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 The aim of this study is to investigate the plaque characteristics of different subtypes of middle cerebral artery(MCA)infarction,lenticulostriate artery(LSA)characteristics,and hemodynamic characteristics through high-resolution magnetic resonance vessel wall imaging(HR-MRI VWI)and perfusion weighted imaging(PWI).Methods A retrospective analysis was conducted on patients with unilateral acute or subacute MCA infarction who underwent HR-MRI VWI and PWI examinations at Qinhuangdao First Hospital from January 2022 to April 2024.Patients were divided into three groups according to the type of infarction:artery-to-artery embolism(AA),branch occlusive disease(BOD),branch occlusive disease and artery-to-artery embolism(BOD-AA).Clinical data,plaque characteristics,lenticulostriate artery characteristics,and hemodynamic characteristics were compared and analyzed among the three groups.To determine factors associated with BOD,the BOD and BOD-AA groups were merged into a BOD+group which was then compared with the AA group.To determine factors associated with the AA group,the BOD-AA and AA groups were combined into an AA+group,followed by comparison with the BOD group.Results A total of 42 patients with unilateral acute or subacute MCA infarction were included according to the inclusion and exclusion criteria.Among them,9 patients were classified as having AA,14 patients as having BOD,and 19 as having BOD-AA.The results showed that the degree of stenosis was higher in the AA+group than in the BOD group,and the difference was statistically significant(Z=-2.536,P<0.05);The number of LSA on the affected side was higher in the BOD+group than in the AA group[2.00(1.50,3.00)vs.3.00(3.00,4.00)],and the difference was statistically significant(Z=-2.889,P<0.05);The relative cerebral blood flow(rCBF)of the centrum semiovale was lower in the AA+group than in the BOD group[0.90(0.84,0.93)vs.0.99(0.97,1.03)],and the difference was statistically significant(Z=-4.555,P<0.05);The rCBF in the basal ganglia was lower in the BOD+group than in the AA group[0.89(0.83,0.93)vs.1.01(0.98,1.04)],and the difference was statistically significant(Z=-4.280,P<0.05).Conclusion Patients in BOD+have a lower degree of stenosis compared to AA group.The spatial relationship between plaques and LSA varies across different subtypes of MCA infarction.Plaques in BOD+patients are positioned closer to the LSA orifice and thus have a higher tendency to occlude the LSA orifice.The affected side has few LSAs and the rCBF in the LSA perfusion area.is lower.

Objective:To explore the influence mechanism of long-term care insurance system on medical expenses,take the pilot model of Nanning City as a sample,and analyze the strategic interaction of multi-party subjects in the implementation of the policy,so as to provide a decision-making basis for the improvement of the design of the long-term care insurance system Methods:A tripartite evolutionary game Nanning model of"government-healthcare institutions-disabled families"is constructed in to explore the game equilibrium and the evolution trend,and numerical simulation is carried out by Matlab Software.Results:The stabilization strategy of the system is(0,1,1),reperring"loose regulation by the government,active cooperation by healthcare institutions,and support by disabled families".The government is the most important subject of the three-party game system,the"supportive"strategy of disabled families is relatively stable,and the sensitivity of healthcare organizations to government punishment is much larger than the sensitivity to rewards.Conclusion:The strategies of the three-party game are influenced by a variety of factors.The supervision strength of Nanning government is influenced by the cost of human and material resources;the law-abiding cooperative behavior of healthcare institutions is mainly influenced by the strength of government fines;the supportive behavior of disabled families is influenced by the government's incentive policy and the rent-seeking behavior of healthcare institutions.When promoting the LTC insurance system,it is recommended to improve the government regulatory mechanism,optimize the rewards and punishments of healthcare institutions,and enhance the willingness of disabled families to participate through economic incentives to effectively control medical expenses.

