Based on the theory of toxin in The Inner Canon of Yellow Emperor （《黄帝内经》）， this paper explores the concept and connotation of toxin from several aspects， including medicinal toxicity， pathogenic toxicity， pathoge-nesis and treatment of toxin pathogen. It explores the mechanism and significance of using toxin substances in curing and inducing diseases， sorts out the etiological and pathological evolution of toxic pathogens， clarifies the derivation and differentiation process from external toxins to internal toxins， and elucidates the interactions between toxin and other pathogenic factors such as phlegm， stasis， dampness， and fire. It further distinguishes the logical hierarchy of toxin caused by metabolic disorders such as sugar， fat， and drowning， clarifies that the essence of the etiology of "hidden toxin"， and determines the corresponding treatment principles and methods for toxic pathogens. It establishes a theoretical framework of traditional Chinese medicine toxic pathogen theory， providing theoretical basis for the clinical treatment of many diseases.

Aquaporin 5(AQP5)is a specific protein that can significantly increase the water permeability of cell membrane,partici-pate in the process of water secretion and absorption,maintain the balance of water molecules inside and outside the cell,and transport water across the membrane.Programmed cell death(PCD)is closely associated with the development and progression of Sj?gren's syn-drome(SS).AQP5 may influence the development and progression of SS by regulating the PCD mechanism.This article reviews the mo-lecular mechanisms of AQP5 in regulating the apoptosis,pyroptosis,autophagy,and ferroptosis of cells in recent years and discusses the potential influence of AQP5 on SS,in order to provide a theoretical basis for the clinical prevention and treatment of SS.

Sjogren's syndrome (SS) is a kind of connective tissue disease with high incidence and difficult to be treated, which belongs to the category of "dryness-arthralgia" in TCM. Xuanfu is a micro-concept of TCM, and is widely distributed and has the properties of "gateway" and "road", playing the role of circulating gas-liquid and operating spirit mechanism. Aquaporin (AQP) is a membrane-specific transmembrane protein that is widely distributed throughout the body and controls the movement of water, ions and gases in and out of cells. In recent years, the Xuanfu theory and AQP have played an important role in the etiology, pathogenesis, and treatment of SS. This article explored the etiology, pathogenesis, and treatment of SS by listing the correlation between Xuanfu and AQP in terms of structure and function, providing more theoretical basis for the application of Xuanfu theory in the treatment of SS.

Objective To explore the effects and underlying molecular mechanisms of high fat diet(HFD)on in-testinal barrier damage and inflammatory reaction in mice with irritable bowel syndrome(IBS)induced by sodium dextran sulfate(DSS).Methods C57BL/6 mice were randomly divided into four groups(n=6):Normal group,DSS group(1.5％DSS solution for one week),HFD+DSS group,and HFD+DSS+WY14643 group(intraperitone-ally injected daily with PPARα agonist WY14643 6 mg/kg).The body weight and liver weight of mice were measured.Colon pathology was observed by HE staining.The protein expression of zonula occludens-1(ZO-1)and occludin was detected by immunohistochemistry.The mRNA expression of tumor necrosis factor-α(TNF-α),interleukin-β(IL-1β),and interleukin-17(IL-17)were determined by qRT-PCR.PPARα protein expression was determined by Western blot.Results The body weight and liver weight of mice in the HFD+DSS group were significantly higher than those in the DSS group(P＜0.001).HE staining showed normal colonic tissue structure in Normal group,while other three groups exhibited varying degrees of mucosal damage with a small amount of in-flammatory cell infiltration and epithelial cell shedding.Among these,the HFD+DSS group displayed the most se-vere intestinal mucosal damage and inflammatory infiltration.Compared with the DSS group,the HFD+DSS group showed decreased ZO-1 and Occludin protein expression(P＜0.001),elevated TNF-α,IL-1 β,and IL-17 mRNA levels(all P＜0.001),and downregulated PPARα protein expression(P＜0.01).Compared with the HFD+DSS group,mice in HFD+DSS+WY14643 group showed improvement in intestinal mucosal damage and reduced infiltration of inflammatory cells.The protein expression of ZO-1 and occludin in colon of mice in the HFD+DSS+WY14643 was increased(all P＜0.05),while the expression of TNF-α,IL-1 β,and IL-17 mRNA was downregulated(P＜0.01 or P＜0.05),and the protein expression of PPAR α was upregulated(P＜0.05).Conclusions HFD-induced obesity aggravates intestinal mucosal damage,intestinal barrier destruction and in-flammatory response in IBS mice,and its molecular mechanism is potentially related to downregulation of PPARαexpression in intestinal tissues.

