This paper summarizes Professor DING Ying's clinical experience in the treatment of systemic lupus erythematosus （SLE） through differentiation of three states， yin fire， latent fire， and fire toxin. It is proposed that fire pathogenic factors constitute a key pathological element running throughout the entire disease course of SLE. The evolution of its pathogenesis centers on these three states， spleen-kidney deficiency with the initial emergence of yin fire as the onset of disease， damage to yin by medicinal toxicity with internal blazing of latent fire as the driver of disease progression， and the interlocking of blood stasis and heat with intense scorching by fire toxin as the critical factor leading to severe and life-threatening conditions. Corresponding to these three stages， targeted prescriptions are formulated， Jiuwei Yishen Formulation （九味益肾方） to tonify the spleen and kidney， raise yang， and disperse fire； Ziyin Xiehuo Decoction （滋阴泄火汤） to nourish yin and fluids while clearing latent fire； and Santeng Changluo Jiedu Decoction （三藤畅络解毒汤） to dispel blood stasis， unblock the collaterals， detoxify， and restrain fire. This staged and integrated therapeutic strategy aims to address both root and branch and to achieve overall regulation， providing valuable guidance for the clinical differentiation and treatment of SLE.

Deep medullary vein （DMV） lesions refer to the structural and functional abnormalities of the small venous system within the deep white matter under pathological conditions. Under normal physiological circumstances， DMV are responsible for venous drainage of deep white matter and clearance of metabolic waste. The pathogenesis of DMV lesions mainly involves luminal stenosis caused by collagen deposition in the venous wall， hemodynamic disturbances due to elevated venous pressure， functional impairment of the venous wall induced by inflammatory responses and cytokines， and microcirculatory disturbance caused by ischemia and hypoxia. Studies have shown that DMV lesions are extensively observed in various neurological disorders， including acute ischemic stroke， cerebral small vessel disease， multiple sclerosis， and Sturge-Weber syndrome， and are closely associated with the imaging manifestations， clinical progression， and prognosis of these diseases. However， despite the continuous improvement in the capability for DMV detection， the specific role of DMV in the pathogenesis of different diseases remains unclear. Further studies are needed to explore the role of DMV in pathophysiological processes and assess its clinical value as a target for early diagnosis and intervention， so as to facilitate the development of precision medicine.

The core pathogenesis of pediatric IgA vasculitis （IgAV） is considered to involve qi movement disorder， with the failure of clear-turbid separation and internal generation of turbid pathogens. Accordingly， the viewpoint of "qi disorder causing turbidity" is proposed. In clinical practice， the disease is divided into the acute， persistent， and stable stages. The acute stage is characterized by impaired dispersion of wei （卫） qi and the internal generation of heat turbidity， while the persistent stage by congestion of ying （营） qi and retention of stasis-turbidity， and the stable stage by depletion of pectoral qi with lingering latent turbidity. In clinical practice， regulating qi and transforming turbidity is taken as the basic therapeutic principle， and the self-formulated Tiaoqi Huazhuo Decoction （调气化浊汤） is used as the basic prescription for staged treatment with flexible modifications. Specifically， the acute stage is treated with the method of dispersing wei qi and clearing heat-turbidity； the persistent stage is recommended to harmonize ying qi and purging stasis-turbidity； and the stable stage should focus on securing pectoral qi and venting latent turbidity.

