OBJECTIVE To investigate the mechanism of the inhibitory effect of total flavonoids from Taraxacum mongolicum on high-fat diet-induced obesity in mice through modulation of intestinal flora. METHODS Twenty-four C57BL/6J mice were randomly divided into blank group， model group and T. mongolicum total flavonoid group， with 8 mice in each group. Except for the blank group， the other 2 groups were given a high-fat diet， while T. mongolicum total flavonoid group was given T. mongolicum total flavonoid [400 mg/（kg·d）] intragastrically， once a day， for 8 consecutive weeks. During the experiment， the food intake of each group of mice was recorded. After the last medication， the body mass， fat weight， blood lipid level and pathological changes of liver and epididymal fat in mice were evaluated to observe the effect of T. mongolicum total flavonoid on the treatment of obesity in mice. The changes in abundance and structure of intestinal flora in mice were detected by amplicon sequencing； the effects of T. mongolicum total flavonoids on fat metabolism related genes were analyzed by qPCR. RESULTS Compared with model group， the body weight of mice in T. mongolicum total flavonoids group was decreased significantly （P＜0.05）； the levels of total lipid cholesterol， triglycerides， and LDL cholesterol were all decreased significantly （P＜0.01）， and the level of HDL cholesterol was increased significantly （P＜0.01）； the fat indexes of inguinal white adipose tissue and epididymal white wind_lz@hactcm.edu.cn adipose tissue were significantly reduced （P＜0.05）； significant improvement in hepatocellular steatosis and adipose cytopathy were significantly improved； mRNA expressions of COX7A1 and COX8B were significantly upregulated （P＜0.05）. The results of bacterial colony detection showed that compared with the model group， there was a rising trend in the diversity of the bacterial colony in T. mongolicum total flavonoids group， and the Sobs index characterization and β diversity were increased significantly （P＜0.05）. Relative abundances of Blautia， norank_f_Ruminococcaceae， Bilophila， Alistipes， classified_f_Ruminococcaceae， Parabacteroides， norank_f_Desulfovibrionaceae， Anaerotruncus were significantly up-regulated（P＜0.05）， while those of Faecalibaculum， Erysipelatoclostridium， GCA-900066575， Tuzzerella， Lactobacillus， norank_f_norank_o_RF39， achnospiraceae_FCS020_group were significantly down-regulated （P＜0.05）. CONCLUSIONS T. mongolicum total flavonoids can reduce body mass， fat weight and blood lipid levels， and repair the pathological damage to liver and epididymal fat in obese mice， which is related to improving intestinal flora disorders caused by high-fat diet.

Objective To investigate the role of triggering receptor expressed on myeloid cells-1(TREM-1)in ath-erosclerosis induced by chronic intermittent hypoxia(CIH).Methods ApoE-/-mice were randomly divided into blank group,model group and experimental group.The mice in the model group and the experimental group were kept in a hypoxic environment and fed with a high-fat diet.After 4 weeks of high-fat feeding,mice in the experi-mental group were intraperitoneally injected with TREM-1 inhibitor LR12(5 mg/kg)for 8 weeks.After 12 weeks of feeding,the level of serum total cholesterol(TC),low density lipoprotein(LDL),triglyceride(TG),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and interleukin-10(IL-10)were detected.Histological analysis of aortic TREM-1 expression,plaque area and macrophage level were examined.Results Compared with blank group,the expression of TREM-1 in the aorta of the model group significantly increased(P＜0.05).Com-pared with model group,the aortic plaque,the level of lipids in serum(TC,LDL,TG)and inflammatory factors(TNF-α,IL-1β,IL-10),aortic plaque,the expression of TREM-1 and infiltrating macrophages in aortic plaque of the experimental group were all significantly reduced(P＜0.05).Conclusions TREM-1 is involved in the develop-ment of CIH-induced AS.Inhibition of TREM-1 can alleviate CIH-induced AS and its mechanism is related to the inhibition of macrophage activation.

