Objective To explore the improving effect of eicosapentaenoic acid(EPA)on the skeletal muscle insulin resistance in obese rats by regulating the p38 MAPK signaling pathway.Methods Fifty male Wistar rats were randomly divided into the control group,model group,inhibitor group,EPA group and inhibi-tor+EPA group,10 cases in each group.The intervention lasted for 6 weeks.The inhibitor group was given 1 mg/kg p38 MAPK inhibitor SB203580 by gavage.The EPA group was given 70 mg/kg EPA by gavage,the in-hibitor+EPA group was given SB203580+EPA by gavage,and the model group and control group were given equal volume of saline.The levels of fasting blood-glucose,fasting serum insulin,glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)and malondialdehyde(MDA)in the skeletal muscles were deter-mined.The rat insulin resistance degree was evaluated by using the intraperitoneal glucose tolerance test(IPGTT)and insulin tolerance test(ITT).The protein and mRNA expression levels of phosphorylation p38 in the rat skeletal muscle tissues were detected by Western blot and qRT-PCR.Results Compared with the control group,the body weight,epididymal fat wet weight,fasting blood-glucose and insulin levels,IPGTT and ITT blood glucose levels,and MDA content in the model group were significantly increased,the GSH-Px and SOD activities were significantly decreased,and the relative expression levels of p-p38 protein and p38 mRNA expression in skeletal muscle tissues were significantly increased(P＜0.05).Compared with the model group,the body weight and epididymal fat wet weight in the EPA group and inhibitor+EPA group were sig-nificantly decreased,while the fasting blood-glucose,fasting serum insulin,IPGTT and ITT blood glucose lev-els and MDA contents in the inhibitor group and EPA group were significantly decreased,the activities of GSH-Px and SOD were significantly increased,and the relative expression level of p-p38 protein in skeletal muscle tissues was significantly decreased(P＜0.05).However,the expression of p38 mRNA in skeletal muscle tissues had no significant change(P＞0.05).Conclusion EPA alleviates the oxidative stress possibly by inhibiting p38 MAPK signaling pathway,thus improves the skeletal muscle insulin resistance of obese rats.

Objective:This study aimed to assess the effects of Peer Balint-style group on the empathy ability of third-year long-term medical students and to provide a theoretical and practical reference for effectively improving their humanistic quality.Methods:Ninety third-year Chinese long-term medicine students participated. Volunteers received either ten sessions of 1.5-h Peer Balint-style group which were led by specially trained peers from June 2019 to August 2019. The College Students' Empathy Ability Questionnaire was used before the experiment and the second day after the experiment. The total score of the scale from the pre-test and post-test and the scores of each dimension conformed to a normal distribution, with equal variance, describing in the form of ( x± s). Paired t-tests were performed to compare the total score and each dimension score before and after the intervention, using SPSS 22.0. Semi-structured interviews were conducted with 7 peer-group leaders and group members after the clinical practice period. The interview materials were analyzed by traditional content analysis. The content of the qualitative research was open-coded to obtain 10 categories, suggesting the role and inadequacy of Peer Balint-style groups. Results:A total of 63 valid samples were obtained. There was no significant difference of ( t=-0.44, P=0.661, P>0.05) between the total score of the post-test (118.00±11.98) and the total score of the pre-test (117.38±12.36). In each dimension, the reverse comprehension score of post-test (9.06±1.97) was significantly different ( t=-2.08, P=0.041, P>0.05) from the pre-test's (8.57±2.15), which increased compared to the pre-test score. Conclusions:Peer Balint-style group had a positive effect on improving empathy among medical students. Compared with the traditional Balint group, it has wider coverage, higher affinity and greater mobility. However, the design of the Peer Balint-style group still needs to be further improved.

