Building on the theory of "state-target differentiation and treatment" proposed by Academician TONG Xiaolin， diabetic foot ulcers （DFUs） are considered to belong to the "collateral injury" stage， characterized by the interplay of five states，i.e. dampness， heat， stasis， deficiency， and impairment. The dynamic biological process of epithelial-mesenchymal transition （EMT） is closely associated with the healing process of DFUs. The treatment of DFUs through staged differentiation under the "state-target differentiation and treatment" theory not only provides a basis for precise clinical treatment， but also offers insights into the regulatory roles of EMT in different states and potential intervention targets. The dampness state typically exits during the inflammatory phase， local inflammation and fluid metabolism disorders inducing EMT. Treatment focuses on draining dampness and alleviating edema， promoting local microcirculation， and improving tissue hypoxia. The heat state often reflects acute local inflammatory responses. Treatment emphasizes clearing heat and resolving toxins， regulating the EMT process to reduce inflammation， control infection， and alleviate redness， swollen， heat， and pain in the affected area. The stasis state mainly occurs during the proliferation phase. Treatment centers on invigorating blood and dissolving stasis， and unblocking the channels and quickening the collaterals. EMT plays a role in remodeling the extracellular matrix， promoting tissue repair and angiogenesis. The deficiency state is common in chronic phase， where treatment prioritizes tonifying qi and nourishing blood while reinforcing healthy qi and dispelling pathogens. EMT regulation focuses on restoring local tissue metabolism and improving the micro-environment to enhance tissue repair capacity. The impairment state represents the progression of disease deterioration. Treatment should focus on supplementing qi， blood， yin， and yang， and also promoting muscle growth and strengthening bones， supplementing by resolving toxins and stasis. EMT plays a role by regulating the activity of extracellular matrix-degrading enzymes to prevent excessive tissue repair and scarring， thereby facilitating the reconstruction of normal tissue structures.

AIM:To investigate the changes of retinal microcirculation after phacoemulsification and the influencing factors of visual acuity.METHODS: Retrospective analysis. A total of 264 cataract patients(264 eyes)who underwent phacoemulsification in our hospital from January 2022 to December 2022 were selected as the study objects. Patients were divided into < 0.3 group(66 eyes)and ≥0.3 group(198 eyes)according to the recovery of best corrected visual acuity(BCVA)at 3 mo after surgery. The changes of retinal microcirculation indexes were compared before and after treatment. Logistic regression and LASSO regression models were used to screen the influencing factors of postoperative BCVA. A nomogram prediction model of postoperative BCVA was constructed and verified. A restricted cubic spline Logistic regression model was established to analyze the dose-response relationship between end-diastolic velocity(EDV), peak systolic velocity(PSV)and the risk of BCVA recovery.RESULTS: At 3 mo postoperatively, EDV and PSV were significantly improved compared with those before treatment, and resistance index(RI)levels were significantly lower than those before treatment(all P<0.05). Preoperative EDV, PSV, aqueous humor cell grade, fundus lesion grade, advanced age and Emery grade were influencing factors for poor BCVA recovery after phacoemulsification in cataract patients(P<0.05). The AUC before and after validation of the nomogram model by Bootstrap method were 0.869(95%CI: 0.815-0.903)and 0.866(95%CI: 0.802-0.895), respectively. The sensitivity was 88.36% and 88.27%, and the specificity was 91.82% and 91.78%, respectively. Restricted cubic spline model analysis showed no nonlinear dose-response relationship between EDV and PSV levels and the risk of poor BCVA recovery in either male or female(P>0.05).CONCLUSION: After phacoemulsification, retinal microcirculation in cataract patients improved significantly. EDV, PSV, aqueous humor cell grade, fundus lesion grade, advanced age and Emery grade are all factors influencing poor BCVA recovery after cataract surgery.

