Based on the traditional Chinese medicine theory that "all pain， itching， and sores are related to the heart"， this paper proposes treating recurrent aphthous ulcers from the perspective of the heart. It suggests that excessive heart fire and tissue erosion due to flaming fire in the heart meridian constitute the core pathogenesis of this condition. Hyperactive heart fire is identified as the key pathogenic factor， while heart yin deficiency， obstruction of the heart collaterals， and malnourishment of the heart spirit are considered significant contributing factors. Clinically， the treatment follows the principle of clearing heart fire as the main strategy， supplemented by nourishing yin， activating collaterals， and calming the spirit. The self-formulated Qingxin Yuchuang Formulation （清心愈疮方） serves as the base prescription， with flexible modifications incorporating the Yuyin Formulation （育阴方）， Huoxue Formulation （活血方）， and Yu'an Formulation （郁安方） to address specific syndromes involving heart yin deficiency， collateral blockage， and emotional disturbance.

Objective: To analyze the key control points of pathogenic microbial contamination during the food processing of school canteens, so as to provide a basis for effectively preventing the occurrence of campus food safety incidents. Methods: In March 2023, 10 school canteens from Zhengzhou City, Henan Province were selected by convenient sampling method. A total of 300 samples were collected from the storage equipment of raw materials, production tools, staff hands, infrastructure, dining utensils and other facilities in the school canteens during the food processing process.The rapid detection method of foodborne pathogens based on isothermal multiple selfmatchinginitiated amplification (IMSA) technology was used to analyze the possible risk of pathogenic microorganism contamination. Fisher exact probability method was applied for the statistical analysis. Results: Among the 300 samples collected, pathogenic microorganisms including Staphylococcus aureus, Salmonella and Listeria monocytogenes were detected in 5 samples, distributed in the food preparation utensils such as cutting boards, operating tables, knives and staff hands, while no pathogenic microorganisms were detected in dining utensils, raw material storage equipment and canteen infrastructure.There was no statistically significant difference between the IMSA rapid detection method and the national standard method for testing Staphylococcus aureus, Salmonella and Listeria monocytogenes(P>0.05). Compared to international method, the positive coincidence of pathogenic microorganism detected by IMSA rapid inspection system was 83.3%(5/6), the negative coincidence was 100%(n=294), and the overall consistency rate was 99.7%. Conclusions The key control points of pathogenic microbial contamination in the food processing process of school canteens mainly are the utensils in the food production process, such as cutting boards, operating tables, knives and staff hands in the food processing process of the school canteen, which could be accurately identified by the rapid detection method of pathogenic microorganism established based on IMSA technology. The quality and efficiency campus food safety supervision should be promoted to prevent the food safety events in school canteen.

