Objective To provide guide for prevention and cure of peritonitis in peritoneal dialysis(PD) by comparing the causative organisms and clinical outcome of PD related peritonitis in younger and elderly patients in our center.Methods All patients who developed PD related peritonitis between January 2006 and December 2013 in Wuhan NO.1 hospital were included.According to their age,episodes were divided into younger patients group (＜ 65 years) and elderly patients group (≥65 years).The microbiology and clinical outcome of PD related peritonitis were compared,and the related risk factors of the treatment failure were analyzed.Results Three hundred and sixty-six episodes of peritonitis occurred in 258 patients during the study period.The overall rate of peritonitis was 1 episode in 76.8 patient-months.Elderly patients had higher incidence of peritonitis (1 episode every 56.4 months vs 1 episode every 88.7 months,P=0.001),higher incidence of fungus infection (9.6％ vs 3.9％,P=0.026) and higher mortality (46.2％ vs 14.0％,P=0.001) than that in younger patients.Cox regression analysis showed that longer duration of PD treatment and fungal peritonitis were both risk factors of the treatment failure.Conclusion Elderly patients had higher incidence of peritonitis,higher incidence of fungus infection and higher PD-related mortality than younger patients.

Objective:Guiding hospitals to strengthen the emphasis on clinical medical research, promote hospital discipline construction, to improve the quality of medical services and clinical innovation capacities.Methods:Starting from different user groups, combines the experience of the knowledge base of the library construction institution of Grade-A Tertiary Hospital and the cooperation experience with various functional departments, this paper analyzes the functional structure of the institutional repository according to the problems faced in the actual work to explore the difficulties during the construction process.Results:The construction of the Institutional Repository of hospitals for different users is imminent. In addition to the use of Institutional Repository to improve the utilization of intelligence and information resources, the construction of institutional repository on the evaluation of science and technology influence can also promote the development of hospital disciplines.Conclusions:A solution method is proposed, based on the background of scientific and technological influence evaluation, the future construction direction of the institutional repository.

ObjectiveTo systematically evaluate the safety of Chinese medicines combined with Tripterygium wilfordii polyglycoside tablets/Tripterygium wilfordii tablets （TWPT/TWT） in the treatment of rheumatoid arthritis （RA）， and to explore the network regulatory mechanisms of enhancing efficacy and reducing toxicity of commonly used combination regimes. MethodThe literature involving the adverse reactions of TWPT/TWT in treating RA was searched and collected from three Chinese databases （CNKI， Wanfang Data， VIP） and three English databases （PubMed， Cochrane Library， Embase） from the inception of the databases to July 2021. All studies were assessed by the Cochrane risk of bias tool， and the data were extracted and analyzed by Stata 15.0. Furthermore， Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine 2.0 （TCMIP v2.0，http：//www.tcmip.cn/） was used to construct a "drug target-symptom gene of efficacy and toxicity" interaction network， to explore the underlying network regulatory mechanisms of enhancing efficacy and reducing toxicity of common T. wilfordii preparation combinations. ResultA total of 2 132 articles on Chinese medicines combined with TWPT/TWT in the treatment of RA were retrieved， and 18 of them were finally included. The systematic review showed that the adverse reactions of TWPT/TWT against RA mainly occurred in the digestive system， blood system， and reproductive system， of which digestive system had the highest incidence of damages. However， the combination with Chinese medicines effectively alleviated the adverse reactions caused by TWPT/TWT ［RR （95% CI）=0.45 （0.30， 0.66）， P<0.01］. In addition， the subgroup analysis indicated that the age of RA patients， course of disease， combination regimen， medication dosage and duration of treatment all affected the occurrence of adverse reactions of TWPT/TWT. It was found in clinical studies that total glucosides of paeony （TGP） and TWPT/TWT was most widely combined， and the effect of TGP in reducing TWPT/TWT-induced hepatotoxicity was also more significant than that of other Chinese medicines. Moreover， taking this combination regime as an example， this paper explored the "efficacy-toxicity" association mechanisms of TGP-TWPT/TWT against RA. The "drug target-symptom gene of efficacy and toxicity" interaction network revealed that the core network targets of TGP-TWPT/TWT enhanced efficacy and reduced toxicity mainly through regulating immunity-inflammation-related pathways， metabolic pathways and cell signal transduction. Especially， interleukin-4 （IL-4） and interleukin-13 （IL-13）， which were involved in the "immunity-inflammation" module， were the common targets of TGP-TWPT/TWT to enhance efficacy and reduce toxicity. The endogenous sterols， bile acids and bile salts， insulin secretion and other metabolic pathways in the "body metabolism" module were closely associated with the mechanisms of TWPT/TWT inducing hepatotoxicity and TGP reducing hepatotoxicity. While cell function regulation pathways， such as stem cell factor （SCF）/tyrosine kinase receptor （KIT） signaling pathway and phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）signaling pathway were involved in both anti-RA effects and hepatotoxicity of TWPT/TWT. ConclusionClinical application of suitable Chinese medicines combined with TWPT/TWT in the treatment of RA can effectively improve the rheumatism and reduce the adverse reactions of TWPT/TWT， and TGP-TWPT/TWT has the most significant toxicity-reducing effect. Further biological network-based investigation indicates that the toxicity-reducing mechanism of TGP-TWPT/TWT may be related to the regulation of interleukin signaling pathway and bile acid metabolism pathway， and the synergistic efficacy-enhancing effect of the combination may be achieved by acting on interleukin signaling pathway and cell function regulation pathway.