Aim To investigate the levels of a disintegrin and metalloprotease 10(ADAM-10)and soluble uro-kinase plasminogen activator receptor(suPAR)in the serum of hypertension patients with atherosclerosis and their relation-ship with the severity of disease.Methods From February 2021 to February 2023,125 hypertension patients with atherosclerosis who visited our hospital were collected as the study group,and 76 healthy people were collected as control group.The patients in the study group were grouped into mild group(n=40),moderate group(n=42)and severe group(n=43)according to the degree of atherosclerosis,after 60 days of treatment,the patients were grouped into a good prog-nosis group(n=74)and a poor prognosis group(n=51)based on their prognosis.Enzyme linked immunosorbent assay(ELISA)was applied to measure serum ADAM-10 and suPAR levels;Clinical data of patients with different prognosis were compared;Pearson method was applied to analyze the relationship between serum ADAM-10,suPAR levels and carotid in-tima-media thickness(IMT)in patients with hypertension and atherosclerosis;Multivariate Logistic regression was applied to analyze the influencing factors of poor prognosis in patients with hypertension and atherosclerosis;Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of ADAM-10 and suPAR alone and jointly for poor prognosis of hypertension with atherosclerosis.Results The levels of serum ADAM-10 and suPAR were significantly higher in the study group than those in control group(P＜0.05);The serum ADAM-10 and suPAR levels in moderate group and severe group were obviously higher than those in mild group(P＜0.05),while the serum ADAM-10 and suPAR levels were obviously higher in severe group than those in moderate group(P＜0.05);The serum ADAM-10 and suPAR levels,left and right IMT,systolic blood pressure,and diastolic blood pressure of patients with poor prognosis were signifi-cantly higher than those of patients with good prognosis(P＜0.05);Pearson correlation analysis showed that serum ADAM-10 and suPAR levels in patients with hypertension and atherosclerosis were positively correlated with systolic blood pres-sure,diastolic blood pressure and IMT(P＜0.001);Logistic regression analysis showed that the increased levels of systolic blood pressure,diastolic blood pressure,ADAM-10,suPAR and IMT were risk factors for poor prognosis of hypertension patients with atherosclerosis(P＜0.05);ROC curve analysis showed that the area under the curve(AUC)of serum AD-AM-10 and suPAR levels alone and jointly predicting poor prognosis of hypertension with atherosclerosis was 0.819,0.830 and 0.900,respectively,the combination of the two was superior to their individual predictions(Zcombination-AD AM-10=2.766,P=0.006;Zcombination-suPAR=2.602,P=0.009).Conclusion The levels of serum ADAM-10 and suPAR in patients with hypertension and atherosclerosis are significantly increased,and are positively correlated with the severity of atherosclero-sis.Both of them have a high predictive value for evaluating the prognosis of patients with hypertension and atherosclerosis.

Covalently closed circular DNA(cccDNA)in hepatocytes is the replication intermediate of hepa-titis B virus(HBV),which is closely related to HBV replication.Meanwhile,it is the transcriptional template of pregenomic RNA(pgRNA),and most of the HBV RNA in serum is derived from unreversed transcribed pgRNA.In recent years,many studies have demonstrated that HBV RNA has an important role in monitoring disease progression and predicting the prognosis of chronic HBV-infected patients,and is a potential biomarker of chronic viral hepatitis B.This article provides an overview of the molecular characterisation of HBV RNA,detection methods and research progress in clinical applications.

