epsis is a systemic inflammatory response syndrome triggered by infection， and its high mortality rate is closely associated with immune imbalance， particularly the imbalance in the differentiation of helper T cell （Th） cell subsets [Th1， Th2， Th17， regulatory T cell （Treg） ] . In recent years， traditional Chinese medicine （TCM）， with its characteristics of multi-component and multi-target actions， has demonstrated unique advantages in regulating Th cell differentiation and function， as well as correcting immune imbalances in sepsis， offering new perspectives for immunotherapy of sepsis. This review summarizes relevant studies on the regulation of Th cell differentiation for sepsis treatment by TCM monomers and active ingredients （such as Astragalus membranaceus ， Scutellaria baicalensis ， Coptis chinensis ， Rheum palmatum ， Ganoderma lucidum ， Ginkgo biloba ， and Cistanche deserticola ）， the alcohol extract of Dai Baijie， and TCM formulas and preparations categorized as blood-activating and stasis-removing， purgative and laxative， warming and tonifying yang， and tonifying qi and nourishing yin. The results indicate that these TCM monomers， active ingredients， extracts， formulas， and preparations can regulate the Th1/Th2 and Th17/Treg balance， target the differentiation balance of Th cell subsets， alleviate inflammatory responses， or improve immune suppression， thereby exerting therapeutic effects on sepsis.

BACKGROUND:With the increasing attention of scholars at home and abroad to children's cervical spine-related diseases,the demand for exploring the anatomical indicators and changes of cervical spine morphology and development in children of different ages is increasing.OBJECTIVE:To explore and analyze the morphological changes of children with different ages and vertebral sequences by measuring the anatomical position indexes of C2-C7 neurocentral synchondrosis in children aged 1-6 years.METHODS:Normal cervical spine CT images were retrospectively collected from 160 children aged 1-6 years at provincial tertiary hospitals.They were divided into six groups according to an age group of 1 year.The raw data of consecutively scanned cervical spine tomography images were imported into Mimics 16.0 software.The positional anatomical indexes of cervical spine segments C2-C7 in coronal and transverse planes were measured and analyzed under the two-dimensional image window by choosing the measurement tools under the toolbar of Measurements.RESULTS AND CONCLUSION:(1)The distance between the two sides of C2-C7 neurocentral synchondrosis and the distance between the left and right sides of neurocentral synchondrosis and the transverse process gradually increased with age.The overall development of vertebrae in each cervical vertebral segment was faster than the ossification of the neurocentral synchondrosis.(2)The cross-sectional angles on both sides of C2-C7 neurocentral synchondrosis gradually increased with age,and the angles between the left and right sides of neurocentral synchondrosis and the anterior and posterior edges of the vertebral body gradually decreased.Both sides of the neurocentral synchondrosis in cervical vertebral segments tended to grow toward the arch site,which mainly promoted the growth and development of the arch.(3)Except for C7,the angle between the coronal planes on both sides of the cervical spine changed little with the descending neurocentral synchondrosis of the cervical spine,and the neurocentral synchondrosis of the cervical spine was more inclined to longitudinal growth and ossification.(4)The neurocentral synchondrosis position changes in C7 were significantly different from those in the rest of the cervical vertebrae.(5)The anatomical indexes of C2-C7 neurocentral synchondrosis position in children have obvious development rules among different ages and vertebral bodies,and these rules are helpful for the clinical diagnosis and treatment of cervical spine diseases in children.

