ObjectiveTo observe the clinical efficacy and safety of Yuyin Lidan granules （YYLD） in preventing the recurrence of common bile duct stones （CBDS） in patients with liver and gallbladder dampness-heat syndrome following endoscopic retrograde cholangiopancreatography （ERCP）. MethodsThis randomized， parallel， controlled trial enrolled postoperative CBDS-ERCP patients who met the inclusion and exclusion criteria. Sixty-four patients were randomly assigned to an observation group or a control group， with 32 cases in each. Both groups received conventional Western medical treatment after ERCP， while the observation group additionally received YYLD for 8 weeks. The follow-up period lasted for 1 year. The efficacy indicators included bile bilirubin levels， traditional Chinese medicine （TCM） syndrome scores， clinical efficacy rate， pancreatitis and inflammation markers， postoperative liver function， and CBDS recurrence rate at 1-year follow-up， which were used to jointly evaluate the clinical efficacy and safety of both groups. ResultsA total of 56 patients completed the study and were included in the final analysis， i.e.， 29 in the observation group and 27 in the control group. Baseline characteristics were comparable between the two groups. Compared with pre-treatment and with the control group after treatment， the bile bilirubin level in the observation group significantly decreased （P<0.05）. After treatment， the clinical cure and marked improvement rates were higher in the observation group than in the control group， showing a statistically significant difference in overall clinical efficacy （P<0.05）. Compared with pre-treatment， the primary and secondary symptoms in the observation group， as well as the primary symptom and the secondary symptom of nausea and vomiting in the control group （weeks 4 and 8）， were significantly reduced （P<0.05）. Compared with the control group after treatment， the observation group showed significant reductions in the primary symptom of loose stools/constipation （day 5 and week 4） and in three secondary symptoms， i.e.， bitter taste and sticky dry mouth， abdominal distension and poor appetite （throughout the treatment period）， and general heaviness and fatigue （day 5 and week 4）， with statistical differences （P<0.05）. Compared with pre-treatment， both groups showed decreased lipase and urinary amylase levels （P<0.05）. However， no significant between-group differences were observed in pancreatitis or inflammation-related indices after treatment. Compared with pre-treatment， all liver function indicators in the observation group and alanine aminotransferase （ ALT ）， γ-glutamyl transferase （ γ-GT ）， alkaline phosphatase （ALP）， and conjugated bilirubin in the control group significantly decreased at weeks 4 and 8 （P<0.05）. Compared with the control group after treatment， only serum total bilirubin and unconjugated bilirubin were significantly reduced in the observation group during the treatment period （P<0.05）. ConclusionYYLD combined with conventional Western medical treatment can effectively regulate bilirubin metabolism （in bile and serum）， improve TCM clinical symptoms， and prevent CBDS recurrence after ERCP in patients with liver and gallbladder dampness-heat syndrome. This regimen is safe and effective and is worthy of further clinical research and promotion.

Barrett's esophagus(BE),a precancerous state of esophageal adenocarcinoma,poses a major challenge for prevention and treatment owing to its complex mechanism of inflammation-cancer transformation and the lack of effective clinical treatment and torsion strategies.Building upon the"preventing disease progression"theory,this study aimed to address the critical clinical challenge of intercepting the pathological progression during the inflammation-cancer transformation of BE by proposing an innovative"two critical nodes-three stages"pathomechanism framework.The pathogenesis of BE originates from liver depression and qi stagnation.The pathological progression evolves through two critical nodes:liver depression transforming into heat and heat transforming into blood stasis,representing a three-stage evolutionary pattern of qi stagnation,heat transformation,and blood stasis formation.Acidic bile salts,acting as a pathogenic toxin,permeate the entire process and catalyze carcinogenesis.Based on this understanding,the therapeutic principles of"treatment from the liver"and"truncation and torsion"were established,emphasizing stage-specific interventions.For the qi stagnation stage,treatment focuses on soothing the liver and regulating qi,as well as moistening,harmonizing,and descending the qi.This is achieved by combining modified Chaihu Shugan Powder with Xuanfu Daizhe Decoction,while using pungent and drying herbs cautiously and supplementing them with light and floral herbs.In the heat transformation stage,the strategy aims to clear the liver and drain heat while protecting yin and harmonizing the stomach,employing modified Huaganjian combined with Yiguanjian and supplemented with Jinlingzi Powder to clear depressed fire.For the blood stasis formation stage,treatment involves activating blood and resolving stasis,combined with supporting healthy qi and removing toxins.This is achieved using a modified Gexia Zhuyu Decoction,supplemented with Liujunzi Decoction,and additions such as Radix Salviae Miltiorrhizae and turtle carapace to disperse nodules and reduce masses.This theoretical framework establishes a diagnostic and therapeutic model characterized by the integration of disease mechanisms with pathology and the mutual reference of macro-level signs with micro-level indicators.It provides a comprehensive clinical practice pathway,complete with principles,methods,formulas,and herbs,for the stage-specific interception of inflammation-cancer transformation in BE using traditional Chinese medicine.

