This paper summarizes Professor SHI Zaixiang's clinical experience in treating high fever caused by sepsis using Chaihu Guizhi Ganjiang Decoction （柴胡桂枝干姜汤）. He holds that the key pathogenesis of sepsis involves constrained heat in the shaoyang and internal accumulation of water and fluids. The clinical manifestations such as high fever， chills， and alternating sensations of cold and heat are attributed to pathogenic heat constrained in the shaoyang. Meanwhile， soft tissue edema and serous cavity effusions are due to shaoyang dysfunction and internal water retention. In clinical practice， treating sepsis-related high fever requires addressing both the shaoyang-constrained heat and the associated edema and effusions. The therapeutic approach focuses on harmonizing the shaoyang and resolving internal fluids， using Chaihu Guizhi Ganjiang Decoction as the base formula with flexible modifications. Professor SHI emphasizes that this formula shows a rapid antipyretic effect， particularly in cases where multiple anti-infective treatments have failed.

Keratoconus is a blinding corneal disease characterized by central or paracentral corneal thinning and conical ectasia, and usually happens in adolescence. Currently, the etiology of keratoconus is unclear. Multiple studies have identified an association between genetics, eye rubbing, allergic diseases, ultraviolet exposure and keratoconus. Recently, several studies identified that sex hormones also played important roles in the pathogenesis of keratoconus. The disturbance of sex hormones may increase the risk of occurrence and progress of keratoconus. This review aims to summarize the pathophysiological effects of sex hormones on the cornea, clarify the effects of sex hormones on keratoconus and its related inflammatory or immune mechanisms, and explore the role of sex hormones in the early diagnosis and treatment of keratoconus, providing reference and help for clinical work.

Objective To investigate the relationship between insomnia,gastrointestinal symptoms,and glycosylated hemoglobin(HbA1c)levels in individuals diagnosed with type 2 diabetes mellitus(T2DM),as well as the related influencing factors.Methods A total of 910 T2DM patients treated in our multicenter from January 2022 to December 2022 were enrolled in this study.General information(gender,age,smoking and drinking history,exercise,course of disease,treatment and complications),HbA1c,Athens Insomnia Scale(AIS)scores and Gastrointestinal Symptoms Rating Scale(GSRS)scores of patients were collected.The differences of sleep and gastrointestinal symptoms between groups were analyzed,and the correlation between the differences and HbA1c was analyzed.Furthermore,the risk factors for non-standard HbA1c were analyzed.Results The AIS score and GSRS score in the HbA1c control group were less than those in the non-standard group(P＜0.01).Insomnia was reported by 37.0％of T2DM patients,and the HbA1c level in the insomnia group was significantly higher than that in the non-insomnia group(10.00％±2.38％vs.8.26％±1.73％,P＜0.01).Gastrointestinal symptoms were present in 57.5％of T2DM patients,and the HbA1c levels in the group with gastrointestinal symptoms were significantly higher than those in the group without gastrointestinal symptoms(9.26％±2.23％vs.8.43％±1.98％,P＜0.01).Furthermore,26.3％of T2DM patients experienced both insomnia and gastrointestinal symptoms.Remarkably,the HbA1c levels in the group with both insomnia and gastrointestinal symptoms were significantly higher than those in the group without either condition(10.18％±2.44％vs.8.45％±1.86％,P＜0.01).Correlation analysis demonstrated a significant association between sleep quality,gastrointestinal function,and HbA1c levels(P＜0.01).The logistic regression analysis result revealed that age,GSRS score,AIS score,and the presence of insomnia combined with gastrointestinal symptoms were independent risk factors for predicting HbA1c≥6.5％(P＜0.01).Having both insomnia and gastrointestinal symptoms concurrently was the strongest risk factor for substandard HbA1c control,and the risk of blood sugar control may increase about 5 times when both appear together.Conclusion Insomnia and gastrointestinal symptoms are common comorbidities in T2DM patients,showing a cross-interfering relationship,and they appear together with poor blood sugar control,interact causally,and amplify each other.