Objective:To explore the value of deep learning imageomics based on MRI sagittal T2WI images in predicting placenta accreta spectrum in high-risk pregnant women.Methods:The complete data of 265 pregnant women who underwent MRI due to suspected placenta implantation in The Second Hospital&Clinical Medical School,Lanzhou University and Zhangye People's Hospital Affiliated to Hexi University from January 2019 to De-cember 2023 were analyzed retrospectively.The patients were randomly divided into training group(n=172)and validation group(n=93)at 7∶3.Multivariate Logistic regression analysis was used to screen the independent risk factors among clinical and imaging characteristics.Radiomics features were extracted based on sagittal T2WI images.Using the DenseNet-121 model as the basic model for deep learning feature extraction,traditional clinical model,radiomic model and deep learning model were constructed to predict PAS.The diagnostic efficiency of each model was evaluated by the area under the receiver operating characteristic(ROC)curve(AUC).Finally,the model with the highest performance was determined as the optimal model.Results:In both the training and validation groups,the PAS group and normal group exhibited statistically significant differences(P<0.05)in terms of the number of cesarean section≥2,history of placenta previa,and placental thickness>40 mm.Multivariate Logistic regression analysis revealed that cesarean section history,placental thickness and placenta previa were independent risk factors for predicting PAS.Among all the models constructed,the diagnostic performance of the combination model of deep learning combined with clinic was higher than the other three models.The AUC in training group and verification group were 0.96(95%CI 0.93-0.98)and 0.91(95%CI 0.87-0.95)respectively.Conclusions:The combined clinical model of deep learning based on MRI may have better performance in the di-agnosis of PAS than clinical or traditional radiomic models.

Objective:To explore the influence mechanism of long-term care insurance system on medical expenses,take the pilot model of Nanning City as a sample,and analyze the strategic interaction of multi-party subjects in the implementation of the policy,so as to provide a decision-making basis for the improvement of the design of the long-term care insurance system Methods:A tripartite evolutionary game Nanning model of"government-healthcare institutions-disabled families"is constructed in to explore the game equilibrium and the evolution trend,and numerical simulation is carried out by Matlab Software.Results:The stabilization strategy of the system is(0,1,1),reperring"loose regulation by the government,active cooperation by healthcare institutions,and support by disabled families".The government is the most important subject of the three-party game system,the"supportive"strategy of disabled families is relatively stable,and the sensitivity of healthcare organizations to government punishment is much larger than the sensitivity to rewards.Conclusion:The strategies of the three-party game are influenced by a variety of factors.The supervision strength of Nanning government is influenced by the cost of human and material resources;the law-abiding cooperative behavior of healthcare institutions is mainly influenced by the strength of government fines;the supportive behavior of disabled families is influenced by the government's incentive policy and the rent-seeking behavior of healthcare institutions.When promoting the LTC insurance system,it is recommended to improve the government regulatory mechanism,optimize the rewards and punishments of healthcare institutions,and enhance the willingness of disabled families to participate through economic incentives to effectively control medical expenses.

Objective:To explore the value of deep learning imageomics based on MRI sagittal T2WI images in predicting placenta accreta spectrum in high-risk pregnant women.Methods:The complete data of 265 pregnant women who underwent MRI due to suspected placenta implantation in The Second Hospital&Clinical Medical School,Lanzhou University and Zhangye People's Hospital Affiliated to Hexi University from January 2019 to De-cember 2023 were analyzed retrospectively.The patients were randomly divided into training group(n=172)and validation group(n=93)at 7∶3.Multivariate Logistic regression analysis was used to screen the independent risk factors among clinical and imaging characteristics.Radiomics features were extracted based on sagittal T2WI images.Using the DenseNet-121 model as the basic model for deep learning feature extraction,traditional clinical model,radiomic model and deep learning model were constructed to predict PAS.The diagnostic efficiency of each model was evaluated by the area under the receiver operating characteristic(ROC)curve(AUC).Finally,the model with the highest performance was determined as the optimal model.Results:In both the training and validation groups,the PAS group and normal group exhibited statistically significant differences(P<0.05)in terms of the number of cesarean section≥2,history of placenta previa,and placental thickness>40 mm.Multivariate Logistic regression analysis revealed that cesarean section history,placental thickness and placenta previa were independent risk factors for predicting PAS.Among all the models constructed,the diagnostic performance of the combination model of deep learning combined with clinic was higher than the other three models.The AUC in training group and verification group were 0.96(95%CI 0.93-0.98)and 0.91(95%CI 0.87-0.95)respectively.Conclusions:The combined clinical model of deep learning based on MRI may have better performance in the di-agnosis of PAS than clinical or traditional radiomic models.

