ObjectiveTo investigate the mechanism of action of Kaixinsan in the treatment of Alzheimer's disease （AD） based on network pharmacology， molecular docking， and animal experimental validation. MethodsThe Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） and the Encyclopedia of Traditional Chinese Medicine（ETCM） databases were used to obtain the active ingredients and targets of Kaixinsan. GeneCards， Online Mendelian Inheritance in Man（OMIM）， TTD， PharmGKB， and DrugBank databases were used to obtain the relevant targets of AD. The intersection （common targets） of the active ingredient targets of Kaixinsan and the relevant targets of AD was taken， and the network interaction analysis of the common targets was carried out in the STRING database to construct a protein-protein interaction（PPI） network. The CytoNCA plugin within Cytoscape was used to screen out the core targets， and the Metascape platform was used to perform gene ontology（GO） functional enrichment analysis and Kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment analysis. The “drug-active ingredient-target” interaction network was constructed with the help of Cytoscape 3.8.2， and AutoDock Vina was used for molecular docking. Scopolamine （SCOP） was utilized for modeling and injected intraperitoneally once daily. Thirty-two male C57/BL6 mice were randomly divided into blank control （CON） group （0.9% NaCl， n=8）， model （SCOP） group （3 mg·kg^-1·d^-1， n=8）， positive control group （3 mg·kg^-1·d^-1 of SCOP+3 mg·kg^-1·d^-1 of Donepezil， n=8）， and Kaixinsan group （3 mg·kg^-1·d^-1 of SCOP+6.5 g·kg^-1·d^-1 of Kaixinsan， n=8）. Mice in each group were administered with 0.9% NaCl， Kaixinsan， or Donepezil by gavage twice a day for 14 days. Morris water maze experiment was used to observe the learning memory ability of mice. Hematoxylin-eosin （HE） staining method was used to observe the pathological changes in the CA1 area of the mouse hippocampus. Enzyme linked immunosorbent assay（ELISA） was used to determine the serum acetylcholine （ACh） and acetylcholinesterase （AChE） contents of mice. Western blot method was used to detect the protein expression levels of signal transducer and activator of transcription 3（STAT3） and nuclear transcription factor（NF）-κB p65 in the hippocampus of mice. ResultsA total of 73 active ingredients of Kaixinsan were obtained， and 578 potential targets （common targets） of Kaixinsan for the treatment of AD were screened out. Key active ingredients included kaempferol， gijugliflozin， etc.. Potential core targets were STAT3， NF-κB p65， et al. GO functional enrichment analysis obtained 3 124 biological functions， 254 cellular building blocks， and 461 molecular functions. KEGG pathway enrichment obtained 248 pathways， mainly involving cancer-related pathways， TRP pathway， cyclic adenosine monophosphate（cAMP） pathway， and NF-κB pathway. Molecular docking showed that the binding of the key active ingredients to the target targets was more stable. Morris water maze experiment indicated that Kaixinsan could improve the learning memory ability of SCOP-induced mice. HE staining and ELISA results showed that Kaixinsan had an ameliorating effect on central nerve injury in mice. Western blot test indicated that Kaixinsan had a down-regulating effect on the levels of NF-κB p65 phosphorylation and STAT3 phosphorylation in the hippocampal tissue of mice in the SCOP model. ConclusionKaixinsan can improve the cognitive impairment function in SCOP model mice and may reduce hippocampal neuronal damage and thus play a therapeutic role in the treatment of AD by regulating NF-κB p65， STAT3， and other targets involved in the NF-κB signaling pathway.

AIM:To analyze the influencing factors of visual outcome after vitrectomy for polypoidal choroidal vasculopathy(PCV)combined with vitreous hemorrhage and establish a predictive model.METHODS: A retrospective analysis was conducted on the clinical data of 129 cases(129 eyes)of patients who underwent vitrectomy for PCV combined with vitreous hemorrhage from June 2021 to January 2024 in our hospital. They were divided into elevated group(71 eyes)and non-elevated group(58 eyes)according to visual outcome at early posoperative stage(within 24 mo). Another 30 cases(30 eyes)of PCV with vitreous hemorrhage undergoing vitrectomy were selected as external validation data. The predictive value of the model for the postoperative visual outcomes of both internal and external populations was evaluated.RESULTS: The non-elevated group had a higher proportion of patients aged ≥60 years, diabetes, continuous abnormalities of the ellipsoid zone(EZ)during surgery, bleeding involving the macular fovea, and postoperative retinal scar formation than the elevated group were independent factors affecting postoperative visual acuity(all P<0.05). The AUC of the predictive model for predicting the postoperative visual outcomes of internal and external populations was 0.824(95%CI: 0.750-0.898)and 0.809(95%CI: 0.723-0.865), respectively.CONCLUSION:Patients aged ≥60 years, diabetes, intraoperative continuous abnormalities of EZ, bleeding involving the macular fovea, and postoperative retinal scar formation are influencing factors for visual outcome after vitrectomy in patients with PCV combined with vitreous hemorrhage. A predictive model based on those factors has been established, which has a certain predictive value for postoperative visual outcome.

