This article adopts Professor CHEN Chaozu′s " sanjiao composed by membrane-striae" theory as its foundation to explore the relationship between irritable bowel syndrome and functional/structural abnormalities of the membrane-striae. Sanjiao encompasses both the tangible membrane and the intangible striae. These striae permeate the entire body，and their pathological changes comprehensively reflect qi，body fluids，and fasciae. Based on the physiological function of the membrane-striae in regulating qi and fluids，the pathogenesis of irritable bowel syndrome is characterized by a disharmony of membrane-striae and an imbalance of the qi-fluid interactions. In the early stage，external pathogens，emotional factors，or dietary stimuli often cause membrane-striae constriction and disordered qi-fluid circulation. In the middle stage，stagnant fluids gradually transform into phlegm retention，leading to membrane-striae obstruction. In the late stage，deficiency of vital qi becomes predominant，manifesting as laxity of membrane-striae with impaired control or weakened conduction. The treatment of irritable bowel syndrome should adopt " unblocking" as the guiding principle. In the early stage，therapy should focus on eliminating pathogenic factors and soothing membrane-striae to promptly restore qi-fluid circulation，thereby attaining unblocking through spasm relief. In the middle stage，treatment should focus on resolving tangible obstructions in membrane-striae，achieving unblocking via dredging. In the late stage，the emphasis should shift to reinforcing healthy qi，particularly by strengthening spleen-kidney yang qi，and achieving unblocking through supplementation. Concurrently，throughout the entire treatment process，the regulation of mental state and easing of emotional tension should be integrated to alleviate patient′s anxiety，achieving the goal of holistic treatment of both body and mind.

Objective To compare the dosimetric differences, plan complexity, verification pass rate, and execution efficiency of volumetric modulated arc therapy (VMAT) plans designed for post-mastectomy radiotherapy of breast cancer using Halcyon 2.0 and VitalBeam accelerators in flattening filter-free mode. Methods A retrospective analysis was conducted on imaging data from 87 female breast cancer patients aged 29 to 75 (49.9 ± 9.9) years who underwent modified radical mastectomy followed by radiotherapy. VMAT plans were designed using both VitalBeam and Halcyon accelerators in flattening filter-free mode. The dosimetric parameters, plan complexity, verification pass rate, and execution efficiency were compared between the plans designed for both accelerators, with a significance level of P<0.05. Results In terms of target volume parameters, Halcyon 2.0 plans demonstrated superior homogeneity index and conformity index. For organs at risk, the Halcyon 2.0 plans showed lower doses for the lungs (D_20% and D_mean) and heart (D_mean) compared to the VitalBeam plans (all P<0.05). Regarding plan complexity, Halcyon 2.0 plans exhibited better median average aperture area variation (0.35 ± 0.02), smaller aperture score, and larger median plan aperture area than VitalBeam plans (all P<0.05). However, VitalBeam plans had a superior median modulation complexity score (0.28 ± 0.01) compared to Halcyon 2.0 plans (P<0.05). Patient plans were assessed using the ArcCHECK phantom, revealing higher pass rates and significantly shorter execution time for Halcyon plans compared to VitalBeam plans (P<0.05). Conclusion Both Halcyon 2.0 and VitalBeam accelerators can provide high-quality VMAT plans for postoperative radiotherapy of breast cancer, with excellent verification pass rates ensuring treatment accuracy and efficacy. However, Halcyon 2.0 offers lower plan complexity, simplifies the treatment planning process, and reduces execution time, thereby achieving higher treatment efficiency and demonstrating greater advantages in clinical applications.

