OBJECTIVE To analyze the serum chemical composition of rats after intragastric administration of water extract of crude Anemarrhenae Rhizoma-crude Phellodendri Chinensis and salted Anemarrhenae Rhizoma-salted Phellodendri Chinensis based on liquid chromatography-mass spectrometry(LC-MS)technology,predict the effect of salt processing on the treatment of type 2 dia-betes in Anemarrhenae Rhizoma-Pheellodendri Chinensis combined with network pharmacology,and preliminarily verify it through in vitro experiments.METHODS Rats were continuously intragastrically administered with crude Anemarrhenae Rhizoma-crude Phello-dendri Chinensis drug pair and salted Anemarrhenae Rhizoma-salted Phellodendri Chinensis drug pair water extract twice,with an in-terval of 1 h.After 60 min of the last administration,the blood was taken from the abdominal aorta,and the protein was precipitated by methanol.After dissolution,the chromatographic column was Shim-pack GIST C18(4.6 mm×150 mm,5 μm);the mobile phase A was 0.1%formic acid water,and the mobile phase B was 0.1%formic acid-acetonitrile;gradient elution,positive and negative ion full scan mode,mass scan range 100-1 500 m/z.Combined with the secondary spectrum of the database and literature,the blood compo-nents of crude Anemarrhenae Rhizoma-crude Phellodendri Chinensis drug pair and salted Anemarrhenae Rhizoma-salted Phellodendri Chinensis drug pair were analyzed and identified.The disease targets of type 2 diabetes were retrieved,and the protein interaction net-work analysis,GO and KEGG pathway enrichment analysis were performed on the intersection targets of blood components and diseases.The"blood components-targets"network diagram was constructed,and the selected core components and core targets were verified by molecular docking using AutoDock software.In the verification experiment,HepG2 cells were used as the experimental ob-ject,and the insulin resistance model was induced by high insulin and high glucose.CCK8 method was used to test the effect of Rhizo-ma Anemarrhenae-Phellodendri Chinensis on cell proliferation before and after salt processing.Western blot was used to detect the ex-pression of PI3K-AKT signaling pathway-related proteins.RESULTS 15 prototype components and 1 mangiferin metabolic compo-nent were identified in the serum of rats.17 prototype components and 1 mangiferin metabolite were identified in the rat serum of the water extract of Anemarrhenae Rhizoma-Phellodendri Chinensis after salt processing.The contents of mangiferin,berberine and 3-isobutylglutaric acid in the blood components after salt-processing were higher than those in the raw products.According to the results of KEGG and GO,the treatment of type 2 diabetes may be related to the transcriptional regulation of RNA polymerase,inflammatory re-sponse,AGE-RAGE,PI3K-AKT pathway and insulin resistance.Cell experiments showed that the ratio of p-PI3K/PI3K,p-AKT/AKT and GLUT4 protein expression could be up-regulated before and after salt processing,and the effect of salt processing group was better than that of the crude group.CONCLUSION This experiment preliminarily revealed the components of Anemarrhenae Rhizo-ma-Phellodendri Chinensis drug pair entering the blood before and after salt exposure,and suggested that ferulic acid,berberine,ber-berrubine,mangiferin,mTOR,SIRT1,EGFR and PPARA may be the main components and targets of Rhizoma Anemarrhenae-Phel-lodendri Chinensis after salt processing to enhance the therapeutic effect of type 2 diabetes.The mechanism may be to enhance the role of PI3K-AKT and other related signaling pathways,providing an important reference for the pharmacodynamic material basis and clini-cal application of Anemarrhenae Rhizoma-Phellodendri Chinensis before and after salt processing.

Objective:To analyze the research hotspots and trends in the field of emergency nursing safety management at home and abroad through bibliometrics, and to provide reference for the research and clinical practice of emergency nursing safety management in China.Methods:The relevant literature in the field of emergency nursing safety management in China National Knowledge Infrastructure and Web of Science databases were searched from January 1, 2014 to December 31, 2023. CiteSpace6.2.R7 software was used for keyword co-occurrence, clustering and mutation analysis, and the hotspot and development trend of the literature were analyzed.Results:A total of 883 literatures were included, including 665 Chinese literatures and 218 English literatures.Nursing safety management had attracted much attention in China, but there were few high-level studies.And the foreign related research had steadily increased. The content of foreign literature was different from that of domestic literature. Chinese literature focused on nursing risk, nursing quality, nursing management, application effectiveness, emergency triage, etc, and focused on critically ill patients.The English literature mainly focused on medical errors, risk management, organizational culture, maternal investment, emergency department, training, depression, emergency care systems,improvement, etc.Conclusions:The research on emergency nursing safety management in China is still in the initial stage. In the future, it is necessary to strengthen safety culture construction, adverse event management, emergency observation, establishment of safety management measures, drug safety management strategies, and patient satisfaction, etc.

