ObjectiveTo investigate the anti-Alzheimer's disease （AD） effect of Dipsacus asper（DA） in the Caenorhabditis elegans model， and decipher the underlying mechanism via the peroxisome proliferator-activated receptor α （PPARα）/transcription factor EB （TFEB） pathway. MethodsFirst， transgenic AD C. elegans individuals were assigned into the blank control， model， positive control （WY14643， 20 µmol·L^-1）， and low-， medium-， and high-dose （100， 200， and 400 mg·L^-1， respectively） DA groups. The amyloid β-42 （Aβ₄₂） formation in the muscle cells， the paralysis time， and the deposition of amyloid β-protein （Aβ） in the head were detected. The lysosomal autophagy in the BV2 cell model was examined by Rluc-LC3wt/G120A. The expression levels of lysosomal autophagy-related proteins LC3Ⅱ， LC3I， LAMP2， and TFEB were detected by Western blot. Real-time quantitative polymerase chain reaction （Real-time PCR） was employed to determine the mRNA levels of autophagy-related genes beclin1 and Atg5 and lysosome-related genes LAMP2 and CLN2 downstream of PPARα/TFEB. A reporter gene assay was used to detect the transcriptional activities of PPARα and TFEB. Immunofluorescence was used to detect the fluorescence intensity of PPARα， and the active components of the ethanol extract of DA were identified by UPLC-MS. RCSB PDB， Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）， and Autodock were used to analyze the binding between the active components and PPARα-ligand-binding domain （LBD）. ResultsCompared with the model group， the positive control group and 200 and 400 mg·L^-1 DA groups showed prolonged paralysis time （P<0.05）， and all the treatment groups showed decreased Aβ deposition in the head （P<0.01）. DA within the concentration range of 50-500 mg·L^-1 did not affect the viability of BV2 cells. In addition， DA enhanced the autophagy flux （P<0.05）， up-regulated the mRNA levels of beclin1， Atg5， LAMP2， and CLN2 （P<0.05， P<0.01）， promoted the nuclear translocation of TFEB （P<0.05）， increased LAMP2 expression and autophagy flux （P<0.05， P<0.01）， and enhanced the transcriptional activities of PPARα and TFEB （P<0.01）. The positive control group and 200 and 400 mg·L^-1 DA groups showed enhanced fluorescence intensity of PPARα in the BV2 nucleus （P<0.01）. UPLC-MS detected nine known compounds of DA， from which 8 active components of DA were screened out. The docking results suggested that a variety of components in DA could bind to PPARα-LBD and form stable hydrogen bonds. ConclusionDA may reduce the pathological changes in AD by regulating the PPARα-TFEB pathway.

Liver failure often has rapid progression， multiple complications， and dangerous conditions. Acute pancreatitis is a common comorbidity during the progression of liver failure， and since acute pancreatitis has extremely similar clinical symptoms and signs to liver failure complicated by spontaneous peritonitis， it is often neglected in clinical practice. This article elaborates on the mechanisms of liver failure complicated by acute pancreatitis from the five aspects of inflammatory response， duodenal papillary dysfunction， gut microbiota dysbiosis， oxidative stress， and microcirculatory disturbance and proposes corresponding preventive measures based on these mechanisms.

Objective:To investigate the clinical characteristics and drug resistance of Klebsiella pneumoniae infections at different systems, providing laboratory reference for the rational use of antibiotics in clinical practice.Methods:The clinical characteristics and drug resistance of patients with Klebsiella pneumoniae infections in respiratory, urinary, hematologic, and other systems who received treatment in Wuzhou Red Cross Hospital from January 2015 to December 2021 were analyzed.Results:From 2015 to 2021, there were 3 496 cases of Klebsiella pneumoniae infections in the hospital, among which the respiratory system was most affected with 2 250 strains (64.34%). The sex ratio of patients with Klebsiella pneumoniae infections at different systems was statistically significant ( χ2 = 266.77, P < 0.001). The respiratory system and hematological system were more commonly infected by Klebsiella pneumoniae in men, while the urinary system was more commonly infected in women. The sex ratio of patients with Klebsiella pneumoniae infections at other systems were similar. The age distribution of patients with Klebsiella pneumoniae infections at different systems was significantly different ( χ2 = 176.54, P < 0.001). Klebsiella pneumoniae infections of the respiratory, urinary, and hematological systems were the most common in people aged > 60-80 years, while Klebsiella pneumoniae infections in other systems were mainly found in people aged > 18-60 years. There were significant differences in the distribution of departments among different Klebsiella pneumoniae infection systems ( χ2 = 1 415.30, P < 0.001). The ICU had the highest incidence of Klebsiella pneumoniae infections in the respiratory system, while the department of internal medicine had the highest incidence of Klebsiella pneumoniae infections in the urinary and hematological systems, and the department of surgery had the highest incidence of Klebsiella pneumoniae infections in other parts of the body. The resistance rate of Klebsiella pneumoniae to common antibiotics for the hematologic system was lower than that of the other three infection systems. For infections in the respiratory system, urinary system, and other body parts, the resistance rates of Klebsiella pneumoniae to amikacin, meropenem, imipenem, and piperacillin/tazobactam were all below 10%, while the resistance rate to tobramycin was below 20%, and the resistance rate to cephalosporins was around 30%. Conclusion:The proportion of Klebsiella pneumoniae infections in different body parts varies by gender, age, and department. For Klebsiella pneumoniae infections in the hematological system, the resistance rate to commonly used antibiotics is lower than that for infections in the other three systems. In contrast, Klebsiella pneumoniae infections in the respiratory system, urinary system, and other systems have a particularly high resistance rate to third- and fourth-generation cephalosporins but are still sensitive to piperacillin/tazobactam and carbapenem antibiotics.

