were compared, and the differences were statistically significant ( F = 4.38, 4.02, P = 0.014, 0.019). Compared with the control group, the serum ADA and whole blood miR-197-3p levels in the other 4 groups were higher ( P < 0.05). Compared with the infection control group, the serum ADA level in the acute stage and chronic stage groups was higher, and the serum ADA level in the latent infection group was lower ( P < 0.05); the level of whole blood miR-197-3p was higher in the acute stage group, but lower in the latent infection group ( P < 0.05). Compared with before treatment, the levels of serum ADA and whole blood miR-197-3p in the infection control, acute stage and chronic stage groups were lower after treatment ( P < 0.05). Multivariate logistic regression analysis showed that increased levels of serum ADA and whole blood miR-197-3p were risk factors for brucellosis [odds ratio ( OR) = 2.235, 3.404, 95% confidence intervals ( CI): 1.491 - 3.362, 1.623 - 7.605, P < 0.001]. ROC curve results showed that serum ADA and whole blood miR-197-3p had auxiliary significance in the diagnosis of brucellosis ( P < 0.001). The area under curve (AUC) of serum ADA combined with whole blood miR-197-3p was 0.933, which was superior to the diagnostic efficacy of serum ADA and whole blood miR-197-3p alone (AUC = 0.823, 0.840). Conclusion:The combination of serum ADA and whole blood miR-197-3p has high clinical value in the diagnosis of human brucellosis, and can provide an important reference for the clinical diagnosis and efficacy evaluation of brucellosis.

Objective:To study the influence of the severity of diabetic retinopathy (DR) on the visual function of patients with type 2 diabetes, to provide scientific basis for the early prevention and control of DR.Methods:This study was designed as a cross-sectional study, recruiting already-diagnosed type 2 diabetes patients in four community health service centers in Guizhou Province between February and September 2022. Employing the Chinese version of the Visual Function Index-14 (VF-14), assess the participants′ near vision, visual adaptation, subjective visual perception, and stereo vision, with higher scores indicating poorer visual function. Categorize the severity of each eye′s damage into no diabetic retinopathy (DR), mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR), and use a 5-level DR grading system to evaluate the overall severity of diabetic retinopathy in both eyes. Employing linear regression analysis to investigate the linear relationship between DR and visual function index. Local weighted regression evaluates the nonlinear relationship between the DR composite score and the scores of visual function, with a steeper slope indicating poorer visual function for that level.Results:A total of 542 patients with type 2 diabetes were investigated, including 244 (45.02%) males, 298 (54.98%) females, and 162 (29.89%) patients with DR. After adjusting for confounders, compared with those without DR, patients with binocular DR Had overall scores ( β=0.136, P=0.003), near vision ( β=0.163, P<0.001), visual adaptation ( β=0.092, P=0.042), subjective vision ( β=0.120, P=0.009) and stereo vision ( β=0.094, P=0.044) were higher than those without DR. There were no differences in visual functions between DR And monocular DR. The local weighted regression curve showed that near vision (slope: 23.78) and overall score (slope: 58.37) increased sharply from mild to moderate NPDR in both eyes. Visual adaptation (slope: 5.37, 7.72), subjective vision (slope: 6.53, 7.93), stereovision (slope: 0.74, 0.91) increased slowly in mild to moderate NPDR in both eyes and in moderate to severe NPDR/PDR in both eyes. Conclusion:Binocular DR is associated with impaired visual function, but there is no difference between monocular DR And non-DR visual function. The early damage of DR To visual function is mainly manifested in near vision. In the prevention and control of DR, more attention should be paid to visual function, especially the change of near vision, and retinal damage should not be assessed solely by visual status.