ObjectiveTo investigate the status and dietary intake risk of pesticide residues in fruits and vegetables sold in Wenzhou, Zhejiang Province from 2020 to 2023, so as to provide a scientific basis for the regulation and management of pesticide in the future. MethodsIn accordance with the requirements and methods specified in the “National Food Contamination and Hazardous Factor Risk Monitoring Work Manual” and the current corresponding national food inspection standards for various foods, a total of 807 samples of vegetables and fruits from various counties and districts of Wenzhou City were collected for testing and analysis. Eventually, 23 types of pesticides with a detection rate greater than 5% and those exceeding the standard were selected for dietary intake risk assessment. ResultsFrom 2020 to 2023, the overall detection rate of pesticide residues in fruits and vegetables monitored in Wenzhou was 71.62%, with an overall exceedance rate of 5.27%. From the results of the monitoring of pesticide residues in fruits and vegetables, fresh legume vegetables had the highest detection rate of 90.00%. Among the six major categories of pesticides monitored, fungicides in vegetables and fruits had the highest detection rates of 68.18% and 85.03%, respectively. The highest exceedance rate in vegetables was organophosphorus pesticides, accounting for 2.85%, while in fruits, neonicotinoid pesticides had the highest exceedance rate of 3.21%. From the perspective of sampling time, the peak detection rate of pesticide residues in fruits and vegetables in Wenzhou occurred in June and October. The index of food safety (IFS) of the 23 pesticides with a detection rate higher than 5% ranged from 0.000 7 to 0.694 2 based on the 95% monitoring value of pesticide residues, which were all less than 1. Calculated at maximum content, the IFS values of dithiocarbamate (calculated by CS₂), chlorothalonil and propiconazole were all greater than 1, indicating that the maximum detection values of the three pesticides exceeded the acceptable safety risk. The risk level of acute dietary intake of the 23 pesticides ranged from 1.26% to 52.65%. ConclusionThe overall situation of pesticide residues in fruits and vegetables sold in Wenzhou from 2020 to 2023 is favourable, but the exceedance rate of pesticide in some fruits and vegetables is high. Special attention should be paid to the pesticide residues of fungicides, neonicotinoid insecticides and organophosphorus pesticides in fresh legume vegetables, bulb vegetables and some fruits sold in Wenzhou, such as acetamiprid in bayberry and cowpea, dimethomorph in strawberry, chlorpyrifos in leek, etc., and monitoring of pesticide residues in food need to be strengthened.

Objective:To analyze the possible factors affecting the long-term visual acuity of macular edema secondary to branch retinal vein occlusion (BRVO-ME) after combination therapy, and construct a risk prediction model.Methods:The data of 125 patients with BRVO-ME who were treated in Xi′an Aier Ancient City Eye Hospital from December 2020 to December 2023 and completed 6-month follow-up were retrospectively analyzed. All patients were treated with ranibizumab combined with dexamethasone intravitreal implants until the central macular thickness returned to normal. The treatment was completed and followed up for 6 months. According to the 6-month follow-up of long-term visual acuity recovery, they were divided into poor recovery group (38 cases) and good recovery group (87 cases). The general data of the two groups were collected and compared. The possible influencing factors (continuous variables) were included in the drawing of the receiver operating characteristic (ROC) curve. According to the optimal threshold, the continuous variables were divided into two categorical variables, and the possible influencing factors were further included in the Logistic regression to obtain the possible influencing factors. Based on the results of the influencing factor analysis and the ROC curve, the decision curve was drawn to verify the clinical benefit of the overall model. Based on the above-mentioned nomogram model, the prediction model was visualized.Results:The course of disease in the poor recovery group was longer than that in the good recovery group: (82.47 ± 15.51) d vs. (71.23 ± 12.45) d, the proportion of ellipsoid/external membrane interruption was higher than that in the good recovery group: 44.74% (17/38) vs. 25.29% (22/87), the initial visual acuity was worse than that in the good recovery group: (0.82 ± 0.21) logMAR vs. (0.66 ± 0.17) logMAR, and the ratio of retinal deep and shallow blood flow density was lower than that in the good recovery group: 1.02 ± 0.35 vs. 1.36 ± 0.41, the difference was statistically significant ( P<0.05). ROC curve analysis showed that the area under the curve of the course of disease, the initial visual acuity, and the ratio of retinal deep and shallow blood flow density to predict the poor recovery of long-term visual acuity in BRVO-ME patients after combined medication were 0.71, 0.73 and 0.75, respectively. The best cut-off values were 85 d, 0.72 logMAR and 1.10, respectively. Logistic regression analysis showed that the course of disease (≥ 85 d), ellipsoid/outer membrane interruption (yes), initial visual acuity (≥ 0.72 logMAR) and ratio of retinal deep and shallow blood flow density (≤1.10) were the influencing factors of poor long-term visual acuity recovery in BRVO-ME patients after combination therapy ( P<0.05). The risk prediction model was constructed by using the course of disease, ellipsoid/outer membrane interruption, initial visual acuity and ratio of retinal deep and shallow blood flow density as predictors, and the decision curve of the model was drawn. It was found that the risk threshold was in the range of 0 to 0.90 and 0.95 to 1.00, and the clinical net benefit rate provided by the model was always greater than 0. The nomogram model was constructed to visualize the risk prediction model. The results showed that the C-index of the model to predict the long-term visual acuity recovery of BRVO-ME patients after combination therapy was 0.90 (95% CI 0.85 to 0.96), which had high predictive value. Conclusions:The course of the disease, interruption of the ellipsoid/outer membrane, initial visual acuity and the ratio of retinal deep and shallow blood flow density are all influencing factors for poor long-term visual recovery in BRVO-ME patients after combination therapy. The risk prediction model constructed based on this has good predictive value for the risk of poor long-term visual recovery in patients.

