ObjectiveBased on the nuclear factor erythroid 2 related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） signaling pathway， this paper explores the effect of Sinisan （SNS） on liver oxidative stress injury in cholestatic hepatitis rats and its mechanism. MethodThirty 6-week-old male SD rats were randomly divided into a control group， model group， low and high dose groups of SNS （2.5 and 5 g·kg^-1） and ursodeoxycholic acid group （UDCA， 63 mg·kg^-1）， with six rats in each group. Rats were administrated for seven consecutive days. On the 5th day， the control group was given olive oil of 10 mL·kg^-1， and the other groups were given alpha-naphthalene isothiocyanate （ANIT） of 80 mg·kg^-1. The serum biochemical indicator levels of cholestasis and the content of antioxidant factors in rat liver were detected by enzyme-linked immunosorbent assay （ELISA）. Hematoxylin-eosin （HE） staining was used to observe the pathological changes in liver tissue. The relative mRNA and protein expressions of Nrf2， HO-1， and quinone oxidoreductase 1 （NQO1） in liver tissue were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot. ResultCompared with the control group， the model group showed a significant increase in the serum biochemical indicator levels of cholestasis and the content of antioxidant factors in liver tissue （P<0.01）. There were obvious pathological changes in the model group such as the disordered arrangement of hepatocytes， obvious congestion and necrosis in the portal area， infiltration of inflammatory cells， and destruction of the interlobular bile duct. The relative mRNA and protein expressions of Nrf2， HO-1， and NQO1 in liver tissue were significantly down-regulated in the model group （P<0.05， P<0.01）. Compared with the model group， the groups of SNS showed a significant decrease in the serum biochemical indicator levels of cholestasis and the content of antioxidant factors in liver tissue （P<0.01）， and the pathological liver injury was obviously improved. The necrotic area was reduced， and the infiltration of inflammatory cells was decreased. In addition， there was a small amount of extravasated blood in the interlobular vein. The relative mRNA and protein expressions of Nrf2， HO-1， and NQO1 in liver tissue were significantly up-regulated （P<0.05， P<0.01）. ConclusionSNS can significantly improve liver injury in cholestatic hepatitis rats， and its mechanism may be related to the inhibition of oxidative stress response mediated by the Nrf2/HO-1 signaling pathway.

Objective To investigate the effects of puerarin on myocardial ischemia-reperfusion injury and its mecha-nism.Methods Molecular docking and dynamics simulation were utilized to predict the binding potential of puerarin and SIRT1.A myocardial ischemia-reperfusion model was established in SD rats by ligating the anterior descending branch of the left coronary artery.The protective effect of puerarin on myocardial injury was observed,and the therapeutic effect of puerarin was compared after inhibition of SIRT1 expression.The infarct volume was detected using 2,3,5-triphenyltetrazolium chloride(TTC)staining.The apoptosis rate and SIRT1 expression of cardiomyocytes were detected by using TUNEL combined with im-munofluorescence.Transmission electron microscope was used to observe the myocardial ultrastructure.Western blot was per-formed to detect the expression of ferroptosis-related proteins.Results Molecular docking studies confirmed the formation of stable complexes between puerarin and SIRT1.Puerarin treatment significantly increased myocardial ischemia-reperfusion injury through upregulation of SIRT1,SLC7A11 and GPX4 expression,and downregulation of IREB2 expression in rats.The protec-tive effect of puerarin on myocardium was abolished once SIRT1 protein expression was inhibited.Conclusion Molecular doc-king and molecular dynamics simulation techniques can accurately predict the interaction of puerarin,and the main target SIRT1.Puerarin inhibits ferroptosis by activating SIRT1 pathway,thereby alleviating myocardial ischemia-reperfusion injury.