Objective:To develop a robotic digestive endoscope system (RDES) and to evaluate its feasibility, safety and control performance by experiments.Methods:The RDES was designed based on the master-slave control system, which consisted of 3 parts: the integrated endoscope, including a knob and button robotic control system integrated with a gastroscope; the robotic mechanical arm system, including the base and arm, as well as the endoscopic advance-retreat control device (force-feedback function was designed) and the endoscopic axial rotation control device; the control console, including a master manipulator and an image monitor. The operator sit far away from the endoscope and controlled the master manipulator to bend the end of the endoscope and to control advance, retract and rotation of the endoscope. The air supply, water supply, suction, figure fixing and motion scaling switching was realized by pressing buttons on the master manipulator. In the endoscopy experiments performed on live pigs, 5 physicians each were in the beginner and advanced groups. Each operator operated RDES and traditional endoscope (2 weeks interval) to perform porcine gastroscopy 6 times, comparing the examination time. In the experiment of endoscopic circle drawing on the inner wall of the simulated stomach model, each operator in the two groups operated RDES 1∶1 motion scaling, 5∶1 motion scaling and ordinary endoscope to complete endoscopic circle drawing 6 times, comparing the completion time, accuracy (i.e. trajectory deviation) and workload.Results:RDES was operated normally with good force feedback function. All porcine in vivo gastroscopies were successful, without mucosal injury, bleeding or perforation. In beginner and advanced groups, the examination time of both RDES and ordinary endoscopy tended to decrease as the number of operations increased, but the decrease in time was greater for operating RDES than for operating ordinary endoscope (beginner group P=0.033; advanced group P=0.023). In the beginner group, the operators operating RDES with 1∶1 motion scaling or 5∶1 motion scaling to complete endoscopic circle drawing had shorter completion time [1.68 (1.40, 2.17) min, 1.73 (1.47, 2.37) min VS 4.13 (2.27, 5.16) min, H=32.506, P<0.001], better trajectory deviation (0.50±0.11 mm, 0.46±0.11 mm VS 0.82±0.26 mm, F=38.999, P<0.001], and less workload [42.00 (30.00, 50.33) points, 43.33 (35.33, 54.00) points VS 52.67 (48.67, 63.33) points, H=20.056, P<0.001] than operating ordinary endoscope. In the advanced group, the operators operating RDES with 1∶1 or 5∶1 motion scaling to complete endoscopic circle drawing had longer completion time than operating ordinary endoscope [1.72 (1.37, 2.53) min, 1.57 (1.25, 2.58) min VS 1.15 (0.86, 1.58) min, H=13.233, P=0.001], but trajectory deviation [0.47 (0.13, 0.57) mm, 0.44 (0.39, 0.58) mm VS 0.52 (0.42, 0.59) mm, H=3.202, P=0.202] and workload (44.62±21.77 points, 41.24±12.57 points VS 44.71±17.92 points, F=0.369, P=0.693) were not different from those of the ordinary endoscope. Conclusion:The RDES enables remote control, greatly reducing the endoscopists' workload. Additionally, it gives full play to the cooperative motion function of the large and small endoscopic knobs, making the control more flexible. Finally, it increases motion scaling switching function to make the control of endoscope more flexible and more accurate. It is also easy for beginners to learn and master, and can shorten the training period. So it can provide the possibility of remote endoscopic control and fully automated robotic endoscope.

