Objective To analyze the urban drinking water quality and its influencing factors in Anhui Province from 2014 to 2022, and to provide a scientific basis for water quality improvement and protection. Methods The data were collected, saved and monitored according to the Standard Test Method for Drinking Water (GB/T5750-2006) and evaluated according to the Hygienic Standard for Drinking Water (GB 5749-2006). Results A total of 20 941 samples were collected, and the overall qualified rate was 84.26%. The qualified rate of urban drinking water increased from 76.9% in 2014 to 93.3% in 2022, and the qualified rate of water quality was on the rise (χ²=544.43, P＜0.01). From 2014 to 2022, the qualified rate of water quality in dry season was higher than that in wet season (χ²=35.98, P<0.001), the qualified rate of surface water was higher than that of ground water (χ²=4440.8, P<0.001), and the qualified rate of peripheral tap water was higher than that of factory water (χ²=145.1, P<0.001). Among all kinds of disinfection methods, chlorination disinfection had the highest qualified rate (χ²=1483.8, P<0.001). The qualified rate of water quality increased with the increase of the scale of water plant. Among the inspected indicators, the main unqualified indicators were chlorine dioxide (7.72%), fluoride (7.41%), free residual chlorine (3.90%), and total bacterial count (2.13%). Conclusion The passing rate of urban drinking water quality in Anhui Province is on an upward trend, and the quality of urban drinking water has improved. However, it is still important to pay attention to the problem of excessive microorganism and fluoride in water, and the quality of drinking water varies from place to place.

It is believed that the occurrence and development of squamous cell carcinoma （SCC） is closely associated with inflammatory responses. The theory of fire and heat， advocated by LIU Wansu， provides significant clinical guidance for understanding the pathogenesis and treatment of SCC. Based on this theory， the pathological mechanisms and clinical characteristics of SCC at different stages were analyzed. In the precancerous and early stages， the primary pathogenesis is qi stagnation leading to internal generation of constrained heat； in post-surgery， the condition shifts to qi deficiency with latent yin fire； during the treatment phase， the pathogenesis involves accumulation of pathogenic factors， excess toxins， and severe heat toxicity； in the late stage， the main pathology is yin deficiency with toxic heat， and phlegm-stasis obstruction of the internal organs. Corresponding stage-based treatment strategies are proposed. In the early stage， regulating qi movement to dissipate constrained heat； for post-surgery， tonifying qi and raising yang to dispel latent fire； during treatment stage， clearing heat and detoxifying to eliminate cancerous toxins； and in the late stage， nourishing yin and unblocking the bowels to clear deficiency heat.

AIM: To investigate the efficacy and safety of dexamethasone versus conbercept in the treatment of diabetic macular edema(DME)with different optical coherence tomography(OCT)subtypes.METHODS: A total of 160 DME patients(160 eyes)admitted to our hospital from January 2021 to March 2023 were prospectively selected, and the patients were randomly divided into dexamethasone intravitreal implant group and conbercept group, with 80 cases(80 eyes)in each group, and DME patients were divided into 51 eyes with serous retinal detachment(SRD), 55 eyes with cystoid macular edema(CME), and 54 eyes with diffuse retinal thickening(DRT)according to OCT characteristics. The best corrected visual acuity(BCVA), central macular thickness(CMT), intraocular pressure and adverse reactions were compared before treatment and at 2, 3 and 6 mo postoperatively.RESULTS: There were differences in BCVA, CMT and intraocular pressure between the two groups at 2, 3 and 6 mo compared with those before operation(all P<0.05). There were differences in BCVA, CMT and intraocular pressure between the dexamethasone intravitreal implant group and the conbercept group in the treatment of patients with different types of DME(all P<0.05). The BCVA of patients with DRT and SRD types in the dexamethasone intravitreal implant group was improved at 3 and 6 mo after treatment compared with that in the conbercept group(all P<0.05). At 6 mo after treatment, the CMT of patients with DRT type in the dexamethasone intravitreal implant group was lower than that in the conbercept group(P<0.05). During the follow-up period, none of the patients experienced adverse events such as cataract exacerbation or retinal detachment.CONCLUSION: Both dexamethasone intravitreal implant and conbercept treatment can improve visual function and macular retinal morphology in patients with different OCT subtypes of DME with good safety, but the dexamethasone intravitreal implant is better than conbercept in the treatment of DRT type.

