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.

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.

Objective:To evaluate the data quality of Shenzhen Type 1 Diabetes Alliance (SZT1D), and to provide a basis for evaluation and improvement for the continuous improvement of data quality.Methods:From December 2018 to July 2021, 697 first-visit type 1 diabetes (T1DM) patients (including 501 in Shenzhen and 196 out-of-Shenzhen) and 120 re-visited T1DM patients (including 113 in Shenzhen and 7 out-of-Shenzhen) who were registered by SZT1D in collaborative research platform network of China Type 1 Diabetes Alliance (hereinafter referred to as China T1D). The data quality was evaluated from three dimensions: data completion, accuracy and revisit. The data completion degree was evaluated by the overall data completion degree and the key indicator completion degree; the data accuracy was evaluated by the probability of abnormal blood glucose value; the patient′s return visit was evaluated by the return visit rate.Results:The main characteristics of T1DM in SZT1D were young and middle-aged adults [age: (34.4±17.1)years] with thin body [BMI: (19.80±3.52)kg/m 2)], half of male and female patients [proportion of male: 52.4%(365/697)]; the main types of diagnosis were classical T1DM [65.22%(150/230)] and latent autoimmune diabetes in adults(LADA) [26.08%(60/230)], and the fasting blood glucose (FPG) [(10.93±6.98)mmol/L] and glycosylated hemoglobin (HbA 1c) [(10.63±3.01)%] were high. The average completion rate of the overall data of the first diagnosed patients in SZT1D was only 60% [(62.9±31.5)%]: the number of patients with overall data completion ≥80% in SZT1D was only 50.2%(350/697); the number of patients with overall data completion ≥80% in Shenzhen was less than that outside Shenzhen [44.3%(222/501) vs 65.3%(128/196), P<0.001]. The key indicators with better completion rate of first-visit were disease course [76.2%(531/697)], age of onset [75.8%(528/697)], family history of diabetes [74.9%(522/697)], etc., but none of them had a completion rate of more than 80%, and the diabetes self-management behavior assessment questionnaire and scale score were completely missing; the frequency of daily blood glucose monitoring [46.1%(231/501) vs 64.3%(126/196), P<0.001], current insulin regimen [44.3%(222/501) vs 63.3%(124/196), P<0.001], number of diabetic ketoacidosis (DKA) since the onset of the disease [45.7%(229/501) vs 64.8%(127/196), P<0.001] and the number of symptomatic hypoglycemia in the past 1 month [39.3%(197/501) vs 63.8%(125/196), P<0.001] were higher in Shenzhen than those reported outside Shenzhen. In addition, the probability of abnormal FPG and postprandial glucose (PPG) [5.2%(24/466); 3.8%(19/236)] were low. The revisit rate was not high [17.2%(120/697)], and the revisit rate in Shenzhen was higher than that outside Shenzhen [22.6%(113/501) vs 3.6%(7/196), P<0.001]. The first revisit rate was 16.2%(113/697) and the second revisit rate was seriously insufficient [1.0%(7/697)]. Conclusions:The data quality of T1DM patients recorded by SZT1D needs to be further improved. Improving the information interconnection between China-T1D and SZT1D, employing quality control personnel and building a systematic data quality evaluation analysis and feedback mechanism are methods to promote the comprehensive, accurate and efficient input of T1DM data and continuously improve the evaluation methods to improve the overall data quality.