Objective:To investigate the effects of lezumab adjuvant therapy on the degree of retinal vasculopathy and immune response in the treatment of macular central diabetic retinopathy (DR).Methods:From July 2022 to December 2023, 120 patients with DR in macular central who received treatment in the Xi′an People′s Hospital (Xi′an Fourth Hospital) were retrospectively selected and divided into two groups according to the treatment methods: the observation group (60 cases, lezumab combined with sitagliptin), and the control group (60 cases, sitagliptin). Patients′glucose metabolism, visual acuity, degree of retinopathy, inflammation [tumor necrosis factor-alpha (TNF-α), interleukin-2 (IL-2), interleukin-10 (IL-10)] and angiogenesis related factors [serum vascular endothelial growth factor (VEGF), midkine (MK), 5′-nucleotidase (CD73)] were evaluated, and the curative efficacy of the two groups was compared. The security of the two schemes was compared.Results:Compared with the control group, the serum concentrations of MK, CD73, TNF-α and VEGF were lower in the observation group after treatment: (1.44 ± 0.06) ng/L vs. (1.67 ± 0.11) ng/L, (1.10 ± 0.27) ng/L vs. (1.31 ± 0.26) ng/L, (11.62 ± 0.89) ng/L vs. (15.96 ± 4.42) ng/L, (84.07 ± 27.07) ng/L vs. (100.72 ± 16.05) ng/L, while the concentration of IL-10 was higher: (65.65 ± 8.68) ng/L vs. (60.02 ± 5.07) ng/L, with statistically significant differences ( P<0.05). There were no statistically significant differences in fasting blood glucose (FBG) and 2 h postprandial blood glucose between two groups before and after treatment ( P>0.05). After treatment, the macular thickness and visual field gray value in the observation group were lower than those in the control group: (302.81 ± 77.08) μm vs. (336.44 ± 10.35) μm, (1.55 ± 0.43)% vs. (2.09 ± 0.51)% ( P<0.05). After 3 months of treatment, the visual acuity in the observation group was higher than that in the control group: 0.493 ± 0.103 vs. 0.439 ± 0.084 ( P<0.05). No serious adverse reactions occurred in both groups. Conclusions:Lezumab assisted sitagliptin has a significant effect in the treatment of DR, which can reduce the degree of lesions, improve vision, and reduce the levels of inflammation and angiogenesis related factors.

Objective To explore the diagnostic value of the radiomic model based on panoramic radiographs in differentiating single or multiple root canals in mandibular first premolars.Methods A retrospective analysis was conducted on 68 patients with CBCT and panoramic radiographs from the affiliated Stomatological Hospital of Nanjing Medical University between July 2022 and November 2023.One hundred and thirty one mandibular first premolars(105 single-root and 26 multiple-root canals)were included in this study.Using stratified random sampling,the mandibular first premolars were divided into a training cohort(104 teeth)and a test cohort(27 teeth)at a ratio of 8∶2.CBCT was used to confirm the root canal configuration,and radiomic features were extracted from panoramic radio-graphs.After feature screening,radiomic models were constructed using extratrees,LightGBM,logistic regression(LR),multi-layer perceptron(MLP),random forest,support vector machine(SVM),and XGBoost.The optimal radiomic model was selected based on receiver operating characteristic(ROC)curve,accuracy,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and decision curve analysis(DCA).Results A total of 107 radiomicfeatures were extracted from panoramic radiographs.After feature filtering,4 radiomic features were ultimately selected using the Lasso model.The XGBoost model showed higher predictive efficiency and stability,with an AUC of 0.962 in the training cohort and 0.770 in the test cohort.DCA curves also in-dicated that the XGBoost model was optimal.Conclusion The radiomic model based on panoramic radiographs demonstrates good per-formance in differentiating single or multiple root canals in mandibular first premolars.

