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.

Objective: To explore the independent and interactive effects of school green space exposure and outdoor activity duration on screening myopia among primary and secondary school students, so as to provide theoretical support for the prevention and control of screening myopia in children and adolescents. Methods: From September to November 2023, 117 487 primary and secondary school students from 497 schools were selected using a cluster random sampling method, covering 98 counties (cities, districts) in Jiangsu Province. Data on the students screening myopia status and associated health influencing factors were collected and analyzed. School green space exposure was quantified using the normalized difference vegetation index (NDVI), which was extracted with ArcGIS Pro software; meanwhile, information on students outdoor activity duration was gathered through self reported questionnaires. Multivariate Logistic regression was applied to assess the independent and interactive effects of green space exposure and outdoor activity duration on screening myopia among primary and secondary school students. Results: Univariate analysis showed that there were statistically significant differences in screening myopia detection rates among primary and secondary school students of different genders, NDVI groups, every outdoor activity duration, monitoring points, school stages, parents educational level, and whether they lived on campus or had parents with screening myopia ( χ 2=88.91-1 950.08, all P <0.05); as the school age and sedentary time increased, the detection rate of screening myopia in primary and secondary school students also increased ( χ 2 trend =8 410.15, 2 028.91, both P <0.05). Independent effects showed that compared to the low NDVI group, the medium and high NDVI groups had lower risks of screening myopia ( OR =0.93, 0.95, both P <0.05). Compared to those with outdoor activity duration<2 h/d, students with outdoor activity duration≥2 h/d had a lower risk of screening myopia ( OR =0.96, P <0.05). When stratified by school level, compared to the low NDVI group, the medium NDVI group had lower risks of screening myopia in primary and junior high schools (primary school: OR =0.91; junior high school: OR =0.88, both P <0.05). Compared to those with outdoor activity duration<2 h/d, junior high school students with outdoor activity duration≥2 h/d had a lower risk of screening myopia ( OR = 0.90, P <0.05). When stratified by monitoring site, urban primary and secondary school students in the medium and high NDVI groups and those with outdoor activity duration≥2 h/d had lower risks of screening myopia ( OR =0.92, 0.92, 0.93, all P <0.05). Interactive effects showed that when medium or high NDVI was combined with outdoor activity duration≥2 h/d, the risks of screening myopia among primary and secondary school students were lower (medium NDVI×≥2 h/d: OR =0.89; high NDVI×≥ 2 h/d : OR =0.89, both P <0.05), and the combined effect was superior to that of a single factor. Conclusion Green space exposure and outdoor activity duration have negative correlations with screening myopia among primary and secondary students, and the combined effect is better than that of a single factor.

