Guided by the theory of latent pathogens， it is believed that the basic pathogenesis of adult-onset Still's disease is the latent pathogens in the deep yin level. The onset of the disease is fundamentally characterized by the deficiency of both qi and yin as the root， with dampness， heat， phlegm， and blood stasis as the branch， which triggered by intruding pathogens activate the latent pathogens in yin level. The treatment focuses on nourishing yin and dispersing heat as the key therapeutic method. It is proposed that clearing and resolving dampness-heat， expelling pathogens outward， dispersing the latent pathogens， reinforcing healthy qi and consolidating the root， boosting qi and nourishing yin as treatment idea. In clinic， Qinghao Biejia Decoction （青蒿鳖甲汤） could be used as the basic formula， and modified with characteristic herb pairs such as Qinghao （Artemisia annua） - Digupi （Lycium chinense） to enrich yin and clear heat， and enforce the power of clearing deficient heat； Biejia （Lawsonia inermis） - Xuchangqing （Vincetoxicum mukdenense） to enrich yin and activate blood， unblock the collaterals and dissipate masses； Duhuo （Angelica biserrata） - Mudanpi （Paeonia × suffruticosa） to dispel wind and activate blood， resolve dampness and unblock the collaterals， so as to clear and warm simultaneously， and regulate qi and blood at the same time； and Chuanshanlong （Dioscorea nipponica） - Difuzi （Bassia scoparia） to dissolve stasis and dispel phlegm， explore and dispel latent pathogens.

Objective This study aims to conduct a comprehensive analysis of the domestic and international standards for prefilled syringes to advance the scientific and international alignment of China's PFS standard system.Methods A thorough review of the framework,scope,and quality control key points of the 2015 national pharmaceutical packaging material standards(abbreviated as YBB standards),the ISO 11040 international standard system and the United States Pharmacopeia standard system was conducted.Comparative analysis was employed to reveal the similarities and differences among the three,thereby uncovering the unique characteristics of each.Results The YBB standards emphasize quality control for prefilled syringes,offering clear and operational guidelines that provide companies with precise directives for production and testing.However,the scope of these standards is relatively limited.ISO standards apply to a wide range of products,featuring comprehensive coverage and a degree of flexibility.They emphasize the universality of products and compatibility with other international standards,which facilitates global production and trade.USP includes several chapters related to prefilled syringes but lacks a certain level of specificity and systematic approach.Conclusion By thoroughly studying and drawing upon the quality control philosophies,standard frameworks,and key control points of prefilled syringes from both domestic and international standards,we aim to provide valuable references for the development of a robust prefilled syringe standard system within the Chinese Pharmacopoeia.

The significance of the retinal neurovascular unit(NVU)in glaucoma has been established,and it holds po-tential as an effective therapeutic target for neurodegenerative disorders such as glaucoma in the future.NVUs are a cell community composed of neurons,glial cells,and vascular cells,and they engage in the physiological and pathological inter-actions between retinal neurovasculature through neurovascular coupling(NVC).As a representative neurodegenerative disorder of the retina,glaucoma is closely associated with retinal microvasculature and glial cells,rendering the normal functioning of the NVU particularly crucial.In this paper,the structural foundation of the NVU was reviewed,including the leading and coordinating roles of retinal neurons and glial cells in the NVU,and the role of NVCs in regulating retinal blood flow,metabolism,and the clearance of toxic substances.Furthermore,the associations of the components of the NVU and their functional abnormalities with glaucoma were elucidated.This paper will deepen the understanding of the mechanisms of glaucoma from a neurovascular perspective,and provide new preventive directions or therapeutic targets for neuropro-tection in glaucoma.