Based on the characteristics of dormant cancer cells， which are "latency" and "opportunistic activation"， this paper classifies them within the scope of "latent pathogen" in traditional Chinese medicine （TCM）. It explores the mechanisms of formation， activation， and elimination of dormant cancer cells based on the latent pathogen theory. It is proposed that qi deficiency is the fundamental internal cause for the formation and growth of dormant cancer cells， qi stagnation is the inducing factor for their activation， and qi restoration presents an opportunity for their elimination. Guided by the latent pathogen theory， the TCM strategy for inhibiting dormant cancer cells includes two aspects. On one hand， methods such as strengthening the root， securing defensive qi， and lifting and supporting the body's upright qi are used to reinforce healthy qi and prevent the latency and accumulation of dormant cancer cells. On the other hand， regulating liver qi and warming yang to promote qi transformation are employed to ensure smooth qi movement， thereby inhibiting the activation of dormant cancer cells and disrupting their survival environment.

Immune checkpoint inhibitors （ICIs） can activate anti-tumour-related immunity in the treatment of malignant tumours， but at the same time， they can also cause non-specific immune activation， leading to the occurrence of immune-related adverse reactions （irAEs）. It is believed that under physiological conditions， ICIs can be classified as tonic agents in traditional Chinese medicine， exerting the effect of warming yang and benefiting qi， but when the immune response become over-excited， ICIs evolve into pathogen of exuberant fire， which is destructive to the body. Combining the different periods of immunotherapy and the degree of symptoms， irAEs are divided into two phases： symptom onset phase （exuberant fire consuming qi and essence） and intermittent phase （latent fire dispersing healthy qi in critical condition）， in which yang movement is excess fire leading to toxicity of the skin and oral mucous membranes， qi constraint transforming into fire leading to toxicity of gastrointestinal tract， qi block generating fire leading to cardiotoxicity， and qi and yin deficiencies leading to fire manifesting as ICIs-related diabetes. The general principle of “simultaneous treatment of qi and fire” is proposed to guide the treatment of irAEs. During the onset phase， draining fire， directing qi downward， and dispelling drug toxicity are used to remove excess fire； raising yang， dispersing fire， and dispelling drug toxicity are used to disperse fire constraint； promoting the flow of yang and qi and dispelling drug toxicity are used to close fire and smoothen the flow； cultivating qi， clearing fire， and dispelling drug toxicity are used to disperse the deficiency fire， so as to achieve the goal of clearing exuberant fire， eliminating drug toxicity， and alleviating acute symptoms. During the intermittent phase， the aim is to generate fire slightly to warm yang qi， block latent fire， and prevent recurrence， and ultimately restore the balance of qi and yang in human physiology to prevent and treat irAEs and improve the quality of life of patients.