Objective To analyze the clinical characteristics and treatment of clostridium difficile infection(CDI)in children.Methods The clinical data of 159 children with CDI admitted to the Department of Gastroenterology and Hepatology,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University from September 2014 to October 2022 were retrospectively analyzed.All ini-tial CDI patients were divided into vancomycin treatment group and metronidazole treatment group according to different treatment meth-ods,Children with recurrent CDI(RCDI)were divided into two groups according to vancomycin or FMT treatment.Results A total of 159 children with initial CDI were included,including 93 males and 66 females,the age of these children was 4.3(1.7,8.0)years.109 children(68.55％)were treated with metronidazole,and 50 children(31.45％)were treated with vancomycin.Recurrence occurred in 51 children after antibiotic treatment,37 children(33.94％)of them treated with metronidazole,and 14 children(28.00％)of them treated with vancomycin,there was no significant difference(P＞0.05).Among RCDI children,21 cases were treated with vancomycin and 30 were treated with FMT.The cure rate of FMT was 90.00％,and the cure rate of vancomycin was 57.14％.The cure rate of FMT was significantly higher than that of vancomycin.There were no serious adverse events reported after two months of FMT treatment.Conclusion Metronidazole can be used as the drug of choice for initial CDI in children.The cure rate of FMT for RCDI is superior to vancomycin treatment.

Objective To investigate the potential effect and mechanism of curcumin in inhibiting synaptic injury in the cortex of rats with cerebral ischemia-reperfusion. Methods Sprague-Dawley rats were divided into sham-operated group, model group, low-dose curcumin (50 mg/kg) group, and high-dose curcumin (100 mg/kg) group. A model of middle cerebral artery occlusion for 2 hours and reperfusion for 24 hours was constructed, and curcumin was administered. Based on the neurological function score, the effects of curcumin on cerebral infarct volume, synaptic ultrastructure changes, inflammatory cell infiltration, and the expression of NLRP3, Caspase-1, Synapsin1, and CAMKⅡ were observed after the end of the animal treatment. Results The neurological function scores were 0, 3.25±0.43, 2.50±0.50, and 1.50±0.50 for the sham-operated group, model group, low-dose curcumin group, and high-dose curcumin group, respectively. The percentage of cerebral infarct volume was 0, (38.89±2.21)%, (33.48±1.77)%, and (23.69±2.19)%, respectively. Compared with the sham operation group, the model group had severe synaptic ultrastructure damage, extensive inflammatory cell infiltration, significantly increased expression of Caspase-1 and NLRP3 (P < 0.5), and significantly decreased expression of Synapsin1 and CAMKⅡ (P < 0.5). Curcumin treatment significantly inhibited synaptic damage, reduced inflammatory cell infiltration, decreased the expression of Caspase-1 and NLRP3 (P < 0.5), and increased the expression of Synapsin1 and CAMKII (P < 0.5), when compared with the model group. Conclusion Ischemia-reperfusion-mediated synaptic injury in rat brain triggers an inflammatory response in cortical nerve cells, and curcumin alleviates synaptic damage and reduces brain injury by inhibiting inflammatory factor levels.