Objective:To analyze the possible factors affecting the long-term visual acuity of macular edema secondary to branch retinal vein occlusion (BRVO-ME) after combination therapy, and construct a risk prediction model.Methods:The data of 125 patients with BRVO-ME who were treated in Xi′an Aier Ancient City Eye Hospital from December 2020 to December 2023 and completed 6-month follow-up were retrospectively analyzed. All patients were treated with ranibizumab combined with dexamethasone intravitreal implants until the central macular thickness returned to normal. The treatment was completed and followed up for 6 months. According to the 6-month follow-up of long-term visual acuity recovery, they were divided into poor recovery group (38 cases) and good recovery group (87 cases). The general data of the two groups were collected and compared. The possible influencing factors (continuous variables) were included in the drawing of the receiver operating characteristic (ROC) curve. According to the optimal threshold, the continuous variables were divided into two categorical variables, and the possible influencing factors were further included in the Logistic regression to obtain the possible influencing factors. Based on the results of the influencing factor analysis and the ROC curve, the decision curve was drawn to verify the clinical benefit of the overall model. Based on the above-mentioned nomogram model, the prediction model was visualized.Results:The course of disease in the poor recovery group was longer than that in the good recovery group: (82.47 ± 15.51) d vs. (71.23 ± 12.45) d, the proportion of ellipsoid/external membrane interruption was higher than that in the good recovery group: 44.74% (17/38) vs. 25.29% (22/87), the initial visual acuity was worse than that in the good recovery group: (0.82 ± 0.21) logMAR vs. (0.66 ± 0.17) logMAR, and the ratio of retinal deep and shallow blood flow density was lower than that in the good recovery group: 1.02 ± 0.35 vs. 1.36 ± 0.41, the difference was statistically significant ( P<0.05). ROC curve analysis showed that the area under the curve of the course of disease, the initial visual acuity, and the ratio of retinal deep and shallow blood flow density to predict the poor recovery of long-term visual acuity in BRVO-ME patients after combined medication were 0.71, 0.73 and 0.75, respectively. The best cut-off values were 85 d, 0.72 logMAR and 1.10, respectively. Logistic regression analysis showed that the course of disease (≥ 85 d), ellipsoid/outer membrane interruption (yes), initial visual acuity (≥ 0.72 logMAR) and ratio of retinal deep and shallow blood flow density (≤1.10) were the influencing factors of poor long-term visual acuity recovery in BRVO-ME patients after combination therapy ( P<0.05). The risk prediction model was constructed by using the course of disease, ellipsoid/outer membrane interruption, initial visual acuity and ratio of retinal deep and shallow blood flow density as predictors, and the decision curve of the model was drawn. It was found that the risk threshold was in the range of 0 to 0.90 and 0.95 to 1.00, and the clinical net benefit rate provided by the model was always greater than 0. The nomogram model was constructed to visualize the risk prediction model. The results showed that the C-index of the model to predict the long-term visual acuity recovery of BRVO-ME patients after combination therapy was 0.90 (95% CI 0.85 to 0.96), which had high predictive value. Conclusions:The course of the disease, interruption of the ellipsoid/outer membrane, initial visual acuity and the ratio of retinal deep and shallow blood flow density are all influencing factors for poor long-term visual recovery in BRVO-ME patients after combination therapy. The risk prediction model constructed based on this has good predictive value for the risk of poor long-term visual recovery in patients.