Objective To retrospectively analyze pathogen distribution,antimicrobial resistance,and their chan-ging trends in patients with infectious endophthalmitis admitted to a hospital in Xingtai area during the past 10 years.Methods Patients with infectious endophthalmitis and were detected pathogens admitted to Hebei Eye Hos-pital from January 2014 to December 2023 were selected for a retrospective study.Culture results and antimicrobial resistance of pathogens from patients with endophthalmitis were summarized and analyzed.The mutation character-istics of resistance genes and cassette chromosome recombinase genes in methicillin-resistant Staphylococcus epider-midis(MRSE)strains were explored.In vitro virulence between MRSE strains carrying mutant and non-mutant genes was compared using serum killing test.Results A total of 671 patients(671 eyes)with infectious endoph-thalmitis were included in the study,with 484 pathogenic strains(from 484 eyes)isolated.The average age of pa-tients was(65.66±25.14)years old.There were no statistically significant differences in the constituent rates of pathogens among infectious endophthalmitis patients of different genders and ages(both P＞0.05).Incidence of in-fectious endophthalmitis was higher in summer and lower in winter.Except 2018,there were statistically significant differences in the constituent rate of infectious endophthalmitis among different seasons from 2016 to 2023(all P＜0.05).A total of 176 strains of Staphylococcus epidermidis,81 strains of Streptococcus,and 48 strains of Pseudo-monas aeruginosa were isolated.The resistance rates of Staphylococcus epidermidis to penicillin,erythromycin,and oxacillin were all over 40％,with a resistance rate of 64.20％to penicillin.From 2019 to 2023,the resistance rates of Staphylococcus epidermidis to penicillin,erythromycin,oxacillin,compound sulfamethoxazole,and cipro-floxacin were all higher than those from 2014 to 2018,and the differences were all statistically significant(all P＜0.05).The resistance rates of Streptococcus to azithromycin,erythromycin,and clindamycin were all over 80％.The resistance rate of Pseudomonas aeruginosa to both ciprofloxacin and piperacillin exceeded 70％.Among the 113 MRSE strains,the resistance genes ermA,ermB,and ermC accounted for 12.39％(n=14),13.27％(n=15),and 74.34％(n=84),respectively.The cassette chromosome recombinase genes mainly included ccrA1-ccrB1,ccrA2-ccrB2,and ccrA3-ccrB3 types.Gene mutations were detected from all three types of resistance genes,with a mutation rate of 81.42％(92/113).The colony count of antimicrobial-resistant gene-mutated Staphylococcus epi-dermidis was higher than that of non-mutated strains in serum killing test at 2 and 3 hours(both P＜0.05).Conclusion The constituent rates of pathogens in infectious endophthalmitis remained stable over the 10 years,with the highest proportion in summer and the lowest in winter.The detection rate of antimicrobial-resistant pathogens presented rising tendency,and the resistance gene of MRSE was mainly ermC.Testing and monitoring of MRSE strains should be strengthened in clinic to prevent the cloning and spread of resistance genes.

