Minimally conscious state （MCS） is at the edge between closed and open consciousness， but it still belongs to the category of "wind-strike block" syndrome. The basic pathogenesis of MCS is the obstruction of pathogenic qi， orifices closed and spirit hidden， with pathological factors including phlegm， fire， and blood stasis. Wind movement and water retention may also be present， and often leading to deficiency syndrome due to the exhaustion of qi， blood， yin， and yang at later stages. Treatment chooses Shexiang （Moschus） as the chief medicinal， emphasizing combination of medicinals and urgency of medication administration； the key therapeutic method is to open the orifices， with focuses on expelling pathogens and reinforcing healthy qi. For patients with severe phlegm or fire， use Xiaochengqi Decoction （小承气汤） to open the lower orifices， discharge heat and unblock the bowels， combined with Shexiang （Moschus） and Niuhuang （Bovis Calculus） to open the upper orifices， awaken the spirit and guide qi. For patients with turbid phlegm as the predominant， temporarily replace Shexiang （Moschus） with Baizhi （Angelicae dahuricae radix）， using Ditan Decoction （涤痰汤） to eliminate phlegm to open the orifices， when turbid phlegm gradually subsided， Shexiang （Moschus） could be added. For patients with blood stasis as the predominant， Tongqiao Huoxue Decoction （通窍活血汤） will be used to activate blood and open orifice， if the blood circulates， the endogenous wind will be calmed， the water will be induced， the orifices will open and the consciousness will restore. For patients with closed orifices and body deficiency， the treatment should open the orifices and reinforce healthy qi， and consider the root and branch simultaneously； qi deficiency syndrome can be addressed with Buyang Huanwu Decoction （补阳还五汤） to boost qi and reinforce healthy qi； yin deficiency syndrome can be treated with Shaoyao Gancao Decoction （芍药甘草汤） combined with Fengsui Pill （封髓丹） to nourish yin， soften sinews， and secure kidney essence； yang deficiency can be managed by using Dihuang Yinzi Decoction （地黄饮子） to enrich yin， supplement yang， and open the orifices.

To summarize the clinical experience of Professor LIU Jinmin in treatment for epilepsy. It is believed that main pathogenesis of epilepsy is yangming failure to close and vital activity loss control， so a therapeutic approach focused on restoring the closure of yangming and regaining vital activity was proposed for the treatment of epilepsy. For excess syndrome， the treatment focuses on draining excess and descending qi， promoting purgation and restoring spirit. When yangming dryness-heat predominates， the approach involves unblock the bowels and regulating the spirit， descending qi and reducing fire， with modified Chengqi Decoction （承气汤） as prescription； when yangming phlegm-fire predominates， the treatment focuses on clearing heat and resolving phlegm， calming mind and suppressing fright， with modified Qingxin Wendan Decoction （清心温胆汤） as prescription； when yangming blood stasis predominates， the approach involves breaking up blood stasis and promoting purgation， eliminating stasis and awakening the mind， with Taoren Chengqi Decoction （桃核承气汤） as prescription. For deficiency syndrome， the treatment emphasizes tonifying deficiency and raising qi， strengthening the stomach and nourishing the spirit. When center qi deficiency and sinking of clear qi of the nutrients from food， the approach involves replenishing and uplifting qi while nourishing vital activity， with modified Liujunzi Decoction （六君子汤） as prescription； when yin deficiency and fluid consumption， the treatment focuses on nourishing stomach and tonifying yin， promoting fluid production and calming the spirit， with modified Maimendong Decoction （麦门冬汤） combined with Yiwei Decoction （益胃汤） as prescriptions. In clinical situations of deficiency-excess complex， it is essential to distinguish the primary condition from the secondary， applying both supplementing and draining methods flexibly to achieve optimal treatment.

With the continuous advancements in immunotherapy and targeted therapy, the treatment management and surgical resection assessment of locally advanced lung cancer have undergone significant changes. In October 2024, the Society of Thoracic Surgeons (STS) released the "STS expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer", which provides the latest insights on the evaluation of resectability and multidisciplinary management of locally advanced lung cancer, neoadjuvant (including perioperative) therapy, and adjuvant therapy. This article aims to interpret this consensus, with the goal of introducing the latest perspectives of the STS consensus to thoracic surgeons and providing a reference for the rational implementation of surgical resection, multidisciplinary management, and standardized comprehensive treatment models for non-small cell lung cancer in China.

