This study systematically reviews the modern research progress of sanjiao （三焦） theory in the past 20 years， and differentiates concepts such as membrane-source， membrane-interstices， and membrane-system in the study of sanjiao essence. On the basis of its core functions of transporting original qi and regulating water metabolism， the study further expands the theoretical connotation of transporting original qi， defines the application boundary of sanjiao syndrome differentiation， and clarifies the conceptual categories of "sanjiao qi-transformation" and "qi-transforming sanjiao"， which reconciles the contradictions between sanjiao as a six fu （腑） organ and sanjiao as a regional division to a certain extent， and provides a valuable exploration for the innovative development of the theoretical system of traditional Chinese medicine.

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 investigate the correlation between indocyanine green(ICG)fluorescence imaging and lymph node metastasis of bladder cancer and its application value.Methods The clinicopathological data of 35 patients with bladder cancer(T1-T4aNxM0)treated in our hospital during Jun.2019 and Mar.2023 were collected.All patients underwent ICG submucous injection,and those with successful imaging received lymph node dissection under fluorescent guidance.After that,the remaining lymph tissue was cleared according to the standard lymph node dissection range,and the resected lymph tissue was subassembled for examination.Patients with non-imaging underwent standard pelvic lymph node dissection according to the routine procedure.Intraoperative lymph node imaging areas were recorded,and postoperative lymph node pathological data were collected.The correlation between fluorescence imaging patterns and lymph node metastasis in patients with different stages of bladder cancer was analyzed with correlation coefficients.Results The ICG fluorescence imaging rate was 91.43％(32/35),and there was no statistically significant difference in the imaging rate among patients with different stages of bladder cancer(P＞0.05).The fluorescence imaging range was significantly correlated with the stage(C=0.351,P=0.034).There was a significant correlation between the imaging range and lymph node metastasis in early-stage patients(C=0.619,P=0.022),but there was no significant difference in the lymph node metastasis rate in advanced patients with different imaging range(P＞0.05).In patients with full staging,the sensitivity of lymph nodes to predict metastasis was 60.00％(6/10),and the negative predictive value was 84.62％(22/26).In early-stage patients,the sensitivity and negative predictive value were 50.00％(1/2)and 93.75％(15/16),respectively.In advanced-stage patients,they were 62.50％(5/8)and 70.00％(7/10),respectively.Conclusion ICG fluorescence imaging rate of tracing lymph node metastasis is high,and the imaging range is significantly related to the tumor stage.For patients with early-stage(T1-T2)bladder cancer,the range of imaging helps to predict the risk of lymph node metastasis and guide the extent of lymph node dissection.Resection of multi-area imaged lymph nodes can comprehensively evaluate the lymphatic metastasis status of early-stage patients.

Objective:To analyze the data changes of tertiary hospitals,secondary hospitals and primary healthcare institutions in Shandong before and after the reform of Dignosis Related Group(DRG)/Diagnosis-Intervention Packet(DIP)payment method,and to explore the impact of the reform of DRG/DIP payment method on the effect of hierarchical diagnosis and treatment.Methods:Data were collected from 16 cities in Shandong Province for a total of 18 quarters in the first half of 2019-2023,including the percentage of expenditure of the health insurance fund,the percentage of discharges,and the sub-average hospitalization cost.Spatial panel models were constructed to conduct σ-convergence and absolute β-convergence analyses.Results:The convergence analysis showed that the inter-regional differences in the percentage of discharges,the percentage of fund expenditure and the average hospitalization cost of tertiary medical institutions were reduced;the regression coefficients of the three indicators in the absolute convergence analysis were significantly negative(β＜0,P＜0.01),indicating that the level of hierarchical diagnosis and treatment in various cities and regions has been equalized.Conclusion:The reform of DRG/DIP payment method reform has effectively optimized the allocation of medical resources in Shandong and reduced regional differences.It is needed to strengthen the effect of the payment method reform,reinforced the incentive of primary care and construct a full-cycle health management-oriented health insurance system in the future.

