ObjectiveBased on modern analytical techniques and a depressed mouse model established by chronic unpredictable mild stress（CUMS）， to evaluate the quality marker（Q-Marker） and pharmacodynamic difference of Baihe Dihuangtang prepared by different processes. MethodsHigh performance liquid chromatography（HPLC） was used to establish the characteristic profiles of Baihe Dihuangtang， and determine the content of Q-Marker in the samples prepared by ancient and modern processes. Seventy C57BL/6J mice were randomly divided into the normal group， model group， fluoxetine group（3 mg·kg^-1）， low and high dose groups of ancient process（6.5， 26 g·kg^-1）， and low and high dose groups of modern process（6.5， 26 g·kg^-1）， with 10 mice in each group. Except for the normal group， CUMS was used to induce depression in mice from the other groups for 28 d. After successful modeling， administration groups were given the corresponding drugs by gavage every day， and the normal and model groups were given an equal volume of pure water by gavage for 21 consecutive days. Change in body mass of mice was recorded， tail suspension test and open field test were used to evaluate the depressive behavior of mice， and enzyme-linked immunosorbent assay（ELISA） was employed to determine the contents of tumor necrosis factor-α（TNF-α）， interleukin（IL）-1β and IL-6 in serum. ResultsCharacteristic profiles of Baihe Dihuangtang prepared by the two processes were established， the similarity between the two was 0.951， and 8 characteristic peaks were recognized with the reference peak of regaloside A. The results of quantitative analysis showed that the Q-Marker content was similar in Baihe Dihuangtang prepared by ancient and modern processes. The results of pharmacodynamics showed that， compared with the normal group， the model group showed increased immobility time in the tail suspension test， reduced total movement distance in the open field test， and elevated IL-1β， IL-6 and TNF-α levels in the serum（P<0.01）. Compared with the model group， the behavioral indicators of mice in the Baihe Dihuangtang treatment group were significantly improved in terms of tail suspension time and open field exercise， and the levels of IL-1β， IL-6 and TNF-α in serum were significantly reduced（P<0.05， P<0.01）. Baihe Dihuangtang prepared by the two processes both had antidepressant effects， and the difference between the two was not statistically significant in improving depressive symptoms. ConclusionQ-Marker of Baihe Dihuangtang prepared by modern and ancient methods are equivalent in content， and the pharmacological effects are consistent， indicating that dried Lilii Bulbus can replace fresh products in the preparation of Baihe Dihuangtang. This study provides a scientific basis for the development of new drugs of Baihe Dihuangtang and a reference for its rational application and clinical use.

ObjectiveBased on modern analytical techniques and a depressed mouse model established by chronic unpredictable mild stress（CUMS）， to evaluate the quality marker（Q-Marker） and pharmacodynamic difference of Baihe Dihuangtang prepared by different processes. MethodsHigh performance liquid chromatography（HPLC） was used to establish the characteristic profiles of Baihe Dihuangtang， and determine the content of Q-Marker in the samples prepared by ancient and modern processes. Seventy C57BL/6J mice were randomly divided into the normal group， model group， fluoxetine group（3 mg·kg^-1）， low and high dose groups of ancient process（6.5， 26 g·kg^-1）， and low and high dose groups of modern process（6.5， 26 g·kg^-1）， with 10 mice in each group. Except for the normal group， CUMS was used to induce depression in mice from the other groups for 28 d. After successful modeling， administration groups were given the corresponding drugs by gavage every day， and the normal and model groups were given an equal volume of pure water by gavage for 21 consecutive days. Change in body mass of mice was recorded， tail suspension test and open field test were used to evaluate the depressive behavior of mice， and enzyme-linked immunosorbent assay（ELISA） was employed to determine the contents of tumor necrosis factor-α（TNF-α）， interleukin（IL）-1β and IL-6 in serum. ResultsCharacteristic profiles of Baihe Dihuangtang prepared by the two processes were established， the similarity between the two was 0.951， and 8 characteristic peaks were recognized with the reference peak of regaloside A. The results of quantitative analysis showed that the Q-Marker content was similar in Baihe Dihuangtang prepared by ancient and modern processes. The results of pharmacodynamics showed that， compared with the normal group， the model group showed increased immobility time in the tail suspension test， reduced total movement distance in the open field test， and elevated IL-1β， IL-6 and TNF-α levels in the serum（P<0.01）. Compared with the model group， the behavioral indicators of mice in the Baihe Dihuangtang treatment group were significantly improved in terms of tail suspension time and open field exercise， and the levels of IL-1β， IL-6 and TNF-α in serum were significantly reduced（P<0.05， P<0.01）. Baihe Dihuangtang prepared by the two processes both had antidepressant effects， and the difference between the two was not statistically significant in improving depressive symptoms. ConclusionQ-Marker of Baihe Dihuangtang prepared by modern and ancient methods are equivalent in content， and the pharmacological effects are consistent， indicating that dried Lilii Bulbus can replace fresh products in the preparation of Baihe Dihuangtang. This study provides a scientific basis for the development of new drugs of Baihe Dihuangtang and a reference for its rational application and clinical use.