Barrett's esophagus(BE),a precancerous state of esophageal adenocarcinoma,poses a major challenge for prevention and treatment owing to its complex mechanism of inflammation-cancer transformation and the lack of effective clinical treatment and torsion strategies.Building upon the"preventing disease progression"theory,this study aimed to address the critical clinical challenge of intercepting the pathological progression during the inflammation-cancer transformation of BE by proposing an innovative"two critical nodes-three stages"pathomechanism framework.The pathogenesis of BE originates from liver depression and qi stagnation.The pathological progression evolves through two critical nodes:liver depression transforming into heat and heat transforming into blood stasis,representing a three-stage evolutionary pattern of qi stagnation,heat transformation,and blood stasis formation.Acidic bile salts,acting as a pathogenic toxin,permeate the entire process and catalyze carcinogenesis.Based on this understanding,the therapeutic principles of"treatment from the liver"and"truncation and torsion"were established,emphasizing stage-specific interventions.For the qi stagnation stage,treatment focuses on soothing the liver and regulating qi,as well as moistening,harmonizing,and descending the qi.This is achieved by combining modified Chaihu Shugan Powder with Xuanfu Daizhe Decoction,while using pungent and drying herbs cautiously and supplementing them with light and floral herbs.In the heat transformation stage,the strategy aims to clear the liver and drain heat while protecting yin and harmonizing the stomach,employing modified Huaganjian combined with Yiguanjian and supplemented with Jinlingzi Powder to clear depressed fire.For the blood stasis formation stage,treatment involves activating blood and resolving stasis,combined with supporting healthy qi and removing toxins.This is achieved using a modified Gexia Zhuyu Decoction,supplemented with Liujunzi Decoction,and additions such as Radix Salviae Miltiorrhizae and turtle carapace to disperse nodules and reduce masses.This theoretical framework establishes a diagnostic and therapeutic model characterized by the integration of disease mechanisms with pathology and the mutual reference of macro-level signs with micro-level indicators.It provides a comprehensive clinical practice pathway,complete with principles,methods,formulas,and herbs,for the stage-specific interception of inflammation-cancer transformation in BE using traditional Chinese medicine.

Objective To retrospectively analyze pathogen distribution,antimicrobial resistance,and their chan-ging trends in patients with infectious endophthalmitis admitted to a hospital in Xingtai area during the past 10 years.Methods Patients with infectious endophthalmitis and were detected pathogens admitted to Hebei Eye Hos-pital from January 2014 to December 2023 were selected for a retrospective study.Culture results and antimicrobial resistance of pathogens from patients with endophthalmitis were summarized and analyzed.The mutation character-istics of resistance genes and cassette chromosome recombinase genes in methicillin-resistant Staphylococcus epider-midis(MRSE)strains were explored.In vitro virulence between MRSE strains carrying mutant and non-mutant genes was compared using serum killing test.Results A total of 671 patients(671 eyes)with infectious endoph-thalmitis were included in the study,with 484 pathogenic strains(from 484 eyes)isolated.The average age of pa-tients was(65.66±25.14)years old.There were no statistically significant differences in the constituent rates of pathogens among infectious endophthalmitis patients of different genders and ages(both P＞0.05).Incidence of in-fectious endophthalmitis was higher in summer and lower in winter.Except 2018,there were statistically significant differences in the constituent rate of infectious endophthalmitis among different seasons from 2016 to 2023(all P＜0.05).A total of 176 strains of Staphylococcus epidermidis,81 strains of Streptococcus,and 48 strains of Pseudo-monas aeruginosa were isolated.The resistance rates of Staphylococcus epidermidis to penicillin,erythromycin,and oxacillin were all over 40％,with a resistance rate of 64.20％to penicillin.From 2019 to 2023,the resistance rates of Staphylococcus epidermidis to penicillin,erythromycin,oxacillin,compound sulfamethoxazole,and cipro-floxacin were all higher than those from 2014 to 2018,and the differences were all statistically significant(all P＜0.05).The resistance rates of Streptococcus to azithromycin,erythromycin,and clindamycin were all over 80％.The resistance rate of Pseudomonas aeruginosa to both ciprofloxacin and piperacillin exceeded 70％.Among the 113 MRSE strains,the resistance genes ermA,ermB,and ermC accounted for 12.39％(n=14),13.27％(n=15),and 74.34％(n=84),respectively.The cassette chromosome recombinase genes mainly included ccrA1-ccrB1,ccrA2-ccrB2,and ccrA3-ccrB3 types.Gene mutations were detected from all three types of resistance genes,with a mutation rate of 81.42％(92/113).The colony count of antimicrobial-resistant gene-mutated Staphylococcus epi-dermidis was higher than that of non-mutated strains in serum killing test at 2 and 3 hours(both P＜0.05).Conclusion The constituent rates of pathogens in infectious endophthalmitis remained stable over the 10 years,with the highest proportion in summer and the lowest in winter.The detection rate of antimicrobial-resistant pathogens presented rising tendency,and the resistance gene of MRSE was mainly ermC.Testing and monitoring of MRSE strains should be strengthened in clinic to prevent the cloning and spread of resistance genes.