It is believed that qi changes throughout the whole process of malignant tumors. Tumour formation is induced by qi constraint in the early stage， qi sinking is the core disease mechanism after tumour surgery， qi counterflow is an important disease mechanism for nausea and vomiting related symptoms in chemotherapy stage， and qi deficiency is the main pathology in recurrence and metastasis stage. It is proposed that the therapeutic principle of “regulating qi with changes” discussed in Miraculous Pivot-Wei Qi Disorder （《灵枢·卫气失常》） should be implemented in traditional Chinese medicine （TCM） pattern identification and treatment of malignant tumours， modifying the treatment with changes， and regulating qi with corresponding methods： for qi constraint， it should soothe to eliminate the tumour by the method of rectifying qi to resolve constraint， with treatment as Shugan Jianpi Formula （疏肝健脾方）； for qi sinking， it should raise to lift up postoperative viscera by the method of boosting qi to raise sinking， with treatment as Shengxian Decoction （升陷汤） from Records of Chinese Medicine with Reference to Western Medicine （《医学衷中参西录》）； for qi counterflow， the method of moving qi and direct counterflow downward will be used to dissipate the accumulated medicinal toxicity， and patients with retention of medicinal toxicity in the middle jiao and ascending counterflow of stomach qi treated by Xuanfu Daizhe Decoction （旋覆代赭汤） from On Cold Damage （《伤寒论》）， patients with middle yang deficiency and turbid ying failing to descend treated by Wuzhuyu Decoction （吴茱萸汤） from On Cold Damage （《伤寒论》） ； for qi deficiency， it should tonify to prevent the tumor toxin from spreading by the method of boosting qi to resolve toxins， treated by Fuzheng Jiedu Formula （扶正解毒方）.

The incidence of breast cancer is rising annually.Along with the broader implementation of tumor screening and increased health awareness,there has been a significant uptick in the diagnosis of early-stage breast cancer.Early-stage breast cancer is generalized to breast cancer without distant metastasis,which is compared to the concept of late-stage breast cancer.The aim of treatment for early-stage breast cancer is to achieve a cure.Treatment is guided by evidence-based medicine,following guidelines and consensus to administer personalized and precise therapies to patients.Clinical research,as the foundational evidence for these guidelines and consensus,brings more optimized treatment for breast cancer patients.According to the updates of domestic and international guidelines and consensus between 2022 and 2023,this review summarized and classified the important clinical studies that have changed the clinical practice for early-stage breast cancer.These studies were based on molecular sub-types and categorized into optimization of neoadjuvant and adjuvant treatment of early breast cancer,escalating and de-escalating of adjuvant treatment,and the optimization of local treatment.The studies related to the optimization of neoadjuvant and adjuvant treatment of human epidermal growth factor receptor 2(HER2)-positive breast cancer included the PHEDRA study which aimed at the application of pyrotinib,a small molecule tyrosine kinase inhibitor(TKI),to neoadjuvant treatment,the ExteNET study which investigated adjuvant treatment of neratinib,and FDChina study which confirmed the efficacy and safety of pertuzumab and trastuzumab fixed dose combination subcutaneous injection(PH FDC SC).The primary study addressing the optimization of neoadjuvant and adjuvant therapy in triple-negative breast cancer(TNBC)was the KEYNOTE-522 study.In terms of escalating in adjuvant therapy,the APHINITY study evaluated the efficacy of pertuzumab added to trastuzumab in high-risk HER2-positive breast cancer.MonarchE and NATALEE focused on the efficacy of abemaciclib and ribociclib in patients with hormone receptor-positive breast cancer.The SOFT TEXT study focused on ovarian function suppression(OFS)combining exemestane or tamoxifen in high-risk premenopausal breast cancer.Descending related studies in adjuvant therapy included the PLAN B study confirming 6 cycles of docetaxel in combination with cyclophosphamide in HER2 negative early intermediate to high-risk breast cancer.Among the studies related to the local treatment of breast cancer,the ACOSOG Z11102 study explored the feasibility of breast conservation in multicenter focal breast cancer.The SOUND study explored the exemption from axillary surgery in people with low-risk breast cancer.The PRIMEⅡ study explored the possibility of exemption from radiotherapy after breast conservation in elderly patients with low-risk breast cancer,and the IMPORT HIGH study compared different dose-escalated simultaneous integrated boost radiotherapy regimens after breast conservation surgery.The FAST-Forward study focused on hypofractionated breast radiotherapy.These studies provided robust evidence for the implementation of clinical practice and the formulation of diagnostic and treatment guidelines and consensus.In this review,we focused on the update of domestic and international breast cancer treatment guidelines,and the impact of these studies on the clinical practice for early-stage breast cancer.

