ObjectiveTo investigate morphological and functional neural network alterations in the primary visual cortex （V1） during early-stage diabetes. Methods32 SPF male C57BL/6J mice were randomly divided into control and diabetic groups（n=16）. Type 1 diabetes was induced by intraperitoneal injection of streptozotocin （STZ）， with model validation via oral glucose tolerance test （OGTT） at week 4. Nissl staining was used to assess morphological changes in brain slices of the two groups. Immunohistochemistry was performed to detect the expression of calcium/calmodulin-dependent protein kinase Ⅱ （CaMKⅡ） and somatostatin （SST） in the V1 area. The co-localization density of SST-positive signals on CaMKⅡ+ neurons was then quantified by ImageJ software. In vivo electrophysiology was used for studying neuronal firing and functional connectivity. ResultsCompared with the control mice， nissl staining showed diabetic mice exhibited significant V1 thinning （P=0.02）， reduced neuronal density （P=0.01）. Immunohistochemistry found decreased SST integral optical density （P=0.02） and elevated mean fluorescence intensity （P=0.01）， and lower SST density on CaMKⅡ+ neurons in the diabetic group than in the control group. Compared with the control mice， in vivo electrophysiology studies indicated that diabetic mice showed reduced action potential peak-to-trough ratio and the absolute values of slope （P<0.01）， as well as impaired functional connectivity， including conditional firing， mutual information， and Granger causality （P<0.000 1）. ConclusionEarly diabetes induces V1 structural atrophy accompanied by SSTergic system disruption and multi-level functional degradation from single neurons to neural networks.

Retinopathy caused by myopia is the first cause of irreversible blinding eye disease in China.The TCM methods to prevent and control myopia mainly include Chinese materia medica and TCM appropriate techniques,which have the advantages of good efficacy,simple operation,and few adverse reactions.This paper believed that internal and external pathogenic factors act on the brain and eyes,breaking their homeostasis,leading to rhythmic disorders,and imbalance of essence,qi and blood is the main pathogenesis of myopia.Based on the idea of"nature and human in the same rhythm"and"the same treatment for common diseases",targeting the above pathogenesis,the method of"brain-eye synchronization"was proposed to restore the homeostasis of the brain and eyes to prevent and control myopia in children and adolescents,and the treatment rules were to regulate the rhythms of the time,harmonize the qi and blood,nourish the blood to soften the tendons,and replenish the essence and blood,so as to achieve the effect of brain-eye synchronization and the treatment of the spirit and the body together.This article summarized the theoretical basis of"brain-eye synchronization"and its clinical application in traditional Chinese and Western medicine,with a view to providing new ideas for the prevention and control of myopia in children and adolescents.

Traditional Chinese medicine upholds the unity of nature and humanity as its fundamental principle,asserting that man is in harmony with heaven and earth and corresponds to the sun and moon.Human life processes align with the circadian rhythms of nature,exhibiting periodic temporal changes-concepts that Western medicine defines as biological rhythms.The"opening-closing-pivot"of the three yin and three yang meridians represents the primary mode of interaction between nature and humanity.This mechanism regulates the transformation of yin and yang to qi within the body,ensuring synchronization with the circadian rhythm.Building upon this foundation,the concept of"the harmony of rhythms and states"was proposed to explain human growth and aging."Rhythms"encompass not only circadian cycles but also the movement of qi and blood,as well as the contraction rhythm of muscle fascia,among other physiological processes."States"refer to the dynamic evolution and transformation of qi during the"opening-closing-pivot"stages in both time and space."Harmony"pertains not only to the individual physiological balance of"rhythms"or"states"but also to their coherent interaction.The fundamental cause of myopia is"the disharmony of rhythms and states",considering that rhythm disorders,qi and blood disorders,and fascia imbalances contribute to this disease.Based on this understanding,myopia prevention and treatment should center on"regulating rhythms and states",with adjusting the pivot to brighten the eyes as the core therapeutic principle throughout the entire cycle of myopia.Treatment should be tailored to different disease stages and supplemented with methods such as time-based regulation,qi and blood harmonization,tendon relaxation and collateral dredging,and essence and blood nourishment to prevent and manage myopia effectively.