Objectives:To explore the impact of inositol-requiring enzyme 1(IRE1)signaling pathway on autophagy flux and cardiac function in mice with myocardial ischemia/reperfusion(I/R)injury. Methods:H9c2 cells were divided into control group,IRE1 group,oxygen glucose deprivation/reoxygenation(OGD/R)group,OGD/R+IRE1 group,chloroquine group,IRE1+chloroquine group,OGD/R+IRE1+chloroquine group,OGD/R+chloroquine group,OGD group,OGD+chloroquine group,OGD+IRE1+RNAi X-box binding protein 1(si-XBP1)group and OGD+IRE1+XBP1 overexpression(XBP1-OE)group.Autophagy flux of cells in each group was evaluated by autophagy double-labeled adenovirus(Adv-RFP-GFP-LC3).The nuclear translocation of X-box binding protein 1(XBP1)was analyzed by immunofluorescence and western blot.Adult male C57BL/6 J mice were randomly divided into sham operation group,I/R group,IRE1 group and I/R+IRE1 group(n=8 each).Cardiac function was evaluated by echocardiography.Quantitative western blot analysis was used to detect protein expression of autophagy-related molecules. Results:(1)Compared with OGD/R group,the expression level of IRE1 protein was significantly upregulated(P<0.001),and the expressions of microtubule-associated proteins light chain 3B(LC3Ⅱ)and sequestosome 1(p62)proteins were significantly decreased in IRE1+OGD/R group(all P<0.05).Compared with OGD/R+chloroquine group,the expression of LC3Ⅱ and p62 protein was significantly increased in OGD/R+IRE1+chloroquine group(all P<0.05).Compared with control group,the fluorescence intensity ratio of IRE1 nucleus/cytoplasm was significantly increased in OGD/R group(P<0.001),and further increased in IRE1+OGD/R group(P<0.001).The level of XBP1 in the nuclear protein was significantly higher in IRE1+OGD/R group than in OGD/R group(P<0.01).Compared with OGD/R+IRE1 group,the yellow punctures was significantly decreased in OGD/R+IRE1+si-XBP1 group(P<0.01),and significantly increased in OGD/R+IRE1+XBP1-OE group(P<0.05).(2)Compared with Sham group,the left ventricular ejection fraction(LVEF)and fractional shortening(FS)were significantly decreased in I/R group(both P<0.05),LVEF and FS reduction could be partly reversed in I/R+IRE1 group.Compared with Sham group,the number of autophagic vacuoles and the expressions of IRE1,LC3Ⅱ and p62 were significantly increased in I/R group(P<0.05).The number of autophagic vacuoles and the expression of p62 were significantly downregulated(both P<0.05),and the expressions of IRE1 and LC3Ⅱ in myocardial tissue were further increased in I/R+IRE1 group as compared to the I/R group(all P<0.05). Conclusions:IRE1 restores the blocked autophagy flux induced by OGD/R and I/R by promoting the nuclear translocation of XBP1,and the recovery of autophagy flux is associated with cardiac function improvement post I/R injury in mice.

BackgroundCompared with adult-onset schizophrenia， patients with adolescent-onset schizophrenia experience a high genetic susceptibility， severe negative symptoms， high recurrence rate， poor prognosis and social function recovery. And clarifying the brain functional alterations in adolescent-onset schizophrenia is of great significance for further elucidating the pathogenesis of the disease and exploring personalized and precise treatment. ObjectiveTo investigate the altered functional and effective connectivity of bilateral precuneus in first-episode patients with adolescent-onset schizophrenia based on resting-state functional magnetic resonance imaging （rs-fMRI）， thus providing reliable imaging evidence in guiding the study on mechanism involved in adolescent-onset schizophrenia. MethodsTwenty-one drugnaïve first-episode patients with adolescent-onset schizophrenia who met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） criteria for schizophrenia were enrolled， and another 21 psychiatrially healthy controls matched on age， educational background and gender were concurrently selected. The schizophrenic subjects were evaluated using the Psychotic Symptom Rating Scales （PSYRATS） and Positive and Negative Symptom Scale （PANSS）. All participants underwent rs-fMRI scans， and the whole-brain seed-based functional and effective connectivity analyses were conducted in bilateral cuneus region. Then the correlation between functional connectivity strength and clinical symptoms of patients was discussed. ResultsIn terms of functional connectivity， the functional connectivity of bilateral precuneus and left middle temporal gyrus was increased in patient group compared with healthy control group ［P<0.01， family-wise error （FWE） correction at cluster level， P<0.05］. In terms of effective connectivity， patient group responded to negative feedback with greater activation of seed region and left middle frontal gyrus than healthy control group. Correlation analysis within patient group denoted that the decreased effective connectivity of bilateral precuneus and left middle frontal gyrus was positively correlated with the total PANSS score （r=0.450， P<0.05）. ConclusionThe resting-state functional and effective connectivity of bilateral precuneus is abnormally alerted in drugnaïve first-episode patients with adolescent-onset schizophrenia， and the decreased effective connectivity of bilateral precuneus and left middle frontal gyrus may be related to the development of clinical symptoms. ［Funded by National Key Research and Development Program of China （number， 2022YFC2009901， 2022YFC2009900）］