Background At present, the practice of pulmonary rehabilitation for pneumoconiosis in China is in a primary stage. The basis for formulating an individualized comprehensive pulmonary rehabilitation plan is still insufficient, which is one of the factors limiting the development of community-level rehabilitation work. Objective To formulate an exercise prescription based on maximum heart rate measured by cardiopulmonary exercise test (CPET), conduct an individualized comprehensive pulmonary rehabilitation program with the exercise prescription for patients with stable pneumoconiosis, and evaluate its role in improving exercise endurance and quality of life, thus provide a basis for the application and promotion of pulmonary rehabilitation. Methods A total of 68 patients were recruited from the Occupational Disease Prevention Hospital of Jinneng Holding Coal Industry Group Co., Ltd. from April to August 2022 , and were divided into an intervention group and a control group by random number table method, with 34 cases in each group. All the pneumoconiosis patients participated in a baseline test. The control group was given routine drug treatment, while the intervention group received multidisciplinary comprehensive pulmonary rehabilitation treatment on the basis of routine drug treatment, including health education, breathing training, exercise training, nutrition guidance, psychological intervention, and sleep management, whose exercise intensity was determined according to the maximum heart rate provided by CPET. The rehabilitation training lasted for 24 weeks. Patients were evaluated at registration and the end of study respectively. CPET was used to measure peak oxygen uptake per kilogram (pVO₂/kg), anaerobic threshold (AT), carbon dioxide equivalent of ventilation (EqCO₂), maximum metabolic equivalent (METs), and maximum work (W_max). The modified British Medical Research Council Dyspnea Questionnaire (mMRC), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Chronic Obstructive Pulmonary Disease Assessment Test (CAT), and Short Form of Health Survey (SF-36) were used to evaluate the potential effect of the comprehensive pulmonary rehabilitation program. Results Among the included 68 patients, 63 patients were having complete data, then 31 cases were assigned in the control group and 32 cases in the interventional group. Before the intervention, there was no significant difference in pVO₂/kg, AT, EqCO₂, METs, or W_max between the two groups (P>0.05). At the end of the trail, the indicators like pVO₂/kg [(19.81±2.38) mL·(min·kg)⁻¹], AT [(14.48±2.33) mL·(min·kg)⁻¹], METs (5.64±0.69), and W_max [(85.25±14) W] of patients in the intervention group were all higher than those [(13.90±2.37) mL·(min·kg)⁻¹, (11.70±1.94) mL·(min kg)⁻¹, (3.97±0.70), and (61.77±14.72) W, respectively] in the control group (P<0.001); there was no significant difference in EqCO₂ between the two groups (P=0.083). Before the trial, there was no significant difference in mMRC, SAS, SDS, PSQI, or CAT scores between the two groups (P>0.05). At the end of the trail, the mMRC score (1.16±0.57), SAS score (27.93±2.12), SDS score (26.48±1.44), PSQI score (1.08±0.88), and CAT score (4.34±3.28) of patients in the intervention group were lower than those [(2.03±0.83), (35.87±6.91), (34.23±6.65), (5.37±3.03), and (13.87±7.53), respectively] in the control group (P<0.001). The SF-36 scores of bodily pain (94.13±10.72), general health (87.50±5.68), vitality (95.31±5.53), mental health (99.88±0.71), and health changes (74.22±4.42) in the intervention group were higher than those [(71.87±32.72), (65.81±15.55), (74.52±16.45), (86.97±16.56), and (29.84±13.50), respectively] in the control group (P<0.001), and no significant difference was found in social functioning and role emotional scores (P>0.05). Conclusion Comprehensive pulmonary rehabilitation can increase the oxygen intake and exercise endurance of pneumoconiosis patients, ameliorate dyspnea symptoms, elevate psychological state and sleep quality, and improve the quality of life.

Breast cancer is the most common malignant tumor in women.With the development of genomics technology and medical frontier technology,the systemic treatment of breast cancer has gradually entered the era of personalized medicine.However,the decision-making of adjuvant radiotherapy for breast cancer still mainly relies on traditional clinicopathological factors,and there is a lack of scientific and reliable tools to guide precise radiotherapy in different populations.Hormone receptor(HR)positive/human epidermal growth factor receptor 2(HER2)negative breast cancer is the most common molecular subtype of breast cancer.The 21-Gene recurrence score(RS)test(Oncotype Dx?,Genomic Health,Redwood City,CA)is a commercially available genomic test for breast cancer.In this article,we reviewed the current research evidence on the use of 21-Gene RS test for radiotherapy decision-making in HR-positive HER2-negative early breast cancer.Current clinical studies support the predictive value of 21-Gene RS test for adjuvant radiotherapy,and several large-scale prospective clinical studies in this area are underway.

Objective:To develop and evaluate a nomogram prediction model for poor outcome in patients with minor acute ischemic stroke (MIS) at 90 days after onset.Methods:Patients with MIS admitted to the Second People's Hospital of Hefei from January 2022 to June 2023 were retrospectively enrolled. At 90 days after onset, the modified Rankin Scale was used for outcome evaluation. <2 points were defined as good outcome and ≥2 points were defined as poor outcome. Multivariate logistic regression analysis was used to identify independent risk factors for poor outcome, and a nomogram prediction model was developed based on these factors. Results:A total of 177 patients with MIS were included, of which 61 (34.46%) had poor outcome. Multivariate logistic regression analysis showed that hypertension (odds ratio [ OR] 3.484, 95% confidence interval [ CI] 1.378-8.810; P=0.008), diabetes ( OR 2.936, 95% CI 1.301-6.625; P=0.009), National Institutes of Health Stroke Scale (NIHSS) score at admission ( OR 2.936, 95% CI 1.027-1.709; P=0.031) and systolic blood pressure at admission ( OR 1.083, 95% CI 1.053-1.115; P<0.001) were the independent risk factors for poor outcome. The established nomogram prediction model had a C-index of 0.828 and the area under the curve was 0.841 (95% CI 0.778-0.891). The calibration curve fitted well with the ideal curve. The clinical decision curve showed that the model had stronger clinical applicability. Conclusions:Hypertension, diabetes, NIHSS score and systolic blood pressure at admission are independent risk factors for poor outcome of patients with MIS. The nomogram based on the above factors has higher discriminative power and clinical value for predicting poor outcome in patients with MIS.