Objective To establish a clinical-CT model,and to observe its value for evaluating lymphovascular invasion(LVI)and/or perineural invasion(PNI)in esophageal squamous cell carcinoma(ESCC).Methods Data of 156 ESCC patients were retrospectively analyzed.The patients were divided into positive group(n=58,LVI[+]and/or PNI[+])and negative group(n=98,LVI[-]and PNI[-])according to postoperative pathological results.Clinical and CT data were compared between groups.Logistic regression analysis was performed to establish a model,and its efficacy of evaluating ESCC LVI and/or PNI was analyzed.Results Significant differences of carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),tumor thickness,tumor volume and CT venous phase value(CTV),the difference between CTV and CT plain phase value(CTP)(△CTV-P)and venous phase enhancement rate(V％)were found between groups(all P＜0.05),and the area under the curve(AUC)of the above parameters for evaluating ESCC LVI and/or PNI was 0.702,0.690,0.731,0.744,0.621,0.631 and 0.599,respectively.CEA,CA199,tumor thickness,tumor volume and CTV were all independent predictive factors for ESCC LVI and/or PNI.A combined model was established based on the above features,and its accuracy,sensitivity and specificity for evaluating ESCC LVI and/or PNI was 82.05％,65.52％and 91.84％,respectively,with AUC of 0.838,higher than that of each single parameter(all P＜0.05).Conclusion The established clinical-CT model could effectively evaluate ESCC LVI and/or PNI.

Objective:Evaluation of the effectiveness of domestic ultrapulsed thulium laser ablation of isolated porcine kidneys.Methods:Forty-two fresh porcine kidneys were taken. One porcine kidney was dissected along the sagittal plane at the renal hilum, and then dissected along the coronal plane and divided into four pieces.A total of 168 pieces of renal tissues were obtained, of which 162 pieces were selected for the domestic hyperpulsed thulium laser ablation of isolated porcine kidneys using the single-needle method and the double-needle method, respectively. The ablation was carried out with different ablation modes (single-needle and double-needle methods), ablation power (4, 5, and 6 W), ablation modes (continuous, low-energy and high-frequency mode, and high-energy and low-frequency mode), and ablation time (10, 15, and 20 s). The size of the ablation area in terms of the long diameter, the short diameter, and the thick diameter were measured and recorded. The embedded tissues were sectioned and stained with HE to study the microscopic pathological characteristics of the ablation foci. The ablation foci volume and sphericity coefficient (Φ) were calculated, and the ablation foci volume and sphericity coefficient were statistically analyzed by analytic factorial design and one-way ANOVA.Results:The gross specimen showed that the single-needle ablation foci were elliptical in shape, containing black carbonized areas and gray-white necrotic areas with clear boundaries, and the peripheral renal tissues were pink, and the ablation focus was clearly demarcated from the normal tissues. The double-needle ablation foci were a large ellipse containing two small ellipse ablation foci, and the structure was similar to that of the single-needle method. Under the light microscope, the center of the ablation focus was a "cavity-like" carbonized area, outside of which was an area of coagulation necrosis, with deepened cell staining, reduced cell volume, disorganized arrangement, loose nuclei, nuclear consolidation, and some cell nuclei were cleaved and ablated. Ablation mode ( P<0.001), ablation pattern ( P <0.001), ablation time ( P <0.001), and ablation power ( P <0.001) all significantly affected ablation focus volume. The volume of the ablation foci increased with increasing number of needle feeds, longer ablation time, higher ablation power, and with the ablation mode being continuous mode. Single-needle ablation produced the largest volume of ablation foci (259.56 mm 3) in continuous mode, ablation time of 20 s, and ablation power of 6 W. Double-needle ablation produced the largest volume of ablation foci (452.00 mm 3) in continuous mode, ablation time of 20 s, and ablation power of 6 W. The analysis of the sphericity coefficient showed that in single-needle ablation, the sphericity coefficient was the largest (Φ=0.76) under the conditions of continuous mode, ablation power of 4 W, and ablation time of 15 s. The sphericity coefficient was the smallest (Φ=0.56) under the conditions of high-energy, low-frequency mode, ablation time of 10 s, and ablation power of 6 W, and the morphology of the ablation foci were more close to ellipsoid shape. When ablated by the double-needle method, the ablation foci morphology was closer to spherical shape (Φ=0.91) under the conditions of continuous mode, ablation time of 10 s, and ablation power of 5 W. The combined main effect and interaction results showed that ablation mode ( P<0.001), ablation pattern ( P<0.001), and ablation power ( P<0.001) significantly affected the sphericity coefficient of the ablation foci, and ablation time did not affect the ablation foci morphology. Conclusions:Domestic ultrapulsed thulium laser ablates isolated porcine kidney tissues with precise effect, the tissue morphology of the unablated area is normal, the thulium laser ablated foci have a definite safe boundary. Choosing double needle method, continuous mode, ablation power 6 W for 20 s, can ablate spherical cancer foci within 1 cm in diameter, which can be used for spherical small kidney cancer ablation. Selecting the single-needle method, high-frequency, low-energy mode and ablation power of 6 W, the ablation foci were similar to the oval volume, and could be used for the ablation of oval small renal cancer. However, this study is only limited to the animal ex vivo model, which needs to be confirmed by further study.