【Objective】 To investigate the relationship between the level of thrombin-antithrombin complex (TAT)/α2-plasmin inhibitor-plasmin complex (PIC) and the utilization rate of mechanical ventilation (MV) in critically ill patients. 【Methods】 For the cross-sectional study, adult patients who had been admitted to the intensive care unit (ICU) for one day or longer and had a record of the first four tests for thrombosis were enrolled. Age, gender, the results of TAT and PIC, disseminated intravascular coagulation score, treatment, and diagnostic information were retrospectively collected from the hospital information system and laboratory information system. Logistic regression model was used to explore the relationship between TAT/PIC and the MV utilization rate. Interaction analysis and subgroup analysis were conducted to explore whether there was any difference between patients with different age and gender, patients with/without DIC, and with/without infection. 【Results】 A total of 1 176 patients were enrolled in this study. The median of the first TAT/PIC was 15.84 (8.13-33.11) in all the patients. The multivariable Logistic regression model results showed that for every 5 increase in TAT/PIC, the possibility of using MV increased by 2.9% (OR=1.029, 95% CI: 1.008-1.050), and the possibility of using MV in Q3 patients was 1.566 times than that in Q1 patients (OR=1.566, 95% CI: 1.095-2.239); the possibility of using MV in Q4 patients was 2.457 times than that in Q1 patients (OR=2.457, 95% CI: 1.694-3.563). Interaction results showed that the relationship between the level of TAT/PIC and MV usage was different in patients with and without infection (Pinteraction=0.02). Further subgroup analysis showed that in the infected patients (674 cases), the possibility of using MV increased by 5.9% for every 5 increase in TAT/PIC (OR=1.059, 95% CI: 1.022-1.097, P=0.001), while there was no significant difference between different TAT/PIC and MV usage in non-infected patients (502 cases) (OR=1.012, 95% CI: 0.984-1.040, P=0.405). 【Conclusion】 There is a correlation between the level of TAT/PIC and mechanical ventilation in patients with infection in the ICU.

Objective:To identify the risk factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery.Methods:A total of 200 elderly patients of both sexes, aged>65 yr, of American Society of Anesthesiology physical status Ⅱ or Ⅲ, scheduled for elective thoracic surgery, were enrolled in the study.Data regarding patient age, gender, body mass index (BMI), American Society of Anesthesiologists physical status, history of hypertension, history of diabetes mellitus, operation method, type of operation, operation time, intraoperative blood loss, use of intraoperative nerve block and use of dexmedetomidine in patient-controlled intravenous analgesia (PCIA) were collected.The patients were followed up after operation, the occurrence of postoperative pain at 48 h after operation was recorded, and patients′ subjective sleep quality at 48 h after operation was assessed using the Pittsburgh Sleep Quality Index Questionnaire (PSQI). Patients were divided into 2 groups according to PSQI score: non-postoperative sleep disturbances group (PSQI score<5) and postoperative sleep disturbances group (PSQI score≥5). A multivariate logistic regression was used to identify the risk factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery.Results:A total of 169 patients were included in this study, and the incidence of postoperative sleep disturbances was 45%.The results of logistic regression analysis showed that history of preoperative insomnia, BMI≥24 kg/m 2, diabetes mellitus, thoracic surgery, radical resection of lung cancer, radical resection of esophageal cancer, operation time≥120 min and moderate and severe postoperative pain were risk factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery, and use of intraoperative nerve block and use of dexmedetomidine during PCIA were protective factors for postoperative sleep disturbances in elderly patients ( P<0.05). Conclusion:History of preoperative insomnia, BMI≥24 kg/m 2, diabetes mellitus, thoracic surgery, radical resection of lung cancer, radical resection of esophageal cancer, operation time≥120 min, moderate and severe postoperative pain are risk factors and use of intraoperative nerve block and use of dexmedetomidine during PCIA are protective factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery.