Objective To investigate the correlation between serum Irisin,long pentraxin 3(PTX3),human metas-tasis-associated lung adenocarcinoma transcript 1(MALAT1)levels and the severity of diabetic retinopathy(DR)and the value of combined diagnosis.Methods Eighty-five patients with type 2 diabetes mellitus(T2DM)combined with DR at Cangzhou Central Hospital from April 2022 to April 2023 were selected as the DR group,85 patients with T2DM alone were selected as the non-DR group,and 85 healthy volunteers were selected as the control group during the same period.Pa-tients in the DR group were further divided into the proliferative DR(PDR)group(38 patients)and the non-PDR group(47 patients)based on whether DR was in the proliferative phase.Clinical data of patients in the DR group were collected,including gender,diastolic pressure,age,systolic pressure,disease course,fasting plasma glucose(FPG),body mass in-dex,hemoglobin A1c(HbA1c),smoking history,triglyceride(TG),drinking history,peak systolic velocity(PSV),peak end-diastolic velocity(PEDV),resistance index(RI),fasting insulin(FINS),family history of diabetes,total cholesterol(TC),and homa-insulin resistance(HOMA-IR).Enzyme-linked immunosorbent assay was used to detect serum levels of Irisin and PTX3 in each group of patients,and real-time quantitative polymerase chain reaction was used to detect the ser-um level of MALAT1.The correlations between serum levels of Irisin,PTX3 and MALAT1 and the severity of DR were ana-lyzed using the Pearson correlation coefficient.The influencing factors of the DR severity were identified using the Logistic regression.The value of serum Irisin,PTX3,and MALAT1 levels in diagnosing DR alone was analyzed using the receiver operating characteristic(ROC)curve.The value of regimens containing and not containing serum Irisin,PTX3,and MAL-AT1 levels in diagnosing DR was analyzed using the ROC curve,net reclassification index(NRI),and integrated discrimina-tion improvement(IDI)index.Results The serum levels of Irisin,PTX3,and MALAT1 were compared among the three groups of patients,and the differences were statistically significant(all P＜0.001).The disease course of patients in the PDR group was longer than that in the non-PDR group,the PSV,PEDV and serum Irisin level were lower than those in the non-PDR group,while the RI,FPG,HbA1c,TG,FINS,HOMA-IR,and serum PTX3 and MALAT1 levels were higher than those in the non-PDR group(all P＜0.05).The serum Irisin level in DR patients was negatively correlated with the severity of DR(r=-0.512,P＜0.001),while the PTX3 and MALAT1 levels were positively correlated with the severity of DR(r=0.497,0.573,both P＜0.05).The Logistic regression analysis showed that the disease course,FPG,HbA1c,TG,FINS,HOMA-IR,PSV,PEDV,RI,and serum levels of Irisin,PTX3 and MALAT1 were influencing factors for the DR progression(allP＜0.05).The area under the curve(AUC)of serum Irisin,PTX3,and MALAT1 levels in diagnosing DR was 0.743,0.811,and 0.773,respectively.Compared with conventional diagnostic protocols,the AUC of the new diagnostic protocol containing serum levels of Irisin,PTX3,and MALAT1 significantly increased(Z=2.708,P=0.007),and the NRI and IDI were 0.039(95％CI:0.022-0.069)and 0.026(95％CI:0.014-0.047),respectively(all P＜0.05).Conclusion The serum Irisin level in DR patients decreases,while the serum PTX3 and MALAT1 levels increase,which are closely related to the severity of DR.Diagnostic plans containing serum Irisin,PTX3,and MALAT1 indicators have high diagnostic value.