Objective:To analyze the association between unhealthy lifestyles and depressive symptoms, anxiety symptoms and stress among secondary school students in Jiangsu Province.Methods:From September to November 2023, a multistage stratified cluster random sampling method was used to select secondary school students from 13 districts and cities in Jiangsu Province. A questionnaire survey was conducted on their unhealthy lifestyles (low physical activity, smoking, drinking, internet addiction, poor sleep quality, and unhealthy diet), as well as their depressive symptoms, anxiety symptoms and stress. The multivariate logistic regression model and mixed graph model were used to construct a network and analyze the association between unhealthy lifestyles and depressive symptoms, anxiety symptoms and stress.Results:A total of 81 414 secondary school students were finally included in this study, including 39 725 (48.79%) female students and 41 689 (51.21%) male students. The prevalence of depressive symptoms, anxiety symptoms and stress were 18.55%, 32.09% and 12.91%, respectively. The multivariate logistic regression model showed that after adjusting for age, gender, urban-rural status, residential status, and family type, compared with students without unhealthy lifestyles, students with low physical activity, smoking, alcohol consumption, internet addiction, poor sleep quality, and unhealthy diet had a significantly increased risk of depressive symptoms ( OR=1.12, 95% CI:1.07-1.17; OR=1.60, 95% CI: 1.49-1.72; OR=1.79, 95% CI: 1.71-1.88; OR=3.05, 95% CI: 2.77-3.36; OR=6.66, 95% CI: 6.40-6.93; OR=1.29, 95% CI: 1.24-1.34) and a significantly increased risk of anxiety symptoms ( OR=1.09, 95% CI: 1.05-1.13; OR=1.42, 95% CI: 1.33-1.52; OR=1.76, 95% CI: 1.69-1.83; OR=2.40, 95% CI: 2.17-2.65; OR=5.79, 95% CI: 5.59-6.00; OR=1.16, 95% CI: 1.12-1.21). Students who smoked, drank alcohol, had internet addiction, and had poor sleep quality had a significantly increased risk of stress ( OR=1.49, 95% CI: 1.38-1.61; OR=1.79, 95% CI: 1.70-1.89; OR=2.25, 95% CI: 2.04-2.48; OR=6.74, 95% CI: 6.43-7.06). The node with poor sleep quality (bridge strength=0.48) in the network constructed by the mixed graph model had the strongest centrality of the bridge connecting unhealthy lifestyles with depressive symptoms, anxiety symptoms and stress. Conclusion:Low physical activity, smoking, alcohol consumption, internet addiction, poor sleep quality, and unhealthy diet increase the risk of depressive symptoms and anxiety symptoms among Jiangsu Province secondary school students. Smoking, alcohol consumption, internet addiction, and poor sleep quality increase the risk of stress among Jiangsu Province secondary school students. Sleep quality is an important intervention target for Jiangsu Province secondary school students to alleviate their negative emotions.

Objective:To build an internet hospital cost-benefit evaluation index system based on a large public tertiary hospital, for references for improving the operation and management of internet hospitals.Methods:From May to October 2024, this study identified the elements of cost-benefit through on-site investigation, literature analysis and expert discussion, and built an initial evaluation index system of cost-benefit of internet hospitals; Delphi method and Pareto chart method were used to determine indicators and their weights; This evaluation index system was used to quantitatively evaluate an internet hospital since its operation for two years (from May 2022 to April 2024).Results:Five profit entities and 26 cost-benefit components had been identified; The expert authority coefficient of the two rounds of Delphi method was 0.73, and the Kendall coefficient was 0.80 ( P<0.001). The costs and benefits of an internet hospital since its operation for two years were 14.06 million yuan and 134.95 million yuan, respectively, with a benefit cost ratio of 9.60. Conclusions:The cost-benefit evaluation index system of internet hospitals built in this study was suitable for these relying on physical hospitals. This system was scientific and practical, and could provide references for cost-benefit evaluation of other Internet hospitals.

OBJECTIVE To explore the distribution of pathogens isolated from the cervical cancer(CC)patients with postoperative urinary catheter-associated urinary tract infection(UTI)and analyze the predictive values of se-rum high mobility group protein B1(HMGB1),Toll-like receptor 4(TLR4)and nuclear factor kappa B(NF-κB).METHODS Totally 116 patients with CC who underwent radical resection in the First Affiliated Hospital of Henan University of Science and Technology from Jan.2021 to Jan.2024 were enrolled in the study and were divided into the infection group with 31 cases and the non-infection group with 85 cases according to the status of complication with UTI after urinary catheterization.The midstream urine specimens were collected by aseptic method,the pathogens were isolated and identified.The serum HMGB1 level was detected by means of enzyme-linked immu-nosorbent assay,the relative expression levels of peripheral blood TLR4 and NF-κB proteins were detected by Western blot.The efficiencies of serum HMGB1,TLR4 and NF-κB in prediction of postoperative urinary catheter-associated UTI in the CC patients were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 49 strains of pathogens were isolated from 31 CC patients with postoperative urinary catheter-associated UTI,and the patients who had infection of single species were dominant.Gram-negative bacteria were the most common pathogens,accounting for 61.22％.There were significant differences in the age,complication with diabetes mellitus,duration of urinary catheter indwelling,postoperative uroschesis and previous history of UTI between the infection group and the non-infection group(P＜0.05);there were significant differences in the levels of serum HMGB1,TLR4 and NF-κB between the two groups(P＜0.05).The area under the curve(AUC)of the joint detection of serum HMGB1,TLR4 and NF-κB was 0.906 in prediction of the postoperative urinary catheter-associated UTI in the CC patients,with the sensitivity 83.87％;the predictive efficiencies of the joint de-tection of the indexes were better than those of the single detection(P＜0.05).CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the CC patients with postoperative urinary catheter-asso-ciated UTI.The joint detection of the serum HMGB1,TLR4 and NF-κB has the highest value in prediction of postoperative urinary catheter-associated UTI in the CC patients.