Objective:To explore the endoscopic features of early gastric cancer (EGC) related to non-curative endoscopic resection, and to construct an assessment model to quantify the risk of non-curative resection.Methods:From August 2006 to October 2019, 378 lesions that underwent endoscopic resection and were diagnosed pathological as EGC in the Department of Gastroenterology, Peking Union Medical College Hospital were included in this case-control study.Seventy-eight (20.6%) non-curative resection lesions were included in the observation group, and 234 lesions which selected from 300 lesions of curative resection were included in the control group according to the difference of operation year ±1 with the observation group, and the ratio of 1∶3 of the observation group to the control group. Univariate and multivariate logistic regression analysis were performed to explore the risk factors for non-curative resection. The independent risk factor with the minimum β coefficient was assigned 1 point, and the remaining factors were scored according to the ratio of their β coefficient to the minimum. A predictive model was established to analyze the 378 lesions.The non-curative resection rates of lesions of different scores were calculated. Results:Univariate analysis showed that the lesion diameter, the location, redness, ulcer or ulcer scar, fold interruption, fold entanglement, and invasion depth observed with endoscopic ultrasonography (EUS) were associated with non-curative resection of EGC lesions ( P<0.05), and contact or spontaneous bleeding may be associated with non-curative resection ( P=0.068). Multivariate logistic regression analysis showed that submucosal involvement (VS confined to the mucosa: β=0.901, P=0.011, OR=2.46, 95% CI: 1.23-4.92), lesion diameter of 3-<5 cm (VS <3 cm: β=0.723, P=0.038, OR=2.06, 95% CI: 1.04-4.09), lesion diameter of ≥5 cm (VS <3 cm: β=2.078, P=0.003, OR=7.99, 95% CI: 2.02-31.66), location in the upper 1/3 of the stomach (VS lower 1/3: β=1.540, P<0.001, OR=4.66, 95% CI: 2.30-9.45), and fold interruption ( β=2.287, P=0.008, OR=1.93, 95% CI: 0.95-3.93) were independent risk factors for non-curative resection of EGC lesions. The factor of lesion diameter of 3-<5 cm and submucosal involvement were assigned 1 point respectively, location in the upper 1/3 of the stomach was assigned 2 points, diameter of ≥5 cm and fold interruption were assigned 3 points respectively, and other factors were assigned 0 point. Then the analysis of 378 lesions showed that the probability of non-curative resection at ≥2 points was 41.9% (37/93), 4 times as much as that at 0 [11.5% (25/217)]. Conclusion:EGC lesions with diameter ≥3 cm, located in the upper 1/3 of the stomach, interrupted folds or submucosal involvement are highly related to non-curative resection. The predictive model based on these factors achieves satisfactory efficacy, but it still needs further validation in larger cohorts.

Objective:To investigate the effects of oxidized low density lipoprotein (Ox-LDL) on cell proliferation and mRNA expression of inflammatory factors in fibroblast-like synoviocytes (FLS) from patients with rheumatoid arthritis (RA).Methods:Tissue culture was used to isolate and 4-6 generation cultured RA-FLS cells were used for subsequent experiments. RA-FLS were stimulated for 24 hours with different con-centr-ations of human Ox-LDL, then the MTS cell proliferation and toxicity test kit were used to detect the prolifer-ation of RA-FLS. Real time-polymerase chain reaction (RT-PCR) was used to test the expression of inflamm- atory factors like interleukin (IL)-6, transforming growth factor (TGF)-β, IL-8, tumor necrosis factor (TNF)-α and receptors like CD36 and scavenger receptor binds phosphatidylsed neoxidized lipoprotein (SR-PSOX) inRA-FLS. T test and F test were used in this study. Results:Ox-LDL (10, 25, 50 μg/ml) could obviously promote the proliferation of RA-FLS, and theabsorbance values (490 nm) were (1.04±0.15), (1.05±0.14), and (1.00±0.10), respectively, all higher than the control group (0.81±0.04) and the difference was statistically significant ( F=4.737, P<0.01). In addition, 50 μg/ml and 100 μg/ml Ox-LDL also promoted the expression of IL-6 mRNA ( F=14.709, P<0.01) and inhi-bited the expression of TGF-β mRNA ( F=299.074, P<0.01), but there was no obvious effect on the expression of IL-8 and TNF-α. Ox-LDL stimulation could obviously promote the expression of SR-PSOX receptor on RA-FLS ( F=68.636, P<0.01) and inhibit the expression of CD36( F=18.085, P<0.01). After the transfection of siRNA, SR-PSOX mRNA level was significantly inhibited and the mRNA expression of IL-6 was significantly decreased after Ox-LDL stimulation of RA-FLS ( t=3.875, P<0.01), while TGF-β mRNA expres-sion was not significantly changed( t=-0.193, P>0.05). Conclusion:Ox-LDL may play a role in promoting the activation of RA-FLS proliferation and the expression of IL-6 mRNA by increasing the SR-PSOX receptor of RA-FLS, suggesting that Ox-LDL is involved in the synovial inflammation of RA.