OBJECTIVE To study the effects of Zigui yichong formula on premature ovarian insufficiency （POI） in mice through glycolysis metabolic pathway. METHODS Eighty SPF C57BL/6N female mice were divided into normal group， model group， Zigui yichong formula group （14.175 g/kg）， Zigui yichong formula+2-deoxy-D-arabino-hexose （2-DG） group （Zigui yichong formula 14.175 g/kg + glycolysis inhibitor 2-DG 100 mg/kg）， with 20 mice in each group. Except for the normal group， POI model mice were induced by intraperitoneal administration of cyclophosphamide in the other groups. After the model was successfully established， each group was given corresponding drugs. HE staining was employed to observe the pathomorphological changes in ovarian tissue and to count follicles at all developmental stages； radioimmunoassay was conducted to measure the serum levels of estradiol （E2）， anti-Müllerian hormone （AMH）， and follicle-stimulating hormone （FSH）； TUNEL assay was employed to detect apoptosis in ovarian granulosa cells of mice； the activities of hexokinase （HK）， pyruvate kinase （PK） and lactate dehydrogenase （LDH） were detected by colorimetry； Western blot and real-time fluorescence quantitative PCR were employed to analyze the protein and mRNA expressions of B-cell lymphoma-2 （Bcl-2）， Bcl-2 associated X protein （Bax）， caspase-3， HK2， pyruvate kinase M2 （PKM2）， and lactate dehydrogenase A （LDHA）. RESULTS Compared with model group， the number of primordial follicles， growing follicles， antral follicles and granulosa cells were increased significantly（P＜0.05）， and granulosa cells arranged neatly， but the number of atretic follicles and granulosa cells apoptosis were decreased significantly in Zigui yichong formula group （P＜0.05）； the serum levels of E2 and AMH， the activities of HK， PK and LDH， protein and mRNA expressions of Bcl-2， HK2， PKM2 and LDHA were increased significantly （P＜0.05）； the serum levels of FSH， the protein and mRNA expressions of Bax and caspase-3， Bax/Bcl-2 ratio were decreased significantly （P＜0.05）. 2-DG could reverse the improvement effects of Zigui yichong formula on the above indexes of POI model mice. CONCLUSIONS Zigui yichong formula may inhibit the apoptosis of ovarian granulosa cells， reduce follicle atresia and improve ovarian reserve function by promoting glycolysis levels in POI model mice.