Objective: To investigate the efficacy, safety, and traditional Chinese medicine (TCM) medication patterns of rituximab (RTX) combined with TCM on treating children with steroid-dependent nephrotic syndrome (SDNS). Methods: One hundred and forty-three children with SDNS who visited the Pediatric Nephrology Department of the First Affiliated Hospital of Henan University of Chinese Medicine from January 2018 to December 2022 were enrolled. A cohort study design was adopted, with " RTX treatment" as the exposure factor. Children who met this exposure factor were assigned to the RTX cohort (RTX, glucocorticoid, immunosuppressive agent, combined with traditional Chinese medicine syndrome differentiation treatment), whereas those who did not were assigned to the basic treatment cohort (glucocorticoid, immunosuppressive agent, combined with traditional Chinese medicine syndrome differentiation treatment ), and followed up for 6 months. The frequency of urinary protein recurrences, urinary protein remission duration, proportion and duration of steroid reduction and cessation, cumulative usage of steroids, proportion of recurrence, recurrence amount of steroid used, efficacy of TCM syndrome, and laboratory and safety indicators after treatment, and height and CD19+ B cell count before and after treatment were compared between the two cohorts. The medication patterns of TCM in the two cohorts were analyzed using frequency statistics, association rule analysis, and systematic clustering analysis. Results: Compared with the basic treatment cohort, the RTX cohort showed a decrease in the frequency of urinary protein recurrence, extended sustained remission of urinary protein, an increase in the proportion of steroid reduction and cessation, a shorter duration of steroid reduction and cessation, a decrease in cumulative steroid dosage, a lower recurrence rate, a decrease in CD19+ B cell count, and a decrease in 24-h urinary total protein quantification and the level of cholesterol (P<0.05). No significant difference in the recurrence amount of steroid used, height, TCM syndrome efficacy, albumin, aspartate transaminase, blood urea nitrogen, platelet count, and safety indicators between the two cohorts. Children with SDNS were mostly characterized by qi and yin deficiency syndrome, followed by spleen and kidney yang deficiency syndrome. A total of 175 TCMs were included, including 28 high-frequency drugs such as Huangqi, Fuling, Gancao, Baizhu, Dangshen, and Jiuyurou. The primary use of medication is to nourish the qi and spleen, nourish the kidney, and warm yang. The analysis of association rules yielded eight binary associations and ten three-phase associations, with Huangqi, Baizhu, Fuling, and Dangshen, being the most closely related. Cluster analysis identified four TCM combinations, primarily focusing on tonifying kidney and replenishing essence, benefiting qi and nourishing yin, and removing blood stasis. Conclusion RTX combined with TCM syndrome differentiation treatment can reduce the recurrence frequency of SDNS, prolong the remission period, reduce the glucocorticoid dosage, and have no marked effect on height growth. No apparent adverse reactions were observed. TCM should focus on nourishing qi and yin while removing blood stasis.

Adolescent idiopathic scoliosis(AIS)is a complex three-dimensional deformity involving coronal,sagittal,and axial planes,with a prevalence that should not be overlooked.With advancements in technology and in-depth research,an increasing number of hospitals and physicians are exploring standardized diagnostic and treatment approaches for AIS.Comprehensive and in-depth understanding is required for AIS,including its etiology,screening and diagnosis,classification,assessment and examination,treatment options,exploration of current focus,and evaluation of quality of life.Such understanding ensures that the diagnostic and treatment are scientific,standardized,and timely.Based on the principles of evidence-based medicine,a consensus on the diagnosis and treatment of AIS is reached after multiple discussions among spinal surgery experts,aiming to provide reference and guidance for clinical practice.

Background and Aims:Pancreatic cancer is one of the most aggressive malignancies of the digestive system and is associated with an inferior prognosis.In recent years,its incidence has shown a trend toward younger onset.Early-onset pancreatic cancer(EOPC),defined as pancreatic cancer diagnosed at≤50 years of age,has been increasing annually and may possess distinct biological and prognostic characteristics.Given the limited data from China,this study aimed to investigate the clinicopathological features and prognostic outcomes of EOPC patients.Methods:Clinical data of 113 patients with EOPC admitted to Xiangya Hospital,Central South University,from January 2017 to December 2023 were retrospectively analyzed.Variables included demographic characteristics,clinicopathological features,and survival information.Kaplan-Meier survival curves were plotted,and differences in survival between the surgical and non-surgical groups were compared.Results:The median age at diagnosis was 46(42-49)years,and males accounted for 65.49%of cases.Blood type A(40.71%)and type O(34.51%)were most common.The main presenting symptoms were abdominal pain(69.91%),weight loss(62.83%),jaundice(43.36%),and abdominal distension(36.28%).Imaging findings showed bile duct dilation in 32.74%,pancreatic duct dilation in 39.82%,vascular invasion in 59.29%,and distant metastasis in 52.21%of patients.Histopathology revealed that adenocarcinoma and ductal adenocarcinoma accounted for 93.81%of all cases,with predominantly moderate or poor differentiation(76.10%).Tumors were the most frequently located in the pancreatic head(65.42%).TNM staging showed lymph node metastasis in 77.88%and stage Ⅳ disease in 52.21%.Laboratory tests demonstrated markedly elevated CA19-9 levels.Kaplan-Meier analysis indicated a median overall survival of 18.6 months for the entire cohort,with significantly longer survival in the surgical group compared with the non-surgical group(29.4 months vs.13.8 months,P=0.001 5).Conclusion:EOPC predominantly affects males and tends to arise in the pancreatic head.It is often diagnosed at an advanced stage or with distant metastasis and is characterized by poor differentiation and strong invasiveness.Surgical resection markedly improves survival and remains the key to prolonged prognosis.Young individuals presenting with unexplained abdominal pain,weight loss,or jaundice should be carefully evaluated through imaging to enable early diagnosis and timely surgical intervention.Future multicenter,large-sample prospective studies are warranted to validate these findings further.