The intestinal flora and its metabolites are closely bound up with the metabolism and immune function of human body and at the meantime affect the metabolisms of nutrients and drugs,which play an important role in maintaining the physiological function.As the largest reservoir of microorganisms within the human body,the intestinal flora play a vital role in maintaining the health.Numerous studies have shown that the alteration of intestinal flora may not only affect the emergence of gastrointestinal diseases but also has impact on the common diseases of multiple systems,it may mediate the emergence and development of relevant diseases through gut-kid-ney axis,gut-liver axis,and gut-brain axis,and interact with the diseases.As a traditional Chinese medicine ex-ternal therapy,the traditional Chinese medicine enema therapy has remarkable advantages in treatment of various clinical diseases and shows significant effect on improvement of intestinal flora imbalance during the disease pro-gression.The effect of the traditional Chinese medicine enema therapy on improving the intestinal flora imbalance of the patients during the process of emergence and development of the common diseases is reviewed in the article.

BACKGROUND:With the increasing attention of scholars at home and abroad to children's cervical spine-related diseases,the demand for exploring the anatomical indicators and changes of cervical spine morphology and development in children of different ages is increasing.OBJECTIVE:To explore and analyze the morphological changes of children with different ages and vertebral sequences by measuring the anatomical position indexes of C2-C7 neurocentral synchondrosis in children aged 1-6 years.METHODS:Normal cervical spine CT images were retrospectively collected from 160 children aged 1-6 years at provincial tertiary hospitals.They were divided into six groups according to an age group of 1 year.The raw data of consecutively scanned cervical spine tomography images were imported into Mimics 16.0 software.The positional anatomical indexes of cervical spine segments C2-C7 in coronal and transverse planes were measured and analyzed under the two-dimensional image window by choosing the measurement tools under the toolbar of Measurements.RESULTS AND CONCLUSION:(1)The distance between the two sides of C2-C7 neurocentral synchondrosis and the distance between the left and right sides of neurocentral synchondrosis and the transverse process gradually increased with age.The overall development of vertebrae in each cervical vertebral segment was faster than the ossification of the neurocentral synchondrosis.(2)The cross-sectional angles on both sides of C2-C7 neurocentral synchondrosis gradually increased with age,and the angles between the left and right sides of neurocentral synchondrosis and the anterior and posterior edges of the vertebral body gradually decreased.Both sides of the neurocentral synchondrosis in cervical vertebral segments tended to grow toward the arch site,which mainly promoted the growth and development of the arch.(3)Except for C7,the angle between the coronal planes on both sides of the cervical spine changed little with the descending neurocentral synchondrosis of the cervical spine,and the neurocentral synchondrosis of the cervical spine was more inclined to longitudinal growth and ossification.(4)The neurocentral synchondrosis position changes in C7 were significantly different from those in the rest of the cervical vertebrae.(5)The anatomical indexes of C2-C7 neurocentral synchondrosis position in children have obvious development rules among different ages and vertebral bodies,and these rules are helpful for the clinical diagnosis and treatment of cervical spine diseases in children.