Objective To analyze the clinical efficacy of transcatheter tricuspid valve replacement (TTVR) in cardiac implantable electronic lead-related tricuspid regurgitation (TR). Methods The patients with severe TR who underwent LuX-Valve TTVR in 9 Chinese medical centers from June 2020 to August 2021 were retrospectively enrolled. They were divided into a cardiac implantable electronic device (CIED) group and a non-CIED group based on whether they had pre-existing CIED implantation. Success of the procedure was defined as safe implantation of the LuX-Valve and complete withdrawal of the delivery system. Prognostic improvement was defined as a decrease of TR grade to≤2+ and an improvement of cardiac function by≥2 grades. Surgical success and postoperative prognosis were compared between the two groups. Results A total of 190 patients were collected, including 50 males and 140 females with a mean age of 66.2±7.8 years. There were 29 patients in the CIED group, and 161 patients in the non-CIED group. In the CIED group, 28 patients were implanted with a permanent pacemaker and 1 patient with a cardioverter-defibrillator. Preoperative New York Heart Association (NYHA) cardiac function class, TR degree, left ventricular ejection fraction, tricuspid annular plane systolic excusion, and cardiac risk scores were comparable between the two groups (P>0.05). Postoperative TR was reduced to≤2+ in all patients, and there was no statistical difference in the incidence of perivalvular leakage between the two groups (P=0.270). Postoperative CT of CIED patients showed the valve was in place, and the lead was not extruded, twisted, or deflected. The in-hospital mortality of the two groups were 10.3% and 1.9%, respectively, and the difference was statistically significant (P=0.047). In addition, there was no statistical difference between the two groups in terms of postoperative improvement of cardiac function and mortality in the 1- and 2-year follow-up. Conclusion TTVR is feasible, safe, and effective in patients with CIED implantation, and the pre-existing lead has no significant effect on the clinical efficacy.

Baihe Dihuangtang is a famous classical formula that has been respected by physicians in the past and is still used today. It was first recorded in ZHANG Zhongjing's Synopsis of the Golden Chamber， and is composed of Lilii Bulbus and Rehmanniae Radix juice. This paper systematically reviewed the research progress of historical evolution， pharmacological activities and clinical applications of Baihe Dihuangtang in recent years， and found that there was no major changes in the composition， decoction method and indications of this formula since the Han dynasty. According to the herbal textual research， the fleshy scaly leaves of Lilium brownii var. viridulum should be selected for Lilii Bulbus in this formula， and the tuberous roots of Rehmannia glutinosa were selected for Rehmanniae Radix. According to the dosage conversion of ancient and modern times， the dosage is 245 g of fresh Lilii Bulbus and 400 g of fresh Rehmanniae Radix， and the ratio of their juice is 1∶1. Its efficacy is to nourish Yin and clear heat， and to tonify the heart and lungs， which is used to treat the heart and lung Yin deficiency syndrome of lily disease. Modern pharmacological studies have shown that the research on the pharmacological effects of Baihe Dihuangtang mainly focuses on anti-depressant， anti-anxiety， improving insomnia and regulating metabolism， and it is mostly used clinically for neurological disorders such as depression， anxiety and insomnia. The quality marker（Q-Marker） of Baihe Dihuangtang were predicted according to the principles of ingredient specificity， component validity， component measurability， formula compatibility， and quality transmissibility and traceability， and it was determined that catalpol， rhmannioside D， regaloside A， regaloside B， regaloside C， and acteoside could be selected as potential Q-Markers of Baihe Dihuangtang， which could provide scientific reference for the establishment of the quality control system and the development of compound preparation of this famous classical formula.