OBJECTIVE To systematically evaluate the risk factors for ineffective eradication therapy of adult Helicobacter pylori(Hp)infection.METHODS Retrieved from PubMed,Web of Science,the Cochrane Library,Embase,CNKI,VIP and Wanfang Data,cohort studies and case-control studies on the eradication therapy for Hp infection in adult patients were searched from Jan.2000 to Jul.2024.After screening literature,extracting data,and evaluating the quality of literature,RevMan 5.3 software was used for meta-analysis,and sensitivity analysis and publication bias analysis were also performed.RESULTS A total of 19 articles were included,all of which were cohort studies,involving 9 931 patients in total.Among them,1 929 patients were ineffective in eradication therapy,with the ineffective rates ranging from 8.02%to 33.33%.Meta-analysis showed that age＜50 years[OR=1.33,95%CI(1.12,1.57),P＜0.001],body mass index(BMI)＞25 kg/m2[OR=1.87,95%CI(1.35,2.59),P=0.000 2],a history of smoking[OR=1.62,95%CI(1.35,1.95),P＜0.001],a history of drinking[OR=1.93,95%CI(1.47,2.54),P＜0.001],living in a rural area[OR=1.74,95%CI(1.41,2.15),P＜0.001],having non-peptic ulcer[OR=3.45,95%CI(1.75,6.67),P=0.000 3],a family members'infection history[OR=4.72,95%CI(3.32,6.74),P＜0.001],poor treatment compliance[OR=4.89,95%CI(3.07,7.79),P＜0.001],amoxicillin resistance[OR=3.42,95%CI(1.95,6.00),P＜0.001]and clarithromycin resistance[OR=8.14,95%CI(5.00,13.24),P＜0.001]had significant impacts on ineffective eradication therapy of Hp infection in adults.Sensitivity analysis and publication bias analysis showed that the result of this study was robust and reliable.CONCLUSIONS Age＜50 years,BMI＞25 kg/m2,a history of smoking,a history of drinking,living in a rural area,having non-peptic ulcer,a family members'infection history,poor treatment compliance,amoxicillin resistance and clarithromycin resistance are risk factors for failure of Hp infection eradication therapy in adults.

Objective:To understand the genetic characteristics of varicella-zoster virus（VZV）prevalent in Qinghai province，China since 2020.Methods:A total of 54 pharyngeal swab specimens were collected from sporadic suspected varicella cases in Qinghai province in 2020，2023，and 2024. Real-time fluorescence quantitative polymerase chain reaction was used for etiological screening of the specimens. Sequencing of three genes，namely ORF22，ORF38，and ORF62，and single-nucleotide polymorphism（SNP）analysis were performed on VZV nucleic acid-positive specimens.Results:All 54 suspected varicella cases were diagnosed with VZV infection，and three gene sequences were successfully obtained from 53 specimens. The results of genotype identification showed that all VZV infection case specimens obtained in this study in Qinghai province were wild strains. Among them，4 specimens in 2020 were of clade 2 type；among 14 specimens in 2023，7 were of clade 2 type and the remaining 7 were of clade 5 type；among 35 specimens in 2024，27 were of clade5 type，5 were of clade 2 type，and 3 were of clade 4 type. The SNP results showed that in 2023 and 2024，one specimen each had an A→G base mutation at position 37 990，and in 2024，3 specimens had a T→C base mutation at position 37946. Among them，the sequences containing the former mutation have been prevalent and spread in multiple regions of China，and the latter has not been reported in other regions of China.Conclusion:From 2020 to 2024 in Qinghai province，at least three genotypes of VZV，namely clade 2 type，clade 5 type，and clade 4 type，co-prevailed，and the clade 5 genotype of VZV may become the dominant prevalent strain.

OBJECTIVES: To explore the value of serum cystatin C (CysC) levels in evaluating renal prognosis in IgA nephropathy (IgAN) patients. METHODS: We retrospectively collected the clinical data of IgAN patients diagnosed by renal biopsy at Guangdong Provincial People's Hospital from January, 2014 to December, 2018. Based on baseline serum CysC levels, the patients were divided into high serum CysC (>1.03 mg/L) group and normal serum CysC (≤1.03 mg/L) group. The composite endpoint for poor renal prognosis was defined as ≥50% decline in estimated glomerular filtration rate (eGFR) and/or progression to end-stage renal disease (ESRD). Lasso regression, multivariate Cox regression and Kaplan-Meier survival analysis were used to identify the risk factors and compare renal survival rates between the two groups. Smooth curves fitting and threshold effect analysis were used to explore the relationship between serum CysC levels and the outcomes. A nomogram model was constructed and its predictive performance was evaluated using concordance index, calibration curve, receiver operating characteristic (ROC) curve and the area under curve (AUC). RESULTS: A total of 356 IgAN patients were enrolled, who were followed up for 4.65±0.93 years. The composite endpoint occurred in 74 patients. High serum CysC was identified as an independent risk factor for poor renal prognosis in IgAN (HR=2.142, 95% CI 1.222 to 3.755), and the patients with high serum CysC levels had a lower renal survival rate (Log-rank χ²=47.970, P<0.001). In patients with serum CysC below 2.12 mg/L, a higher CysC level was associated with an increased risk of poor renal prognosis (β=3.487, 95% CI: 2.561-4.413, P<0.001), while above this level, the increase of the risk was not significant (β=0.676, 95% CI: -0.642-1.995, P=0.315). The nomogram model based on serum CysC and 3 other independent risk factors demonstrated good internal validity with a concordance index of 0.873 (95% CI: 0.839-0.907) and an AUC of 0.909 (95% CI: 0.873-0.945). CONCLUSIONS Serum CysC levels are associated with renal prognosis in IgAN patients, and high serum CysC an independent risk factor for poor renal prognosis.
Humans ; Glomerulonephritis, IGA/diagnosis* ; Cystatin C/blood* ; Prognosis ; Risk Factors ; Retrospective Studies ; Glomerular Filtration Rate ; Kidney Failure, Chronic ; Male ; Female ; Adult ; Nomograms ; Middle Aged