The intestinal flora and its metabolites are closely bound up with the metabolism and immune function of human body and at the meantime affect the metabolisms of nutrients and drugs,which play an important role in maintaining the physiological function.As the largest reservoir of microorganisms within the human body,the intestinal flora play a vital role in maintaining the health.Numerous studies have shown that the alteration of intestinal flora may not only affect the emergence of gastrointestinal diseases but also has impact on the common diseases of multiple systems,it may mediate the emergence and development of relevant diseases through gut-kid-ney axis,gut-liver axis,and gut-brain axis,and interact with the diseases.As a traditional Chinese medicine ex-ternal therapy,the traditional Chinese medicine enema therapy has remarkable advantages in treatment of various clinical diseases and shows significant effect on improvement of intestinal flora imbalance during the disease pro-gression.The effect of the traditional Chinese medicine enema therapy on improving the intestinal flora imbalance of the patients during the process of emergence and development of the common diseases is reviewed in the article.

Sepsis-induced lung injury is a common type of sepsis complicated with multiple organ dysfunction syndrome,whose uncontrolled inflammatory response and oxidative stress are the key pathological mechanisms.As an important pathway of anti-inflammatory and anti-oxidative stress,the nuclear factor-erythroid 2-related factor 2(Nrf2)signaling pathway is very important in the occurrence and development of sepsis-induced lung injury.This review summarizes relevant research conducted over the past decade on the regulation of the Nrf2 signaling pathway by traditional Chinese medicine(TCM)to ameliorate sepsis-induced lung injury.It has been found that 14 kinds of TCM effective ingredients(including five types of compounds:flavonoids,terpenes,alkaloids,saponins,phenols)and 6 kinds of compound preparations(including three types of formulas:heat-clearing and detoxifying formulas,purgative formulas for promoting bowel movement,and formulas for reinforcing vital qi and consolidating the constitution)can inhibit inflammatory responses and oxidative stress by activating Nrf2 signaling pathway and intervening in related pathways such as those involving Kelch-like ECH-associated protein 1,heme oxygenase-1,antioxidant response element and AMP-activated protein kinase,thereby alleviating sepsis-induced lung injury.

Purpose To investigate the expression of Clau-din18.2 and its relationship with clinicopathological parameters and prognosis in Epstein-Barr virus-associated gastric cancer(EBVaGC),and also to analyze the correlation between the ex-pression of Claudin18.2 and PD-L1,ARID1A,and HER2.Methods Tissue samples of 694 patients received radical gas-trectomy,and 25 cases of EBVaGC were selected according to EBER results and matched one by one.Immunohistochemistry was employed to assess the expression levels of Claudin18.2,PD-L1,ARID1A and HER2 in EBVaGC and non-EBVaGC.Ka-plan-Meier survival analysis was performed for analyzing the re-lationship between the expression of Claudin18.2,PD-L1 and ARID1A and the prognosis of gastric cancer patients,and the survival curve was drawn.Spearman correlation analysis was used to assess the respective relationships between Claudin18.2 and PD-L1,ARID1A,and HER2.Results The positive/high expression rates of Claudin18.2 in EBVaGC were 76％and 64％respectively.Furthermore,the positive/high expression rates of Claudin18.2 in non-EBVaGC were 32％and 20％,respective-ly.Claudin18.2 expression showed positively correlations with the tumor site(proximal stomach)in gastric cancer patients.In addition,compared with non-EBVaGC,PD-L1 CPS score was higher in EBVaGC(P＜0.001),and the deletion rate of AR-ID1A expression was also higher in EBVaGC(P=0.012).But there was no significant difference,and so did not the expression level of HER2 between EBVaGC and non-EBVaGC.Survival a-nalysis revealed that positive/high expression of Claudin18.2 did not show a significant correlation with prognosis.Sperman corre-lation analysis indicated a positive correlation between Clau-din18.2 and PD-L1(r=0.338 4,P=0.016 2),while the ex-pression of Claudin18.2 was negatively correlated with ARID 1A(r=-0.354 5,P=0.011 5).Finally,there was no signifi-cant correlation between Claudin18.2 and HER2.Conclusion Claudin18.2 is highly expressed in EBVaGC,which is correla-ted with PD-L1 and ARID1A.It provides more options of combi-nation therapies for patients with advanced gastric cancer.