The mesencephalic astrocyte-derived neurotrophic factor (MANF) has been recently identified as a neurotrophic factor, but its role in hepatic fibrosis is unknown. Here, we found that MANF was upregulated in the fibrotic liver tissues of the patients with chronic liver diseases and of mice treated with CCl₄. MANF deficiency in either hepatocytes or hepatic mono-macrophages, particularly in hepatic mono-macrophages, clearly exacerbated hepatic fibrosis. Myeloid-specific MANF knockout increased the population of hepatic Ly6C^high macrophages and promoted HSCs activation. Furthermore, MANF-sufficient macrophages (from WT mice) transfusion ameliorated CCl₄-induced hepatic fibrosis in myeloid cells-specific MANF knockout (MKO) mice. Mechanistically, MANF interacted with S100A8 to competitively block S100A8/A9 heterodimer formation and inhibited S100A8/A9-mediated TLR4-NF-κB signal activation. Pharmacologically, systemic administration of recombinant human MANF significantly alleviated CCl₄-induced hepatic fibrosis in both WT and hepatocytes-specific MANF knockout (HKO) mice. This study reveals a mechanism by which MANF targets S100A8/A9-TLR4 as a "brake" on the upstream of NF-κB pathway, which exerts an impact on macrophage differentiation and shed light on hepatic fibrosis treatment.

Objective:To evaluate the diagnostic value of cardiac magnetic resonance (CMR) in myocardial contusion.Methods:A case-control study was performed on 42 patients with blunt chest injury treated in Affiliated Hospital of Hangzhou Normal University from September 2018 to January 2021. There were 24 males and 18 females, with the age range of 23-66 years [(44.2±10.9)years]. The patients were divided into myocardial contusion group ( n=20) and non-myocardial contusion group ( n=22) according to the clinical diagnostic criteria of myocardial contusion (cardiac troponin I>0.06 ng/ml). All the patients underwent CMR examination within 7 days after hospitalization, and eletrocardiography (ECG) as well as transthoracic echocardiography (TTE) examinations with 24 hours. Abnormal findings on CMR, ECG and TTE were compared between the two groups. The receiver operating characteristic (ROC) curve was used for the comparison of the diagnostic efficacy of CMR, ECG and TTE for myocardial contusion. The area under the curve (AUC), sensitivity, specificity, positive predictive value and Youden index of CMR, ECG and TTE were calculated, respectively. Results:There were 15 patients (75%) presenting CMR abnormalities in myocardial contusion group compared to 2 patients (9%) in non-myocardial contusion group ( P<0.01). CMR abnormalities mainly included myocardial oedema, ischemia or hemorrhage, which were located in the left ventricle of 12 patients (71%), right ventricle of 3 (18%) and ventricular septal of 3 (12%). There were 12 patients (60%) showing ECG abnormalities in myocardial contusion group compared to 7 patients (32%) in non-myocardial contusion group ( P>0.05). Abnormal ECG changes included 8 patients (42%) with sinus tachycardia or bradycardia, 5 (26%) with ST-T changes, 3 (16%) with atrial premature beat, 2 (11%) with bundle branch block and 1 (5%) with frequent premature ventricular contractions. There were 10 patients (50%) showing TTE abnormalities in myocardial contusion group compared to 9 patients (41%) in non-myocardial contusion group ( P>0.05). TTE abnormalities manifested as left ventricular diastolic dysfunction in 12 patients (63%) and wall motion abnormalities in 7 (37%). The AUC of CMR, ECG and TTE for diagnosing myocardial contusion was 0.83 (95% CI 0.70-0.96), 0.64 (95% CI 0.47-0.81) and 0.55 (95% CI 0.70-0.72), respectively. For CMR, ECG and TTE, the diagnostic sensitivity was 75.0%, 60.0% and 50.0%, with the specificity of 91.0%, 68.2% and 59.1%, the positive predictive value was 88.2%, 63.2% and 52.6%, and the Youden index of 66.0, 28.2 and 9.1, respectively. Conclusion:CMR can accurately detect myocardial contusion, with better diagnostic performance than ECG and TTE as well as relatively higher sensitivity and specificity, indicating that CMR has great value for clinical diagnosis of myocardial contusion.