Objective:To investigate the clinical efficacy and safety of the triplet regimen of flumatinib, venetoclax (VEN) and azacitidine (AZA) for Philadelphia chromosome-positive (Ph +) mixed-phenotype acute leukemia (MPAL). Methods:The clinical data of 2 Ph + MPAL patients treated with triplet regimen of flumatinib, VEN and AZA who were admitted to the Institute of Hematology & Blood Diseases Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College in February and March 2023 were retrospectively analyzed, and the relevant literature was reviewed. Results:Patient 1 was a 56-year-old female, and patient 2 was a 59-year-old male. Both patients were diagnosed with Ph + B cell/myeloid (B/My) MPAL. After the first course of induction chemotherapy with the triplet regimen, patient 1 achieved hematological complete remission (HCR), complete cytogenetic remission (CCyR) and major molecular response (MMR), and patient 2 achieved HCR and CCyR. During the entire treatment process, the adverse reactions of two patients were mainly fever and ≥ grade 3 hematological adverse reactions, which were relieved after the use of antibiotics and intermittent infusion of blood products. When the patient achieved HCR and received consolidation treatment with the same regimen, the adverse reactions were mild. Conclusions:The triplet regimen of flumatinib, VEN and AZA is safe and effective for the treatment of Ph + MPAL, and is a new induction therapy option for such patients.

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.

Objective:To analyze the current status, hotspots, and future research trends of Ganmai Dazao Decoction.Methods:Literature about Ganmai Dazao Decoction was retrieved from the CNKI, Wanfang Data, Chongqing VIP, and CBM from January 1, 1994, to June 30, 2024. CiteSpace 6.3.R1 software was used for co-occurrence analysis of authors and institutions, as well as co-occurrence, clustering, timeline, and burst analysis of keywords.Results:A total of 696 articles were included, with an overall fluctuating upward trend in annual publications in this field, peaking in 2018 (51 articles). The institution with the most publications was Nanjing University of Chinese Medicine (12 articles); the journal with the most publications was Inner Mongolia Journal of Traditional Chinese Medicine (28 articles); among the authors, five published the most, with only 3 articles each. Research mainly focused on clinical applications of TCM, theory exploration, animal experiments, and other areas. Conclusions:The publication volume of Ganmai Dazao Decoction research shows an overall upward trend, with high attention on the treatment of diseases such as depression, organ dysregulation, and perimenopausal syndrome. The research hotspots include the mechanism of Ganmai Dazao Decoction in anti-depression and endocrine regulation and so on.

Objective To investigate the relationship between CT lung volume parameters(CT-LVP)and pulmonary function grade in patients with idiopathic pulmonary fibrosis(IPF)and its prediction of acute exacerbation.Methods A total of 204 patients with IPF were selected and divided into mild group(67 cases),moderate group(72 cases)and severe group(65 cases)according to the semi-quantitative scoring method of high-resolution computed tomography(HRCT).The correlation between CT-LVP and pul-monary function parameters(PFP)were analyzed.The predictive value of CT-LVP for acute exacerbation in severe IPF was ana-lyzed.Results The whole lung volume(WLV),normal lung volume(NLV)and normal lung volume percentage(NLV%)in severe group were lower than those in mild and moderate groups,whereas interstitial lung disease volume(ILDV)and interstitial lung disease volume percentage(ILDV%)were higher than those in mild and moderate groups,with statistical significance(P<0.05).WLV,NLV,ILDV,NLV%,ILDV%showed strong correlations with forced expiratory volume in 1 second percentage(FEV1%),forced expiratory volume in 1 second to forced vital capacity ratio(FEV1/FVC),diffusing capacity of the lung for carbon monoxide percent-age(DLCO%),and residual volume to total lung capacity ratio(RV/TLC).Receiver operating characteristic(ROC)curve analysis showed that the combination of WLV,NLV,ILDV,NLV%and ILDV%had higher accuracy in predicting acute exacerbation,area under the curve(AUC)>0.75(P<0.05).Conclusion CT-LVP is closely related to PFP,and the accuracy of CT-LVP combination in predicting acute exacerbation is high,which provides a theoretical basis for preventing acute exacerbation of IPF.

