Retinal microcirculatory disorder is a key factor in the occurrence and development of diabetic retinopathy （DR）， and also an important link in the prevention and treatment of DR. The theory of "Gaozhuo" holds that the microcirculatory disorder in DR is based on the deficiency of spleen Qi and is characterized by the obstruction caused by "Gaozhuo" and blood stasis. The deficiency of spleen Qi is an essential precondition for the endogenous formation and accumulation of Gaozhuo， while Gaozhuo invasion is the direct cause of microcirculatory disorders in DR. The deficiency of spleen Qi and the endogenous formation of Gaozhuo mean the process in which glucose metabolism dysfunction induces an excessive production of inflammatory factors and lipid metabolites. The obstruction caused by "Gaozhuo" and blood stasis is the direct pathogenesis of microcirculatory disorders in DR， encompassing two stages： Gaozhuo obstruction and turbidity and stasis stagnation. Gaozhuo obstruction and turbidity and stasis stagnation represent the process in which inflammatory factors and lipid metabolites damage the retinal microcirculation and induce thrombosis， thus mediating microcirculatory disorders. Turbidity and stasis stagnation and blood extravasation outside the vessels reveal the progression to microvascular rupture and hemorrhage resulting from the microcirculatory disorders. According to the pathogenesis evolution of the theory of "Gaozhuo"， microcirculatory disorders in DR can be divided into deficiency of spleen Qi with Gaozhuo obstruction， deficiency of spleen Qi with turbidity and stasis stagnation， and turbidity and stasis stagnation with blood extravasation outside the vessels. Clinically， treatment principles should focus on strengthening the spleen and benefiting Qi， resolving turbidity， and dispersing stasis. Different syndrome patterns should be addressed with tailored therapies， such as enhancing the spleen and benefiting Qi while regulating Qi and reducing turbidity， strengthening the spleen and benefiting Qi while resolving turbidity and dispelling stasis， and strengthening the spleen and resolving turbidity while removing stasis and stopping bleeding. Representative prescriptions include modified Wendantang， modified Buyang Huanwutang， modified Danggui Buxuetang， Zhuixue Mingmu decoction， Tangmuqing， Shengqing Jiangzhuo Tongluo Mingmu prescription， Danhong Huayu decoction， and Yiqi Yangyin Huoxue Lishui formula.

Aromatic inhalation therapy is a key traditional Chinese medicine （TCM） approach for preventing respiratory infectious diseases. Its foundational theory， "aromatics acting on the spleen"， is deeply rooted in TCM principles and supported by modern medical research. The theory posits that the aromatic properties of medicinals primarily act on the spleen， and the aromatic inhalation therapy achieved its protective effects by modulation of the spleen and spleen channel to enhance the regulation of wei qi， striae and interstices. In TCM， the spleen is considered the mother of the lungs， with the function of nurturing lung； it is also seen as the source of wei qi， responsible for external defense； and the root of healthy qi， forming the foundation of acquired （postnatal） constitution. Thus， preventive strategies for respiratory infectious diseases focus on strengthening the spleen. From a modern medical perspective， the spleen's role in regulating lung immune responses， the shared immune functions of the respiratory and gastrointestinal mucosa， and the spleen's overall immune modulation provide scientific evidence for using aromatic inhalation therapy to prevent respiratory infections. Additionally， aromatic inhalation therapy offers several advantages， including direct action， rapid onset， minimal side effects， controllable risks， convenience， and ease of dissemination， making it a practical and effective preventive measure for respiratory infectious diseases.

Ferroptosis of chondrocytes is a significant contributor to osteoarthritis (OA), for which there is still a lack of safe and effective therapeutic drugs targeting ferroptosis. Here, we screen for anti-ferroptotic drugs in Food and Drug Administration (FDA)-approved drug library via a high-throughput manner in chondrocytes. We identified a group of FDA-approved anti-ferroptotic drugs, among which vitamin K showed the most powerful protective effect. Further study demonstrated that vitamin K effectively inhibited ferroptosis and alleviated the extracellular matrix (ECM) degradation in chondrocytes. Intra-articular injection of vitamin K inhibited ferroptosis and alleviated OA phenotype in destabilization of the medial meniscus (DMM) mouse model. Mechanistically, transcriptome sequencing and knockdown experiments revealed that the anti-ferroptotic effects of vitamin K depended on growth arrest-specific 6 (Gas6). Furthermore, exogenous expression of Gas6 was found to inhibit ferroptosis through the AXL receptor tyrosine kinase (AXL)/phosphatidylinositol 3-kinase (PI3K)/AKT serine/threonine kinase (AKT) axis. Together, we demonstrate that vitamin K inhibits ferroptosis and alleviates OA progression via enhancing Gas6 expression and its downstream pathway of AXL/PI3K/AKT axis, indicating vitamin K as well as Gas6 to serve as a potential therapeutic target for OA and other ferroptosis-related diseases.

