OBJECTIVE:To discuss the irrational combined use of traditional Chinese with western medicines to provide basis for clinical safe medication. METHODS:Referring to the domestic pertinent literature together with our clinical experiences, some common and typical incompatibility between the traditional Chinese medicines and western medicines were analyzed, sorted and classified and summarized to derive the mechanism for the incompatibility. RESULTS & CONCLUSION:Irrational combined use between traditional Chinese medicines and western medicines can result in lower curative efficacy and higher toxic effect or even severe drug-induced diseases that may lead to serious consequences, therefore, great importance should be attached to this matter.

OBJECTIVE:To study the chemical constituents of the root of Rumex japonicus. METHODS: The root of Rumex japonicus was separated by different methods such as organic solvent method and column chromatography, and its structure was identified by spectrum technology. RESULTS: A total of seven compounds were isolated from the root of Rumex japonicus, which were identified to be as ?-sitosterol, quercetin, rumizin, emodin, physcion, chrysophanol and 1,6,7-trihydroxy-3-methoxyanthraquinone. Among them, quercetin and 1,6,7-trihydroxy-3-methoxyanthraquinone were isolated from this plant for the first time. CONCLUSION: This study provides scientific evidences for further study of the root of Rumex japonicus.

BACKGROUND:Treatment methods for high anal fistula include fistula removal, incision and thread drawing, selective mucosal flap displacement, fibrin glue closure, fistula liagtion between sphincter, most of which show many advantages, including long-term healing, a low success rate, high recurrence rate, and high postoperative complication rate.
OBJECTIVE:To observe the clinical effect of acelular extracelular matrix in the treatment of high anal fistula, and to explore a minimaly invasive treatment for high anal fistula.
METHODS: Totaly 100 cases of high anal fistula were randomly divided into treatment group and control group, 50 cases in each group. Treatment group were treated with alogenic acelular extracelular matrix, and control group were treated with traditional low incision with high thread-drawing. Then, we observed and compared the operation time, bleeding volume, postoperative pain score (visual analog scale score), postoperative pain
duration, anal incontinence severity score (Wexner score), wound healing time, one-stage success rate, cure rate, recurrence rate.
RESULTS AND CONCLUSION: Compared with the control group, the treatment group showed lower scores in the operation time, bleeding volume, wound healing time, visual analog scale score, postoperative pain duration, and anal incontinence severity score (P < 0.05), but higher scores in one-stage success rate and cure rate (P < 0.05). There was no difference in the recurrence rate between the two groups. These findings indicate that the alogenic acelular extracelular matrix for treatment of high anal fistula exhibits smal trauma, quick recovery,
short course of treatment, high cure rate and has no damage to the anal function and appearance.

Objective To investigate the effect of small interfering RNA (siRNA) interference in the expression of epidermal growth factor receptor (EGFR) on the radiosensitivity of esophageal squamous carcinoma (Eca-109) and esophageal adenocarcinoma (OE-19) cell lines.Methods Human Eca-109 and OE-19 cell lines were selected as study subjects.Various EGFR-siRNA and negative siRNA were synthesized chemically through lipofection.Reverse transcription-polymerase chain reaction and Western blot were applied to measure the expression of EGFR before and after transfection,and the CCK8 assay was applied to analyze the influence of transfection on cell proliferation.Blank control groups of Eca-109 and OE-19 cells (O1 and O2 groups),simple irradiation groups (R1 and R2 groups),and EGFR-siRNA irradiation groups (E-R1 and E-R2 groups) were set,and the doses for single irradiation were 0,2,4,6,and 8 Gy.The colony-forming assay was applied to calculate survival fraction (SF) and sensitization enhancement ratio (SERD0 ratio),and flow cytometry was applied to evaluate the influence of EGFR-siRNA combined with radiotherapy on cell cycle distribution and apoptosis rate,and the dose for single irradiation was 6 Gy.Results The expression of EGFR in both cell lines was significantly down-regulated by EGFR-siRNA,and the inhibition rate of cell proliferation by transfection was＜5％ (4.9％ and 4.5％,respectively).The results of colony-forming assay showed that the cells in the E-R1 and E-R2 groups had a lower SF than those in the O1 and O2 groups,with an SERD0ratio of 1.40 and 1.01,respectively.The results from flow cytometry showed that compared with the E-R2 group,the E-R1 group had a higher proportion of cells in G2/M phase and a lower proportion of cells in S phase after irradiation (P=0.016 and 0.028),as well as a higher apoptosis rate (P=0.007).Conclusions Compared with the cell line OE-19,the cell line Eca-109 has a significantly increased radiosensitivity when treated with siRNA interference in EGFR expression.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

OBJECTIVE To systematically review the pharmacoeconomic evaluation literature about proprotein convertase subtilisin/kexin type 9 （PCSK9） inhibitors for the prevention of cardiovascular disease in patients with hypercholesterolemia， and to provide a reference for clinical treatment， health decision-making and future follow-up research. METHODS Retrieved from English and Chinese databases such as PubMed and CNKI， the pharmacoeconomic literature about PCSK9 inhibitors （evolocumab and alirocumab） for the prevention of cardiovascular disease in patients with hypercholesterolemia was collected from the establishment of the database to October 8， 2023. The quality of the included literature was assessed with Consolidated Health Economic Evaluation Reporting Standards 2022 （CHEERS 2022） scale. The descriptive analysis was performed for basic information， model structure， related parameters， sensitivity analysis and the results of included studies. RESULTS & CONCLUSIONS A total of 29 literature were included， with overall good quality. The evaluation mainly adopted the Markov model from the healthcare system， payer and societal perspective. The effectiveness and utility data mainly came from the previous studies； the direct cost was mainly considered with a discount rate of 1.5%-5.0% per year， while the willingness-to-pay threshold was often set at 1-3 times the gross domestic product per capita. Most health output indicators were measured in life years and quality-adjusted life years. The sensitivity analysis of most studies demonstrated the robustness and the main influential factor was the drug cost. Most Chinese studies showed that PCSK9 inhibitor was not cost-effective for the prevention of cardiovascular disease in patients with acute coronary syndrome， myocardial infarction and atherosclerotic cardiovascular disease. It was cost-effective to use PCSK9 inhibitors for the prevention of cardiovascular disease only in specific groups， such as patients with triple vessel disease， patients with newly diagnosed acute coronary syndrome and low-density lipoprotein cholesterol≥100 mg/dL. Future research should refer to the CHEERS 2022 scale to improve the design， and strive to select large-scale， high-quality data to enhance the quality of reports and the transparency of health decisions， so as to more accurately assess the cost-effectiveness of PCSK9 inhibitors.