Objective:To understand the iodine nutrition status of 8 - 10 years old children in Yantai City, and to provide a scientific basis for scientific iodine supplementation according to local conditions.Methods:Using multi-stage stratified cluster random sampling method, each county (city and district, hereinafter referred to as county) in Yantai City in 2022 was divided into 5 areas according to east, west, south, north and center, and 1 township (street) was selected as the survey site for each area, and 1 school was selected for each survey site, and 40 non-residential children aged 8 - 10 years old in each elementary school were selected as the target respondents, and the salt samples of edible salt in their homes were collected, and the urine samples of salt iodine and urinary iodine content were measured at random. A sample of salt and a random sample of urine were collected from the children's homes, and the salt iodine and urine iodine content were measured. Some of the children were sampled and their thyroid gland was tested using ultrasound. Each survey site is based on administrative villages (communities); administrative villages with centralized water supply collect one sample of terminal water; administrative villages with decentralized water supply take two wells (or all of them if there are fewer than 10 wells) in each of the five directions: east, west, south, north, and central, and collect water samples from the wells to test the iodine content of the water. Zhifu District and Zhaoyuan City each took 2 canteens of enterprises and institutions and 5 medium-sized and 5 small restaurants to collect salt samples of edible salt and test the salt iodine content.Results:A total of 2 343 children were tested for urinary iodine and salt iodine; the median urinary iodine was 147.10 μg/L, and the median urinary iodine in children from different regions was 173.96, 148.20, 148.05, and 136.04 μg/L, respectively, with statistically significant differences ( H = 15.55, P = 0.001); the median salt iodine was 17.81 mg/kg, and the different regional The median salt iodine was 0.00, 0.00, 20.02, and 22.48 mg/kg, respectively, and the difference was statistically significant ( H = 263.48, P < 0.001); the iodized salt coverage rate (15.34%, 48.37%, 69.63%, and 76.69%) and the consumption rate of qualified iodized salt (13.50%, 39.14%, 61.86%, and 69.17%) were compared in different regions were compared, and the differences were statistically significant (χ 2 = 257.65, 235.64, P < 0.001). A total of 1 419 children underwent ultrasound examination of the thyroid gland, and there were no statistically significant differences when comparing the rates of goiter (2.44%, 2.18%, 3.04%, and 3.12%) and nodule detection (3.90%, 4.90%, 5.89%, and 2.18%) among the children in different regions (χ 2 = 0.85, 6.69, P > 0.05). A total of 2 488 water samples were monitored, and the median water iodine was 3.70 μg/L. When comparing the median water iodine in different regions, the difference was statistically significant ( H = 141.21, P < 0.001). A total of 120 salt samples of edible salt from catering units were tested, and the consumption rate of qualified iodized salt was 62.50%. Conclusion:The consumption rate of qualified iodized salt among children in Yantai was below 90%, but their iodine nutrition was at an appropriate level, suggesting that the iodine intake of children in Yantai may not be entirely dependent on iodized salt.

Objective:To investigate the relationship among health cognition, dietary habits and health levels in population receiving health examinations.Methods:A cross-sectional survey was carried out in 55 339 subjects who underwent the health examinations at the Third Xiangya Hospital of Central South University in 2022. Exploratory factor analysis was used to classify dietary patterns, variance component analysis was employed to validate the questionnaire′s validity, and reliability analysis was conducted to test the questionnaire′s reliability. For continuous data, analysis of variance was used, while chi-square tests were applied for categorical data. Furthermore, a structural equation model for health cognition was constructed to analyze the interrelationships between health cognition, dietary patterns and health levels in the subjects.Results:The health cognition level of men was significantly higher than that of women (19.40±2.96 vs 19.26±2.96, F=34.11, P<0.001). The health cognition level of people aged≥50 years was 19.89±3.17, the highest among all age groups ( F=434.93, P<0.001). The health cognition level of overweight people was 19.53±2.95, higher than that of other weight groups ( F=84.09, P<0.001). The mental health assessment results in men were significantly better than that in women (11.98±3.79 vs 12.76±4.21, F=521.07, P<0.001), women generally had better health indicators than men. Participants aged 50 years and above had the best mental health indicator assessments, scored 11.13±3.26 ( F=1 053.30, P<0.001). And the mental health indicator assessments in overweight people was the best, while it was the worst in subjects with lower body mass index (12.04±3.84 vs 13.31±4.38, F=104.05, P<0.001). According to the structural equation model, the overall effect of health cognition on the health level of the population undergoing health examinations was 0.66. At the same time, there was a partial intermediary effect between health cognition and health level, the direct effect of health cognition on dietary patterns was 0.31, and the direct effect of dietary patterns on health level was 0.61. Conclusion:Health cognition has both direct and indirect effects on the health status in population receiving health examinations.