Objective:To understand the genetic characteristics of varicella-zoster virus（VZV）prevalent in Qinghai province，China since 2020.Methods:A total of 54 pharyngeal swab specimens were collected from sporadic suspected varicella cases in Qinghai province in 2020，2023，and 2024. Real-time fluorescence quantitative polymerase chain reaction was used for etiological screening of the specimens. Sequencing of three genes，namely ORF22，ORF38，and ORF62，and single-nucleotide polymorphism（SNP）analysis were performed on VZV nucleic acid-positive specimens.Results:All 54 suspected varicella cases were diagnosed with VZV infection，and three gene sequences were successfully obtained from 53 specimens. The results of genotype identification showed that all VZV infection case specimens obtained in this study in Qinghai province were wild strains. Among them，4 specimens in 2020 were of clade 2 type；among 14 specimens in 2023，7 were of clade 2 type and the remaining 7 were of clade 5 type；among 35 specimens in 2024，27 were of clade5 type，5 were of clade 2 type，and 3 were of clade 4 type. The SNP results showed that in 2023 and 2024，one specimen each had an A→G base mutation at position 37 990，and in 2024，3 specimens had a T→C base mutation at position 37946. Among them，the sequences containing the former mutation have been prevalent and spread in multiple regions of China，and the latter has not been reported in other regions of China.Conclusion:From 2020 to 2024 in Qinghai province，at least three genotypes of VZV，namely clade 2 type，clade 5 type，and clade 4 type，co-prevailed，and the clade 5 genotype of VZV may become the dominant prevalent strain.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Retinopathy caused by myopia is the first cause of irreversible blinding eye disease in China.The TCM methods to prevent and control myopia mainly include Chinese materia medica and TCM appropriate techniques,which have the advantages of good efficacy,simple operation,and few adverse reactions.This paper believed that internal and external pathogenic factors act on the brain and eyes,breaking their homeostasis,leading to rhythmic disorders,and imbalance of essence,qi and blood is the main pathogenesis of myopia.Based on the idea of"nature and human in the same rhythm"and"the same treatment for common diseases",targeting the above pathogenesis,the method of"brain-eye synchronization"was proposed to restore the homeostasis of the brain and eyes to prevent and control myopia in children and adolescents,and the treatment rules were to regulate the rhythms of the time,harmonize the qi and blood,nourish the blood to soften the tendons,and replenish the essence and blood,so as to achieve the effect of brain-eye synchronization and the treatment of the spirit and the body together.This article summarized the theoretical basis of"brain-eye synchronization"and its clinical application in traditional Chinese and Western medicine,with a view to providing new ideas for the prevention and control of myopia in children and adolescents.

Objective To analyze the endowment features of patients with primary angle-closure glaucoma(PACG)based on circuit-qi theory,thus to provide approaches for revealing the etiology,pathogenesis and prevalence of PACG.Methods From October 2023 to March 2024,a total of 204 patients with PACG admitted to the Eye Hospital,China Academy of Chinese Medical Sciences were enrolled into the analysis.The natal day of the patients was used for the calculation of conception day,and then the conception day was used for the analysis of the features of five circuits and six qi based on the stem-branch lunar year of conception day.A database of information of five circuits and six qi on conception day was constructed,and then the features of their endowments at conception were statistically analyzed.Results No statistically significant differences were shown in the distribution of the dominant qi,guest qi,sitian(celestial control)and zaiquan(terrestrial effect)at conception in PACG patients(P＞0.05),but there were statistically significant differences in the distribution of yearly circuit,comprehensive circuit-qi,and combined circuit-qi at conception in PACG patients(P＜0.05).Most of PACG patients had the circuit-qi features of shaomu(deficiency of wood)-yangming dryness gold-shaoyin monarch fire,and taitu(excess of earth)-shaoyin monarch fire-yangming dryness gold at conception.Conclusion Those who are conceived at the date with circuit-qi features of shaomu and taitu,comprehensive circuit-qi features of shaomu-yangming dryness gold-shaoyin monarch fire and taitu-shaoyin monarch fire-yangming dryness gold,and combined circuit-qi features of shunhua(qi generating circuit)and celestial restriction(qi restricting circuit)are vulnerability to PACG.The development of the constitution of PACG patients may be related to the congenital circuit-qi features of pathogenic dryness attacking the lung,and metal exuberance restricting wood.