Objective The aim of this study is to investigate the plaque characteristics of different subtypes of middle cerebral artery(MCA)infarction,lenticulostriate artery(LSA)characteristics,and hemodynamic characteristics through high-resolution magnetic resonance vessel wall imaging(HR-MRI VWI)and perfusion weighted imaging(PWI).Methods A retrospective analysis was conducted on patients with unilateral acute or subacute MCA infarction who underwent HR-MRI VWI and PWI examinations at Qinhuangdao First Hospital from January 2022 to April 2024.Patients were divided into three groups according to the type of infarction:artery-to-artery embolism(AA),branch occlusive disease(BOD),branch occlusive disease and artery-to-artery embolism(BOD-AA).Clinical data,plaque characteristics,lenticulostriate artery characteristics,and hemodynamic characteristics were compared and analyzed among the three groups.To determine factors associated with BOD,the BOD and BOD-AA groups were merged into a BOD+group which was then compared with the AA group.To determine factors associated with the AA group,the BOD-AA and AA groups were combined into an AA+group,followed by comparison with the BOD group.Results A total of 42 patients with unilateral acute or subacute MCA infarction were included according to the inclusion and exclusion criteria.Among them,9 patients were classified as having AA,14 patients as having BOD,and 19 as having BOD-AA.The results showed that the degree of stenosis was higher in the AA+group than in the BOD group,and the difference was statistically significant(Z=-2.536,P<0.05);The number of LSA on the affected side was higher in the BOD+group than in the AA group[2.00(1.50,3.00)vs.3.00(3.00,4.00)],and the difference was statistically significant(Z=-2.889,P<0.05);The relative cerebral blood flow(rCBF)of the centrum semiovale was lower in the AA+group than in the BOD group[0.90(0.84,0.93)vs.0.99(0.97,1.03)],and the difference was statistically significant(Z=-4.555,P<0.05);The rCBF in the basal ganglia was lower in the BOD+group than in the AA group[0.89(0.83,0.93)vs.1.01(0.98,1.04)],and the difference was statistically significant(Z=-4.280,P<0.05).Conclusion Patients in BOD+have a lower degree of stenosis compared to AA group.The spatial relationship between plaques and LSA varies across different subtypes of MCA infarction.Plaques in BOD+patients are positioned closer to the LSA orifice and thus have a higher tendency to occlude the LSA orifice.The affected side has few LSAs and the rCBF in the LSA perfusion area.is lower.