Post-stroke depression (PSD) is an important mental complication of stroke, affecting nearly 1/3 of stroke patients, seriously affecting patients' functional recovery and quality of life, and is associated with increased mortality of stroke patients. Traditional antidepressant treatments include medication and psychotherapy, but there may be problems with adverse reactions, tolerance, or limited effectiveness. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive neuroregulatory technique, offers a new treatment option for patients with PSD. This article reviews the application of rTMS in the treatment of PSD and its possible mechanism.

The Chinese Neonatal Network(CHNN) was established in 2018 with the mission of establishing a national collaboration platform, conducting high-quality and collaborative research, and ultimately improving the quality of neonatal-perinatal care and health in China.At present, 112 hospitals across the country have joined CHNN.CHNN has established a national standardized cohort of very premature infants/very low birth weight infants with >10 000 enrollments each year, has been leading data-driven collaborative quality improvement initiatives, conducting multicenter clinical studies, and performing multi-level training programs.Guided by the principles of collaboration and sharing, data-driven, continuous improvement, and international integration, CHNN has become an important platform for clinical and research collaboration in neonatal medicine in China.

Objective : To investigate the effect of motile cilia of ependymal cells on cerebral edema induced by ischemic stroke. Methods : SD rats(n = 60) were randomly divided into sham group and ischemia⁃reperfusion model group. In the model group , a 2 h reperfusion 24 h model of ischemia was constructed by the method of suture. The Longa ′s⁃5 point method and the 2 , 3 , 5 ⁃triphenyltetrazolium chloride (TTC) staining were used to assess neurological function and the cerebral infarction volume , respectively. The dry and wet weight method was used to measure brain water content. The morphological changes of motile cilia were observed by HE staining and scanning electron microscope (SEM) . The level of SPAG6 expressed in tissues with motile cilia was measured by Western blot. Immunofluorescence was used to detect the structure of motile cilia and the expression distribution of SPAG6 in brain. Results : Compared with the sham group , the infarct volume and neurological function score of the model group increased significantly , and the brain edema was obvious (P < 0. 05) . HE staining and SEM results showed that the brain tissue structure of the sham group was tight and regular and the ependymal cell nucleus was round and full. The motile cilia in sham group were arranged orderly and the structure was complete. The brain tissue structure of the model group was loose and the ependymal cell nucleus was wrinkled、condensed and dyed. A large number of necrotic cells were generated , and the structure of motile cilia was disordered. The number and density of motile cilia were significantly reduced , and the arrangement was disordered. Western blot results showed that the total protein content of SPAG6 in the model group was higher than that in the sham group , but the results were not statistically different. Immunofluorescence results showed that compared with the sham group , the length of motile cilia in the model group was significantly shorter (P < 0. 05) . The fluorescence intensity of SPAG6 in the model group was higher than that in the sham group , but the results were not statistically different. Compared with the sham group , the average fluorescence intensity of SPAG6 in ependymal cells of the model group significantly increased , and the difference was statistically significant (P < 0. 05) ; and cerebral ischemia⁃reperfusion injury reduced the expression of SPAG6 fluorescence in the cilia ( P < 0. 05 ) . Conclusion Cerebral ischemia⁃reperfusion down⁃regulates the expression of SPAG6 in motile cilia of ependymal cells , resulting in abnormal structure and dysfunction of motile cilia , and subsequent brain edema injury.