Intestinal barrier damage is a prominent feature of non-alcoholic fatty liver disease （NAFLD） and serves as a critical factor driving the progression from simple fatty liver to non-alcoholic steatohepatitis （NASH）， fibrosis， and cirrhosis. The "turbid pathogenic factors entering the blood" theory integrates classical traditional Chinese medicine （TCM） principles with contemporary disease evolution trends and research findings. It posits that endogenous turbid pathogenic factors within the body infiltrate the blood vessels， leading to impure and viscous blood quality， thereby triggering various diseases. Based on this theory， this article elucidated the pathogenic mechanism of NAFLD-associated intestinal barrier damage. It argued that in NAFLD， the liver loses its dredging function， and the spleen becomes obstructed and dysfunctional. Moreover， essential nutrients fail to be properly transformed， resulting in the internal generation of turbid pathogenic factors. This subsequently initiates a series of pathological changes， namely， "infiltration of phlegm-turbidity into the blood， eroding the intestinal mucosa"， "infiltration of glucose-turbidity into the blood， macerating and eroding the intestinal mucosa"， "infiltration of heat-turbidity into the blood， scorching and eroding the intestinal mucosa"， and "infiltration of stasis-turbidity into the blood， stagnating and eroding the intestinal mucosa"， ultimately causing intestinal barrier damage. Furthermore， guided by the "turbid pathogenic factors entering the blood" theory， this article explored TCM intervention strategies： employing medicinals targeting the liver meridian to address the root cause and reduce the generation and deposition of turbid pathogenic factors in the liver， administering blood-system medicinals to clear the blood and purge turbidity， thereby intercepting the progression of the disease mechanism， and applying tonifying medicinals to bolster healthy Qi and defend against turbid invasion， allowing the damaged intestinal mucosa to gradually heal. This article presented novel theoretical and medicinal perspectives for analyzing NAFLD-associated intestinal barrier damage based on the "turbid pathogenic factors entering the blood" theory， aiming to provide new entry points and broader horizons for related research and clinical practice.

Metabolic dysfunction-associated fatty liver disease （MAFLD） and type 2 diabetes mellitus （T2DM） have a high comorbidity rate， emerging as a major global public health issue. The concept that the middle energizer acting as a balance refers to the role of the middle energizer in maintaining the balance of Qi and blood， dryness and dampness， as well as water and fire （Yin and Yang） in the human body. The core feature of MAFLD with T2DM is the metabolic imbalance， which is closely related to the dysfunction of the middle energizer's balancing role. This article explores the mechanisms of metabolic imbalance in MAFLD with T2DM from the perspective of the middle energizer acting as a balance， proposing that middle energizer dysfunction is the root cause. Qi movement， dryness-dampness， and ministerial fire are the two ends of the balance. MAFLD with T2DM is accompanied by various seemingly contradictory pathological states and imbalances， such as "Qi stagnation and failure of free movement vs. Qi dispersion without retention"， "damp-turbidity obstruction vs. internal dryness and fluid consumption"， and "ministerial fire decline vs. hyperactivity and scorching". On this basis， the traditional Chinese medicine （TCM） intervention strategies and their microscopic mechanisms are discussed. For the root cause of middle energizer imbalance， wind-dispelling herbs and Qi-replenishing and middle energizer-invigorating herbs are used to restore the balancing role of the middle energizer （delaying glucose and lipid absorption， restoring intestinal homeostasis， and ameliorating insulin resistance in skeletal muscle and adipocytes）. For the secondary imbalances， pungent-dispersing and liver-soothing herbs combined with sour-astringent herbs are used to balance Qi movement （alleviating mitochondrial dysfunction in hepatocytes and impaired glucose transport in tissue cells）. Bitter-warm and dampness-draining herbs combined with sweet-cold and moistening herbs are used to balance dryness and dampness （reducing hepatic steatosis， cellular hyperosmotic dehydration， and intracellular metabolic disorders）. Yang-lifting and warm-invigorating herbs combined with clearing-descending and Yin-nourishing herbs are used to balance ministerial fire （ameliorating hepatocyte apoptosis and liver fibrosis processes and alleviating systemic chronic inflammation and related damage）. According to the theory of the middle energizer acting as a balance， this article explores the mechanisms of metabolic imbalance in MAFLD with T2DM and TCM intervention strategies， providing new insights and a framework for related scientific research and clinical practice.