Objective To identify early Klebsiella pneumoniae(KP)infection after liver transplantation and its impact on prognosis.Methods Clinical data of 171 liver transplant recipients were retrospectively analyzed,and they were divided into the non-infection(n=52)and infection groups(n=119)according to the bacterial culture results at postoperative 2 weeks.In the infection group,KP was not detected in 86 cases(non-KP infection group),and KP was cultured in 33 cases(KP infection group).Preoperative,intraoperative and postoperative data were statistically compared between the non-infection and infection groups,and between the non-KP infection and KP infection groups.The risk factors of early KP infection after liver transplantation and the influencing factors of long-term survival of the recipients were analyzed.Results Compared with the non-infection group,model for end-stage liver disease(MELD)score and total bilirubin level were higher,the operation time was longer,the length of postoperative intensive care unit(ICU)stay and the length of hospital stay were longer,the amount of intraoperative red blood cell transfusion was higher,the hospitalization expense was higher,the incidence of severe complications was higher,white blood cell count,absolute neutrophil cell count and neutrophil-to-lymphocyte ratio at postoperative 14 and 30 d were higher,absolute lymphocyte count at postoperative 14 d was lower and hemoglobin level at postoperative 30 d was lower in the infection group.The differences were statistically significant(all P＜0.05).Compared with the non-KP infection group,MELD score,total bilirubin level and aspartate aminotransferase(AST)level were higher,the operation time and the length of postoperative ICU stay were longer,the hospitalization expense was higher,the 90-d fatality was higher,the albumin level at postoperative 14 d was lower,and total bilirubin level at postoperative 30 d was higher in the KP infection group.The differences were statistically significant(all P＜0.05).Among 33 recipients with KP infection,16 cases were resistant to carbapenem antibiotics,and 7 of them died within postoperative 90 d.Seventeen cases were intermediate or sensitive to carbapenem antibiotics,and 4 of them died within postoperative 90 d.Preoperative MELD score ≥17 and operation time≥415 min were the independent risk factors for KP infection after liver transplantation(both P＜0.05).The length of postoperative ICU stay ≥44 h and KP infection were the independent risk factors for long-term prognosis of liver transplantation(both P＜0.05).Conclusions KP infection is an independent risk factor for death after liver transplantation.High preoperative MELD score and long operation time are the independent risk factors for early KP infection after liver transplantation.

Objective:To explore the incidence of hepatitis B virus (HBV) reactivation in the population with HBV associated liver cancer after receiving programmed death receptor 1 (PD-1) inhibitors combined with targeted therapy, and the prognostic differences between HBV reactivation and non reactivation populations during this treatment.Methods:A retrospective analysis was conducted on patients with primary liver cancer who received PD-1 inhibitor combined with targeted drugs treatment at the Zhongshan Hospital, Fudan University (Xiamen Branch) from January 2019 to June 2021. Clinical data such as age, sex, liver function status, cirrhosis, HBV DNA level, alpha fetoprotein, tumor stage, anti-tumor program and anti HBV program, tumor treatment response, progression free survival (PFS), and total survival (OS) were collected for t test, χ 2 test and Kaplan-Meier survival analysis. Results:A total of 66 enrolled patients were enrolled, of which 17 cases experienced HBV reactivation, with an incidence rate of 25.76%; The rates of HBV reactivation at 3 months, 6 months, 1 year, 2 years, and 3 years were 6.06%(4/66), 12.12%(8/66), 19.70%(13/66), 22.73%(15/66), and 25.76%(17/66), respectively. There was no significant difference between the HBV reactivation group and the non HBV reactivation group in age, sex, liver function status, cirrhosis, HBV DNA level, alpha fetoprotein, tumor stage, anti-tumor and anti HBV programs, objective response rate (ORR) and disease control rate (DCR) (all P>0.05). However, the PFS and OS of the HBV reactivation group were significantly lower than those of the non HBV reactivation group, at 4.00 months vs 8.50 months ( P=0.002) and 12.90 months vs 19.77 months ( P=0.014), respectively. Conclusions:Patients with primary live cancer who receive PD-1 inhibitor combined with targeted therapy are at risk of HBV reactivation, and those who experience HBV reactivation have significantly poorer tumor progression and survival prognosis compared with non HBV reactivated patients.

ObjectiveTo observe the effect of tendon clearing combined with Zizhu ointment on the serum levels of nucleotide-binding oligomerization domain-like receptor protein 3 （NLRP3） inflammasomes， interleukin （IL）-1β， and IL-18 in the treatment of non-ischemic diabetic foot ulcers. MethodA total of 106 patients with non-defective diabetic foot ulcers who attended the outpatient clinic and wards of the Vascular Surgery Department of Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine from March 2023 to March 2024 were selected. The patients with non-ischemic diabetic foot ulcers who met the inclusion criteria were assigned with the random number table method into an observation group and a control group， with 53 patients in each group. Patients in both groups received basic treatment. The local ulcers in the observation group received tendon clearing combined with Zizhu ointment， while those in the control group received conventional debridement combined with topical solution of bovine basic fibroblast growth factor. The serum NLRP3， IL-1β， and IL-18 levels， ulcer area， traditional Chinese medicine （TCM） symptom scores， visual analogue scale （VAS） score， and DMIST score were measured and recorded in the two groups before and after treatment. The ulcer healing rate and incidence of adverse reactions were compared between the two groups. ResultThe observation group had higher ulcer healing rate than the control group （P<0.01）. After treatment， both groups showed lowered serum NLRP3， IL-1β， and IL-18 levels， reduced ulcer area， and declined TCM symptom score， VAS score， and DMIST score （P<0.01）. Moreover， these indicators were lower in the observation group than in the control group （P<0.05， P<0.01）. Neither group showed significant changes in the liver and kidney function indicators after treatment. Significant adverse reactions occurred in neither group during the treatment course. ConclusionTendon clearance combined with Zizhu ointment was effective and safe in treating non-ischemic diabetic foot ulcers. It may exert the therapeutic effect by reducing the inflammation of the local ulcers.