Objective:To investigate the effect of levodopa and benserazide combined with pramipexole in the treatment of Parkinson's disease (PD) and its influence on cognitive function and oxidative stress indicators.Methods:From January 2021 to December 2023, the clinical datas of 110 PD patients in the Neurocritical Rehabilitation Center of Xi'an International Medical Center Hospital were selected for a prospective study. Based on the principle of balanced and comparable baseline features between groups, they were divided into single drug group (odd number, 55 cases, oral levodopa and benserazide, effective dose: 500-1 000 mg/d) and combined group (even number, 55 cases, pramipexole based on single drug group, effective dose: 0.375-4.500 mg/d) according to the simplified randomization method (odd-even number method). The therapeutic effect (Unified Parkinson's Disease Rating Scale (UPDRS)), improvement status of symptoms, cognitive ability (Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA)), oxidative stress indicators (superoxide dismutase (SOD), malondialdehyde) and brain injury indicators (central nervous system specific protein β (S100β), human Parkinson protein 7 (PARK7)) before and after treatment and adverse drug reactions were compared between groups of patients.Results:After treatment, the scores of UPDRS Ⅰ, Ⅱ and Ⅲ dimensions in the two groups were significantly decreased, and the above scores with ((5.53±1.16, 20.43±3.98, 14.37±3.07) points) in combined group were significantly lower than ((7.06±1.64, 24.56±4.37, 17.32±3.83) points) in single drug group ( t values were 5.65, 5.18 and 4.46, respectively; all P<0.001). After treatment, the autonomic disorder and sensory disturbance were significantly improved in both groups, but the proportion of sensory disturbance after treatment in combined group (20.00%, 11/55) was significantly lower than that in single drug group (38.18%, 21/55), and the difference was statistically significant ( χ2=4.41, P=0.036). The MMSE score in the two groups after treatment was decreased significantly while the MoCA score was increased significantly, but the MMSE score in combined group with ((10.38±1.95) points) was significantly lower than ((12.27±2.26) points) in single drug group. The difference was statistically significant ( t=4.70, P<0.001) while the MoCA score with ((18.46±3.21) points) was significantly higher compared with ((16.84±3.07) points) in single drug group.The difference was statistically significant ( t=2.71, P=0.008). After treatment, SOD in the two groups was risen significantly while malondialdehyde was declined significantly, and SOD in combined group with ((82.53±10.63) U/L) was significantly higher than ((76.54±8.85) U/L) in single drug group, while malondialdehyde with ((4.64±0.85) μmol/L) was significantly lower than ((6.46±1.26) μmol/L) in single drug group. The difference is statistically significant ( t values were 3.21 and 8.88, respectively; P values were 0.002 and <0.001). The levels of S100β and PARK7 in both groups were reduced significantly after treatment, and the combined group ((73.64±5.72) ng/L, (78.04±6.93) μmol/L) had significantly lower levels than the single drug group ((15.73±3.25) ng/L, (22.23±3.84) μmol/L). The differences were statistically significant ( t-values were 3.63 and 9.58, respectively; both P<0.001). There was no statistical difference in incidence of adverse drug reactions between groups ( P>0.05). Conclusion:Levodopa and benserazide combined with pramipexole can enhance the cognitive function of PD patients and improve the oxidative stress indicators, with few adverse reactions, safe and effective, and is worthy of application.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To explore the role and potential mechanisms of all-trans retinoic acid(ATRA)on activation and oxidative stress of hepatic stellate cell(HSC).Methods Platelet-derived growth factor(PDGF-bb,10 ng/ml)was applied to induce the activation of HSCs,which was then treated with ATRA at a dosage of 5 μmol/L for 48 h.The effects of ATRA on HSC activation were evaluated by detecting changes in cell growth viability and phenotypic marker expression.The effects of ATRA on HSC oxidative stress were evaluated by detecting changes in intracellular reactive oxygen species(ROS),reduced glutathione(GSH)and malondialdehyde(MDA),and the expression of antioxidant genes.The effects of ATRA on HSC autophagic activity were evaluated by detecting changes in autophagy marker expression and autophagic flow.Results Compared with the PDGF-bb group,the cell viability was significantly reduced in ATRA-treated HSCs(P＜0.01),as well as the expression of α-SMA and Collagen I.The intracellular levels of ROS and MDA were significantly reduced in ATRA-treated HSCs(P＜0.01),whereas the GSH level was significantly increased(P＜0.01).The expression levels of antioxidant genes(NRF2,HO-1,and ATF4),were significantly higher in ATRA-treated HSCs than those in the normal ones under PDGF-bb condition(P＜0.01).Meanwhile,the expression of autophagy markers Beclin 1 and LC3 Ⅱ/I,and signal of autophagy flow in ATRA-treated HSCs were found to be significantly reduced(P＜0.01).Conclusion ATRA significantly inhibited PDGF-bb-induced HSC activation and reduced the level of oxidative stress and autophagic activity of HSCs,which had potential applications in the prevention and treatment of liver fibrosis.