Objective To evaluate the effectiveness of the central government-funded echinococcosis control programme in Tianzhu Tibetan Autonomous County, Gansu Province from 2007 to 2022, so as to provide insights into echinococcosis control. Methods Administrative villages were sampled using a multi-stage cluster random sampling method from Tianzhu Tibetan Autonomous County, Gansu Province from 2007 to 2022, and all residents at ages of 12 years and older in the sampled villages were screened for echinococcosis, and schools were sampled using a cluster sampling method, and all children at ages of 12 years and older in the sampled schools were screened for echinococcosis. Domestic dogs were sampled using a systematic random sampling method, and one domestic dog stool sample was collected from each household. Stray dog stool samples were collected outside the villages, and Echinococcus coproantigens were detected using enzyme-linked immunosorbent assay in domestic and stray dogs. In addition, echinococcosis was screened in sheep and cattle in designated slaughterhouses in Tianzhu Tibetan Autonomous County. The trends in the prevalence of echinococcosis in humans and livestock and the positive rate of Echinococcus coproantigens in dogs were examined with the Cochran-Armitage trend test. In addition, individuals screened for echinococcosis were randomly sampled from 2007 to 2022 for survey on the awareness of echinococcosis control knowledge. Results A total of 290 356 person-times were screened for echinococcosis among residents at ages of 12 years and older in Tianzhu Tibetan Autonomous County, Gansu Province from 2007 to 2022, with 1 094 residents detected with cystic echinococcosis, and the detection of echinococcosis appeared a tendency towards a gradual decline over years (χ² = 358.602, P < 0.001). A total of 32 931 person-times were screened for echinococcosis among children at ages of 12 years and older in Tianzhu Tibetan Autonomous County, Gansu Province from 2007 to 2022, with 296 children detected with echinococcosis, and the detection of echinococcosis appeared a tendency towards a gradual decline over years (χ² = 267.673, P < 0.001). A total of 33 230 domestic dog stool samples were tested for Echinococcus coproantigens in Tianzhu Tibetan Autonomous County, Gansu Province from 2007 to 2022, with 1 777 Echinococcus coproantigens-positive samples tested, and the positive rate of Echinococcus coproantigens appeared a tendency towards a decline in domestic dogs over years (χ² = 2 210.428, P < 0.001), while the positive rate of Echinococcus coproantigens showed a tendency towards a rise in domestic animals from 2016 to 2022 (χ² = 37.745, P < 0.001). The positive rate of Echinococcus coproantigens remained relatively stable in stray dogs in Tianzhu Tibetan Autonomous County, Gansu Province from 2019 to 2022 (χ² = 0.315, P = 0.575). A total of 10 973 sheep were screened for echinococcosis in Tianzhu Tibetan Autonomous County from 2007 to 2022, with 334 sheep detected with echinococcosis, and the detection of echinococcosis appeared a tendency towards a decline in sheep over years (χ² = 53.579, P < 0.001); however, there was no significant change in the detection of echinococcosis during the period from 2015 through 2022 (χ² = 1.520, P = 0.218). A total of 2 400 cattle were screened for echinococcosis in Tianzhu Tibetan Autonomous County from 2017 to 2022, with 231 cattle detected with echinococcosis, and the detection of echinococcosis showed a tendency towards a decline over years (χ² = 5.579, P < 0.05). The awareness of echinococcosis control knowledge increased from 44.37% in 2007 to 94.00% in 2022 among residents at ages of 12 years and older and from 52.50% in 2007 to 92.50% in 2022 among children at ages of 12 years and older in Tianzhu Tibetan Autonomous County, respectively. Conclusions There has been a reduction in the detection of echinococcosis in humans and domestic animals and the positive rate of Echinococcus coproantigens in dogs and a rise in the awareness of the echinococcosis control knowledge following the implementation of the central government-funded echinococcosis control programme in Tianzhu Tibetan Autonomous County, Gansu Province; however, integrated echinococcosis control measures are still required for further control of the prevalence of echinococcosis.

Objective:To verify the clinical efficacy and safety of Qufeng Tongxuan method in treating low- and moderate-volume intracerebral hemorrhage at acute stage.Methods:A prospective, multicenter, randomized, double-blind, placebo-controlled study was performed; patients with low- and moderate-volume intracerebral hemorrhage at the basal ganglia and/or thalamus accepted treatment in 16 hospitals from September 2019 to April 2022 were enrolled. These patients were divided into experimental and control groups with a block randomized method by SAS software. Patients in control group were given conventional western medicine treatment; those in experimental group accepted Qufeng Tongxuan method (sequential therapy of Shexiang Huayu Xingnao granules and Zhilong Huoxue Tongyu granules) besides conventional western medicine treatment. NIHSS was used to assess neurological function before treatment and on 7 th, 14 th, 30 th, and 90 th d of treatment. Prognoses of these patients were assessed by modified Rankin scale (mRS) before treatment and on 180 th d of treatment. Brain CT was performed before treatment and on 7 th and 14 th d of treatment to calculate the hematoma volume. Before treatment and on 14 th d of treatment, changes of coagulation function, liver and kidney functions of the 2 groups were compared. Adverse reactions during treatment in the 2 groups were recorded. Results:No significant differences in NIHSS scores were noted between the 2 groups before treatment, on 7 th, 14 th, and 30 th d of treatment ( P>0.05); NIHSS scores in experimental group on 90 th d of treatment were signficantly lower than those in control group ( P<0.05); NIHSS scores in experimental group decreased gradually before treatment and on 7 th, 14 th, 30 th and 90 th d of treatment, with statistical significances ( P<0.05). No significant differences in mRS scores were noted between the 2 groups before treatment ( P>0.05); mRS scores in experimental group on 180 th d of treatment were signfciantly lower than those in control group ( P<0.05). No significant difference in hematoma volume was noted between the 2 groups before treatment and on 7 th and 14 th d of treatment ( P>0.05); both groups had gradually decreased hematoma volumes before treatment and on 7 th and 14 th d of treatment, respectively, with significant differences ( P<0.05); the volume difference of hematoma between 14 th d of treatment and before treatment in experimental group (6.42[4.10, 11.73]) was significantly higher than that in control group (4.00[1.25, 10.58], P<0.05). No significant differences in liver and kidney function indexes or coagulation function indexes were noted between the 2 groups before treatment and on 14 th d of treatment ( P>0.05). Adverse reaction incidence was 9.52% ( n=12) in experimental group and 10.34% ( n=12) in control group, without statistical difference ( P>0.05). Conclusion:Under premise of conventional western medicine treatment, Qufeng Tongxuan method can promote hematoma absorption and improve neurological deficit symptoms in low- and moderate-volume intracerebral hemorrhage at acute stage, without obvious adverse reactions.

