Xiang thinking is a cognitive approach that reflects the relationships between phenomena and their underlying principles by analyzing their external manifestations through methods such as analogy， reasoning， deduction， and symbolism. This article applied xiang thinking to analyze the etiology and pathogenesis of "wind， fire， phlegm， and blood stasis" in stroke， thereby exploring its impact on the principles of syndrome differentiation and treatment of this condition. Meanwhile， the article traced the construction process of xiang thinking， and interpreted the concept of "toxin pathogen" in traditional Chinese medicine from four perspectives， state， attribute， origin， and law. Furthermore， the relationship between the process of constructing xiang thinking and the origin of etiology， identification methods， pathogenesis evolution， and treatment strategies for stroke with syndrome of combined blood stasis and toxin was explored， so as to provide insights into research on the etiology and pathogenesis of stroke， as well as clinical diagnosis and treatment approaches.

Tumor metabolic reprogramming and immune escape synergistically promote tumor progression, in which methionine (Met) metabolism plays a key role through epigenetic regulation and immune microenvironment remodelling. This paper systematically summarzes the mechanisms by which aberrant Met metabolism leads to “methionine addiction” and maintains the malignant phenotype of tumor cells, and describes its multiple modulations of the immune system: inducing T-cell depletion, promoting the polarization of M2-type macrophages, inhibiting the activity of NK cells, and enhancing the function of tumor-associated fibroblasts. Furthermore, therapeutic strategies targeting Met metabolism, including methionine-restricted diets, metabolic enzyme (MAT2A, NNMT) inhibitors, and epigenetic targets (PRMT5 inhibitors), are explored to provide theoretical reference for the development of Met-targeted therapies.

This study investigates the neuroprotective potential of extracellular vesicles (EVs) delivering quercetin-3-O-β-d-glucuronic acid (QG-EVs) in cerebral ischemia-reperfusion injury (CIRI). Targeted brain delivery of QG-EVs was confirmed, with neuron cells identified as pivotal in modulating CIRI through single-cell RNA sequencing (scRNA-seq). Activating transcription factor 4 (Atf4) was highlighted as a critical regulatory factor, and in vitro studies revealed that silencing Atf4 diminished the neuroprotective effects of QG-EVs, increasing oxidative stress levels and neuronal apoptosis. In a CIRI mouse model, the knockdown of Atf4 attenuated the protective outcomes provided by QG-EVs, further affirming the role of Atf4 in mediating neuroprotection. Behavioral assessments and protein analysis showed that QG-EVs significantly reduced neuronal damage and pro-apoptotic markers, while improving neurological function via Atf4 upregulation. The outcomes hint at the potential of QG-EVs as a beneficial therapeutic modality to mitigate neuronal damage in CIRI by enhancing Atf4 expression, highlighting its potential for improving ischemic stroke outcomes.

Objective To explore and analyze the application effect of hospital quality monitoring system in medical quality management.Methods 800 patients from March 2021 to March 2022 were selected as the control group and routine medical quality management was adopted;and 800 patients from April 2022 to April 2023 were selected as the experimental group and the hospital quality monitoring system was adopted for medical quality management.Results The complication rate and re-admission rate after implementation were significantly lower than before implementation,with statistical significance(P＜0.05).The satisfaction of patients after implementation was significantly higher than before implementation,and the difference was statis-tically significant(P＜0.05).The score of medical service quality after implementation was significantly higher than before im-plementation,and the difference was statistically significant(P＜0.05).Conclusion The application effect of hospital quality monitoring system in medical quality management is remarkable,and it is worthy of promotion.

Xiang thinking is the key way of thinking to construct the life model of human body in traditional Chinese medicine （TCM）， and the theory of ascending and descending of qi movement is an important manifestation of xiang thinking in the theory of TCM. Based on the theory of qi movement， this paper interpreted the mechanism of ischemic stroke through the perspective of xiang thinking "earth weakness - wood constraint - fire hyperactivity"， as "earth weakness in the central and dampness accumulated to phlegm" "wood constraint and stirring wind led to blood stasis" and "fire hyperactivity and fire toxin showed flaming upward" due to disorder of qi movement. Combined with the "xiang of medicinal properties and therapy methods" to discuss the treatment and prescriptions of ischaemic stroke， applying wind medicinals to elevate ji-earth （己土） and yi-wood （乙木）， so that phlegm and stasis can be eliminated， and cold medicinals to descend jia-wood （甲木） and wu-earth （戊土） so that fire toxin can be cleared， with a view to restore ascending and descending of qi movement for ischaemic stroke.