Objective To compare the predictive value of controlling nutritional status score(CO-NUT),prognostic nutritional index(PNI)and prognostic inflammation and nutritional index(PINI)for se-vere stroke complicating lung infection(SCLI),and to analyze the risk factors for severe SCLI occurrence.Methods A retrospective analysis on the clinical data of 98 cases of severe stroke firstly visited and treated in the nervous intensive care unit(NICU)of this hospital from August 2022 to August 2023 was performed.The patients were divided into the SCLI group and non-SCLI group according to whether or not SCLI occurring during the hospitalization.Logistic regression was used to analyze the independent risk factors influencing se-vere SCLI.The sensitivity,specificity,Youden index and Kappa value of the three tools in predicting severe SCLI were calculated,and the area under the receiver operating characteristic(ROC)curve(AUC)was plot-ted.Results Among 98 cases,there were 35 cases(35.71％)of SCLI occurrence during hospitalization.The multivariate logistic regression analysis results showed that the mechanical ventilation use(OR=1.33,95％CI:1.06-2.76),nasogastric tube use(OR=1.42,95％CI:1.25-2.68),high CONUT(OR=2.74),95％CI:2.02-3.69),low PNI(OR=0.70,95％CI:0.51-0.96)and low PINI(OR=2.51,95％CI:1.78-3.62)were the independent risk factors for severe SCLI(P＜0.05).AUC of the ROC curve of CONUT,PNI and PINI for predicting SCLI was 0.729,0.723 and 0.697 respectively.The sensitivity was 0.707,0.685 and 0.631,and the specificity was 0.872,0.764 and 0.712,respectively.The Youden index was 0.579,0.449 and 0.343 respectively,and the Kappa value was 0.621,0.534 and 0.432 respectively.Conclusion CONUT,PNI and PINI all are correlated with the SCLI risk.CONUT has the highest predictive value for SCLI.

Objective To systematically evaluate the incidence rate of low-level viremia(LLV)in chronic hepatitis B(CHB)patients and related influencing factors,and to provide evidence-based medicine evidence for effective intervention and prevention of LLV in clinical practice.Methods This study was conducted according to the PRISMA guideline,with a PROSPERO registration number of CRD42023455304.CNKI,Wanfang Data,VIP,SinoMed,PubMed,Embase,Web of Science,and the Cochrane library were searched for observational studies on LLV and related influencing factors in CHB patients published up to July 21,2023.Stata 16.0 software was used to perform the meta-analysis.Results A total of 12 articles were included,with a total sample size of 3408 cases,among whom there were 1181 patients with LLV.The meta-analysis showed that the incidence rate of LLV was 32.8%(95%confidence interval[CI]:27.6%—38.3%)in treatment-experienced CHB patients.High HBsAg quantification(odds ratio[OR]=2.107,95%CI:1.782—2.491,P<0.001),positive HBeAg(OR=3.258,95%CI:2.629—4.038,P<0.001),high HBV DNA level at baseline(OR=1.286,95%CI:1.157—1.430,P<0.001),and history of entecavir treatment(OR=3.089,95%CI:1.880—5.074,P<0.001)were risk factors for LLV;duration of antiviral therapy≥3 years(OR=0.175,95%CI:0.093—0.331,P<0.001)and high alanine aminotransferase level at baseline(OR=0.985,95%CI:0.978—0.992,P<0.001)were protective factors against LLV.The sensitivity analysis showed no significant change in effective value,suggesting that the results of the meta-analysis were relatively stable.The funnel plot of the studies included was basically symmetrical,and the results of the Egger's test and the Begg's test suggested that there was no obvious publication bias in the articles included.Conclusion Clinicians should guide decision making based on the influencing factors for LLV and related clinical evidence,so as to reduce long-term clinical risks and avoid adverse outcomes.