Objective To explore the characteristics of apolipoprotein E(APOE)gene polymorphism in patients with Alzheimer's disease(AD)and mild cognitive impairment(MCI)due to AD,as well as its corre-lation with baseline levels of ketone bodies.Methods A total of 110 AD patients from the outpatient and neu-rology wards of the hospital from January 2020 to October 2023 were selected as the AD group,105 patients(none of whom had used anti dementia drugs)were selected as the MCI group,and 110 healthy elderly exami-nees in the physical examination center were selected as the control group.APOE gene polymorphism,and the levels of serum β-hydroxybutyrate(HB)and urine ketone bodies were measured.The distribution of APOE genotype among the three groups was analyzed,and the differences of the levels of serum HB and urine ketone bodies were compared among those carried APOE ε4 allele and those did not.Results Among the three groups,the statistical significance was found in the differences of APOE genotype and ε2,ε3,ε4 allele(P<0.05).The proportion of APOE ε4 allele carriers in the AD group and the MCI group was higher than that in the control group(P<0.05).The levels of serum βHB in the AD group and the MCI group were lower than that in the control group(P<0.05).The levels of serum βHB in those carried APOE ε4 in the AD group were significantly lower than that in the control individuals(P<0.05).There was no statistically significant differ-ence in serum βHB levels between individuals carried and not carried APOE ε4 in the three groups(P>0.05).There was no statistically significant difference in the levels of urinary ketones among the three groups(P>0.05).There was no statistically significant difference in urine ketone bodies levels between individuals carried and not carried APOE ε4 in the three groups(P>0.05).Conclusion The reduced baseline levels of serum βHB in AD patients are associated with APOE ε4 allele.

Continuous arterial blood pressure monitoring by radial artery catheterization is an indispensable monitoring technique for children in the perioperative period and critical care, and the factors that affect the success of catheterization have always been the focus of clinical researches. This study reviewed the research progress on the factors related to the success of radial artery catheterization in children from the perspectives of operator's factors, patient's factors, and operation equipment and materials.

Objective:To assess the safety and efficacy of Anthocyanins for the treatment of Alzheimer's disease.Methods:From November 2018 to December 2020, a multicenter, double-blind, randomized controlled clinical study was conducted in 6 hospitals.The regular medication for the two groups was memantine, with the addition of a combination preparation containing Anthocyanins for the experimental group and a placebo for the control group.The Mini-Mental State Scale(MMSE), Montreal Cognitive Assessment Scale(MoCA), Alzheimer's Disease Assessment Scale-Cognitive Subscale(ADAS-cog), Activities of Daily Living Scale(ADCS-ADL)and Hamilton Depression Scale(HAMD)were used for assessment at the beginning.After 16 weeks of treatment, MMSE, MoCA, ADCS-ADL, ADAS-cog and the Clinician's Interview-Based Impression of Change Plus Caregiver Input(CIBIC-Plus)Scale were conducted and adverse events were recorded.Results:A total of 66 patients were enrolled, with 33 in the control group and 33 in the experimental group.There were no significant differences in cognitive function scores between the two groups before enrollment.Differences in MMSE scores, MOCA scores and ADAS-cog scores before and after treatment between the control group and the experimental group were 1.9±2.4 vs.3.4±2.0( t=2.62, P=0.011), 1.8±1.9 vs.2.9±1.4( t=2.45, P=0.018)and 3.0±2.3 vs.5.3±4.6( t=2.45, P=0.019), respectively.The differences were statistically significant.Instrumental activities of daily living(IADL)scores before and after treatment in the control group were 21.6±5.7 vs.22.6±6.2( t= 2.09, P= 0.046), and those in the experimental group were 22.7±5.4 vs.23.4±5.4( t= 2.45, P= 0.021). The differences between the two groups before and after treatment were statistically significant. Conclusions:Treatment with Anthocyanins can delay the decline of cognitive function and activities of daily living ability in patients with Alzheimer's disease.Anthocyanins may be a promising therapeutic drug for Alzheimer's disease in the future.

Objective:To analyze the pathologic features of responses to neoadjuvant immunotherapy of squamous cell carcinoma (SCC) of the lung.Methods:The study included 31 patients with resected lung SCC post neoadjuvant immunotherapy. All patients were recruited from the neoadjuvant anti-PD-1 (Sintilimab) phase Ⅰb clinical trial (ChiCTR-OIC-17013726). The histopathological morphology and different degrees of pathologic response to immunotherapy were evaluated basing on irPRC standard.Results:According to the percentage of residual viable tumor (% RVT), pathologic responses of complete pathologic response (cPR), major pathologic response (MPR) and non-MPR were noted in 19% ( n=6), 29% ( n=9), and 52% ( n=16) of patients respectively. In addition, extensive immune activation phenomena (immune cell infiltration, including infiltration of lymphocytes, plasma cells, foamy macrophages, lymphocyte aggregation and tertiary lymphoid structures formation) and tissue repair features (giant cells, granuloma formation, proliferative fibrosis and neovascularization) were observed in tumor regression bed. Conclusions:Neoadjuvant immunotherapy has favorable effect on lung SCC. Pathologic assessment of resected lung cancer specimens after neoadjuvant immunotherapy shows unique histopathological features consistent with its mechanism.