Objective To explore the optimal ratio of Baitong decoction based on efficacy,clarify its spectrum-effect relationship,and identify its potential quality markers.Methods An ulcerative colitis(UC)model in mice was established using dextran sulfate sodium.The efficacy of Baitong decoction with varying drug ratios was assessed by evaluating the apparent score,pathological score and inflammatory factor changes of UC in each group of experimental animals.The fingerprints of Baitong decoction with different ratios were established by high performance liquid chromatography(HPLC),and the relationship between the content of each substance and its efficacy was analyzed by partial least squares regression to determine the potential quality markers of Baitong decoction.Results Baitong decoction was most effective in relieving ulcerative colitis when the mass ratio of Fuzi,Ganjiang and Congbai was 1∶2∶2.The fingerprinting identified 14 common peaks across 7 ratios,with 9 peaks were found to be associated with the remission of ulcerative colitis by partial least squares regression analysis.Conclusion The optimal ratio of Fuzi,Ganjiang and Congbai for treating UC is 1∶2∶2.The spectrum-effect relationship analysis suggested that the quality markers of Baitong decoction may be the substances represented by peak 2(benzoylaconine),3,5,6,8(mesaconine),9(aconitine),10(hypaconitine),13(10-gingerol)and 14.

Objectives:This study aims to investigate the impact of different Low-Density Lipoprotein cholesterol(LDL-C)levels on progression of intermediate coronary stenosis,and the associated risk factors leading to the progression of such lesions. Methods:Data were collected on 219 consecutive patients admitted at the Fuwai Central China Vascular Hospital from January 2020 to February 2021,underwent angiographic examinations and diagnosed with intermediate coronary stenosis,with at least one follow-up angiography after 11 months.Offline quantitative flow ratio(QFR)analysis was performed on these cases.Patients were divided into two groups:LDL-C controlled group(LDL-C<1.8 mmol/L,148 patients with 191 vessels)and LDL-C uncontrolled group(LDL-C≥1.8 mmol/L,71 patients with 98 vessels).Coronary artery QFR and anatomical indicators such as minimal lumen diameter,minimal lumen area,percentage diameter stenosis,percentage area stenosis were compared within and between the groups.Further analysis was performed to identify influencing factors leading to changes in coronary physiological parameters derived from QFR. Results:Within the LDL-C controlled group,there was no significant difference in the QFR values of the vessels compared to baseline(P>0.05),whereas in the LDL-C uncontrolled group(P<0.05),a notable decline in QFR was observed.Patients in the LDL-C controlled group had lower rates of maximum diameter and area stenosis and higher minimum lumen diameter and area(all P<0.05).Through multifactorial Logistic regression analysis,it was found that a body mass index＞28 kg/m2,LDL-C≥1.8 mmol/L,and a history of myocardial infarction were independent risk factors leading to the decline in QFR(all P<0.05). Conclusions:It was found that patients in the LDL-C controlled group had higher coronary artery QFR,minimum lumen diameter and area,lower rates of maximum diameter and area stenosis.