To investigate tick species and prevalence of Anaplasmataceae and spotted fever group Rickettsia(SFGR)in ticks collected from sheep and goats in Leibo county,Sichuan Province.Ticks were preliminary identified by morphological characters and the genomic DNAs of ticks were ex-tracted.Molecular detection was performed by PCR targeting gene fragment of tick ITS-2,gltA and ompA genes of Rickettsia spp.,16S rRNA and rpoB genes of Anaplasma spp.and Ehrlichia spp.Positive PCR products were sequenced and phylogenetic trees were built based on these genes.The results showed that a total of 353 adult ticks collected from sheep and goats were identified as H.longicornis.The total prevalence of SFGR in H.longicornis was 22.66％(80/353)with only R.raoultii detected,which was closely related to R.raoultii(JQ792163)isolated from Dermacentor niveus in Tibet.The total prevalence of Anaplasmataceae was 87.82％(310/353)with six Ana-plasma species(A.bovis,A.capra,A.marginale,Anaplasma cf.marginale,Anaplasma sp.,Can-didatus A.mediterraneum)and two Ehrlichia species(E.chaffeensis and Ehrlichia sp.)detec-ted.Go-infection was found in some H.longicornis as high as 7.37％(26/353).The results indica-ted that H.longicornis may be the dominant tick species in Leibo county with high infections rates of Anaplasmataceae and SFGR.The close monitoring of the tick-borne pathogens should be strengthened in the future research work.

Ginsenoside Compound K(CK)is a kind of protopanaxadiol ginsenosides,which exerts antitumor effects on various cancers,such as lung cancer,liver cancer and breast cancer.Pharmacological studies have proved that CK induces tumor cell cycle arrest and apoptosis,as well as regulates tumor cell autophagy and inhibits tumor metastasis by regulating multiple signaling pathways(AMPK/mTOR and PI3K/Akt et cetera).However,as an intestinal metabolite of natural protopanaxadiol ginsenosides,CK cannot be directly extracted from the ginseng plant.Therefore,biotransformation from natural ginsenosides such as ginsenoside Rb1 or biosynthesis are utilized to obtain CK.Biotransformation of CK uses enzymes or microorganisms to transform different ginsenosides or their structural analogs into CK;biosynthesis of CK cultures cell factories and biosynthetic enzymes to synthesize glucose and other simple compounds into CK.In this review,we systematically summarized the research progress in biopreparation and antitumor mechanism of CK in recent years,with the aim of providing evidence for the future development of CK as a clinical anti-tumor candidate drug or an adjunctive drug.

Objective To systematically evaluate the effect of red ginseng on improving metabolic syndrome,and to provide basis for clinical practice.Methods Retrieval from PubMed,Embase,The Cochrane Library,Web of Science,Clinical Trials Gov,WanFang Data and CNKI databases,articles of RCTs about red ginseng on improving metabolic syndrome were included.The searching range was from the establishment of the database to May 2022.The articles were screened according to inclusion and exclusion criteria,and then the inclusion study was analyzed through RevMan 5.4.1 software.Results Totally 17 randomized controlled trials involving 957 patients were included.Compared with the control group,red ginseng exhibited significant effect on fasting blood glucose,total cholesterol,low-density lipoprotein,systolic blood pressure and diastolic blood pressure(P<0.05),and its effect was related to the disease,age,duration of administration and dosage.Conclusion Red ginseng could significantly improve the symptoms of hyperglycemia,hyperlipidemia and hypertension in metabolic syndrome,which provides a theoretical basis for clinical use of red ginseng in treating metabolic syndrome.

Objective To investigate the consistency between colonoscopic Boston bowel preparation score and the bowel cleanliness evaluated by pre-endoscopy naked eye faecal observation,so as to provide a guidance on bowel preparation.Methods From September 2018 to June 2019,convenience sampling method was used to select 150 inpatients who underwent colonoscopy in the Department of Gastroenterology of a tertiary hospital in Guangzhou as the research objects.Before colonoscopy,the compound polyethylene glycol electrolyte powder was taken orally according to the bowel preparation plan for cleaning the colorectum.Before the colonoscopic examination,the naked eye observation method by nurses was used to observe the transparency of the excreta to evaluate the cleanliness of colorectum.Then the colorectal cleanliness was evaluated by endoscope by the operator using the Boston bowel preparation assessment scale(BBPS)during colonoscopy.Results A total of 145 patients completed the study.The cleanliness of bowel preparation was 93.1%with the naked eye observation and 88.27%with colonoscopy.There was no significant difference between the two assessment methods in judging the effectiveness of bowel preparation(P<0.05).The sensitivity of naked eye observation in judging bowel preparation was 96.10%with a 29.41%of specificity.The positive predictive value was 91.11%,and the negative predictive value was 50%(Kappa=0.310,P<0.001).Conclusion The naked eye observation and evaluation method for bowel preparation has advantages in high sensitivity,low specificity,high positive predictive value and low negative predictive value.It can be used as a preliminary evaluation method for cleanliness of colorectum before colonoscopy.

Under the new situation of rapid development of medical science and technology, how to effectively cultivate medical students’ humanistic spirit and comprehensively improve medical quality is an important responsibility of medical college teachers. Blend-learning can guide students to immersive learning in multiple dimensions and forms. Obstetrics and Gynecology is one of the main compulsory courses for clinical medical students, which is faced more sensitive and vulnerable female patients, and required higher humanistic quality training for medical students. Through the construction of the blend-learning platform, medical humanities can be better integrated into the content and teaching design of medical education, and students can be more appropriately imperceptibly trained in medical humanities in obstetrics and gynecology teaching, so as to enhance medical students’ medical humanities quality in the process of obstetrics and gynecology diagnosis and treatment, and improve doctor-patient relationship.