Objection:To evaluate the effects of the miniscrew supported removable palatal arch for maxillary molar distalization.Methods:33 patients with mild to moderate crowding teeth and maxillary protrusion were treated with the miniscrew supported remova-ble palatal arch.The lateral cephalograms and dental plaster models were taken at the beginning of the treatment(T0)and at the end of molar distalization(T1).The multicentre variables were measured and compared with statistical software.Results:Cephalometrics showed that the average distance(mm)of the firs molar distalization was 3.6(P＜0.001),molar distal tipping was 6°(P＜0.001)and molar intrusion(mm)was 0.6(P＜0.05).The measurements of right and left molar distalization on plaster models were 4.2 mm(P＜0.001)and 4.0 mm(P＜0.001)respectively,the width of dental arch was increased by 3.1 mm(P＜0.05).The data of distalization of the first molar showed no statistical difference between right and left side on plaster cast and between model and cephalometric meas-urements.On the right side the angle between the mesial-distal tips line and the middle line was increased by 1.6°(P＞0.05),on the left by 4.8°(P＜0.05).Conclusion:The none extraction therapy for mild to moderate crowding teeth and maxillary protrusion can be realized by miniscrew supported removable palatal arch distalization appliance.

In order to understand the prevalence of Akabane disease(AKAD)in Guizhou Province and the molecular characteristics of the isolates,the whole-genome sequence of a strain of Akabane virus(AKAV)from a bovine AKAD-positive sample was determined and analyzed.The genotype and genetic variation of the strain were also explored.Based on the conserved S sequence,a fluores-cence quantitative PCR(qPCR)detection method was established and applied for the investigation of AKAV infection status in four large-scale beef cattle farms of Guizhou.Results showed that the S,M and L fragments of the bovine strain were highly homologous to the Tianjin strain(TJ2016/China/2016)and the Australian strain(JaLAB39/Australia/1959),where they were in the same evolutionary branch and belonged to genotype Ⅱ.Sensitivity assay found that the lowest detection limit was 2.5 X 101 copies/μL.Specificity assay showed the established method detected only AKAV with no amplification on bovine bluetongue virus(BLUV),Pasteurella multocida(PM),bovine infectious rhinotracheitis virus(IBRV)and bovine Mycoplasma bovis.The variation coefficients of inter-and intra batches in the repeatability test were both lower than 2.26％.These findings illus-trated that the established qPCR method had high sensitivity,good specificity and repeatability.A total of 298 serum samples from 4 large-scale beef cattle farms in Qianxi City and Huangping County of Guizhou Province were collected and tested for AKAV by the method.Out of 298 sam-ples,25 positive samples(25/298)were detected as positive with a positive rate of 8.39％.In sum-mary,this work provided the reference data for a deep understanding of the molecular prevalence of AKAV in Guizhou Province and laid foundation for the prevention and control of AKAD.