Objective:To investigate the amyloid precursor protein (APP) expression in brain glioma tissues and cerebrospinal fluid of glioma patients and their significances.Methods:(1) Fifty-six brain glioma specimens surgically resected and pathologically confirmed in our hospital from January 2015 to December 2020 were collected, including 9 with WHO grading I, 14 with WHO grading II, 18 with WHO grading III, and 15 with WHO grading IV. In addition, the necrotic brain tissues of 4 patients with hypertensive intracerebral hemorrhage during hematoma removal at the same time period were collected as controls. Western blotting and real-time quantitative PCR (RT-qPCR) were used to detect the APP protein and mRNA expressions in glioma tissues and control brain tissues, respectively. (2) The cerebrospinal fluid of above 56 patients with glioma, 4 patients with viral meningitis, 4 patients with bacterial meningitis, 4 patients with autoimmune encephalitis, 5 patients with epilepsy, 3 patients with migraine and 3 normal subjects were collected at the same time period, and the APP content in the cerebrospinal fluid of all subjects were detected by ELISA.Results:(1) Western blotting and RT-qPCR showed that the APP protein and mRNA expressions in glioma tissues of WHO grading I, II, III and IV were significantly higher than those in control brain tissues, and the APP protein and mRNA expressions in glioma tissues of WHO grading I, II, III and IV increased successively, with statistical differences ( P<0.05). There were no significant differences in APP protein and mRNA expressions between first-onset glioma and recurrent glioma in glioma tissues of WHO grading I and II ( P>0.05); while in glioma tissues of WHO grading III and IV, APP mRNA expression in recurrent glioma was statistically higher than that in first-onset glioma ( P<0.05). (2) ELISA results showed that APP content in patients with viral meningitis, bacterial meningitis, autoimmune encephalitis, epilepsy or migraine was not significantly different as compared with that in normal controls ( P>0.05). The APP content in cerebrospinal fluid of patients with WHO grading I, II, III and IV gliomas was significantly higher than that in normal controls, and the APP content in cerebrospinal fluid of patients with WHO grading I, II, III and IV gliomas increased successively, with statistical differences ( P<0.05). Conclusion:APP is highly expressed in glioma tissues and cerebrospinal fluid of patients with glioma, and its expression is significantly correlated with the pathological grades of glioma; the detection of APP expression in cerebrospinal fluid can be used as a new screening method for glioma patients.

Objective : To determine expression profile of VISTA on lymphocyte and the potential regulatory effects on immune response in a murine model of sepsis. Methods : Expression profile of VISTA on T lymphocytes in the spleen and peripheral blood was examined. Mice wereintravenously injected with an agonistic VISTA mAb(MH5A) or isotype control , and then the survival rate , cytokine expression , bacterial burden and lymphocyte apoptosiswere determined. Results : VISTA was substantially expressed on T cell from the spleen and peripheral blood , septic peritonitis did not induce significant changes in the expression profiles at 24h post surgery(P > 0. 05 in each comparison) . Treatment with MH5A improved the survival of septic mice(8/12 vs 2/12 , P = 0. 01) , accompanied by reduced lymphocyte apoptosis [(30 123 ± 6 400) vs (45 482 ± 8 652) , P = 0. 03] , decreased bacterial burden and lessened cytokines expression , such as TNF⁃α , IL⁃6 , IL⁃1β and IFN⁃γ(P < 0. 05 in each comparison) . Conclusion The present study identified VISTA as a novel immune checkpoint in the regulation of T cell apoptosis and inflammatory response during sepsis. VISTA agonism might offer a promising approach in the immunotherapy for sepsis.

