Objective:To establish a diagnostic system for heat toxin syndrome of acute cere-bral infarction.Based on this toxin syndrome diagnostic system,the general principles of heat toxin development will be uncovered,and the critical turning point at which the heat toxin syndrome occurs will also be explored.Methods:In this study,a total of 271 hypertension patients with cerebral infarction within 72 h were recruited from the Affiliated Dongfang Hospital of the Beijing University of Chinese Med-icine,the Affiliated Dongzhimen Hospital of Beijing University of Chinese Medicine,the Affil-iated Renmin Hospital of Peking University,the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,the Affiliated Hospital of Shandong University of Traditional Chinese Medicine,the Affiliated Hospital of Changchun University of Traditional Chinese Medicine,the Affiliated Hospital of Hebei University of Traditional Chinese Medicine and China Meitan General Hospital from August,2008,to December,2009.The patients' Chi-nese medical information was recorded on days 1,3,5,7,and 14 during their hospitalizations.The medical records were recorded according to traditional Chinese medicine (TCM) theory and included the serum marker levels at the beginning and at the end of the trial.The time line was also analyzed.Results:The level of Hs-CRP,PAG,NSE,OX-LDL,and MMP-9 were abnormal and,were higher in CI patients compared to hypertension patients.In the study of the heat toxin diagnosis system,according to the entropy clustering results,30 combinations of the medical information can be sorted into the traditional syndromes,but 13 combinations cannot be sorted.To obtain more precise symptoms related to the heat toxins,a logistic regression equation was set up with the variables from the unsorted medical information;the dependent variables were fever and BP fluctuation.Weighted variables were obtained.MLP analysis demonstrated that the diagnosis model was stable and precise.The accuracy reached 83.82％.The ROC test showed that seven points of the diagnosis system was the best cutting point,with a sensitivity of 0.857 and a spec-ificity of 0.955.Progressing stroke was related to heat toxin syndrome.When the turning point appeared,the combination of symptoms,such as coma,aphasia,gummy eyes,and halitosis,predicted the deterioration or recovery of Cl.The heat toxin syndrome existed in every sub-type of Cl;however,the observed heat toxin levels were highest in PACl and lowest in LACl.Meanwhile,blood and sputum stasis syndromes transformed into heat toxicity were one source of heat toxin syndrome.Conclusion:Heat toxin syndrome,as well as qi/blood/sputum stasis,co-existed in the CI pa-tients,and the transformation frequently appeared during the process.Three to five days after the onset of Cl was the turning point,at which time several combinations of medical indicators make it possible to predict the development of Cl.

The " liver disease affecting to the spleen" theory first appeared in Nanjing and was further elaborated in Jingui Yaolue. This theory encapsulates the traditional Chinese medicine principles of the " unity of the five viscera" and the " preventive treatment of disease" . The theory emphasizes that the spleen is the pivotal point where depression may progress from a functional disorder to an organic disease. The liver governs the emotions and qi flow, whereas the spleen is responsible for qi, blood, and body. In the early stages of the disease, emotional disorders and qi flow disorders primarily affect the liver, manifesting as depression or low mood. As the condition progresses, the liver (Wood) overacts on the spleen (Earth), disrupting liver and spleen functions and causing qi and blood disharmony. This stage is marked by fatigue and psychomotor retardation. Prolonged illness depletes qi and blood, eventually involving all five viscera, disrupting the harmony of the five spirits, and affecting both body and spirit. At this advanced phase, intense emotional distress or agitation often arises, accompanied by a heightened risk of suicide. The disease progression follows a dynamic " qi-blood-spirit" pattern, in which depression begins in the liver, characterized by qi stagnation, then affects the spleen, involving blood disharmony. In later stages, the disease eventually affects all viscera, with profound effects on both physical and mental health. Treatment strategies should align with the disease stage. Early intervention should focus on regulating the flow of qi, treating the liver, and strengthening the spleen. In the middle stages, qi and blood should be harmonized while promoting the harmonized functions of the liver and spleen. In the later stages, treatment should harmonize the five viscera to restore balance between body and spirit. Guided by this theory, integrating modern medical understanding of the progression of depression from emotional to somatic symptoms and adopting a stage-based approach to treatment in clinical practice can yield effective therapeutic outcomes for managing depression and related disorders.

Objective To examine the changing antimicrobial resistance profile of Enterobacter spp.isolates in 53 hospitals across China from 2015 t0 2021.Methods The clinical isolates of Enterobacter spp.were collected from 53 hospitals across China during 2015-2021 and tested for antimicrobial susceptibility using Kirby-Bauer method or automated testing systems according to the CHINET unified protocol.The results were interpreted according to the breakpoints issued by the Clinical & Laboratory Standards Institute(CLSI)in 2021(M100 31st edition)and analyzed with WHONET 5.6 software.Results A total of 37 966 Enterobacter strains were isolated from 2015 to 2021.The proportion of Enterobacter isolates among all clinical isolates showed a fluctuating trend over the 7-year period,overall 2.5％in all clinical isolates amd 5.7％in Enterobacterale strains.The most frequently isolated Enterobacter species was Enterobacter cloacae,accounting for 93.7％(35 571/37 966).The strains were mainly isolated from respiratory specimens(44.4±4.6)％,followed by secretions/pus(16.4±2.3)％and urine(16.0±0.9)％.The strains from respiratory samples decreased slightly,while those from sterile body fluids increased over the 7-year period.The Enterobacter strains were mainly isolated from inpatients(92.9％),and only(7.1±0.8)％of the strains were isolated from outpatients and emergency patients.The patients in surgical wards contributed the highest number of isolates(24.4±2.9)％compared to the inpatients in any other departement.Overall,≤ 7.9％of the E.cloacae strains were resistant to amikacin,tigecycline,polymyxin B,imipenem or meropenem,while ≤5.6％of the Enterobacter asburiae strains were resistant to these antimicrobial agents.E.asburiae showed higher resistance rate to polymyxin B than E.cloacae(19.7％vs 3.9％).Overall,≤8.1％of the Enterobacter gergoviae strains were resistant to tigecycline,amikacin,meropenem,or imipenem,while 10.5％of these strains were resistant to polycolistin B.The overall prevalence of carbapenem-resistant Enterobacter was 10.0％over the 7-year period,but showing an upward trend.The resistance profiles of Enterobacter isolates varied with the department from which they were isolated and whether the patient is an adult or a child.The prevalence of carbapenem-resistant E.cloacae was the highest in the E.cloacae isolates from ICU patients.Conclusions The results of the CHINET Antimicrobial Resistance Surveillance Program indicate that the proportion of Enterobacter strains in all clinical isolates fluctuates slightly over the 7-year period from 2015 to 2021.The Enterobacter strains showed increasing resistance to multiple antimicrobial drugs,especially carbapenems over the 7-year period.