Objective To investigate the predictive value of a decision tree-based machine learning model for prognosis in acute paraquat(PQ)poisoning(APP)patients.Methods A retrospective study was conducted.The clinical data of APP patients from Cangzhou Central Hospital between May 2012 and August 2021 were collected,including gender,age,time from ingestion to gastric lavage,proportion of hemoperfusion,serum PQ concentration,biochemical indicators[white blood cell count(WBC),alanine aminotransferase(ALT),serum creatinine(SCr),serum amylase,and serum potassium],and blood gas indicators[arterial blood lactic acid(Lac),base excess(BE),and arterial partial pressure of oxygen(PaO2)].Patients were divided into a survival group(n = 56)and a death group(n = 74)based on 90-day prognosis,and the clinical data between the two groups were compared.The multivariate Logistic regression analysis was conducted to analyze the risk factors of prognosis in APP patients,and two decision tree models(i.e.,with/without serum PQ concentration)were constructed based on the risk factors.The predictive value was evaluated by the receiver operator characteristic(ROC)curve,and the area under the ROC curve(AUC)of two decision tree models was compared by Hanley&McNeil method.Results The 90-day survival rate of the patients was 43.1%(56/130).Compared with death group,patients in the survival group had lower WBC[×109/L:8.9(7.0,11.6)vs.17.4(11.9,23.1)],ALT[U/L:25.3(21.2,31.8)vs.29.3(23.2,40.3)],SCr[μmol/L:64.0(53.0,74.0)vs.91.0(72.5,141.5)],Lac[mmol/L:2.5(1.4,4.0)vs.7.1(3.7,11.0)],and serum PQ concentration[ng/L:0.3(0.1,0.9)vs.2.9(1.9,8.1)],the difference were statistically significant(all P<0.05),higher BE[mmol/L:-2.5(-4.2,-1.1)vs.-7.2(-10.9,-4.7)]and serum potassium[mmol/L:3.7(3.5,4.0)vs.3.2(2.8,3.7)],the difference were statistically significant(all P<0.05),and patients were younger[years:33.5(26.0,47.8)vs.42.5(26.0,58.0),P<0.05].Univariate Logistic regression analysis showed that age,WBC,ALT,SCr,serum potassium,Lac,BE and serum PQ concentration were independent risk factors of 90-day survival[odds ratio(OR)and 95%confidence interval(95%CI)were 1.03(1.01-1.05),1.30(1.18-1.44),1.04(1.01-1.07),1.02(1.01-1.04),7.59(3.25-17.70),1.64(1.35-1.99),1.51(1.29-1.76),7.00(3.41-14.37),P values were 0.018,<0.001,0.011,<0.001,<0.001,<0.001,<0.001,<0.001].Multivariate Logistic regression analysis with serum PQ concentration showed that WBC,serum potassium,and serum PQ concentration were independent risk factors for 90-day survival[OR and 95%CI were 1.17(1.03-1.33),7.29(1.66-32.01),5.49(2.48-12.13),P values were 0.014,0.008,<0.001].Multivariate Logistic regression analysis without serum PQ concentration showed that age,WBC,serum potassium and BE were independent risk factors for 90-day survival[OR and 95%CI were 1.05(1.01-1.08),1.20(1.07-1.34),3.12(1.01-9.66),1.41(1.16-1.72),P values were 0.008,0.002,0.049,0.001].The decision tree model based on serum PQ concentration and serum potassium showed an AUC of 0.94(95%CI was 0.89-0.98),along with 91.9%sensitivity,89.3%specificity,and 90.0%accuracy.The decision tree model based on WBC,BE,and age showed an AUC of 0.89(95%CI was 0.84-0.95),with 86.5%sensitivity,91.1%specificity,and 88.5%accuracy.Pairwise comparison of the AUC using Hanley&McNeil method demonstrated that no statistical difference between the two decision tree models(Z = 1.34,P = 0.180).Conclusion The decision tree-based models can provide quantitative and intuitive prediction tools for the early detection of prognosis in APP patients in clinical practice.

The introduction of " Cardiovascular-Kidney-Metabolic" syndrome highlights the importance of prioritizing the prevention and treatment of cardio-renal-vascular complications early in diabetes diagnosis. However, it raises the question of whether reclassifying diseases with defined cause and established treatment into a broad 'syndrome’ with an unclear cause improves disease nomenclature. It would be prudent for the relevant authorities to provide clarification on the terminology used.