Objective: To elucidate the potential mechanisms by which Chinese herbal medicine (CHM) regulates gut microbiota (GM) to influence the development of primary open-angle glaucoma (POAG). Methods: Data mining, network pharmacology, and Mendelian randomization (MR) analyses (two-sample design) were conducted in integration to systematically explore the CHM-GM-POAG axis. Literature-based data mining method was applied to identify frequently used herbs and herb pairs for POAG, and the properties and meridian tropism of the herbs were analyzed as well. Target prediction and pathway enrichment analyses were performed to identify shared molecular pathways among CHM components, GM, and POAG. MR analysis was performed to assess the genetically predicted causal associations between specific microbial taxa and POAG risk. Results: Our data mining work indicated that commonly used CHMs were mainly bitter and sweet in flavors and cold in property, with meridian tropism toward the liver, lung, and kidney. The predominant therapeutic effects of the CHMs included soothing the liver and regulating Qi, promoting blood circulation, and reducing fluid retention. Representative herb pairs were Shudihuang (Rehmanniae Radix Praeparata)-Gouqi (Lycii Fructus) with Zexie (Alismatis Rhizoma), Gouqi (Lycii Fructus)-Fuling (Poria) with Shudihuang (Rehmanniae Radix), and Juhua (Chrysanthemi Flos)-Gouqi (Lycii Fructus) with Zexie (Alismatis Rhizoma). Network pharmacology revealed overlapping targets involving antioxidative, anti-inflammatory, and metabolic regulation pathways. MR analysis demonstrated that higher abundances of Ruminiclostridium 6 [odds ratio (OR) = 0.73, 95% confidence interval (CI): 0.58 – 0.92, P = 0.007], Ruminococcaceae UCG-002 (OR = 0.77, 95% CI: 0.63 – 0.96, P = 0.018), Ruminococcus torques group (OR = 0.71, 95% CI: 0.57 – 0.90, P = 0.004), and Victivallis (OR = 0.82, 95% CI: 0.70 – 0.96, P = 0.016) were causally associated with reduced POAG risk, whereas Actinomyces (OR = 1.34, 95% CI: 1.06 – 1.68, P = 0.013) and Blautia (OR = 1.39, 95% CI: 1.01 – 1.90, P = 0.042) showed positive associations. Conclusion This study revealed potential causal links between GM and POAG and provided integrative evidence that CHM may modulate the microbiota to exert neuroprotective effects. These findings offer new integrative insights into the gut-eye axis and a theoretical basis for developing microbiota-targeted CHM strategies in glaucoma management.

Objective:To evaluate the quality of test papers and to analyze students'mastery of knowledge through the analysis of test papers,so as to provide reference for the reform of test proposition and correction teaching.Methods:Using paper analysis software(Ver 2.0),the paper quality,the students'scores and the answers to the questions of the final exam paper of Physiology of grade 2021 students majoring in nursing were analyzed.Results:The composition of the test paper was consistent with the requirements of the teaching programme,the difficulty of subjective and objective test questions was moderate,the differentiation of subjective test questions was good,the differentiation of objective test questions was general,and the reliability and validity were good.The overall performance was basically normal distribution.The full score ratio of objective test questions was higher than that of subjective test questions,and the zero score test questions were mostly concentrated in chapter 10 and chapter 4.Conclusion:Test paper analysis can feedback the problems and shortcomings of test paper proposition and teaching process,promote the quality of test paper and teaching model innovation,and improve the quality of teaching.

Skin modeling of transdermal drug delivery system refers to experimental models that mimic the structure and function of human skin to explore and evaluate absorption,penetration,and efficacy of medicines in transdermal drug delivery.It provides an alternative to traditional human skin experiments and reduces the use of human skin in medical research,which is convenient,controllable,and cost effective.For skin models of transdermal drug delivery systems,this article introduces commonly used animal skin models,artificial skin models,and recombinant human skin models from the perspective of the transdermal absorption pathway of medicines,and analyzes their advantages,disadvantages,and applications so provide references the research and development of transdermal formulations and topical therapies.

Background Clozapine belongs to atypical antipsychotic drugs that has shown significant efficacy in treating schizophrenia.However,clozapine can induce arrhythmias in patients.Currently,there is a lack of systematic research on the types and incidence of clozapine-induced arrhythmias.Objective To explore the types and incidence of arrhythmias in patients with schizophrenia induced by clozapine through Meta-analysis,so as to provide references for clinical treatment.Methods On October 31,2022,a search was conducted through PubMed,Embase,Cochrane Library and China National Knowledge Infrastructure(CNKI)to collect relevant literature on clozapine-induced arrhythmia in patients with schizophrenia.Joanna Briggs Institute(JBI)was used to evaluate the quality of the included literature.Meta-analysis was conducted using Review Manager 5.4.Results A total of 12 studies were included,involving 42 490 schizophrenia patients taking clozapine.The incidence of arrhythmias caused by clozapine was 23％(95％CI:0.16～0.29).Among them,the incidence of tachycardia was 25％(95％CI:0.15～0.35),atrial arrhythmia was 6％(95％CI:-0.02～0.14),ventricular arrhythmia was 7％(95％CI:-0.02～0.16),conduction block was 2％(95％CI:0～0.04),QTc prolongation was 4％(95％CI:-0.04～0.12)and T-wave changes was 23％(95％CI:0.16～0.30).Conclusion Schizophrenia patients taking clozapine may increase their risk of developing arrhythmia,with tachycardia being the most prevalent.