Epilepsy is a disease of the central nervous system caused by excessive neuronal discharges in the brain,characterized by sudden,recurrent and self-limited onset. The brain's qi collateral and the brain neural network are highly correlated and internally consistent in terms of structure and function. The theory of "brain's qi collateral-abnormal collateral",which is centered on the structural disorder and dysfunction of brain's qi collateral leading to the poor circulation of brain's qi collateral,can comprehensively explain the related pathogenesis of epilepsy and the law of disease evolution,so it has important clinical value. Taking the pathogenic characteristics as an entry point and based on the theory of "brain's qi collateral-abnormal collateral",this paper argues that phlegm and qi stagnation,wind in the brain's qi collateral,and phlegm and blood stagnation damaging the brain's collaterals,as well as the structural and functional characteristics of brain's qi collateral that circulate bi-directionally are the key factors for epilepsy to present sudden,recurrent,and self-limited characteristics. According to the therapeutic principle of "Collaterals need to be unobstructed to function normally",it is proposed that the method of regulating the qi and collaterals should be used as the basic treatment principle throughout the treatment. In addition,the method of resolving phlegm and eliminating blood stasis is supplemented for different pathological changes,while combining the syndrome differentiation of zang-fu viscera and attaching importance to the accompanying symptoms of epileptic seizures,to regulate the brain's qi collateral to achieve the effects of wind quenching and epileptic arrest. This is to provide reference for the treatment of epilepsy in traditional Chinese medicine.

Objective To investigate the inhibitory effect of bardoxolone methyl(CDDO-Me)on activation of NLRP3 inflammasome and its mechanism for alleviating acute liver injury(ALI).Methods Mouse bone marrow-derived macrophages(BMDM)and THP-1 cells were pre-treated with CDDO-Me followed by treatment with Nigericin,ATP,MSU,intracellular LPS transfection for activation of NLRP3 inflammasomes,or poly A:T for activation of AIM2 inflammasomes.The levels of caspase-1 and IL-1β in the cell culture supernatant was determined with Western blotting and ELISA to assess the inhibitory effect of CDDO-Me on NLRP3 inflammasomes and its specificity.In the animal experiment,male C57BL/6J mouse models of acetaminophen-induced ALI were treated with low-dose(20 mg/kg)and high-dose(40 mg/kg)CDDO-Me,and the changes in serum levels of IL-1β,TNF-α,AST and ALT were measured by ELISA and liver tissue pathology was observed using HE staining.Results In mouse BMDM and THP-1 cells,CDDO-Me dose-dependently inhibited the activation of NLRP3 inflammasomes without significantly affecting the secretion of non-inflammasome-related inflammatory factors IL-6 and TNF-α or AIM2 inflammasome activation.In the mouse models of ALI,CDDO-Me treatment at both the low and high doses significantly reduced serum levels of IL-1β,AST and ALT,ameliorated histological changes and reduced inflammatory cell infiltration in the liver tissue,and the effects exhibited a distinct dose dependence.Conclusion CDDO-Me can specifically inhibit the activation of NLRP3 inflammasomes to alleviate acetaminophen-induced ALI in mice.