Objective To explore the potential profiles of symptom burden among stroke patients and to analyze the differences in the characteristics of different classes of stroke patients,providing references for clinical nursing practice.Methods A convenience sampling method was used to select 485 stroke patients treated at 4 tertiary-level general hospitals in Anhui Province from July to December 2024 as the study population.The general information questionnaire,Stroke Symptom Cluster Scale,Personal Mastery Scale,and Cognitive Reserve Index questionnaire.Latent profile analysis was employed to explore the categories of symptom burden among stroke patients,and multiple logistic regression was used to assess the influence factors of each category.Results A total of 456 valid questionnaires were collected,with a valid response rate of 94.02％.Symptom burden among stroke patients can be divided into 4 latent profiles:low symptom burden group(69.08％),multiple symptom burden group(8.12％),moderate burden-physical activity impairment group(11.18％),and moderate burden-emotional and cognitive language impairment group(11.62％).The patient's age,number of stroke episodes,number of chronic diseases,systemic inflammation response index,personal mastery,and cognitive reserve were the factors influencing the latent profiles of symptom burden in stroke patients(P＜0.05).Conclusion The symptom burden of stroke patients shows significant heterogeneity.Medical staff can develop targeted nursing interventions based on the category characteristics and influencing factors of the symptom burden in stroke patients.

Objective:To investigate the current status of subjective well-being among stroke patients, and to explore the pathways and effects of influencing factors using structural equation model, so as to provide reference for improving subjective well-being among stroke patients.Methods:From July to November 2024, the stroke patients admitted to the First Affiliated Hospital of Bengbu Medical University, the Second Affiliated Hospital of Bengbu Medical University, Hefei First People′s Hospital were selected by convenience sampling method. A cross-sectional survey was conducted using a general demographic questionnaire, General Well-Being Scale, Cognitive Reserve Index questionnaire, Social Support Rating Scale, Stroke Symptom Cluster Scale, and FRAIL Scale, and AMOS 26.0 was used to analyse the pathways and effects of influencing factors of subjective well-being.Results:A total of 435 questionnaires were collected, 410 were valid.Among 410 cases, 266 case were males, 144 were females, with an age of (65.96 ± 12.15) years. The subjective well-being scores of stroke patients were (72.58 ± 11.66) points. Cognitive reserve and social support were positively correlated with subjective well-being ( r = 0.517, 0.554, both P<0.01), while symptom burden and frailty were negatively correlated with subjective well-being ( r = -0.687, -0.670, both P<0.01). Path analysis showed that symptom burden, frailty, cognitive reserve, and social support had a direct impact on subjective well-being (path coefficients were -0.500, -0.266, 0.148, and 0.144, respectively, all P<0.05), while cognitive reserve, social support, and symptom burden had an indirect impact on subjective well-being (path coefficients were 0.287, 0.249, and 0.108, respectively, all P<0.05). Conclusions:The subjective well-being of stroke patients is influenced by multiple factors, with symptom burden being an important factor affecting subjective well-being. Intervention strategies such as improving cognitive reserve, strengthening social support systems, and preventing frailty can improve the subjective well-being of patients.