Glaucoma is the leading cause of irreversible blindness worldwide.Conventional glaucoma surgeries have disadvantages like injuring the tissue of conjunctiva and sclera.Recently, there have been many new treatments called minimally invasive glaucoma surgery (MIGS) sprung up, which aims to lower intraocular pressure and reduce the use of glaucoma medications with less ocular injury.The resistance of aqueous outflow comes from both proximal and distal anatomically.The proximal resistance comes from trabecular meshwork and the inner wall of Schlemm canal (SC), while the distal resistance is decided by the outer wall of SC, aqueous vein, collector canals, episcleral veins and intrascleral venous plexus.Therefore, we could classify the MIGS by anatomical site and the mechanism to control intraocular pressure into different types.First, the MIGS acts on trabecular meshwork, which could be separated into removing proximal resistance including increasing trabecular meshwork bypass, expanding SC, cutting through trabecular meshwork and removing both proximal and distal resistance including Xen Gel Stent and PRESERFLO Microshunt.Second, MIGS procedures reduce intraocular pressure by increasing suprachoroidal drainage or by disrupting the ciliary body to reduce aqueous humor production.The MIGS expanding suprachoroidal drainage is independent of intraocular pressure level, like Cypass Micro-Stent, iStent Supra and iSTAR MINIject.The MIGS destroying ciliary body to reduce humor production include ultrasound cycloplasty, micropulse cyclophotocoagulation, and endocyclophotocoagulation.Despite MIGS can control intraocular pressure effectively in a less invasive way, close follow-ups are still necessary to see its long-term effectiveness and safety.However, the emerging implants are quite confusing to many ophthalmologists.It is especially true for Chinese surgeons as most MIGS are still under clinical trial and have not entered Chinese market.Therefore, this article summarizes the current mainstream MIGS and discussed the design and surgical outcomes of these surgeries.

Objective To investigate the impact and related mechanisms of L-carnitine on lipid metabolism,microinflammation,and oxidative stress status in hemodialysis patients with chronic kidney disease,and explore the potential mechanisms.Methods The data of patients with chronic kidney disease receiving dialysis admitted to Xingtai People's Hospital from January 2022 to January 2023 were collected,and they were divided into levocanidin group(levocanidin+conventional treatment)and conventional treatment group.The two groups were compared in terms of treatment safety and renal function indexes[blood creatinine(Scr)and urea nitrogen(BUN)],lipid metabolism status[total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),and serum free carnitine(FC)],microinflammatory markers[interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)]and oxidative stress markers[malondialdehyde(MDA),superoxide dismutase(SOD),and glutathione peroxidase(GSH-Px)].Results A total of 120 patients were included in the study,with 60 in each group.After 6 months of treatment,there was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05),but the Scr and BUN of the patients in the levocanidin group were lower than those in the conventional treatment group(P＜0.05),and the therapeutic efficacy rate was higher than that in the conventional treatment group(P＜0.05).Regarding lipid metabolic status,serum TC,TG,LDL-C and ApoB levels of patients in the levocanitine group decreased compared with those before treatment(P＜0.05),while serum ApoA1 and FC were elevated(P＜0.05);and serum ApoB levels of patients in the conventional treatment group decreased compared with those before treatment(P＜0.05).The levels of TC,TG,LDL-C and ApoB were significantly lower and the levels of ApoA1 and FC were significantly higher in the leucovorin group than in the conventional treatment group(P＜0.05),whereas there was no significant difference in the levels of serum HDL-C(P＞0.05).In terms of microinflammatory status,IL-6,IL-8,TNF-α,and CRP levels decreased in both groups compared with those before treatment(P＜0.05),but IL-6,IL-8,TNF-α,and CRP levels of patients in the leucovorin group were significantly lower than those in the conventional treatment group(P＜0.05).As for the oxidative stress indexes,the SOD and MDA levels of patients in both groups decreased(P＜0.05),while the GSH-Px levels increased(P＜0.05)compared with the pretreatment;and compared with the conventional treatment group,patients in the levocanitine group had higher levels of GSH-Px,and lower levels of SOD and MDA(P＜0.05).Conclusion The use of L-carnitine may further ameliorate microinflammation and oxidative stress by improving lipid metabolism in dialysis patients with chronic kidney disease.