Objective To investigate the inhibitory effect of bardoxolone methyl(CDDO-Me)on activation of NLRP3 inflammasome and its mechanism for alleviating acute liver injury(ALI).Methods Mouse bone marrow-derived macrophages(BMDM)and THP-1 cells were pre-treated with CDDO-Me followed by treatment with Nigericin,ATP,MSU,intracellular LPS transfection for activation of NLRP3 inflammasomes,or poly A:T for activation of AIM2 inflammasomes.The levels of caspase-1 and IL-1β in the cell culture supernatant was determined with Western blotting and ELISA to assess the inhibitory effect of CDDO-Me on NLRP3 inflammasomes and its specificity.In the animal experiment,male C57BL/6J mouse models of acetaminophen-induced ALI were treated with low-dose(20 mg/kg)and high-dose(40 mg/kg)CDDO-Me,and the changes in serum levels of IL-1β,TNF-α,AST and ALT were measured by ELISA and liver tissue pathology was observed using HE staining.Results In mouse BMDM and THP-1 cells,CDDO-Me dose-dependently inhibited the activation of NLRP3 inflammasomes without significantly affecting the secretion of non-inflammasome-related inflammatory factors IL-6 and TNF-α or AIM2 inflammasome activation.In the mouse models of ALI,CDDO-Me treatment at both the low and high doses significantly reduced serum levels of IL-1β,AST and ALT,ameliorated histological changes and reduced inflammatory cell infiltration in the liver tissue,and the effects exhibited a distinct dose dependence.Conclusion CDDO-Me can specifically inhibit the activation of NLRP3 inflammasomes to alleviate acetaminophen-induced ALI in mice.

Objective To investigate the mechanism of high mobility group protein 1(HMGB1)-mediated pyroptosis involved in pulmonary vascular remodeling in mice with pulmonary arterial hypertension(PAH).Methods Forty SD mice were divided into control group,PAH group,PAH+HMGB1 neutralizing antibody(HMGB1 Ab)group and PAH+necronecroamide(NSA)group.Except the control group,the remaining 3 groups were treated with hypoxia to establish PAH model.PAH+HMGB1 Ab group and PAH+NSA group were treated with HMGB1 Ab and NSA respectively.After the treatment,the mean pulmonary artery pres-sure(mPAP)and right ventricular hypertrophy index(RVHI)of mice in each group were detected.Hema-toxylin-eosin staining was used to observe the pulmonary histopathological changes and calculate the percent-age of pulmonary artery wall thickness(WT)and the percentage of pulmonary artery wall area(WA).The serum levels of interleukin(IL)-1β and IL-18 were detected by enzyme-linked immunosorbent assay.The ex-pression of gasdermin D(GSDMD)in lung tissues of mice in each group was observed by immunohistochemi-cal staining.Real-time fluorescence quantitative PCR and western blot were used to detect the expression of HMGB1,nucleotide-binding oligomerized domain-like receptor protein 3(NLRP3),apoptosis-associated speck-like protein(ASC),Cysteinyl aspartate-specific proteinase-1(Caspase-1),and GSDMD in lung tissues of mice in each group.Results Compared with control group[(1.81±0.19)kPa,(0.27±0.03)],mPAP and RVHI in PAH group[(3.97±0.41)kPa,(0.41±0.04)]were significantly increased,and the difference was statistically significant(P＜0.05).Compared with the control group,the pulmonary artery wall of PAH group was significantly thickened,and the vascular smooth muscle cells proliferated and hypertrophy.The de-gree of pulmonary artery wall thickening in PAH+HMGB1Ab and PAH+NSA groups was significantly re-duced compared with PAH group.WT and WA in PAH group[(42.06±4.38)％,(50.56±5.24)％]were sig-nificantly higher than those in control group[(23.64±2.46)％,(25.12±2.63)％],the difference was statisti-cally significant(P＜0.05).Compared with control group[(23.56±2.48)pg/mL,(22.68±2.32)pg/mL],se-rum levels of IL-1β and IL-18 in PAH group[(94.51±9.62)pg/mL,(58.21±5.97)pg/mL]were significant-ly increased,and the difference was statistically significant(P＜0.05).Compared with PAH group[(48.57±5.02)％],the positive rate of GSDMD in PAH+HMGB1Ab and PAH+NSA groups[(16.52±1.76)％,(14.62±1.59)％[was significantly decreased,and the difference was statistically significant(P＜0.05).The protein expression of HMGB1,NLRP3,ASC,Caspase-1 and GSDMD in lung tissues of PAH group were sig-nificantly higher than those of control group(P＜0.05).Conclusion HMGB1 neutralizing antibody can in-hibit pyroptosis of PAH mice,thereby reducing pulmonary artery pressure and improving pulmonary vascular remodeling.