Objective:To investigate the application value of transanal intersphincteric resec-tion under direct vision in the Jackknife position in the anal preserving surgery for ultra-low rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 15 patients with ultra-low rectal cancer who underwent transanal intersphincteric resection under direct vision in the Jackknife position, combined with laparoscopic total mesorectal excision in Huizhou Municipal Central Hospital from September 2021 to November 2022 were collected. There were 9 males and 6 females, aged (63±9)years. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative outcomes. All the 15 patients underwent operations successfully, without conversion to open abdo-minal operation. There were 5 cases of partial ISR and 10 cases of subtotal ISR. The operation time and volume of intraoperative blood loss of 15 patients were (260±30)minutes and 20(range, 10-30)mL, respectively. The distance from anastomosis to anal margin was (1.6±0.8)cm. The duration of post-operative hospital stay was 10(range, 8-13)days, and all 15 patients underwent colonic and anasto-mosis with staplers and protective ileostomy at the terminal ileum. Three patients had postoperative complications within 30 days after surgery, of whom 1 case with grade A anastomotic leakage was cured after conservative treatment and 2 cases with anastomotic membranous stenosis were cured by anal enlargement. (2) Postoperative pathological examination. The number of lymph nodes dissected of 15 patients was 18 ±6, and the distance between the tumor and distal resection margin was 1.3(range, 1.0-2.0)cm. The surgical specimens of all 15 patients showed complete mesorectum and negative for proximal, distal and circumferential margins. Results of postoperative pathological examination showed that there was 1 case in stage pT1N0M0, 9 cases in stage pT2N0M0, 1 case in stage pT2N1M0, 1 case in stage ypT0N0M0, 2 cases in stage ypT2N0M0, 1 case in ypT3N1M0 stage. The histological subtype showed 11 cases of moderately differentiated adenocarcinoma and 4 cases of well-differentiated adenocarcinoma. (3) Follow-up. All 15 patients were followed up for 15(range, 12-24)months. No local recurrence and distant metastasis of the tumor was found, and no tumor-related death occurred. All 15 patients underwent stoma closure. The postoperative anal function assessment of 15 patients showed no disorder in 5 cases, mild disorder in 8 cases and severe disorder in 2 cases.Conclusion:Transanal intersphincteric resection under direct vision in the Jackknife position in the anal preserving surgery for ultra-low rectal cancer is safe and feasible.

Purpose/Significance To introduce the knowledge graph technology in the field of electronic information into the study of traditional Chinese medicine(TCM)terminology,and to demonstrate the dialectical relationship between the therapeutic effects of TCM and its nature,flavor,meridians and TCM diseases in a vivid way.Method/Process The top-down ontology construction method is adopted to build the top-level structure of TCM ontology on the Protégé platform.Taking the 2020 edition of the Chinese Pharmacopoeia as the data source,the TCM information in the pharmacopoeia is split and extracted,and the information of each axis is sorted,disambiguated and nor-malized.With the help of the Protégé platform,entities and relationships are created,and the TCM triple data is output in RDF data for-mat.Finally,the Neo4j graph database is used to store and display the RDF data to form a systematic TCM knowledge graph.Result/Con-clusion It mainly realizes the construction of the knowledge graph of TCM in the pharmacopoeia,and fully reveals the complex knowledge system structure in the field of TCM through data statistical analysis,knowledge measurement and drawing of visual graphics.

Objective To study the application value of pneumonia severity index high-risk score (PSI-HR) in high risk patients and neutrophil-to-lymphocyte ratio (NLR) in the condition evaluation of the pa-tients with respiratory tract infection in ICU.Methods The clinical data of the patients with lower respiratory tract infection hospitalized in the department of intensive care medicine of this hospital from January 2020 to July 2023 were retrospectively analyzed.According to the ICU outcomes,the patients were divided into the im-provement group (n=77) and the poor prognosis group (n=25),and the receiver operating characteristic (ROC) curve was drawn to analyze the evaluation value of PSI-HR score combined with NLR,NLR,PSI-HR score,PSI-HR grade and PSI grade in the prognosis of the patients with lower respiratory tract infection. Results The case fatality rates of the patients with different grades of PSI were 40.00％ (16/40) for the grade 5,18.75％ (6/32) for the grade 4,22.22％ (2/9) for the grade 3 and 4.76％ (1/21) for the grade 2,re-spectively.There was no significant correlation between different PSI grades and case fatality rate (r=0.911,P=0.089).The case fatality rates of different grades of PSI-HR were 75.00％ (3/4) for the grade 6,46.67％ (7/15) for the grade 5,28.57％ (6/21) for the grade 4,17.24％ (5/29) for the grade 3,and 12.12％ (4/33) for the grade 2,respectively,and the PSI-HR grade was positively correlated with the case fatality rate of the patients (r=0.955,P=0.011).The area under the ROC curve (AUC) of predicting the prognosis of the pa-tients with lower respiratory tract infection from great to small was 0.828(95％CI:0.717-0.938,P<0.05) for PSI-HR score combined with NLR,0.754 (95％CI:0.637-0.871,P<0.05) for NLR,0.744 (95％CI:0.636-0.852,P<0.05) for PSI-HR score,and 0.706 (95％CI:0.584-0.829,P<0.05) for PSI-HR grade and 0.695 (AUC=0.695,95％CI:0.582-0.807,P<0.05) for PSI grade.Conclusion The PSI-HR grade has good correlation with the case fatality rate of the patients with lower respiratory tract infection.The effi-ciency of PSI-HR grade combined with NLR for predicting the prognosis in the patients with lower respiratory tract infection in ICU is better than that of single index.