Objective To investigate the association between nonalcoholic fatty liver disease(NAFLD)and osteoporosis in elderly patients.Methods A total of 824 patients,aged≥60 years,who were hospitalized in Department of Gerontology,Peking University People's Hospital,from June 2016 to April 2023 were enrolled,with 398 patients in the osteoporosis group and 426 in the non-osteoporosis group.Related data were collected from all subjects,including general information,blood biochemical parameters,liver ultrasound,and bone mineral density measured by dual-energy X-ray examination.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical variables;a binary Logistic regression analysis was used to investigate the independent risk factors for osteoporosis.Results Compared with the non-osteoporosis group,the osteoporosis group had a significantly higher age,a significantly higher proportion of female patients or patients with diabetes,and a significantly lower body mass index(all P<0.05).The osteoporosis group had a significantly higher proportion of patients with NAFLD than the non-osteoporosis group(36.2%vs 24.6%,χ2=12.878,P<0.001).Compared with the non-osteoporosis group,the osteoporosis group had significantly lower levels of hemoglobin,uric acid,and albumin and significantly higher levels of total cholesterol,low-density lipoprotein cholesterol(LDL-C),bone-specific alkaline phosphatase,and tartrate-resistant acid phosphatase(all P<0.05).The binary Logistic regression analysis showed that old age(odd ratio[OR]=1.040,95%confidence interval[CI]:1.015-1.066,P=0.002),female sex(OR=4.089,95%CI:2.607-6.411,P<0.001),NAFLD(OR=1.697,95%CI:1.076-2.678,P=0.023),diabetes(OR=1.509,95%CI:1.008-2.260,P=0.046),and LDL-C(OR=1.431,95%CI:1.010-2.029,P=0.044)were independent risk factors for osteoporosis in elderly patients.Considering the impact of diabetes on the research findings,a subgroup analysis was performed for the patients without diabetes,and the results showed that NAFLD(OR=1.573,95%CI:1.015-2.439,P=0.043)was an independent risk factor for osteoporosis in the elderly patients without diabetes.Conclusion NAFLD,old age,and female sex are independent risk factors for osteoporosis in elderly patients.

ObjectiveTo observe the glucose-lowering， insulin resistance-improving， and anti-inflammatory effects of flavonoids from mulberry leaves （FML） and explore their underlying mechanism. MethodMale db/db mice aged 6-7 weeks were randomly divided into a model group， a high-dose FML group （1.00 g·kg·d^-1）， and a low-dose FML group （0.50 g·kg^-1·d^-1）. C57BL mice of the same age were assigned to the normal group. After six weeks of intervention， fasting blood glucose （FBG）， serum fasting insulin levels （Fins）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， free fatty acid （FFA）， blood creatinine （SCr）， blood urea nitrogen （BUN）， and aspartate aminotransferase （AST） levels were measured， and the homeostasis model assessment of insulin resistance （HOMA-IR） was calculated. Superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px）， and catalase activities in the liver were measured. Morphological changes in the liver were assessed by hematoxylin-eosin （HE） staining. The protein expression of cyclooxygenase-2 （COX-2）， inducible nitric oxide synthase （iNOS）， and nuclear factor-κB （NF-κB） in the liver was detected by Western blot. ResultCompared with the model group， the high-dose and low-dose FML groups showed significant reductions in FBG， Fins， HOMA-IR， IL-6， TNF-α， and FFA levels （P<0.05， P<0.01）， and increased levels of SOD， GSH-Px， and catalase in the liver （P<0.05， P<0.01）. HE staining of the liver in the FML groups showed improved arrangement of hepatocytes， reduced inflammatory cell infiltration， and alleviated cellular steatosis compared with the model group. The protein expression of COX-2， iNOS， and NF-κB in the liver significantly decreased in the FML groups as compared with that in the model group （P<0.05， P<0.01）. ConclusionFML have glucose-lowering and insulin resistance-improving effect， which may be attributed to their regulation of the NF-κB pathway in the liver of diabetic mice， leading to the suppression of the release of COX-2， iNOS， and inflammatory cytokines， thereby improving the inflammatory state.