Objective: To investigate the relationship between hemoglobin levels and prognosis of cerebral infarction in elderly patients aged 75 years and over. Methods: A retrospective analysis of 238 elderly patients (≥75 years old) with cerebral infarction admitted into our hospital from January 2016 to June 2018 was performed. The age, gender, serum creatinine and risk factors for stroke (hypertension, diabetes, dyslipidemia, homocysteine, atrial fibrillation, smoking, drinking), coronary heart disease, previous stroke history, tumor history, National Institutes of Health Stroke Scale (NIHSS) score, hemoglobin, hematocrit and other basic data were recorded. The patients were divided into the group with good prognosis (mRS score ≤ 2) and the group with poor prognosis (mRS score > 2). The relationship between hemoglobin levels and the prognosis of cerebral infarction in elderly patients were analyzed. Results: After 6 months of follow-up, 124 (52.1%, 124/238) stroke patients had a good prognosis, and 114 (47.9%, 114/238) patients had a poor prognosis, including 21 deaths. Anemia at admission (OR=2.433, 95%CI: 1.213-4.591, P=0.011), new-onset anemia after hospitalization (OR=2.615, 95%CI: 1.333-6.521, P=0.043) and the low level of minimum hemoglobin during hospitalization (OR=0.847, 95%CI: 0.671-0.971, P=0.038) were independent risk factors for poor prognosis in elderly stroke patients aged ≥75 years. New-onset anemia after hospitalization (OR=1.015, 95%CI: 1.002-1.027, P=0.022), the low level of minimum hemoglobin during hospitalization (OR=0.801, 95%CI: 0.654-0.981, P=0.027), the decrement of hemoglobin ≥20 g/L (OR=1.342, 95%CI: 1.011-1.763, P=0.000) at reexamination were independent risk factors for the mortality in elderly patients with cerebral infarction. Conclusions Anemia at admission, new-onset anemia after hospitalization, and the low level of minimum hemoglobin during hospitalization are independent predictors for poor prognosis in cerebral infarction patients aged ≥75 years. The decrement of hemoglobin ≥20 g/L after admission is an independent predictor for high mortality in elderly patients with cerebral infarction.

To investigate risk factors of death in newborns with congenital diaphragmatic hernia (CDH). A total of 126 newborns with CDH from June 2012 to September 2018 were enrolled. Concomitant malformations were recorded by descriptive analysis. Newborns received surgical treatment (=120) for CDH were divided into survival group and fatal group. The risk factors of death were analyzed by univariate and multivariate logistic regression and the ROC curve with generated with relevant variables. There were 55 CDH newborns with concomitant malformations (43.7%), including 20 cases (15.9%) with multi-malformation. Logistic regression analysis showed that premature rupture of membranes (PROM), postoperative atelectasis, long duration of postoperative mechanical ventilation, postoperative high oxygenation index (OI) were related to death (all <0.05), and the delayed surgery was a protective factor (<0.05). In ROC analysis of postoperative OI in predicting death, the area under the curve (AUC) was 0.841, with the cutoff value of 5.74, the sensibility and specificity of OI was 81.0% and 75.0%, respectively(<0.01). Newborns with CDH have a high rate of malformations. The risk factors of death were PROM, postoperative atelectasis, postoperative long duration of mechanical ventilation and higher postoperative OI, and delayed surgery may reduce mortality.
Hernias, Diaphragmatic, Congenital ; diagnosis ; mortality ; surgery ; Humans ; Infant ; Infant Death ; Infant, Newborn ; Logistic Models ; ROC Curve ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity

OBJECTIVETo review the application of thoracoscopic repair for treatment of congenital diaphragmatic hernia in neonates, so as to improve the cure rate.

METHODSClinical data of 47 neonates with congenital diaphragmatic hernia receiving thoracoscopic repair from June 2012 to June 2017 were reviewed. The admission age, gestational age, birth weight, timing of diagnosis, hernia location, clinical manifestation, surgical timing, surgical method, operation time, postoperative mechanical ventilation time of patients were analyzed.

RESULTSThere were 42 cases of left diaphragmatic hernia and 5 cases of right diaphragmatic hernia. Thirteen cases were diagnosed prenatally. Primary diaphragmatic repair was successfully accomplished under thoracoscope in 45 neonates without perioperative complications, while 2 patients were converted to open surgery. The average operation time was (63±13) min (42-150 min), the average blood loss was (3.0±1.7) mL (1.0-9.0 mL), and the average postoperative mechanical ventilation time was (3.9±1.4) d (2.0-11.0 d). Two patients died and the treatment was withdrawn in 3 patients with an overall cure rate of 89.4% (42/47).

CONCLUSIONSThoracoscopic repair is effective and can be used as first-choice treatment of diaphragmatic hernia in neonates.