Objective: To understand the status of awarences and the influencing factors of food safety among medical students in Shangdong Province,and to provide a reference for improving a healthy eating habit among students on their knowledge about food safety,attitude and behavior. Methods: A total of 2 322 students from 2 medical colleges and universities in Shandong province selected through stratified cluster sampling were investigated with questionnaires. Results: Univariate analysis of variance showed that food safety knowledge differed by gender, grade, major, origin of student, whether learned nutrition knowledge, monthly cost on food (χ2/H=20.48, 128.02, 98.61, 36.50, 77.60, 171.03,P<0.01). In multiple Logistic regression analysis, results showed that gender, major,origin of student, monthly cost on food and the attention of food affect college students’ food safety awareness (P<0.05). Conclusion Food safety awareness among medical students in Shandong Province is relatively high but varies by multiple factors. It is necessary to improve food safety awareness of medical students through various channels.

Objective To explore relationship of the anesthetic risks and intraoperative complications.Methods Preoperative anesthetic risks were assessed with Hussman's method from May 2015 to May 2016 in 2 494 surgical patients, including 1 462 males and 1 032 females.Intraoperative data and complications were tracked and recorded.Results Three hundred and thirty-six intraoperative complications occurred, accounting for 13.47% of total patients.The cardiovascular complications were a major intraoperative complications, accounting for 80.7%.2 494 patients were graded respectively into risk grade 1 with 1 540 (61.75%), grade 2 with 660 (26.46%), grade 3 with 202 (8.10%), grade 4 with 80 (3.21%) and grade 5 with 12 (0.48%).The incidence of complications were 112 (7.28%), 82 (12.42%), 82 (40.59%), 50 (62.50%) and 10 (83.33%) respectively.The sensitivity of prediction was 33.33%, 24.40%, 24.40%, 14.88% and 2.78%;the specificity 33.76%, 73.26%, 94.44%, 98.61% and 99.91%;and the accuracy 33.76%, 66.64%, 85.01%, 87.33% and 86.85%, respectively, in patients with risk grade 1, 2, 3, 4 and 5.Conclusion Hussman's method of anesthetic risks well predicts the intraoperative complications.

Objective This study aims to analyze the independent risk factors associated with postoperative delirium of patients undergoing Stanford A aortic dissection surgery.Methods Clinical data of the patients who underwent Stanford A aortic dissection surgery from December 2014 to October 2015 were collected.All patients received surgery under deep hypothermic circulatory arrest(DHCA) and the nasal temperature goal was below 23℃.After surgery,patients were transferred to the cardiovascular ICU,where they received standard postoperative care.The delirium was diagnosed according to the criteria of the confusion assessment method for the intensive care unit(CAM-ICU).The possible risk factors of pre-operation,during operation or post-operation were analyzed via univariate analysis and multivariate logistic regression to determine the independent risk factorsof postoperative delirium.Results 148 patients underwent Stanford A aortic dissection surgery which the incidence of postoperative delirium was 31.1％ (46/148).Univariate analysis showed the associated risk factors were age,hypertension,cognitive impairment,emergency operation,operation time,aorta clamping time,DHCA time,fluctuation of blood pressure during operation,blood transfusion,quality of sleep,length of ICU stay and electrolyte disturbance(P ＜ 0.05).Multivariate logistic regression analysis revealed that hypertension,cognitive impairment,fluctuation of mean arterial blood pressure(MAP) ＞ 30 mmHg (1 mmHg =0.133 kPa),DHCA time ＞ 40 min,postoperative poor quality of sleep and electrolyte disturbance were independently associated with postoperative delirium after Stanford A aortic dissection surgery(P ＜ 0.05).Conclusion Delirium is a frequent complication.Factors independently associated with delirium are hypertension,cognitive impairment,DHCA time,postoperative poor quality of sleep and electrolyte disturbance.Prevent,assess and manage delirium should be paid more attention and reinforced.