A case report of multiple neuropathic arthropathy in a patient with syphilis was reported. A 54-year-old man was admitted to the hospital 10 years ago due to edema and pain with limited motion for 3 d after a sprain in his right foot. Imaging examination then showed bone and joint destruction of the talus and scaphoid of the right foot. The talonavicular and calcaneocuboid joint arthrodesis was performed. Ten years later, he was admitted again due to pain in his left hip for 2 months after a fall. Present imaging examination showed disappearance of the femoral head and dislocation of the hip joint. Syphilitic neuroarthropathy was diagnosed and total hip arthroplasty was performed. After operation, the right foot and left hip yielded good results without obvious pain and joint dislocation. Literature review showed that the causes of neuropathic arthropathy were very wide, but multiple neuropathic arthropathy in patients with syphilis was rarely reported. The treatment of neuropathic arthropathy should be considered based on comprehensive factors such as the location of the affected joint, the degree of damage and the impact on function. The aim of treatment is to obtain painless, stable and functional joints. With sensory loss of the patients, enhancing restriction of the joint during surgery is of importance to effectively prevent postoperative dislocation and obtain good function.

Background: and Purpose Performing the differential diagnosis of Parkinson’s disease (PD) and multiple-system atrophy of parkinsonian type (MSA-P) is challenging. The oculomotor performances of patients with PD and MSA-P were investigated to explore their potential role as a biomarker for this differentiation. Methods: Reflexive saccades and smooth pursuit were examined in 56 patients with PD and 34 with MSA-P in the off-medication state. Results: Patients with PD and MSA-P had similar oculomotor abnormalities of prolonged and hypometric reflexive saccades. The incidence rates of decreased reflexive saccadic velocity and saccadic smooth pursuit were significantly higher in MSA-P than in PD (p<0.05 for both). Multiple logistic regression analysis indicated that slowed reflexive saccades (odds ratio [OR]=8.14, 95% confidence interval [CI]=1.45–45.5) and saccadic smooth pursuit (OR=5.27, 95% CI=1.24–22.43) were significantly related to MSA-P. Conclusions The distinctive oculomotor abnormalities of saccadic smooth pursuit and slowed reflexive saccades in MSA-P may serve as useful biomarkers for discriminating MSA-P from PD.

Objective To explore the risk factors of aspiration during hospitalization in patients with ischemic stroke (IS) and establish a predictive model. Methods Based on the case-control design, clinical materials of 316 IS patients treated in the Department of Neurology of Suzhou Ninth Hospital Affiliated to Soochow University from March 2022 to October 2023 were retrospectively collected. According to incidence of aspiration during hospitalization, the patients were divided into case group with 89 cases (aspiration occurred during hospitalization) and control group with 227 cases (no aspiration occurred during hospitalization). Univariate and multivariate Logistic regression analyses were performed in both groups to screen out the risk factors of aspiration during hospitalization in IS patients. R software was used to extract 70 % of the data from the two groups as the training set (establishing a Nomogram model), and the remaining 30 % data was used as test set. Value of predictive model was evaluated by area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration curve, and decision curve. Results There were significant differences in the terms of age, the National Institutes of Health Stroke Scale (NIHSS) score, number of lesions, homocysteine (Hcy) level, spontaneous cough, and grading of Wada drinking water test between the case group and the control group (P < 0.05). Multivariate Logistic analysis showed that large age (OR=2.201, 95 %CI, 1.254 to 3.865), high NIHSS score (OR=4.816, 95 %CI, 1.652 to 14.041), multiple lesions (OR=2.649, 95 %CI, 1.249 to 5.613), high level of Hcy (OR=1.501, 95 %CI, 1.044 to 2.158), weakened or absent spontaneous cough (OR=3.384, 95 %CI, 1.639 to 6.987), and high grading of Wada drinking water test (OR=2.878, 95 %CI, 1.422 to 5.783) were the risk factors of aspiration during hospitalization in IS patients (P < 0.05). In the training set, the AUC of the Nomogram model for predicting aspiration during hospitalization in IS patients was 0.872 (95 %CI, 0.827 to 0.919), and was 0.859 (95 %CI, 0.807 to 0.904) in the test set. The calibration curve analysis showed that P value was 0.869 in the training set and 0.898 in the test set. The decision curve analysis for both the training set and test set showed that the Nomogram model was of good clinical applicability. Conclusion The risk of aspiration during hospitalization in IS patients is related to large age, high NIHSS score, multiple lesions, high level of Hcy, weakened or absent spontaneous cough, and high grading of Wada drinking water test. The Nomogram predictive model established on these factors can effectively evaluate the risk of aspiration during hospitalization in IS patients.