The treatment of large-segment bone defects is a severe trouble. The emergence of bone tissue engineering, a current research hotspot, has brought promising treatment strategies to this field. Bone marrow mesenchymal stem cells (BMSCs), as a kind of seeding cells for bone tissue engineering, have multipotentials, including easy isolation and culture, abundant sources and easy to expand. BMSCs can be differentiated into osteoblasts by a variety of methods to achieve the purpose of bone repairing. Currently, the components to induce osteogenic differentiation of BMSCs include cellular factors, hormones, biological materials, traditional Chinese medicine, physical stimulation and non-coding RNA. Osteogenic differentiation of BMSCs is a very complex process, which is controled by kinds of signaling pathways to maintain a balanced in bone metabolism, mainly including BMPs/Smad signaling pathway, transforming growth factor-β signaling pathway, Wnt signaling pathway, etc. The development of active factors and scaffold which can induce osteogenic differentiation of BMSCs is the basis for the development of bone tissue engineering. Further exploration of signaling pathways could reveal some specific molecular mechanisms and find new therapeutic targets in regeneration medicine. However, some issues, such as osteoblasts differentiation of BMSCs, mutual interference of signal pathways, clinical transformation and clinical application, are still needed to be resolved.

Objective:To construct a care system for stroke patients based on the management mode of the Siebens domain to guide nursing practice.Methods:Taking the Siebens field management model as the research framework, applying Johns Hopkins′ evidence-based nursing method to synthesize the evidence, and determining the care system for stroke patients through two rounds of expert consultation.Results:The positive coefficients of the two rounds of expert consultation were 100%, the coefficients of expert authority were 0.808 and 0.865, and the coordination coefficients of expert opinions were 0.428 and 0.409. The finally constructed index system for the care of stroke patients includes 4 primary indicators, 11 secondary indicators, and 60 tertiary indicators.Conclusion:The constructed index system for the care of stroke patients is a scientific, reliable and credible evaluation system, which can provide a theoretical basis for the development of intervention measures for the care of stroke patients.