Objective To explore the effects of aberrant O-glycosylation modifications induced by the knockout of Cosmc or T-synthase genes on the expression profiles of miRNAs in exosomes derived from colorectal cancer cells and to reveal the molecular mechanisms of O-glycosylation in the development of colorectal cancer and identify potential biomarkers for early diagnosis and treatment.Methods This research specifically targets the Cosmc or T-synthase genes in the human colorectal cancer cell line HCT116 to create stable cell lines exhibiting abnormal O-glycosylation with CRISPR/Cas-9 gene editing technology.Exosomes originating from these colorectal cancer cells were isolated and authenticated.A microarray chip equipped with primer sequences for 16 miRNAs closely associated with colorectal cancer was employed to assess the differential expression of miRNAs within these exosomes with fluorescent quantitative polymerase chain reaction(PCR).And then,a cohort of miRNAs that exhibited significant and consistent changes in expression levels across the exosomes from both cell lines was selected.These miRNAs were further validated independently with traditional fluorescent quantitative PCR.Subsequently,data from The Cancer Genome Atlas Program(TCGA)database containing patient information on colorectal cancer was harnessed.Employing R programming language,Gene Set Enrichment Analysis(GSEA)was conducted on the upregulated miRNA to investigate the downstream pathways significantly impacted and the malignant biological behaviors they may influence.Results The absence of either Cosmc or T-synthase genes results in the dysregulation of O-glycosylation in colorectal cancer cells,leading to the exposure of Tn antigens.This,in turn,affects the expression levels of specific miRNAs in exosomes derived from these cells.Specifically,the expression of hsa-miR-125b-1-3p was downregulated,while that of hsa-miR-218-5p was upregulated.Notably,hsa-miR-218-5p were found to be closely associated with the epithelial-mesenchymal transition(EMT)process in tumor cells,which is a key mechanism in cancer progression.Conclusion It elucidates that the aberrant O-glycosylation mediated by the knockout of Cosmc or T-synthase genes significantly influences the expression of certain miRNAs in exosomes from colorectal cancer cells,potentially affect the EMT process in colorectal cancer and thereby promoting distant metastasis.Given the inherent stability and detectability advantages of colorectal cancer-derived exosomes,the altered expression levels of miRNAs within these exosomes may serve as indicators of the stated of abnormal O-glycosylation in colorectal cancer.These findings suggest that exosomal miRNAs have potential as biomarkers for monitoring disease progression and therapeutic efficacy.Consequently,this could pave the way for more personalized diagnostic and treatment strategies tailored to individual colorectal cancer patients,enhancing the precision and effectiveness of clinical management.

Objective To evaluate the influencing factors of aspiration in neurological critically ill patients by Meta-analysis.Methods PubMed,Embase,Web of Science,CNKI,and Wanfang Data were searched from inception to 1 October,2023,to obtain relevant studies on influencing fac-tors of aspiration in neurological critically ill patients.The literature screening,data extraction and quality evaluation were completed by two researchers.RevMan 5.4 and Stata 13.0 software were ap-plied for pooled Meta-analysisand assessed publication bias,respectively.Results A total of 8 arti-cles,including 1,315 neurocritical care patients,were included in this study.Nine influencing factors related to aspiration were extracted for Meta-analysis.The Meta-analysis results showed that the three influencing factors that caused aspiration in neurocritical care patients were stroke history(OR=5.03,95％CI,2.71 to 9.32,P＜0.000 01),National Institutes of Health Stroke Scale(NIHSS)score＞10(OR=3.35,95％CI,1.75 to 6.42,P=0.000 3),and gastric residual volume＞150mL(OR=7.13,95％CI,2.55 to 9.96,P=0.001).Conclusion This study provides a scientific basis for clinical healthcare professionals to early identify high-risk patients for aspiration,take targeted inter-vention measures,and prevent the occurrence of aspiration.