Objective To investigate the efficacy of the ultraviolet A-riboflavin cross-linking corneal stromal lenticule punctal plug for the treatment of dry eyes in rabbits.Methods Thirty-two New Zealand white rabbits(64 eyes)were se-lected and randomly divided into a normal group,a model group,a conventional plug group and a cross-linking plug group,with 8 rabbits(16 eyes)in each group.Rabbits in the normal group were not treated.In the model group,moderate-to-se-vere dry eye rabbit models were constructed but no treatment was given.Rabbits in the conventional and cross-linking plug groups were implanted with conventional and cross-linking plugs after model construction,respectively.The tear film func-tions of the experimental rabbits,including tear secretion volume(SIT),corneal fluorescein sodium staining,tear film break-up time(BUT),and tear meniscus height(TMH),were detected before the intervention,1 day,1 week,2 weeks,and 4 weeks after the intervention.In addition,the corneas of each group were collected for hematoxylin and eosin(HE)staining to observe the changes of the corneal epithelium 4 weeks after the intervention.Finally,the non-cross-linking and cross-linking corneal stromal lenticules were placed separately in 1 g·L-1 of type Ⅰ collagenase to observe the change of the lenticule diameter over time.Results In the cross-linking plug group,the SIT,BUT and TMH values 2 and 4 weeks after the intervention were significantly higher than those before the intervention(all P＜0.01).In the conventional plug group,the SIT,BUT and TMH values 4 weeks after intervention were significantly higher than those before the intervention(all P＜0.01).After 4 weeks of intervention,the corneal staining of rabbits in the cross-linking plug group was better than that in the conventional plug group and model group.The HE staining results showed that in the cross-linking plug group,the corneal epithelial thickness of rabbits was basically normal,epithelial cells were basically arranged in order,and a single layer of columnar epithelial cells was observed on the basal layer.The dissolution time of the corneal stromal lenticule after cross-linking was significantly increased,compared with that of the non-cross-linking one.Conclusion The ultraviolet A-riboflavin cross-linking corneal stromal lenticule punctal plug has a more stable therapeutic effect on the rabbit dry-eye model than the conventional one,so it is expected to provide a novel approach for the clinical treatment of dry eyes.

Objective In response to the prevalent issue of insufficient professional quality among nursing staff working in care homes,this study aims to conduct a foundational assessment using the"Medical and Elderly Care Integration Institution Elderly Care Staff Professional Quality Assessment Scale"based on the job competency theory,and then investigate the effective-ness of the"333"tiered training model following the initial assessment.Methods A convenience sampling method was used to select 160 caregivers from care homes in Wuxi.The caregivers were equally divided into an experimental group and a control group.A baseline assessment of professional competence was conducted using the professional quality assessment indicator system before training.The experimental group was treated with a tiered training model and training program,which were proposed using literature research and questionnaire survey methods and according to the results of baseline professional quality assessment.The control group did not undergo tiered training,but took the same training program as in the experimental group.SPSS 21.0 soft-ware was used for analysing the training outcome data.Results By comparison,the experimental group showed significantly re-duced learning time and had significantly higher assessment scores.The satisfaction degree of the elderly people and the caregiv-ers of the experimental group was significantly higher than that of the control group.The satisfaction ratings with training course design,training methods,and information-based teaching in the experimental group were significantly higher than those in the control group.Conclusion Assessing the professional quality of medical and elderly caregivers is essential for tired training.Tiered training is an effective way to improve the quality and efficiency of training,and a complete training organization system and a sound management mechanism are essential guarantees for implementing tiered training.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective In response to the prevalent issue of insufficient professional quality among nursing staff working in care homes,this study aims to conduct a foundational assessment using the"Medical and Elderly Care Integration Institution Elderly Care Staff Professional Quality Assessment Scale"based on the job competency theory,and then investigate the effective-ness of the"333"tiered training model following the initial assessment.Methods A convenience sampling method was used to select 160 caregivers from care homes in Wuxi.The caregivers were equally divided into an experimental group and a control group.A baseline assessment of professional competence was conducted using the professional quality assessment indicator system before training.The experimental group was treated with a tiered training model and training program,which were proposed using literature research and questionnaire survey methods and according to the results of baseline professional quality assessment.The control group did not undergo tiered training,but took the same training program as in the experimental group.SPSS 21.0 soft-ware was used for analysing the training outcome data.Results By comparison,the experimental group showed significantly re-duced learning time and had significantly higher assessment scores.The satisfaction degree of the elderly people and the caregiv-ers of the experimental group was significantly higher than that of the control group.The satisfaction ratings with training course design,training methods,and information-based teaching in the experimental group were significantly higher than those in the control group.Conclusion Assessing the professional quality of medical and elderly caregivers is essential for tired training.Tiered training is an effective way to improve the quality and efficiency of training,and a complete training organization system and a sound management mechanism are essential guarantees for implementing tiered training.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.