Objective:To identify and characterize one Spiroplasma strain (designated as DGKH1) isolated from the blood of a patient with sepsis. Methods:The traditional bacterial culture, staining, morphological observation, physiological and biochemical identification, 16S rRNA gene sequencing, phylogenetic analysis, genome sequencing, and the genome-related index analysis were performed to accurately determine the taxonomic status of the strain DGKH1. Antibiotic susceptibility testing was performed using a specific kit for culturing and testing Ureaplasma urealyticum/ Metamycoplasma hominis. Results:The strain DGKH1 could weakly grow on Columbia blood agar, chocolate agar, and Haemophilus chocolate 2 agar. However, it did not grow in liquid culture medium containing tetracycline (4 μg/ml), doxycycline (1 μg/ml), minocycline (1 μg/ml), josamycin (2 μg/ml), roxithromycin (1 μg/ml), clarithromycin (1 μg/ml), or telithromycin (1 μg/ml). DGKH1 resembling Metamycoplasma hominis formed "fried egg-like colonies" on Mycoplasma solid culture medium. DGKH1 could not be stained by Gram staining. When observed under transmission electron microscopy (TEM) using phosphate buffer as the matrix, the bacteria were spiral-shaped. Results of 16S rRNA gene sequence alignment showed that DGKH1 was highly similar (99.85%) to Spiroplasma eriocheiris CCTCC M 207170 T. However, the urea decomposition test was positive, which was different from all of the known Spiroplasma species. The phylogenetic analysis based on whole genome showed that DGKH1 was clustered in a small branch along with Spiroplasma eriocheiris CCTCC M 207170 T. However, the average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) values between the two strains were 94.14% and 56.00%, respectively, both below the threshold for prokaryotic species identification. Conclusions:DGKH1 represented a potential new species of genus Spiroplasma, closely related to Spiroplasma eriocheiris. Some microbiological characteristics of DGKH1 were similar to Mycoplasmas. However, the natural host and epidemiological data of DGKH1 need to be further studied.

Objective: To understand the situation of neglect of preschool children in the urban area of Xi an under the background of multi child policy, so as to provide a reference for making effective prevention. Methods: In Novmber 2022, according to the multi stage stratified cluster sampling principle, 2 450 parents of children aged 3-6 years were randomly selected from 7 urban areas of Xi an to participate in the questionnaire survey. A questionnaire survey was conducted using the "Neglect Evaluation Norms of 3-6 Years Old (Preschool) Children in Urban Areas of China". SPSS 18.0 software was used for statistical description, Chi square test and variance analysis. Results: The total neglect rate of preschool children in the urban area of Xi an was 29.0% and the total neglect score was (37.58±8.44). There was no statistical difference in the neglect status of children in different grade groups ( χ 2/ F =1.61, 2.98, P >0.05). The neglect score of boys was higher than girls ( t =2.45, P <0.05). There was no statistical difference in the neglect rate and neglect score of boys and girls in other levels ( P >0.05); except for the significant difference in the neglect degree of medical treatment, education and safety ( t =2.01, 2.28, 2.02, P <0.05). The rate and score of neglect in multi-child families were higher than only-child families ( χ 2/ t = 13.68, -4.54, P <0.05). There were significant differences in the rate and degree of neglect of children with different birth order, which were "third and fourth-born>second-born>first-born" ( χ 2/ F = 10.84 , 2.79, P <0.05). The neglect rate and score of "single parent family" were significantly higher than that of "nuclear family" and "three-generation family" ( χ 2/ F =4.78, 2.79, P <0.05). Conclusion The neglect situation of preschool children in urban area of Xi an is still serious, especially in multi-child families. It should actively explore the risk factors and formulate effective intervention measures.

This study was performed to investigate the effects of Arbutin(Ar)on oxidative stress,apoptosis level and inflammatory response of H9c2 cardiomyocytes induced by lipopolysaccharide(LPS).H9c2 cardiomyocytes were randomly divided into blank control group,lipopolysaccharide group(LPS),LPS+Ar(25 μmol/L)group,LPS+Ar(50 μmol/L)group,LPS+Ar(100 μmol/L)group and Ar(50 μmol/L)group.CCK-8 was used to detect the cell viability of H9c2 cardiomyocytes after LPS treatment and Ar treatment;DCFH-DA fluorescence labeling was used to detect the ROS levels of H9c2 cardiomyocytes;flow cytometry was applied to detect cell apoptosis rate;Western blot was used to detect the expression of apoptosis-related proteins(Caspase-3)and inflammatory proteins(IL-1β and TNF-α).Data showed that compared with the LPS group,the cell viabilities were recovered after Ar treatment.The level of oxidative stress markers(ROS),apoptosis rate,and inflammatory factor levels(IL-1β and TNF-α)in the LPS+Ar groups were significantly reduced compared with the LPS group(P<0.05).In conclusion,Ar can alleviate the damage,apoptosis,oxidative stress and inflammatory response of LPS-induced H9c2 cardiomyocytes.