Objective:In order to explore the impact of corona virus disease 2019(COVID-19)on the hospitalization of children with bronchiolitis and to improve clinicians′ understanding of the characteristics of bronchiolitis during the COVID-19 epidemic.Methods:This was a multicenter clinical study, and the data have been collected from 23 children′s medical centers in China.All the clinical data were retrospectively collected from children with bronchiolitis who were hospitalized at each study center from January 1, 2019 to December 31, 2021.The results included gender, age at hospitalization, length of stay, respiratory syncytial virus(RSV) test results, severity rating, ICU treatment, and the total number of children hospitalized with respiratory tract infection during the same period.The clinical data of children with bronchiolitis in 2019 before COVID-19 epidemic and in 2020、2021 during COVID-19 epidemic were statistically analyzed and compared.Results:According to a summary of data provided by 23 children′s medical centers, there were 4 909 cases of bronchiolitis in 2019, 2 654 cases in 2020, and 3 500 cases in 2021.Compared with 2019, the number of bronchiolitis cases decreased by 45.94% in 2020 and 28.70% in 2021.In 2019, 2020 and 2021, there were no significant differences in gender ratio, age, and duration of hospitalization.Compared with 2019, the ratio of bronchiolitis to the total number of hospitalizations for respiratory tract infection decreased significantly in 2020 and 2021( χ2=12.762, P<0.05; χ2=84.845, P<0.05).The proportion of moderate to severe bronchiolitis cases in both 2020 and 2021 was lower than that in 2019, and the difference was statistically significant ( χ2=4.054, P<0.05; χ2=8.109, P<0.05).There was no statistically significant difference in the proportion of bronchiolitis cases requiring ICU treatment between 2019, 2020, and 2021 ( χ2=1.914, P>0.05).In 2019, a total of 52.60%(2 582/4 909) of children with bronchiolitis underwent RSV pathogen testing, and among them, there were 708 cases with RSV positive, accounting for 28.00%.In 2020, 54.14%(1 437/2 654) of children with bronchiolitis underwent RSV pathogen testing, and there were 403 cases with RSV positive, accounting for 28.04%.In 2021, 66.80%(2 238/3 500) of children with bronchiolitis underwent RSV pathogen testing, and there were 935 cases with RSV positive, accounting for 41.78%.Compared with 2019 and 2020, the RSV positive rate in 2021 showed a significant increase( χ2=99.673, P<0.05; χ2=71.292, P<0.05). Conclusion:During the COVID-19 epidemic, the implementation of epidemic prevention and control measures reduced the hospitalization rate and severity of bronchiolitis, but did not reduce the positive rate of RSV detection.

Objective:To study the clinical phenotype and molecular genetic characteristics of a Chinese Han family with X-linked retinoschisis (XLRS), and to determine the associated gene variations.Methods:A pedigree investigation was performed.The clinical characteristics and pedigree analysis of a Han Chinese family line with XLRS was conducted in August 2021 at the Xiamen Eye Center Affiliated to Xiamen University.All patients and the carriers underwent comprehensive medical history collection and routine ophthalmological examinations, including visual acuity, non-contact tonometer, slit lamp microscope, direct ophthalmoscope, and optical coherence tomography.The proband and some patients underwent medical optometry, fundus photography or wide-angle fundus photography, and electroretinogram examination.Peripheral venous blood samples were collected from the family members, and whole exome sequencing (WES) analysis was performed on the proband samples.For variants screened by WES, the expanded verification in other patients and normal persons in the family was carried out by Sanger sequencing.Multiple bioinformatic tools were used to analyze the pathogenicity of variants.This study protocol was approved by the Ethics Committee of Xiamen Eye Center of Xiamen University (No.XMYKZX-KY-2021-012). Written informed consent forms were obtained from each subject or guardian of minors.CADD, FATHMM and other bioinformatics tools were used to analyze the pathogenicity of the variation sites.Results:The Han XLRS pedigree consisted of 8 individuals in 3 generations.Out of the 3 cases diagnosed with XLRS based on clinical evaluation, all were male.The mother of the proband was a carrier of related genes.There were 5 persons with normal phenotypes.There was no history of consanguineous marriages within the family, and the disease was shown to be intergenerational, which is consistent with the recessive inheritance of the X chromosome.None of the patients had a history of systemic disease or any other abnormal manifestations.The prevailing feature of ophthalmopathy was poor binocular vision since childhood.The proband and his younger brother had spoke split in the macula, and their grandfather showed atrophy of retinal nerve fibers.Genetic analysis revealed a hemizygous variation c. 214G>C: p.Glu72Gln in the RS1 gene in all the patients in this family.The proband's mother was heterozygous at this site, and all other phenotypically normal family members exhibited wild type at this site.This variant was predicted to be a deleterious variation and likely to cause disease based on bioinformatics analysis. Conclusions:The proband and patients in this Han Chinese family have the known c. 214G>C: p.Glu72Gln hemizygous variation of the RS1 gene and exhibit mild XLRS, which was consistent with the recessive inheritance of X chromosome.