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 analyze the data changes of tertiary hospitals,secondary hospitals and primary healthcare institutions in Shandong before and after the reform of Dignosis Related Group(DRG)/Diagnosis-Intervention Packet(DIP)payment method,and to explore the impact of the reform of DRG/DIP payment method on the effect of hierarchical diagnosis and treatment.Methods:Data were collected from 16 cities in Shandong Province for a total of 18 quarters in the first half of 2019-2023,including the percentage of expenditure of the health insurance fund,the percentage of discharges,and the sub-average hospitalization cost.Spatial panel models were constructed to conduct σ-convergence and absolute β-convergence analyses.Results:The convergence analysis showed that the inter-regional differences in the percentage of discharges,the percentage of fund expenditure and the average hospitalization cost of tertiary medical institutions were reduced;the regression coefficients of the three indicators in the absolute convergence analysis were significantly negative(β＜0,P＜0.01),indicating that the level of hierarchical diagnosis and treatment in various cities and regions has been equalized.Conclusion:The reform of DRG/DIP payment method reform has effectively optimized the allocation of medical resources in Shandong and reduced regional differences.It is needed to strengthen the effect of the payment method reform,reinforced the incentive of primary care and construct a full-cycle health management-oriented health insurance system in the future.

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 investigate the correlation between indocyanine green(ICG)fluorescence imaging and lymph node metastasis of bladder cancer and its application value.Methods The clinicopathological data of 35 patients with bladder cancer(T1-T4aNxM0)treated in our hospital during Jun.2019 and Mar.2023 were collected.All patients underwent ICG submucous injection,and those with successful imaging received lymph node dissection under fluorescent guidance.After that,the remaining lymph tissue was cleared according to the standard lymph node dissection range,and the resected lymph tissue was subassembled for examination.Patients with non-imaging underwent standard pelvic lymph node dissection according to the routine procedure.Intraoperative lymph node imaging areas were recorded,and postoperative lymph node pathological data were collected.The correlation between fluorescence imaging patterns and lymph node metastasis in patients with different stages of bladder cancer was analyzed with correlation coefficients.Results The ICG fluorescence imaging rate was 91.43％(32/35),and there was no statistically significant difference in the imaging rate among patients with different stages of bladder cancer(P＞0.05).The fluorescence imaging range was significantly correlated with the stage(C=0.351,P=0.034).There was a significant correlation between the imaging range and lymph node metastasis in early-stage patients(C=0.619,P=0.022),but there was no significant difference in the lymph node metastasis rate in advanced patients with different imaging range(P＞0.05).In patients with full staging,the sensitivity of lymph nodes to predict metastasis was 60.00％(6/10),and the negative predictive value was 84.62％(22/26).In early-stage patients,the sensitivity and negative predictive value were 50.00％(1/2)and 93.75％(15/16),respectively.In advanced-stage patients,they were 62.50％(5/8)and 70.00％(7/10),respectively.Conclusion ICG fluorescence imaging rate of tracing lymph node metastasis is high,and the imaging range is significantly related to the tumor stage.For patients with early-stage(T1-T2)bladder cancer,the range of imaging helps to predict the risk of lymph node metastasis and guide the extent of lymph node dissection.Resection of multi-area imaged lymph nodes can comprehensively evaluate the lymphatic metastasis status of early-stage patients.