OBJECTIVE： To investigate the protective effect of total flavonoids from the leaves of Choerospondias axillaris （TFLC） on myocardial ischemia reperfusion injury （MIRI） model rats. METHODS： Male SD rats were randomly divided into sham operation group， model group， positive control group （verapamil， 0.02 g/kg）， TFLC low-dose and high-dose groups （0.1， 0.4 g/kg）， with 10 rats in each group. Administration groups were intragastrically given relevant medicine （2 mL/100 g）； sham operation group and model group were given constant volume of normal saline intragastrically， once a day， for consecutive 7 d. After last medication， MIRI model was induced by modified ligation method. The times and duration of ventricular tachycardia （VT） and ventricular fibrillation （VF） in rats were recorded with biological function experiment system during reperfusion period.The activity of CK and contents of TNF-α， IL-6， NF-κB and NO in serum were determined by ELISA double antibody clip art assay. The morphological characteristics of myocardial tissue was observed by HE staining. The myocardial infarction scope （i.e. the ratio of myocardial tissue mass to ventricular mass） was measured by TTC method. RESULTS： Compared with sham operation group， the times and duration of VT and VF were increased or prolonged significantly in model group； CK activity， serum contents of TNF-α， IL-6 and NF-κB were enhanced or increased significantly， while NO content was decreased significantly （P＜0.05 or P＜0.01）. Obvious myocardial infarction focus， serious cell structure damage， disorderly muscle fibers arrangement， cell nucleus pyknosis and accompanied inflammatory cell infiltration were all observed in cardiac tissue； the mass of infarcted myocardial tissue and ventricular as well as the scope of myocardial infarction increased significantly （P＜0.01）. Compared with model group， the times and duration of VT and VF were decreased or shortened significantly in administration groups； CK activity， serum contents of TNF-α， IL-6， NF-κB were decreased significantly， while NO content was increased significantly （P＜0.05 or P＜0.01）. The above symptoms of myocardial injury were improved；the mass of infarcted myocardial tissue and ventricular as well as the scope of myocardial infarction was significantly reduced （P＜0.05 or P＜0.01）. CONCLUSIONS： TFLC can relieve MIRI-induced ischemic arrhythmia and myocardial damage， reduce the release of inflammatory factors， promote the recovery of myocardial and endothelial cell function， reduce the scope of myocardial infarction and has a certain protective effect.

Objective To investigate the expression of miRNA-31 in peripheral blood mononuclear cells (PBMCs) of rheumatoid arthritis (RA) patients,and the relationship between miRNA-31 and disease activity of RA.Methods After obtaining the informed consent,peripheral blood samples of 56 RA patients,12 systemic lupus erythematosus (SLE) patients,6 Sj(o)gren's syndrome (SS) patients and 30 healthy controls were collected from the Department of Rheumatology,Peking University Third Hospital.RNA was extracted from the PBMCs which were separated by Ficoll-Paque PLUS.The expression of miRNA-31 in the PBMCs of RA patients,SLE patients,SS patients and healthy controls was detected by real-time Polymerase Chain Reaction (PCR).Furthermore,according to the RA disease activity score (DAS28),RA patients were divided into high,moderate and low disease activity groups and remission group,and miRNA-31 expression was compared between different groups.Data were analyzed using t test or Mann-Whitney U test.Results The expression of miRNA-31 in PBMCs of RA patients was 7.25 times (P=0.003 8) higher when compared with that of the control group.To be specific,the expression of miRNA-31 was 10.63 times in PBMCs of high activity RA group (P=0.01) and 8.95 times in moderate activity RA group (P=0.000 3) when compared with that of the control group,and there was no significant difference between low activity,remission groups and control groups in terms of miRNA-31 expression.Furthermore,the expression of miRNA-31 in PBMCs of SLE patients was not significantly different from the control and miRNA-31 expression in PBMCs of SS patients was 1.64 times (P=0.02) higher than that of the RA patients,but the average level of miRNA-31 was much less than that of RA patients.The increased miRNA-31 may serve as a diagnostic marker for disease activity of RA.