Objective:To investigate the influence of varied oxygen (O 2) concentration environments on the phenotypic transformation of pulmonary artery smooth muscle cells (PASMC) and the mechanism of pulmonary hypertension. Methods:Primary rat PASMC were isolated and cultured through the process of enzymatic digestion. Following identification, the stable passaged PASMC were subjected to a 6-hour incubation in sealed containers with normal O 2 content (group C) and relative O 2 content comprising 55% (group H55), 75% (group H75), and 95% (group H95). mRNA and protein expression of α-Actin (α-SMA), smooth muscle 22α (SM22α), osteopontin (OPN), and matrix metalloproteinase-2 (MMP-2) were measured using real-time quantitative PCR and western blot analysis. Results:The H55 group displayed no significant difference from the C group in terms of mRNA and relative protein expression levels for α-SMA, SM22α, OPN, and MMP-2 (all P>0.05). On the other hand, groups H75 and H95 exhibited a reduction in mRNA and relative protein expression of α-SMA and SM22α, along with an increase in mRNA and relative protein expression of OPN and MMP-2 when compared with both the C and H55 groups (all P<0.05). The H95 group showed a higher relative mRNA expression of MMP-2 as compared to the H75 group ( P<0.05). Conclusions:Oxygen concentration environments of 75% or higher can serve as the foundation for the pathogenesis of pulmonary hypertension, essentially by inducing a phenotypic transformation in PASMC towards adopting a robust secretory function. This induction is contingent upon the concentration of oxygen present.

With the performance improvement of the medical electronics and the progress of social development,the utilization rate of implantable medical electronic devices in China shows an increasing trend in recent years,and will maintain a growing trend in the future as population aging is accelerating.Even though implantable medical electronic devices have extremely low failure rates,the explicit clinical accidents caused by their reliability issues deserve sufficient attention in consideration of the large quantity of patients.Compared with other countries,there is lack of domestic researches on application risk of implantable medical electronic devices due to radiation therapy and diagnosis,which is reflected in not only the clinical research,but also the researches on the underlying physical damage mechanism and macro performance of the devices.Therefore,it is crucial and urgent to explore the application risk of implantable medical electronic devices caused by radiation therapy and diagnosis,which has high clinical and scientific significance.The study conducts a literature survey on the risks of medical electronic devices in the radiation environment generated by clinical treatment,summarizes the risks encountered in the aspects of total dose effect,electromagnetic compatibility and instantaneous effect,analyzes the above behaviors from the physical mechanism and perspective,and puts forward some meaningful suggestions for medical electronic engineering and clinical treatment.

With the performance improvement of the medical electronics and the progress of social development,the utilization rate of implantable medical electronic devices in China shows an increasing trend in recent years,and will maintain a growing trend in the future as population aging is accelerating.Even though implantable medical electronic devices have extremely low failure rates,the explicit clinical accidents caused by their reliability issues deserve sufficient attention in consideration of the large quantity of patients.Compared with other countries,there is lack of domestic researches on application risk of implantable medical electronic devices due to radiation therapy and diagnosis,which is reflected in not only the clinical research,but also the researches on the underlying physical damage mechanism and macro performance of the devices.Therefore,it is crucial and urgent to explore the application risk of implantable medical electronic devices caused by radiation therapy and diagnosis,which has high clinical and scientific significance.The study conducts a literature survey on the risks of medical electronic devices in the radiation environment generated by clinical treatment,summarizes the risks encountered in the aspects of total dose effect,electromagnetic compatibility and instantaneous effect,analyzes the above behaviors from the physical mechanism and perspective,and puts forward some meaningful suggestions for medical electronic engineering and clinical treatment.