Metabolic dysfunction-associated fatty liver disease （MAFLD） and type 2 diabetes mellitus （T2DM） have a high comorbidity rate， emerging as a major global public health issue. The concept that the middle energizer acting as a balance refers to the role of the middle energizer in maintaining the balance of Qi and blood， dryness and dampness， as well as water and fire （Yin and Yang） in the human body. The core feature of MAFLD with T2DM is the metabolic imbalance， which is closely related to the dysfunction of the middle energizer's balancing role. This article explores the mechanisms of metabolic imbalance in MAFLD with T2DM from the perspective of the middle energizer acting as a balance， proposing that middle energizer dysfunction is the root cause. Qi movement， dryness-dampness， and ministerial fire are the two ends of the balance. MAFLD with T2DM is accompanied by various seemingly contradictory pathological states and imbalances， such as "Qi stagnation and failure of free movement vs. Qi dispersion without retention"， "damp-turbidity obstruction vs. internal dryness and fluid consumption"， and "ministerial fire decline vs. hyperactivity and scorching". On this basis， the traditional Chinese medicine （TCM） intervention strategies and their microscopic mechanisms are discussed. For the root cause of middle energizer imbalance， wind-dispelling herbs and Qi-replenishing and middle energizer-invigorating herbs are used to restore the balancing role of the middle energizer （delaying glucose and lipid absorption， restoring intestinal homeostasis， and ameliorating insulin resistance in skeletal muscle and adipocytes）. For the secondary imbalances， pungent-dispersing and liver-soothing herbs combined with sour-astringent herbs are used to balance Qi movement （alleviating mitochondrial dysfunction in hepatocytes and impaired glucose transport in tissue cells）. Bitter-warm and dampness-draining herbs combined with sweet-cold and moistening herbs are used to balance dryness and dampness （reducing hepatic steatosis， cellular hyperosmotic dehydration， and intracellular metabolic disorders）. Yang-lifting and warm-invigorating herbs combined with clearing-descending and Yin-nourishing herbs are used to balance ministerial fire （ameliorating hepatocyte apoptosis and liver fibrosis processes and alleviating systemic chronic inflammation and related damage）. According to the theory of the middle energizer acting as a balance， this article explores the mechanisms of metabolic imbalance in MAFLD with T2DM and TCM intervention strategies， providing new insights and a framework for related scientific research and clinical practice.

Objective To compare the performance of two different deep learning models,VTcGAN and Pix2pix,in generating synthetic computed tomography(sCT)from magnetic resonance imaging(MRI)of nasopharyngeal carcinoma(NPC),and to evaluate their accuracies in treatment planning dose calculations.Methods MRI and CT images as well as treatment planning data of 115 NPC patients were retrospectively selected,and paired dataset was obtained through rigid image registration,with 105 cases as the training set,and the remaining 10 cases as the test set.Two kinds of models,namely Pix2pix model based on conventional convolutional neural network and the improved VTcGAN model based on Transformer network,were constructed with the consistent structure except for the bottleneck network in the generator.The generated sCT images(sCTPix2pix and sCTVTcGAN)were assessed in terms of image quality,intensity value and dosimetric differences.Results For the cases in test set,the mean error,mean absolute error,peak signal-to-noise ratio,and structural similarity index between the ground truth CT images and the sCTPix2pix were(-0.86±12.42)HU,(40.77±3.06)HU,(33.45±0.62)dB,and 0.928±0.013,respectively;and those between the ground truth CT images and the sCTVTcGAN were(-1.10±8.56)HU,(37.40±2.08)HU,(34.33±0.45)dB,and 0.936±0.009,respectively.For the criterion of 1 mm/1%,the averaged gamma passing rates of sCTPix2pix and sCTVTcGAN were(96.62±1.08)%and(96.88±0.99)%at a dose threshold of 10%,(94.31±1.03)%and(94.72±0.91)%at a dose threshold of 50%,(84.62±1.74)%and(86.06±1.41)%at a dose threshold of 80%,respectively.Conclusion The proposed VTcGAN model is superior to the traditional Pix2pix model in terms of accuracy in generating sCT from MRI of NPC,and it can fulfill the requirements for dose calculation in the MRI-Only workflow.