Objective To develop predictive models based on decision tree and logistic regression algo-rithms for pulmonary multidrug-resistant organism(MDRO)infection risk in intensive care unit(ICU)pa-tients,and compare their predictive performance to provide references for pulmonary MDRO infection preven-tion.Methods A total of 350 ICU patients admitted to the hospital from January 2021 to December 2023 were enrolled and divided into an infection group(n=52)and a non-infection group(n=298)based on the pres-ence of pulmonary MDRO infection.Clinical data from both groups were collected and analyzed to identify risk factors for pulmonary MDRO infection in ICU patients.Using the risk of pulmonary MDRO infection in ICU patients as the dependent variable and the indicators with statistically significant differences in univariate anal-ysis as the independent variables,predictive models for pulmonary MDRO infection risk were developed by u-sing decision tree algorithms and logistic regression analysis.The predictive performance of these two models was compared.Results There were statistically significant differences(P＜0.05)between the infection and non-infection groups in terms of age,history of diabetes,hospital stay≥2 weeks,indwelling urinary catheter,chlorine dioxide disinfection,prolonged bedridden status,and disturbance of consciousness.Logistic regression analysis with pulmonary MDRO infection risk in ICU patients as the dependent variable showed that age ≥60 years,indwelling catheter,hypoproteinemia,and disturbance of consciousness were risk factors for pulmonary MDRO infection in ICU patients,while chlorine dioxide disinfection was a protective factor.Based on these risk factors and regression coefficients,the original warning model was established as:logit(P 1)=0.856 × age+0.928 × indwelling catheter+0.916 × chlorine dioxide disinfection+0.866× hypoproteinemia+0.986 × disturbance of consciousness-4.371.The Hosmer-Lemeshow test indicated good model fit(coefficient of de-termination R2=0.579,P=0.531).The decision tree model for pulmonary MDRO infection risk in ICU pa-tients constructed using decision tree algorithm comprised 4 layers and 9 nodes,selecting four clinical features as nodes:presence of consciousness disturbance,indwelling catheter,hypoproteinemia,and age≥60 years,with consciousness disturbance being the most significant predictor.The decision tree model showed an area under the curve(AUC)of 0.892(95％CI:0.835-0.949)on receiver operating characteristic(ROC)analy-sis,compared to 0.862(95％CI:0.812-0.912)for the logistic regression model.Delong test revealed no sig-nificant difference in predictive performance between the two models(Z=1.148,P=0.095).Conclusion Both the decision tree model and logistic regression model established for predicting the risk of pulmonary MDRO infection in ICU patients demonstrate high predictive performance with comparable efficacy.

Objective:To study the effects of Shengui Jiajian Pills on myocardial fibrosis and the transforming growth factor-β1 (TGF-β1)/Smads signaling pathway in elderly rats with hypothyroidism; To preliminarily explore the mechanism of Shengui Jiajian Pills in treating hypothyroid heart disease through the TGF-β1/Smads pathway.Methods:Totally 60 SD rats were randomly divided into normal group, model group, sodium levothyroxine group, and Shengui Jiajian Pills low-, medium-, and high-dosage groups, with 10 rats in each group. A model of elderly hypothyroid heart injury in rats was prepared by freely drinking 0.1% propylthiouracil (PTU) for 10 weeks. Each group of rats was gavaged with the corresponding drug once a day for 6 weeks. After the last gastric lavage, an electrocardiogram was performed, hematoxylin-eosin staining (HE) was used to observe pathological changes in the heart tissue; bitter acid-toluidine blue staining was used to detect fibrosis of the heart tissue; TUNEL staining was used to observe myocardial cell apoptosis; Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4) in the serum, as well as brain natriuretic peptide (BNP), creatine kinase isoenzymes MB (CK-MB), and lactate dehydrogenase (LDH); Western blot was used to detect the relative expressions of TGF-β1, p-Smad2, p-Smad3, α-smooth muscle actin (α-SMA), matrix metalloproteinase-1 (MMP-1), TIMP1, Bax, and Caspase-3 in the heart tissue; and immunofluorescence was used to detect the positive expressions of TGF-β1, Smad3, α-SMA, and MMP-1 in the heart tissue.Results:Compared with the model group, the inflammatory cell infiltration and cell damage in the heart of rats in each dosage group of Shengui Jiajian Pills were improved, the myocardial fibrosis area ratio was significantly reduced ( P<0.05), and the myocardial cell apoptosis rate significantly decreased ( P<0.05), the levels of TSH, BNP, CLD, and HK-MB in serum significantly decreased ( P<0.05). The levels of FT3 and FT4 increased in the Shengui Jiajian Pills medium- and high-dosage groups ( P<0.05), while the positive expressions of TGF-β1, Smad3, α-SMA, and MMP-1 decreased ( P<0.05). The protein expression of TGF-β1, p-Smad3, MMP-1, Bax, and Caspase-3 decreased ( P<0.05), and the expression of TIMP-1 increased ( P<0.05). The expression of Smad7 increased in the Shengui Jiajian Pills medium-dosage group ( P<0.05). Conclusion:Shengui Jiajian Pills may reduce myocardial collagen fiber deposition by modulating the TGF-β1/Smad3 signaling pathway, thereby partially reversing the pathological features of hypothyroidism-induced myocardial injury, with more pronounced effects observed in the medium and high dosage groups.