A total of 231 patients aged>60 years who underwent orthopedic surgery in Department of Orthopedics of Emergency General Hospital from November 2019 to June 2022, were enrolled. All patients received a comprehensive geriatric assessment before surgery. The demographic characteristics, medical history of patients were collected, the geriatric syndrome, postoperative complications were analyzed. The risk factors of postoperative complications were analyzed with Logistic regression. The preoperative comprehensive geriatric assessment showed that the most common geriatric syndrome was cognitive impairment (29.9%, n=69), followed by frailty (14.3%, n=33), nutritional risk (10.4%, n=24), functional dependence (7.8%, n=18), depression and anxiety (3.9%, n=9). Postoperative complications occurred in 38 cases, including delirium in 18 cases (7.8%), respiratory infection in 15 cases (6.5%), heart failure in 9 cases (3.9%) and death in 1 case (0.4%). The Logistic regression analysis showed that anemia ( OR=5.278, 95% CI:1.237-22.518), frailty ( OR=2.865, 95% CI:1.049-7.829) and cognitive impairment ( OR=3.796, 95% CI:1.526-9.442) were independent risk factors for adverse postoperative outcomes ( P<0.05). The study indicates that incidence of preoperative geriatric syndrome in patients undergoing evaluation is common; and anemia, frailty and cognitive impairment may be related to adverse clinical outcomes in elderly patients after surgery.

Objective:To investigate the efficacy and safety of transcranial alternating current stimulation (tACS) in treating migraine without aura.Methods:A prospective study was performed. From June 2021 to June 2022, 40 migraine without aura patients treated at Vertigo Center, Department of Neurology, Second Affiliated Hospital of Zhengzhou University were enrolled; they were randomly assigned to true group ( n=20) and pseudo group ( n=20); treatment was given for 4 consecutive weeks and follow-up was given for 4 weeks. Pseudo group did not receive current stimulation, while true group received stimulation by 77.5 Hz, 15 mA alternating current through electrodes placed on the forehead and bilateral mastoid (twice/d, 40 min each time, 5 d as a course, a total of 4 courses). Efficacies and adverse reactions were assessed before treatment, and at the end of treatment and follow-up, respectively. Results:Compared with pseudo group, the average monthly migraine days, visual analog scale (VAS) scores, Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA) scores and Hamilton Depression Scale (HAMD) scores decreased statistically in true group ( P<0.05), and Migraine-specific Quality of Life Questionnaire (MSQ) scores increased statistically in true group ( P<0.05). In true group, compared with those before treatment, the average monthly migraine days, VAS scores, PSQI, HAMA scores and HAMD scores significantly decreased, and MSQ scores increased statistically at the end of treatment and follow-up ( P<0.05). During treatment, no adverse reactions such as seizures, hearing loss, scalp burns, dizziness, or tinnitus were noted in true group and pseudo group. Conclusion:Repeated tACS can obviously reduce frequency and degree of migraine, improve quality of life in migraine without aura patients; and good safety can be recorded.

Objective:To analyze the abnormal vestibular function of Wernicke encephalopathy (WE) and to explore its diagnostic value.Methods:WE patients who visited the Vertigo Center of the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2021 were retrospectively collected. All patients were evaluated by clinical neurology. Before treatment, all patients completed video head impulse test (vHIT) and video nystagmusgraphy (VNG) in addition to cranial magnetic resonance and serum thiamine level examination.Results:All 12 patients had a history of eating defects, including 8 cases of alcoholism. All 12 patients had walking instability, 7 cases had dizziness and 8 cases had oscillopsia. Six cases had ophthalmoplegia. All 12 cases showed positive gaze nystagmus. The pathological saccades of bilateral horizontal semicircular canals were found in 12 patients by vHIT before treatment, but there was only 1 patient showing abnormality in vertical semicircular canals, the difference being statistically significant ( P<0.05). All patients could detect bilateral, horizontal, gaze-evoked nystagmus, including 3 cases with vertical nystagmus, 1 case with abnormal saccade test, 3 cases with abnormal smooth tracking test and 1 case with abnormal optokinetic test. There were abnormalities in the caloric test, including 6 cases of bilateral dysfunction and 2 cases of unilateral dysfunction. Conclusions:WE patients may have abnormal vHIT and bilateral, horizontal, gaze-evoked nystagmus, which is similar to the special abnormal signs of simultaneous damage of both peripheral and central vestibular dysfunction.Vestibular function test is valuable for diagnosis of WE, and it is suitable for patients with a history of nutritional disorders who have dizziness or walking instability and suspected WE.