Objective To compare the performance of two different deep learning models,VTcGAN and Pix2pix,in generating synthetic computed tomography(sCT)from magnetic resonance imaging(MRI)of nasopharyngeal carcinoma(NPC),and to evaluate their accuracies in treatment planning dose calculations.Methods MRI and CT images as well as treatment planning data of 115 NPC patients were retrospectively selected,and paired dataset was obtained through rigid image registration,with 105 cases as the training set,and the remaining 10 cases as the test set.Two kinds of models,namely Pix2pix model based on conventional convolutional neural network and the improved VTcGAN model based on Transformer network,were constructed with the consistent structure except for the bottleneck network in the generator.The generated sCT images(sCTPix2pix and sCTVTcGAN)were assessed in terms of image quality,intensity value and dosimetric differences.Results For the cases in test set,the mean error,mean absolute error,peak signal-to-noise ratio,and structural similarity index between the ground truth CT images and the sCTPix2pix were(-0.86±12.42)HU,(40.77±3.06)HU,(33.45±0.62)dB,and 0.928±0.013,respectively;and those between the ground truth CT images and the sCTVTcGAN were(-1.10±8.56)HU,(37.40±2.08)HU,(34.33±0.45)dB,and 0.936±0.009,respectively.For the criterion of 1 mm/1%,the averaged gamma passing rates of sCTPix2pix and sCTVTcGAN were(96.62±1.08)%and(96.88±0.99)%at a dose threshold of 10%,(94.31±1.03)%and(94.72±0.91)%at a dose threshold of 50%,(84.62±1.74)%and(86.06±1.41)%at a dose threshold of 80%,respectively.Conclusion The proposed VTcGAN model is superior to the traditional Pix2pix model in terms of accuracy in generating sCT from MRI of NPC,and it can fulfill the requirements for dose calculation in the MRI-Only workflow.

Objective To analyze delay in visiting a doctor and diagnosis of tuberculosis patients in Xicheng District treated by different types of designated medical institutions in Beijing.Methods We derived the data of tuberculosis patients from China disease prevention and control information system,the patients were managed by Tuberculosis Prevention and Control Institute of Xicheng District from January 1,2020 to December 31,2020.The patients were divided into prevention institute group and designated hospital group according to the current diagnosis unit.The basic information and characteristics of two groups were analyzed retrospectively.Results 74.86％patients were able to visit a doctor in two weeks,72.13％patients were diagnosed in two weeks.The proportion of patients delayed for 6 weeks or more in visiting a doctor in the designated hospital group was less than that in the prevention institute group,the proportion of patients diagnosed in time in the designated hospital group was higher than that in the prevention institute group,but the rest were not significant.Logistic regression showed that concomitant diabetes was a risk factor for delay in visiting a doctor,non-local residence was a protective factor for it.Diagnosis unit was a protective factor for diagnosis delay.Conclusion Most patients in Xicheng district could visit a doctor and be diagnosed in time,while some patients delay in visiting a doctor and diagnosis.Compared with the prevention institute,tuberculosis patients in designated hospitals less delay in visiting a doctor for more than 6 weeks and less delay in diagnosis.Patients with diabetes has a higher risk of delay in visiting a doctor.

Objective To evaluate the biochemical indicators,nutritional status,and immune levels of pa-tients with pulmonary aspergillosis(PA)and other pulmonary diseases,and to construct a predictive model for PA so as to improve the diagnostic efficacy of clinical PA.Methods A total of 40 PA patients and 39 pa-tients with other pulmonary diseases who were hospitalized in the hospital from January 2020 to August 2022 were retrospectively analyzed.The expression trends and differences of serum 1,3-β-D Glucan(G test),galac-tomannan test(GM test),biochemical indexes,blood routine indexes and immune cell subsets were analyzed and compared.The receiver operating characteristic(ROC)curve and binary Logistic regression analysis were used to construct the predictive model for PA by the combination of clinical indicators.Results Serum GM test,G test,albumin,hemoglobin,hematocrit,lymphocytes,B lymphocytes,CD44 T lymphocytes and CD4/CD8 ratio displayed significant differences between PA patients and patients with other lung disease(P＜0.05).The levels of GM test in alveolar lavage fluid of PA patients were significantly higher than that in the serum,and the differences were statistically significant(P＜0.05).The ROC curve analysis showed that the GM test,as an independent predictor of PA,had good predictive accuracy[0.85＜area under the curve(AUC)＜0.95].Besides,albumin,natural killev cells,CD4+T lymphocytes and CD4/CD8 ratio had general predictive efficacy(0.70＜AUC＜0.85).The prediction efficacy of G test and B lymphocytes was poor(AUC＜0.70).The Logistic regression analysis showed that the combination of GM test and serum albumin could construct the optimal prediction model,and the prediction formula of the combined model was as fol-lows:Logit(P)=17.781× GM-0.131×albumin+1.394.The prediction accuracy of the combined model was 0.924(95％CI:0.865-0.982),the sensitivity was 87.5％,the specificity was 81.2％,and the cut off value was 17.781×GM-0.131×albumin-1.735.Conclusion This study retrospectively analyzed the differences in various clinical indicators between patients with PA and patients with other pulmonary diseases,and then screen the key clinical indicators as candidate predictors which displayed significantly different ex-pression between the two groups.The optimal prediction model for the diagnosis of PA is constructed by the combination of GM test and serum albumin through ROC curve and Logistic regression analysis.This model may significantly improve the diagnostic efficiency of PA in clinical,and provide the reference for the early di-agnosis and effective treatment of PA patients.