Objective To explore the influencing factors of cognitive impairment in non-dialysis patients with chronic kidney disease(CKD).Methods A total of 60 hospitalized non-dialysis patients with CKD in the Department of Nephrology of Northern Jiangsu People's Hospital Affiliated to Yangzhou University from September 2022 to September 2023 were enrolled as research objects.According to the estimated glomerular filtration rate(eGFR),they were divided into stage 1 to 2 of CKD group[eGFR ≥60 mL/(min·1.73 m2)]with 23 cases,the stage 3 of CKD group[eGFR 30～＜60 mL/(min·1.73 m2)]with 20 cases,and stage 4 to 5 of CKD group[eGFR＜30 mL/(min·1.73 m2)]with 17 cases.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate the cognitive function of the patients.Basic data and common clinical laboratory in-dicators on hospital admission were collected to analyze the differences in cognitive function levels under different renal function statuses and to explore the influencing factors of cognitive impairment.Results The incidence rates of cognitive impairment in the stage 1 to 2 of CKD group,stage 3 of CKD group,and stage 4 to 5 of CKD group were 47.8％,85.0％,and 94.1％respectively,the median MoCA scored 26,24 and 20 respectively,with statistically significant between-group differ-ences(P＜0.05).Cognitive function was significantly negatively correlated with age(r=-0.634,P＜0.001),blood urea nitrogen(BUN)(r=-0.574,P＜0.001),serum creatinine(Cr)(r=-0.417,P＜0.001),cystatin C(Cys-C)(r=-0.327,P=0.011),serum β2-microglobulin(β2-MG)(r=-0.259,P=0.046),and N-terminal pro-brain natriuretic peptide(NT-proBNP)(r=-0.474,P＜0.001),and was significantly positively correlated with hemoglobin(HB)(r=0.401,P=0.001)and eGFR(r=0.485,P＜0.001).Multivariate Logistic regression analysis showed that age(P=0.006)and NT-proBNP(P=0.041)were influencing factors of cognitive im-pairment in non-dialysis patients with CKD.Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC),sensitivity,and specificity of age for prediction were 0.860,0.864 and 0.812 respectively,the AUC,sensitivity,and specificity of NT-proBNP for pre-diction were 0.808,0.795 and 0.875 respectively,and the combined prediction of age and NT-proBNP had an AUC,sensitivity,and specificity of 0.893,0.955,and 0.750,respectively.Conclusion As renal function deteriorates,the incidence rate and severity of cognitive impairment in non-dialysis patients with CKD tend to increase.Advanced age,renal function deterioration,high NT-proBNP level,and anemia are associated with the occurrence of cognitive impairment in non-di-alysis patients with CKD,among which age and NT-proBNP are influencing factors for cognitive im-pairment.

Objective To evaluate the predictive value of different anthropometric indices in as-sessing body fat content in patients with chronic kidney disease(CKD).Methods Bioelectrical im-pedance analysis was used to measure body fat percentage and visceral fat area in 279 non-dialysis CKD patients.Height and body mass were measured to calculate body mass index(BMI).Waist and hip circumferences were measured to calculate waist-to-hip ratio.Skinfold thickness(triceps skinfold thickness and subscapular skinfold thickness)was also measured.Pearson correlation analysis was employed to explore the correlations between anthropometric indices and body fat percentage as well as visceral fat area.Receiver operating characteristic(ROC)curves were plotted,and the DeLong test was conducted to compare the differences in the area under the curve(AUC)of the ROC curves.Results Pearson correlation analysis revealed significant correlations between body fat percentage and BMI(r=0.419,P＜0.001),hip circumference(r=0.450,P＜0.001),triceps skinfold thickness(r=0.229,P＜0.001),and subscapular skinfold thickness(r=0.324,P＜0.001).Significant correlations were also observed between visceral fat area and BMI(r=0.658,P＜0.001),hip circumference(r=0.648,P＜0.001),triceps skinfold thickness(r=0.194,P=0.001),and subscapular skinfold thickness(r=0.333,P＜0.001).ROC curve analysis demonstrated that the triceps skinfold thickness had the largest AUC value(0.732)for diagnosing obesity in CKD patients,with a sensitivity of 62.1％and specificity of 78.8％,indicating a moderate diagnostic performance.BMI and hip circumference had AUC values of 0.806 and 0.804,respectively,for as-sessing visceral obesity in CKD patients,showing good diagnostic performance.In contrast,the waist-to-hip ratio exhibited poor diagnostic value for both overall obesity and visceral obesity.Conclusion Measuring BMI and hip circumference is valuable for diagnosing visceral fat accumula-tion in CKD patients.However,when assessing overall obesity in CKD patients,multiple anthropo-metric indices should be combined for comprehensive evaluation.Additionally,our results indicate that different anthropometric indices have varying diagnostic values for different types of obesity,ne-cessitating appropriate selection based on actual circumstances.