Objective:To design a new medication guidance tool for clinical intravenous therapy and nursing safety which covers all-dimensional information of intravenous therapy and nursing needs, and observe its application effects.Methods:(1) The treatment plans of common and frequently-occurring diseases in the priority departments of Class Ⅲ general hospitals in Jilin Province from January 2016 to December 2017 were retrospectively investigated and summarized to determine the index framework of intravenous therapy guidance tools. (2) The status quo survey, expert meeting and literature search were used to determine the content of the guidance tool and the drug information. (3) The expert consensus was used to determine the presentation of the guidance tool. (4) Totally 127 nurses in the departments were selected by convenient sampling for a non-contemporaneous controlled trial to compare the effects of the guidance tool after one month of application and nursing staff's level of knowledge about the risk of intravenous therapy.Results:(1) A guidance tool with 8 specialties, 73 treatment plans, and 326 commonly used drug information presented with specialties as an index and visualized signs was designed and developed, which covers relevant information such as requirements for infusion device materials, selection of infusion device, and requirements for inter-group tube flushing and sealing. (2) From May to June 2019, the nurses were tested before and after use, who were required to complete the specialist drug knowledge questionnaire within the specified time. The accuracy of the three dimensions of the physical and chemical properties of drugs, pharmacological effects, and safe use was 89.76%, 90.55%, and 95.27%, respectively, which were higher than that before use, and the difference was statistically significant ( P<0.05) . Conclusions:Based on the needs of clinical intravenous therapy and nursing safety medication, the novel guidance tool for intravenous therapy and safe medication nursing is designed and completed, which can effectively improve the nurses' ability to safely use intravenous medications and work efficiency and is worth promoting in clinical practice.

Objective To observe the effect of excessive fluoride exposure on expression of tight junction protein zonula occludens-1 (ZO-1) in human vascular endothelial cells and to explore the mechanism.Methods Human umbilical vein endothelial cells (HUVECs) were cultured in vitro.Group design was adopted.Groups of 0.0 (control group) and 0.4,0.8,1.2 mg/L fluoride treatment groups (low,medium and high dose groups) and insulin-like growth factor-1 (IGF-1) group [before adding 1.2 mg/L fluoride ion (F-),100 nmol/L of IGF-1 was added in advance for 2 hours] were set up respectively.Each group of cells was cultured for 24 h to extract cellular proteins.The expression of ZO-1,phosphatidylinositol kinase (PI3K),protein kinase B (AKT) and phosphorylated AKT (p-AKT)were detected and analyzed by Western blotting.Results The expression of intracellular ZO-1 (0.063 ± 0.002,0.043 ± 0.007,0.039 ± 0.004,0.028 ± 0.007) decreased obviously with gradual increase of F-concentration in cultural medium (F =21.36,P ＜ 0.01).And the expressions of ZO-1 in all three fluorine groups were clearly lower than that in the control group (P ＜ 0.05).At the same time,the expression of ZO-1 in high fluorine group was significantly lower than those in other fluorine groups (P ＜ 0.05).There were significant differences in the expression of PI3K (0.032 ± 0.004,0.031 ± 0.002,0.017 ± 0.001,0.017 ± 0.005) and p-AKT/AKT (0.745 ± 0.046,0.806 ±0.007,0.666 ± 0.058,0.641 ± 0.040) among all groups (F =20.38,9.57,P ＜ 0.01 or ＜ 0.05).The expressions of PI3K and p-AKT/AKT in high fluorine group were obviously lower than those of control and mild fluorine groups,and p-AKT/AKT in moderate fluorine group was clearly lower than that of mild fluorine group (P ＜ 0.05).After pretreatment with IGF-1,the expression of ZO-1 (0.055 ± 0.015) increased significantly compared to that of high fluorine group (P ＜ 0.05).Conclusion Excessive fluoride exposure has decreased the expression of ZO-1 in HUVECs through the PI3K/AKT signaling pathway.

Objective: To explore the relationship between gross motor development and perceived motor competence among children aged 7-8 years old. Methods: Random cluster sampling method was used to conduct a test among 162 students aged 7-8(78 boys,84 girls)by using Test of Gross Motor Development Ⅲ(TGMD-3) and 3 and Pictorial Scale of Perceived competence and Social Acceptance for Young Children(PSPC-P). Results: There were no statistical significance of perceived motor competence in different genders,and ages among children(t=-0.82, -0.58, P>0.05). Gross motor development differed significantly in different age groups (t=-4.79, P<0.01). Eight-year-old group(63.10±5.70) scored higher than 7-year-old group(57.96±7.76).There exists clear association between gross motor scores and perceived motor competence (r=0.29, P＜0.01), as well as locomotor development and manipulative development with perceived motor competence (r=0.21, 0.24, P<0.05). Conclusion There are close correlations between gross motor development and perceived motor competence among children aged 7 to 8 years. Manipulative development shows obvious influences on perceived motor competence. No gender differences are found in perceived motor competence.