Objective:To analyze the hotspots of international acupuncture research; To evaluate the influence of each hotspot; To explore its development trend.Methods:Acupuncture research related literature was retrieved from the Web of Science core database from January 1, 2019 to January 1, 2022. 42 highly cited literature was extracted using BICOMB 2.01 software, and a 42×42 co-occurrence matrix was constructed. A co-citation cluster analysis figure was drawn with SPSS 26.0 software. The CPT values of each hotspot identified in the cluster figure were computed using the formula CPT=(C/P)/T=C/(P·T). Bubble charts were drawn to show each hotspot's annual publication of articles.Results:Totally 23 research hotspots were identified, including consensus on the quality of evidence and recommendation intensity, assessment of the efficacy of acupuncture for chronic pain and analgesic mechanisms of acupuncture. The bubble chart showed that the annual attention of 23 hotspots varied, with 14 hotspots increasing year by year, 5 hotspots remaining stable, and only 4 hotspots decreasing year by year.Conclusions:The study has found that the direction of acupuncture research in the past three years focuses on acupuncture indication research, acupuncture mechanism research and evidence-based methodology research. China is the main contributor to the expansion of acupuncture indication research. The international trend of acupuncture development is obvious. Chinese acupuncture research faces greater competitive pressure, and the influence of core papers is insufficient.

Purpose: Nurses play an important role in ensuring patient rehabilitation and are involved in all aspects of multidimensional rehabilitation.Therefore, strengthening rehabilitation nursing education is vital to ascertain high-quality rehabilitation and optimum outcomes. This study examined the effectiveness of a new teaching reform—a modified Six-Sigma-based training program—against a conventional educational program on rehabilitation specialist nurses’ core competencies, post-training performance, and satisfaction. Methods: A quasi-randomized controlled trial was conducted to assess the effectiveness of the modified training program. We recruited 56 learners from the 2020 training course at the Hunan Rehabilitation Specialist Nurse Training Base as the control group. Sixty learners from the base’s 2021 training course were recruited as the intervention group. Data were collected in a consistent manner from both groups after the training program was implemented. Results: Those who underwent the modified training program showed better improvement in all core competencies than those who underwent the conventional training program (p < .05); the scores for theoretical knowledge, clinical nursing lectures, reviews, and nursing case management improved significantly following the teaching reform (p < 0.05). Further, overall satisfaction as well as base management and theoretical teaching satisfaction improved significantly (p < .05). Conclusion The modified training program strengthens rehabilitation nurses’ base management abilities; enhances their core competencies; expands their interest in and breadth, depth, and practicability of theoretical courses; and updates the teaching methods.

【Objective】 This study aims to summarize the hotspots of acupuncture research in China and abroad in recent 10 years. 【Methods】 The core collection of Web of Science was retrieved, and the literature on experimental and clinical research of acupuncture in China and abroad was collected from January 1, 2012 to December 31, 2021. The included literature was visually analyzed using CiteSpace 6.1.R3. Statistical analysis was carried out in the annual number of papers, authors, countries, and journals. According to the author's country, the literature was divided into Chinese and global categories for keywords clustering analysis and co-citation references analysis independently to obtain hotspots and trends in acupuncture research. 【Results】 There are 1 215 articles in acupuncture experimental medicine, 3 805 articles in acupuncture clinical medicine in China; 551 articles in acupuncture experimental medicine, and 4 538 articles in acupuncture clinical medicine abroad. The number of articles on acupuncture abroad remains stable and flat, whereas the annual number of domestic papers shows a continuously growth trend. LIU Cunzhi from Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University in China is the author who has published the most articles in the field of acupuncture in the recent decade. China is the most productive country in publishing such research articles. Evidence-based Comprehensive and Alternative Medicine is the journal with the most published articles. The mechanisms of acupuncture on nerve regeneration or nerve recovery and research on the mechanisms of acupuncture analgesia are hotspots in experimental acupuncture research, and the treatment of neuropathic pain and dysfunctional diseases with acupuncture are hotspots in clinical acupuncture research in China. Research on the mechanism of protection of the cardiovascular system by acupuncture and research on the mechanism of analgesia by acupuncture are hotspots in experimental research on acupuncture abroad. Studies on the amelioration of inflammatory pain and psychological or psychiatric disorders by acupuncture also serve as hotspots in clinical research on acupuncture abroad. 【Conclusion】 Acupuncture research in China focuses on the treatment of internal diseases and visceral pain, while acupuncture research abroad concentrates on the alleviation and improvement of cancer and psychological and mental diseases. Treatment of internal diseases and mental diseases with acupuncture is the trend of future research.