Aim To investigate the effect and mechanism of angiotensin Ⅱ(Ang Ⅱ)on ferroptosis in white adi-pocytes.Methods The 3T3-L1 preadipocytes were differentiated into white adipocytes by inducer stimulation.The experiment was divided into control group,Ang Ⅱ group,Ang Ⅱ+Fer-1(ferroptosis inhibitor)group and Ang Ⅱ+PFT-α(p53 inhibitor)group.Ang Ⅱ was used to treat cells.RT-qPCR and Western blot were used to detect the expression levels of ferroptosis factors and adipokines.JC-1 kit was used to detect mitochondrial membrane potential(MMP)level.Iron ion kit was used to detect intracellular iron content.Glutathione(GSH)kit was used to detect GSH content.Fer-1 and Ang Ⅱ were added to treat cells to detect the the changes of ferroptosis level.The expression of p53 and spermidine/spermine N1-acetyltransferase 1(SAT1)protein was detected.Subsequently,PFT-α and Ang Ⅱ were added to co-treat cells to detect the changes of p53 and SAT1 protein expression,and to observe the effect of inhibiting p53 expression on the expression levels of ferroptosis factors and adipokines.Results 3T3-L1 cells were successfully differentiated into white adipocytes by stimulator-induced differentiation.Ang Ⅱ induced ferroptosis in white adipocytes.RT-qPCR results showed that compared with control group,the mRNA expression of anti-ferroptosis factor glutathione peroxidase 4(GPX4),solute carrier family 7 member 11(SLC7A11)and iron regulatory protein 1(IRP-1)was down-regulated in Ang Ⅱ group,and the mRNA expression of pro-ferroptosis factor acyl-CoA synthetase of long-chain family member 4(ACSL4)was up-regulated.Western blot results showed that compared with control group,the protein expression of SLC7A11 and GPX4 was down-regulated in Ang Ⅱ group,and the protein expression of ACSL4 was up-regulated.Ang Ⅱ treatment increased the content of intracellular iron ions and decreased the levels of GSH and MMP.Compared with Ang Ⅱ group,the mRNA expression of IRP-1 and SLC7A11 was up-regulated in Ang Ⅱ+Fer-1 group.Ang Ⅱ induced changes in the expression profile of adipokines in white adipocytes.Western blot results showed that compared with control group,the protein ex-pression of pro-inflammatory adipokine leptin(LEP),resistin(RETN),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)was up-regulated in Ang Ⅱ group,and the protein expression of anti-inflammatory adipokine adiponectin(AD-PN)and omentin 1(ITLN1)was down-regulated.In addition,Ang Ⅱ increased the protein expression of p53 and SAT1.Inhibition of p53 expression can improve the level of ferroptosis and adipokine expression in white adipocytes trea-ted with Ang Ⅱ.Western blot results showed that compared with Ang Ⅱ group,the protein expression of p53 and SAT1 was down-regulated in Ang Ⅱ+PFT-α group,the protein expression of SLC7A11 and GPX4 was up-regulated,and the protein expression of ACSL4 was down-regulated.The protein expression of ADPN was up-regulated in Ang Ⅱ+PFT-αgroup,and the protein expression of TNF-α,LEP and RETN was down-regulated.Conclusion Ang Ⅱ induces fer-roptosis in white adipocytes through activating the p53/SAT1 signaling pathway.