Objective:To survey the post competency of general practitioners who completed residency training in Suzhou Municipal Hospital.Methods:A questionnaire survey on post competency of general practitioners was conducted from January to March 2022. General practitioners who completed standardized residential training in Suzhou Municipal Hospital from 2009 to 2021 were randomly selected for the survey. The self-designed questionnaire included the basic information and post competency in terms of clinical, public health, research and teaching abilities as well as medical ethics and humanism. A self-evaluation was also performed and the abilities were graded (A 86-100, B 70-85, C 55-69, D 0-54), and grade A was classified as excellent.Results:A total of 163 questionnaires were distributed and 157 valid ones were collected with a recovery rate of 96.3%. Among 157 respondents 62 (39.5%) were males. The participants mainly worked in urban community health service institutions (78 (49.7%)), and most of them worked as general practice (119 (75.8%)). For the self-assessment of clinical skills, the proportion of respondents with excellent abilities in history taking, basic drug use, diagnosis and treatment of common diseases, and chronic disease management was 58.8% (70/119), 57.1% (68/119), 54.6% (65/119) and 54.6% (65/119), respectively. The proportion of respondents with excellent abilities in evidence-based clinical decision making, physical examination, tests interpretation, referral services, family medical services, rehabilitation services, first aid, and psychological counseling and treatment was 43.7% (70/119), 42.9% (52/119), 38.7% (46/119), 37.8% (45/119), 33.6% (40/119), 22.7% (27/119), 21.0% (25/119), and 16.8% (20/119), respectively. For the self-assessment of basic public health service ability, the proportion of respondents with excellent abilities in health education, disease prevention and control, health management, health care for key and special groups, handling public health emergencies, management of infectious diseases, epidemiology-based community diagnosis and community health leadership was 38.7% (46/119), 33.6% (40/119), 33.6% (40/119), 26.1% (31/119), 25.2% (30/119), 2.7% (27/119), 22.7% (27/119), and 21.0% (25/119), respectively. For humanistic literacy, the proportion of respondents with excellent abilities in privacy protection, sense of responsibility for patients, understanding patients′ needs, effective communication and cooperation with patients was 82.4% (98/119), 73.9% (88/119), 61.3% (73/119), 55.5% (66/119) and 2.1% (62/119), respectively. For research and teaching, the proportion of respondents with excellence abilities in continuous learning and innovation, training and teaching and literature retrieval was 47.9% (57/119), 10.9% (13/119), 10.1% (12/119), respectively. In addition 56.3% (67/119) of respondents were interested in scientific research, 23.5% (28/119) had published articles as the first author or correspondence author, and only 6.7% (8/119) had scientific research projects in the last 5 years.Conclusion:The post competency of general practitioners who received standardized residency training in our hospital varies in different aspects, their abilities in basic public health service, scientific research and teaching are relatively low, which need to be strengthened.

Objective:To investigate the application effects of a one-time filling root canal in root canal therapy in plateau areas and evaluate its feasibility in oral clinic in plateau areas.Methods:Sixty-eight patients who received root canal therapy for anterior teeth and premolars (75 teeth) from August to December 2018 in Shannan People's Hospital were included in this study. They were divided into control group ( n = 33; 36 teeth) and observation group ( n = 35; 39 teeth) according to odd and even numbers of admission date. Patients in the control group received conventional root canal therapy and those in the observation group underwent one-time root canal filling therapy. Efficacy was compared between the two groups. Results:After 1 week, 2 weeks and 1 month of treatment, the success rate in the control group was 88.9%, 94.4%, 100.0%, respectively, and it was 87.2%, 94.9% and 100.0%, respectively in the observation group. There was no significant difference in success rate between the two groups at three time points studied (all P > 0.05). Conclusion:One-time filling root canal therapy can achieve ideal therapeutic effects under strict control of surgical indications. This method is worthy of clinical promotion especially in plateau areas.