Objective:To investigate the effects of external application of Sanying Plaster on the size of thyroid nodules and the states of depression and anxiety in patients with benign thyroid nodules.Methods:A randomized controlled trial was conducted. A total of 120 patients with benign thyroid nodules from the outpatient clinic of the Department of Thyroid Diseases at Shanghai Traditional Chinese Medicine Hospital from June to December 2022 were selected as the subjects of the study. They were divided into two groups using the random number table method, with 60 patients in each group. The control group received lifestyle intervention treatment, while the treatment group received Sanying Ointment in addition to the treatment of the control group. Both groups were treated for 3 months. TCM syndrome scores were measured before and after treatment; the maximum diameter of thyroid nodules was measured using a color Doppler ultrasound transverse section; the quality of life was assessed using the short form 36 (SF-36); the degree of anxiety and depression was evaluated using the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS); adverse reactions during the treatment period were recorded, and the clinical efficacy was evaluated.Results:During the treatment period, 4 cases in the treatment group and 3 cases in the control group did not complete the treatment. Finally, 56 cases in the treatment group and 57 cases in the control group entered the efficacy evaluation. The total effective rate of the treatment group was 71.4% (40/56), and that of the control group was 14.0% (8/57), with a statistically significant difference between the two groups ( χ2=26.82, P<0.001). After treatment, the TCM syndrome score of the treatment group (10.02±3.65 vs. 16.65±3.44, t=-10.24) was lower than that of the control group ( P<0.001); the maximum diameter of thyroid nodules [11.00 (4.65, 19.93) mm vs. 15.00 (7.15, 28.50) mm, Z=-2.43] was lower than that of the control group ( P<0.05); the SF-36 score [121.83 (117.00, 130.00) vs. 114.42 (104.25, 127.50), Z=-2.62] was higher than that of the control group ( P<0.01); the SDS (46.72±4.59 vs. 57.02±5.99, t=14.80) and SAS (42.25±5.72 vs. 50.60±7.12, t=10.04) scores were lower than those in the control group ( P<0.001). The incidence of adverse reactions during the treatment period in the treatment group was 3.5% (2/57), and no adverse reactions occurred in the control group. Conclusion:The external application of Sanying Ointment helps to reduce the size of thyroid nodules in patients with benign thyroid nodules, improve the quality of life and anxiety and depression, and increase clinical efficacy with good safety.

Objective To establish and evaluate a gas chromatography-tandem mass spectrometry(GC-MS/MS)method for the detection of six common drugs(methamphetamine,meperidine,caffeine,codeine,cocaine and ketamine)in blood,and to improve the determination basis of results.Methods The above six drugs were added into the blank blood,and GC-MS/MS was used for detection after ether extraction.The collection,quantification and confirmation were carried out under the mode of multi-reaction monitoring(MRM).The qualitative results of the above six drugs were evaluated based on the maximum allowable deviation of the retention time and relative ion abundance ratio in the qualitative results of GC-MS/MS.Results There was a good linear relationship between the six common drugs,among which ketamine and caffeine had the lowest detection limit(0.01 μg/mL),methamphetamine had the highest detection limit(0.5 μg/mL).The retention time(RT)and relative retention time(RRT)of the target substance were stable under the six supplemental levels,and the absolute deviation(ΔRTabsolute)of RT was within±0.025 min.The absolute deviation of RRT(ΔRRTabsolute)was within±0.004.The relative ion abundance ratio absolute deviation(ΔIabsolute)is±20%,and the relative ion abundance ratio relative deviation(ΔIrelative)is±50%.Conclusion This study clarified the reference range for qualitative determination of six common drugs in blood matrix detected by GC-MS/MS,and effectively supplemented the qualitative determination indicators of existing instrumental analysis methods.