Ulcerative colitis(UC)is a chronic im-mune-mediated disease characterized by diffuse mucosal inflammation and clinical symptoms of ab-dominal pain,diarrhea,mucopurulent bloody stool and tenesmus.Due to its complex etiology,difficult treatment and poor prognosis,UC has been listed as one of the modern refractory diseases by the World Health Organization.MicroRNAs(microR-NAs)regulate various biological processes such as cell growth,differentiation,and development by regulating gene expression.Studies have shown that miRNA is involved in the pathogenesis of UC through various pathways such as intestinal muco-sal barrier homeostasis disorder,intestinal flora im-balance and excessive differentiation of immune cells,and is expected to become a new target for clinical treatment of UC.In order to better under-stand the role of miRNA in the pathogenesis of UC and provide new research directions for the treat-ment of UC,this article reviews the correlation be-tween miRNA and the pathogenesis of UC,the po-tential of miRNA as a biomarker of UC,and the treatment strategies of miRNA in UC in recent years.

BackgroundMost of the researches on continuous nursing education is from the perspective of patients， and there is a lack of studies on the impact of continuous nursing education on patient caregivers， and the care quality of caregivers is closely related to postoperative rehabilitation status of the patients. ObjectiveTo investigate the effect of continuous nursing education on anxiety relief of caregivers of patients with all-robot coronary artery bypass surgery， and to provide references for improving caregivers' anxiety and promoting patients' recovery. MethodsA total of 120 caregivers of patients with all-robot coronary artery bypass surgery at the First and Sixth Center of 301 Chinese PLA General Hospital were included from January 1， 2021 to December 31， 2022. The caregivers were randomly divided into study group and control group with 60 cases in each group by systematic random sampling method. Before the patient discharge from the hospital， all caregivers received routine nursing education. The study group received continuous nursing education for 4 weeks after patient discharged. Self-rating Anxiety Scale （SAS） was used to evaluate the two groups before and one month after discharge. ResultsOne month after discharge， SAS score in the study group was significantly lower than that in the control group ［（57.77±14.08） vs. （70.19±13.60）， t=-4.913， P<0.01］， and the proportion of SAS score above 60 in the study group was significantly lower than that in the control group （41.67% vs. 75.00%， χ²=-13.714， P<0.01）. ConclusionContinuous nursing education may help reduce the level of anxiety in caregivers of patients with all-robot coronary artery bypass surgery.

Background::The clinical characteristics of patients with the comorbidities of hypertension and coronary artery disease (HT-CAD) and atrial fibrillation (AF) are largely unknown. This study aimed to investigate the prevalence of AF in patients with HT-CAD and clinical characteristics of patients with both HT-CAD and AF.Methods::This cross-sectional study was conducted in Chinese People’s Liberation Army General Hospital in Beijing, China, and included 20,747 inpatients with HT-CAD with or without AF from August 2008 to July 2018. We examined the overall prevalence, clinical characteristics, comorbidity profiles, treatment patterns, and blood pressure (BP) control of patients with both HT-CAD and AF. Multivariate logistic regression was used to investigate the associations of cardiovascular risk factors with AF in patients with HT-CAD.Results::The overall prevalence of AF in patients with HT-CAD was 4.87% (1011/20,747), and this increased with age; to be specific, the prevalence in women and men increased from 0.78% (2/255) and 1.02% (26/2561) at the age of <50 years to 8.73% (193/2210) and 10.28 % (298/2900) at the age of ≥70 years, respectively. HT-CAD patients who had AF had a higher prevalence of cardiovascular-related comorbidities than those without AF. Multivariate logistic regression showed that age, gender (male), body mass index, heart failure, and chronic kidney disease were independently associated with the risk of AF in patients with HT-CAD. For those with both HT-CAD and AF, 73.49% (743/1011) had a CHA 2DS 2-VASc score of ≥4, and only about half of them had the BP controlled at <140/90 mmHg, which indicated a high risk of thromboembolism and stroke. The use of oral anticoagulation increased during the study period (10.00% [20/200] in 2008 to 2011 vs. 30.06% [159/529] in 2015 to 2018, P < 0.01), but remained at a relatively low level. Conclusions::AF is highly prevalent among patients with HT-CAD. Patients with both HT-CAD and AF have a higher prevalence of cardiovascular-related comorbidities, lower BP control rate, and lower use of oral anticoagulation.