OBJECTIVE：To establish a method for the determination of 8 glycosides（astragaloside Ⅰ，Ⅱ，Ⅲ，Ⅳ and calycosin glucopyranoside ，2′-hydroxy-3′，4′-dimethoxy-isoflavan-glucoside and 9，10-dimethoxy-pterocarpan-glucoside） and 4 aglycones（calycosin，formononetin，7，2′-dihydroxy-3′，4′-dimethoxy-isoflavan and 3-hydroxy-9，10-dimethoxy-pterocarpan） in Astragalus membranaceus ，and to investigate the effects of different processing temperatures on the contents of above 12 components. METHODS ：The contents of 12 components in A. membranaceus and samples processed under different temperatures（120，140，160，180，200 ℃）were determined by UPLC-MS/MS. The determination was performed on ACQUITY UPLC HSS T 3 column with mobile phase consisted of 0.1 mol/L formic acid water solution -0.1 mol/L formic acid acetonitrile solution （gradient elution ）at the flow rate of 0.5 mL/min. The column temperature was 30 ℃. The detection wavel ength was 260 nm，and sample size was 2 μL. Electrospray ion source（ESI）was used under positive ion mode （ESI+）. The mass scanning range was mass ratio （m/z）of 50-1 500，with capillary voltage of 2 000 V and ion source temperature of 100 ℃. The desolvation temperature was 400 ℃；flow rate of atomizing gas （N2） was 40 L/h，and that of desolvation was 800 L/h；collision energy （CE）was 20-30 V；data acquisition rate was 0.5 s/scan. RESULTS：The linear range of astragaloside Ⅰ，astragaloside Ⅱ，astragaloside Ⅲ，astragaloside Ⅳ，calycosin-glucopyranoside， calycosin，ononin，formononetin，2′-hydroxy-3′，4′-dimethoxy-isoflavan-glucoside，7，2′-dihydroxy-3′，4′-dimethoxy-isoflavan，9， 10-dimethoxy-pterocarpan-glucoside and 3-hydroxy-9，10-dimethoxy-pterocarpan were 0.001 16-0.232 0，0.000 276-0.055 2， 0.000 22-0.044 0，0.000 225-0.045 0，0.000 734-0.587 0，0.001 17-0.234 0，0.000 742- 0.148 0，0.001 30-0.260，0.003 98-0.795 0， 0.000 476-0.476 0，0.001 89-0.378 0，0.000 336-0.336 0 μg（all R2≥0.999 2），respectively. The limits of detection were 6.2×10－6， 4.8×10－6，3.8×10－6，3.4×10－6，5.8×10－6，4.8×10－6，4.2×10－6，3.2×10－6，5.8×10－6，2.6×10－6，4.2×10－6，6.4×10－6 μg，respectively. The limits of quantitation were 12.6×10－6，16.2×10－6，14.4×10－6，14.8×10－6，18.8×10－6，16.4×10－6，15.4×10－6，10.8×10－6，20.2×10－6， 12.4×10－6，14.6×10－6，23.4×10－6 μg，respectively. RSDs of precision ，stability（24 h）and repetition tests were all lower than 3.0％（n＝6）. The average recoveries were 99.1％，100.2％，98.7％，101.9％，98.6％，102.1％，99.2％，100.3％，98.7％， 99.2％，99.3％ and 100.8％，with the RSDs of 1.9％，2.2％，2.4％，1.8％，2.1％，1.7％，2.3％，1.9％，2.4％，1.8％，2.2％ and 1.9％（n＝6），respectively. The results showed that the contents of astragaloside Ⅰ，Ⅱ and Ⅲ decreased gradually with the increase of processing temperature ；the content of astragaloside Ⅳ increased gradually with the increase of temperature. The content of flavonoid glycosides ，such as calycosin glucopyranoside ，ononin，2′-hydroxy-3′，4′-dimethoxy-isoflavan-glucoside and 9， 10-dimethoxy-pterocarpan-glucoside decreased with the increase of temperature ；the corresponding aglycone components as flavonoid glycosides ，formononetin，3-hydroxy-9，10-dimethoxy- pterocarpan increased firstly and then decreased with the increase ； the content of 7，2′-dihydroxy-3′，4′- dimethoxy-isoflavan decreased with the increase of temperature. CONCLUSIONS ：Established UPLC-MS/MS method can be used for determination of 12 components in A. membranaceus . After processed under different temperature，the contents of glycosides decreased in general ，while the contents of aglycones increased in general.

Objective:To investigate the effects of tantalum coating on adhesion, proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in vitro. Methods:In this study, BMSCs were extracted from 6 6-week-old rats and cultured in vitro to the third generation. Tantalum coating was manufactured on Ti6Al4V by chemical vapor deposition. The cells were identified by flow cytometry before they were induced with different mediums for osteogenesis, chondrogenesis and adipogenesis. The adhesion, proliferation and osteogenic differentiation of BMSCs were detected with fluorescence staining, Cell Counting Kit-8 (CCK8) assay and Q-PCR, respectively. Recorded and compared were the adhesion rate, proliferation rate, and expression of osterix (OSX), Runt-related transcription factor 2 (RUNX2), osteonectin (OSN) and osteopontin (OPN) of BMSCs on the surface of titanium alloy round plates (the Ti6Al4V group) and of tantalum coating round plates (the Ta group). Results:The flow cytometry revealed CD44 (94.55%), CD90 (95.01%) and CD34 (0.06%). Alkaline phosphatase (ALP) staining was positive after osteogenic induction for 14 days; Alizarin red staining showed calcified nodules after osteogenic induction for 21 days; oil red O staining was positive after adipogenic induction for 21 days; alcian blue staining found chondrogenic ability after chondrogenic induction for 21 days. Laser confocal microscopy showed that the BMSCs grew in patches aggregated and closely linked on the surface of titanium alloy round plates (in the Ti6Al4V group) and of tantalum coating round plates (in the Ta group). More BMSCs adhered on the tantalum coating plates than on the titanium alloy plates and exhibited better ductility. The proliferation rates of BMSCs on tantalum coating were significantly faster than those on titanium alloy after 1, 3, 5 and 7 days of co-culture in vitro ( P<0.05).Q-PCR showed that tantalum coating promoted the expression of OSN and OPN after 7 days of culture significantly higher than titanium alloy did ( P<0.05).After 21 days of co-culture in vitro, tantalum coating enhanced the expression of OSX, RUNX2, OSN and OPN significantly higher than titanium alloy did ( P<0.05). Conclusion:Compared to titanium alloy which is used for conventional orthopedic implants, tantalum coating can observably promote adhesion, proliferation and osteogenic differentiation of BMSCs.