Objective:To analyze the sleep quality and sleep structure of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) complicated with patent foramen ovale (PFO), and to study the effect of PFO on the sleep structure of OSAHS.Methods:Fifty-six patients with OSAHS complicated with PFO, 64 patients with simple OSAHS and 62 controls were collected from December 2018 to March 2020 in Centre of Sleep Disorders, the Second Affiliated Hospital of Zhengzhou University. Pittsburgh Sleep Quality Index and polysomnography were used to compare the sleep quality and sleep structure of the three groups.Results:Compared with the control group [6/62(9.68%)], OSAHS complicated with PFO group [54/56(96.43%)] and simple OSAHS group [53/64(82.81%)] had higher incidence of poor sleep quality (χ2=112.08, P<0.0l). Furthermore, compared with the control group, the OSAHS complicated with PFO group and simple OSAHS group showed reduced sleep efficiency [PSQI total score was 0.5 (0, 1), 2 (1, 3) and 2 (1, 2) respectively, H=74.549, P<0.01] and reduced proportions of rapid eye movement (REM; 20.45%±3.49%, 12.19%±5.95% and 15.11%±7.21%,respectively, F=21.17, P<0.01) and slow wave sleep (N3; 21.24%±4.12%, 14.15%±6.08%, 17.68%±6.35%, respectively, F=29.51, P<0.01); the N1 (4.47%±2.40%, 9.50%±5.34%, 9.55%±4.61%, respectively, F=30.07, P<0.05) and N2 sleep (53.88%±4.35%, 64.09%±7.49%, 58.14%±6.67% , respectively, F=46.21, P<0.05) were prolonged; the inocturnal lowest oxyhemoglobin saturation (SpO 2) level was lower, mean SpO 2 reduction at night was higher [3.00% (0, 4.00%),6.00% (5.00%, 8.75%) and 4.00% (4.00%, 5.00%), respectively, H=72.24, P<0.05], and periodic leg movement index [16.30(4.80, 32.82), 33.30(9.26, 54.80) and 23.10(8.38, 31.83),respectively, H=17.86, P<0.05], arousal index [11.60(7.73, 17.55), 23.90(14.03, 30.45) and 15.6(11.23, 20.78), respectively, H=22.80, P<0.05] and sleep apnea and hypopnea index (AHI; 1.60±1.38, 23.90±7.27 and 16.24±4.22,respectively, F=136.97, P<0.05) increased. Compared with the simple OSAHS group, the incidence of poor sleep quality was higher, the proportions of slow wave sleep (N3, F=29.51, P=0.047) and REM ( F=21.17, P=0.012) were decreased, N2 sleep ( F=46.21, P=0.000) was prolonged, mean SpO 2 reduction at night ( Z=54.28, P=0.000), wake after sleep onset [116.00(89.88, 143.00) min vs 135.00(118.50, 168.38) min, Z=25.71, P=0.023], arousal times [14.00(8.25, 8.00) vs 17.50(9.00,23.00),respectively, Z=19.68, P=0.041], microarousal ( Z=23.57, P=0.044), and AHI ( F=136.97, P=0.000) were increased in the OSAHS complicated with PFO group. Conclusions:OSAHS complicated with PFO patients had poor sleep quality and high incidence of sleep disorders. They had sleep disorder at night, which was characterized by the decrease of REM sleep and slow wave sleep, the prolongation of N2, the decrease of nocturnal SpO 2 and the increase of awakening times, and the increase of arousal times and AHI. PFO can aggravate the sleep disorder of OSAHS.

The high elastic modulus of scaffolds or implants will result in stress shielding effect, which may lead to bone resorption and scaffold or implant loosening in the late stage. Porous scaffolds and implants can adjust their porosity and elastic modulus according to the mechanical environment, thereby reducing stress shielding; meanwhile, porous structures are beneficial to bone tissue growth, which is conducive to osseointegration. Three kinds of basic structure for porous scaffolds and implants by 3D printing were summarized, namely, uniform porous structure, bone-like trabecular structure and functionally graded structure. The design methods of these structures were introduced respectively, including computer-aided design (CAD)-based, implicit surface-based, image-based and topology optimization-based design method, so as to provide references for solving the stress shielding problem, as well as designing porous scaffolds and implants.

Migraine and cerebral small vessel disease (CSVD) are 2 common neurovascular diseases in clinical practice.Their pathogeneses are still not clear.Migraine may increase the risk of CSVD,and CSVD can also cause migraine attacks by triggering cortical spreading depression and other mechanisms.The relationship between the two diseases is mutual and complex,and is influenced by a variety of factors,but the mechanism of this potential relationship is not yet very clear.With further research,the reports about the relationship between migraine and CSVD are increasing.This article summarizes the pathophysiological mechanisms of migraine and CSVD and the correlation between both.