Objective To observe the therapeutic effect of a patented disposable detachable soft injection probe(DDSI probe)for mucosal suturing of the internal orifice in the treatment of high simple anal fistula.Methods From January 2020 to December 2023,12 cases of high simple anal fistula were selected.The DDSI probe was used to accurately locate the internal orifice of the anal fistula.The fistula tract was excised,and the mucosa of the internal orifice was sutured.The time for internal orifice exploration during surgery,Visual Analogue Scale(VAS)scores for pain at 1,3,and 7 d postoperatively,Wexner incontinence scores at 1 month postoperatively,and recurrence rate at 12 months postoperatively were observed.Results The time for internal orifice exploration ranged 2-5 min,with an average of 3.2 min.On postoperative day 1,the VAS scores were 0 in 2 cases,1 in 4 cases,2 in 5 cases,and 3 in 1 case.On postoperative day 3,the VAS scores were 0 in 2 cases,1 in 9 cases,and 2 in 1 case.On postoperative day 7,the VAS scores were 0 in 9 cases and 1 in 3 cases.At 1 month postoperatively,the Wexner incontinence scores were 0 in 10 cases and 1 in 2 cases.Eleven cases were cured,and 1 case recurred(diagnosed at 12 months after surgery).Conclusion The DDSI probe for internal orifice exploration,combined with fistula tract excision and mucosal suturing of the internal orifice,shows satisfactory therapeutic effects in the treatment of high simple anal fistula.

Objective:To study the distribution characteristics of current patients with Kashin-Beck disease (KBD) in Molidawa Daur Autonomous Banner (referred to as Morin Banner), and provide suggestions for service management.Methods:Information of KBD current patients in Morin Banner was collected from January 1, 2018 to June 30, 2024 using the "KBD Current Patient Survey System" provided by the Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention. A descriptive study method was used to analyze the basic information and clinical data of current patients.Results:As of June 30, 2024, a total of 6 223 KBD current patients were reported in Morin Banner, and the patients were distributed in 15 townships (towns). There was a statistically significant difference in the prevalence rate of KBD among different townships (towns, χ 2 = 3 069.01, P < 0.001). The minimum age of the KBD current patients was 27 years old, and the maximum was 98 years old, mainly concentrated in the age range of 45 - 74 years old, accounting for 95.7% (5 954/6 223). There was a significant difference in the prevalence rate of KBD among different age groups (χ 2 = 5 912.76, P < 0.001). The male to female ratio was 1.00∶1.14 (2 910 ∶ 3 313), and there was a statistically significant difference in prevalence rate of KBD between genders(χ 2 = 44.38, P < 0.001). The KBD current patients mainly had a primary school education, married, and farmers, accounting for 59.2% (3 685/6 223), 89.8% (5 590/6 223), 93.2% (5 802/6 223), respectively; and the clinical grading of patients is mainly degree Ⅰ. There was a statistically significant difference in the rate of limb disability among patients with different clinical grades (χ 2 = 64.26, P < 0.001). The rate of limb disability in males was higher than that in females (χ 2 = 10.36, P = 0.001). Conclusions:The KBD current patients in Morin Banner are distributed in various township (town), with middle-aged and elderly famers being the main ones. It is necessary to strengthen monitoring of KBD, and pay attention to personalized treatment and management of KBD current patients.

Isolated axillary recurrence(AR)after breast cancer surgery is one of the critical factors influencing patients'prognosis.With advancements in diagnostic and therapeutic techniques,the clinical understanding of AR has progressively deepened.However,due to the low incidence of AR,systematic studies on its clinical features remain limited.High-quality clinical trials,such as ACOSOG Z0011 and AMAROS,have demonstrated that in patients with varying statuses of sentinel lymph node,axillary lymph node dissection(ALND)and sentinel lymph node dissection(SLND)provide comparable control of AR.In recent years,the trend towards de-escalation axillary surgery has advanced the development of less invasive techniques such as targeted axillary lymph node dissection.The SOUND trial further confirmed the safety and feasibility of omitting axillary surgery in patients with tumors≤2 cm.In addition,a series of clinical studies have identified a variety of potential high-risk factors,including patient age,number of positive lymph nodes,high Ki-67 proliferation,extranodal extension,and axillary soft tissue infiltration.However,there is no broad consensus regarding the association of these factors with AR.This review comprehensively summarized the clinical characteristics,risk factors and personalized management strategies of AR,with an emphasis on the impact of different axillary surgical approaches,radiotherapy and systemic therapy on the AR risk.In addition,more high-quality clinical studies are urgently needed to further clarify prognostic factors and optimize individualized treatment strategies,so as to provide more precise management for patients.