Objective:To explore the application effect of online and offline mixed teaching based on DingTalk platform in clinical practice teaching of respiratory department.Methods:The Batch 2016 ( n= 40) and Batch 2017 ( n=47) undergraduates of clinical medicine in Qiqihar Medical College were selected as the research objects, and they were divided into a control group and a research group. The control group adopted traditional offline theoretical teaching, while the research group adopted online-offline mixed teaching, focusing on teaching design and teaching objectives, teaching subjects, teaching resources, network platforms and teaching activities (classroom learning and evaluation). The theoretical and practical test scores of the two groups of interns were compared, and the evaluations of the students in the research group on the effect of online and offline mixed teaching were collected. Excel 2013 was used to sort out the data, and R software was used for data processing and statistical analysis. T-test was used for measurement data and Chi-square test was used for counting data. Results:The operational test scores [(28.16±1.70) points] and theoretical scores [(82.07±6.40) points] of the students in the study group were higher than those in the control group [(23.35±2.88) points and (76.20±5.67) points], with significant differences ( P<0.001). Compared with the students in the control group, the students in the research group were more satisfied with the mixed teaching method. Conclusion:The online and offline mixed teaching is conducive to improving students' comprehensive performance, learning effect, and promoting students' clinical diagnosis and treatment skills, self-study, innovation abilities and clinical competence.

Despite recent studies, relatively few are known about the diversity of fungal communities in the deep Atlantic Ocean. In this study, we investigated the diversity of fungal communities in 15 different deep-sea sediments from the South Atlantic Ocean with a culturedependent approach followed by phylogenetic analysis of ITS sequences. A total of 29fungal strains were isolated from the 15 deep-sea sediments. These strains belong to four fungal genera, including Aspergillus, Cladosporium, Penicillium, and Alternaria. Penicillium, accounting for 44.8% of the total fungal isolates, was a dominant genus. The antiaflatoxigenic activity of these deep-sea fungal isolates was studied. Surprisingly, most of the strains showed moderate to strong antiaflatoxigenic activity. Four isolates, belonging to species of Penicillium polonicum, Penicillium chrysogenum, Aspergillus versicolor, and Cladosporium cladosporioides, could completely inhibit not only the mycelial growth of Aspergillus parasiticus mutant strain NFRI-95, but also the aflatoxin production. To our knowledge, this is the first report to investigate the antiaflatoxigenic activity of culturable deep-sea fungi. Our results provide new insights into the community composition of fungi in the deep South Atlantic Ocean. The high proportion of strains that displayed antiaflatoxigenic activity demonstrates that deep-sea fungi from the Atlantic Ocean are valuable resources for mining bioactive compounds.

Despite recent studies, relatively few are known about the diversity of fungal communities in the deep Atlantic Ocean. In this study, we investigated the diversity of fungal communities in 15 different deep-sea sediments from the South Atlantic Ocean with a culturedependent approach followed by phylogenetic analysis of ITS sequences. A total of 29fungal strains were isolated from the 15 deep-sea sediments. These strains belong to four fungal genera, including Aspergillus, Cladosporium, Penicillium, and Alternaria. Penicillium, accounting for 44.8% of the total fungal isolates, was a dominant genus. The antiaflatoxigenic activity of these deep-sea fungal isolates was studied. Surprisingly, most of the strains showed moderate to strong antiaflatoxigenic activity. Four isolates, belonging to species of Penicillium polonicum, Penicillium chrysogenum, Aspergillus versicolor, and Cladosporium cladosporioides, could completely inhibit not only the mycelial growth of Aspergillus parasiticus mutant strain NFRI-95, but also the aflatoxin production. To our knowledge, this is the first report to investigate the antiaflatoxigenic activity of culturable deep-sea fungi. Our results provide new insights into the community composition of fungi in the deep South Atlantic Ocean. The high proportion of strains that displayed antiaflatoxigenic activity demonstrates that deep-sea fungi from the Atlantic Ocean are valuable resources for mining bioactive compounds.