Objective:To observe the effect of stellate ganglion block(SGB)on the inflammatory response in rats with acute peritonitis,and to explore whether the possible anti-inflammatory mechanism related to the activation of α7nAChR receptor-mediated cholinergic anti-inflammatory pathway.Methods:A total of 36 SD rats were randomly divided into three groups,with 12 rats in each group:sham operation group(S group),acute peritonitis group(AP group)and SGB treatment group(SGB group).2%acetic acid(1 ml/100 g)was intraperitoneally injected to prepare acute peritonitis rat model in AP group and SGB group,and corresponding dose of normal saline was injected into S group.Right cervical sympathetic nerve was separated but not ligated in AP group and S group,the right cervical sympathetic nerve was severed and ligated in SGB group.Abdominal aorta blood samples were collected 24 h after opera-tion,and serum levels of IL-1β,IL-6 and TNF-α were measured by ELISA,pathological changes of peritoneal tissue were observed by light microscope and expression of α7nAChR in peritoneal tissue was measured by Western blot.Results:Compared with S group,se-rum levels of IL-1β,IL-6 and TNF-α in AP and SGB groups were significantly increased(P<0.05).Serum levels of IL-1β,IL-6,TNF-α in SGB group were significantly lower than those in AP group(P<0.05).HE staining of peritoneal tissues in each group revealed that the S group maintained intact peritoneal structure with normal cellular arrangement,while the AP group exhibited disorganized archi-tecture with extensive inflammatory cell infiltration,frequent hemorrhage,and prominent necrotic cells.In contrast,the SGB group displayed only mild inflammatory infiltration with preserved cellular morphology and minimal hemorrhagic or necrotic changes.The ex-pression level of α7nAChR protein in SGB group was significantly higher than that in S group and AP group.Conclusion:SGB can re-duce the inflammatory response of acute peritonitis rats,and its mechanism may be related to the cholinergic anti-inflammatory path-way mediated by α7nAChR.

Objective:To screen out the disinfection procedure and disinfectant suitable for the actual production of specific pathogen free(SPF)chicken embryo eggs,so as to ensure the disinfection effect of specific pathogen free(SPF)chicken embryo eggs in vaccine production.Methods:This study compares the microbial counting methods of soaking,swabbing with cotton swabs and pouring after thin-film filtration for SPF chicken embryo eggs in a GMP production workshop,and selects the most suitable method for SPF chicken embryo egg microbial counting.Experi-mental groups A,B,and C use self-prepared concentrations of 1∶50 sporicidal agent dilution solution,1∶128 alka-line phenol salt dilution solution,and ready-to-use compound quaternary ammonium disinfectant(sterile),respec-tively,and follow the actual disinfection procedures in the workshop to disinfect and sample the surfaces of SPF chicken embryo eggs entering different cleanliness grades,while using sterile water instead of disinfectant as the control group.The average bactericidal rate is calculated by recording the number of colonies and monitoring the viability of chicken embryo cells using microbial culture,and the disinfection effect of the three disinfectants on SPF chicken embryo eggs is evaluated.Results:The comparison of the results from the three methods shows that the method of sampling SPF chicken embryo eggs by immersion and then counting the microbial colonies through membrane filtration is superior to the other two methods.The final cleaning rate of the control group,which used sterilized injection water to clean the SPF chicken embryo eggs,was 91.67％to 96.97％,while the final steriliza-tion rate of the experimental group,which used the above three disinfectants to disinfect the SPF chicken embryo eggs,was 100.00％.By comparing the cell counts of the experimental group and the control group,it was found that the live cell density of the control group was(6.03-6.25)× 105 cells·mL-1,and that of the experimental groups A-C was(6.08-6.17)× 105 cells·mL-1,(5.99-6.25)× 105 cells·mL-1,and(5.87-6.21)× 105 cells·mL-1 respectively;the cell viability of the control group was 90.33％to 91.35％,and that of the experi-mental groups A-C was 88.25％to 92.12％,89.45％to 93.59％,and 88.02％to 92.89％respectively.Through statistical analysis,it was found that the P values of all experimental groups compared with the control group were greater than 0.05,indicating no statistically significant difference.Conclusion:By comparing the dis-infection effects,cell density and cell viability of the three disinfectants and comprehensively considering factors such as cost and risk of the three disinfectants,1∶50 sporicide dilution,1∶128 alkaline phenolate dilution and ready-to-use compound quaternary ammonium salt disinfectant(sterile)can all be used for the daily surface disin-fection of SPF chicken embryo eggs in the production workshop.The selection of an appropriate disinfectant should be based on specific application scenarios and requirements.