OBJECTIVE：To investigate the “dose-effect-toxicity”correlation of Miao medicine Wikstroemia indica before and after processed on anti-immnue inflammation of mice . METHODS ：Mice were divided into blank group ，model group ，ethanol extract of W. indica raw product groups 1-6，ethanol extract of W. indica processed product by “sweat soaking method ”groups 1-6 （hereinafter called “raw groups 1-6”“processed groups 1-6”for short ，drug dosage were 0.13，0.20，0.26，0.52，1.04，2.6 g/kg）， positive group （cyclophosphamide，36.4 mg/kg），with 10 mice in each group. Except for blank group ，other groups were given 1％ 2，4-dinitrofluorobenzene-acetone-sesame oil mixed solution to induce delayed type hypersensitivity model. After modeling， blank group and model group were given constant volume of 1.0％ CMC-Na solution intragastrically ，and administration groups were given relevant medicine 20 mL/kg intrag astrically，oncea day ，for consecutive 5 d. A fter last medication ，ear swelling degree of mice were recorded ；the inhibition rate of swelling degree， half effective dose （ED50） and 95％ confidence 158-02-32）； interval（CI）of raw and processed products were calculated ； the weight of heart ，liver，spleen，lung and kidney were measured and the indexes of organs were calculated ；ELISA 1161472062@qq.com and modified chemical oxidation method were used to determine the serum levels of inflammatory factors （TNF-α， IL-10） and liver and renal function indexes （ALT，AST， TBIL，BUN，CREA）. RESULTS：Compared with blank group ，the degree of ear swelling in the model group was significantly increased（P＜0.05）. Compared with model group ，ear swelling degree of mice were decreased significantly in different doses groups of ethanol extract of raw and processed products of W. indica （P＜0.05）. The inhibition rate of swelling increased with the increase of dose ，ED50 and 95％CI of delayed hypersensitivity ear swelling were 0.239 6（0.129 0，0.445 2）g/kg and 0.147 3（0.076 8，0.282 7）g/kg，respectively. Compared with blank group ，liver index and serum TNF-α level of mice were increased significantly in model group ，while lung index and serum IL- 10 level were decreased significantly （P＜0.05）. Compared with model group ，the levels of liver indexes （positive group ，raw group 3，processed groups 1-6）and serum TNF-α levels（positive group ，raw groups 1-3，processed groups 1-4） were decreased significantly in different administration groups ；while the levels of lung indexes （positive group ，raw groups 3-6 and processed groups 3-6），serum IL- 10 levels（raw groups 1，2，4 and 5，processed groups 2-6），ALT，AST，BUN and CREA levels （raw groups 4-6），TBIL levels （raw groups 3-6 ）were increased significantly （P＜ 0.05）. CONCLUSIONS ：The ethanol extract of raw product of W. indica has certain anti-inflammatory activity ，and has certain hepatorenal toxicity to mice ，with certain “dose-effect-toxity”correlation. The ethanol ectract of processed product of W. indica has certain anti-inflammatory activity too ，but its hepatorenal toxicity was lower than raw product. The “sweat soaking method ” possesses the function of “retaining efficiency and reducing toxicity ”for processing W. indica .

Objective To investigate the relationship between the right-to-left shunt(RLS)detected with contrast-enhanced transcranial Doppler (c-TCD) and recurrent stroke in patients with cryptogenic stroke.Methods The consecutive patients w ith ischemic stroke w ere enrol ed. The patients w ith cryptogenic stroke w ere screened according to the TOAST criteria. They w ere divided into either a RLS positive group or a RLS negative group according to the c-TCD findings, and then they w ere fol ow ed up for a period of one year. They w ere also divided into a recurrent group and a non-recurrent group according to w hether they had recurrence or not. Results A total of 118 patients w ith cryptogenic ischemic stroke w ere enrol ed, including 46 in the RLS positive group, 72 in the RLS negative group, 10 in the recurrent group, and 108 in the non-recurrent group. There w ere no significant differences in demographic and baseline data betw een the RLS negative group and the RLS positive group. There w ere significant differences in RLS positive rate (7/10 vs.39/108; P=0.046) and proportion of patients with server RLS (2/10 vs.1/108; P=0.019) betw een the recurrent group and the non-recurrent group. Multivariate logistic regression analysis show ed that the positive RLS w as an independent predictor of recurrent stroke (odds ratio 4.896, 95% confidence interval 1.135-21.120;P=0.033). Conclusions The positive RLS may be an independent risk factor for the recurrence in patients w ith cryptogenic ischemic stroke.