Objective:To analyze the current prevalence of pre-diabetes (PDM) and its relationship with overweight and obesity in an adult health check-up population.Methods:This study was a cross-sectional and retrospective cohort study and was applied using whole-cluster random sampling method. A total of 491 379 adults who underwent health check-ups at the Health Management Centre of Sichuan Provincial People′s Hospital from January 2017 to July 2023 were selected to analyze the epidemiological characteristics of PDM and overweight-obesity, as well as the trend of change over time. A retrospective cohort study was conducted on 19 001 of the subjects who underwent≥3 health check-ups and did not have diabetes and PDM at baseline, and the relationships between body mass index, waist circumference and the risk for developing PDM were analyzed using Cox proportional risk regression models. And the dose-response relationship between body mass index, waist circumference and the risk for developing PDM was analyzed using restricted cubic spline regression (RCS).Results:Of the 491 379 cases included in the cross-sectional study, 275 084 were male and 216 295 were female, 163 158 cases were under 40 years old, and 328 221 cases were 40 years old and above; the total prevalence of PDM was 19.41% in 2017-2023, with an overall increasing trend. Of the 19 001 people included in the cohort study, a total of 2 487 (13.09%) new cases of PDM were identified at the end of follow-up. After adjusting for confounding factors, overweight ( HR=1.150, 95% CI: 1.047-1.263), obesity ( HR=1.335, 95% CI: 1.149-1.552) and abdominal obesity ( HR=1.218, 95% CI: 1.105-1.342) were risk factors for PDM. The risk of PDM rised with the increase of body mass index (>22.9 kg/m 2, Pnon-linear=0.973) and waist circumference (>80 cm, Pnon-linear=0.830), with a linear dose-response mode. In different gender and age groups, it was found the greater the body mass index (>24.1 kg/m 2 for men,>21.5 kg/m 2 for women;>23.3 kg/m 2 for age≥40 years,>24.1 kg/m 2 for age<40 years) and waist circumference (>85 cm for men, >73 cm for women; >82 cm for age ≥40 years, >85 cm for age <40 years), the higher the risk of PDM. Conclusions:The prevalence of PDM is on the rise in the adult health check-up population. To prevent PDM, it is necessary to control the body mass index and waist circumference to a lower level than the overweight and obesity standards.

Objective:To observe the effect of pecking moxibustion on the pattern characteristics of redness,swelling,heat,and pain in the affected joints,also the synovial cell ultrastructure in rats with rheumatoid arthritis(RA)due to damp heat affecting bones/joints,and to explore the anti-inflammatory mechanism of pecking moxibustion in treating the early stage of RA. Methods:Eighteen rats were randomly selected from 78 female ones as the blank group,and all the other rats were subjected to preparing the"differentiation of disease and pattern"RA model due to damp heat affecting bones/joints by using the method of"collagen-induced arthritis plus windy,damp,and hot environment stimulation".Fifty-four rats with successful modeling were randomly divided into a model group,a drug group,and a pecking moxibustion group,with 18 rats in each group.Rats in the drug group were given methotrexate at a dose of 1 mg/(kg·bw)on the 1st,8th,and 15th days.Rats in the pecking moxibustion group were treated with pecking moxibustion at Quchi(LI11),Dazhui(GV14),and Ashi points,and each point was treated with moxibustion for 15 min every day and a total of 3 courses of treatment,with 6 d as a course of treatment.After treatment,the capillary permeability,joint swelling,joint surface temperature,and plantar thermal pain threshold of the diseased joints in rats were observed,and the ultrastructural changes of synovial cells were observed by transmission electron microscopy. Results:The local swelling,surface temperature,and Evans blue(EB)leakage volume were significantly higher(P<0.05),the thermal pain threshold was significantly lower(P<0.05),and the synovial cell ultrastructure was obviously damaged in the affected joints in the model group compared with the blank group.The swelling degree,surface temperature,and EB leakage volume were significantly reduced(P<0.05),the thermal pain threshold was significantly increased(P<0.05),and the ultrastructural abnormalities of synovial cells were significantly improved in the diseased joints in the drug group and the pecking moxibustion group compared with the model group.The thermal pain threshold of rats in the pecking moxibustion group was significantly improved compared with the drug group(P<0.05). Conclusion:Pecking moxibustion obviously improves the pattern characteristics of local redness,swelling,heat,and pain in the diseased joints of rats with RA due to damp heat affecting bones/joints and effectively repairs the ultrastructure of the damaged synovium.It suggests that the pecking moxibustion intervention has a significant anti-inflammatory effect on early RA.

Aim To explore the correlation between residual lipoprotein cholesterol(RLP-C)and the occurrence and severity of peripheral arterial disease(PAD)in patients with type 2 diabetes mellitus(T2DM).Meth-ods 392 T2DM patients with complete data who attended the Department of Endocrinology and the Department of Cardio-vascular Medicine of People's Hospital of Henan University of Traditional Chinese Medicine from May 2022 to December 2022 were selected and classified into PAD group(n=203)and non-PAD group(n=189).General clinical data were collected between the groups,the difference of RLP-C level was compared between the two groups,the correlation between RLP-C and PAD was examined by using univariate and multivariate Logistic regression analysis,and ROC curve was plotted to analyze the predictive value of RLP-C for PAD.Results Compared with non-PAD group,RLP-C level was significantly higher in PAD group(P＜0.001);RLP-C was positively correlated with the severity of PAD(r=0.443,P＜0.001);Multifactorial Logistic regression analysis revealed that RLP-C was a major risk factor for the development of PAD in T2DM(P＜0.001);The area under the curve(AUC)of RLP-C level prediction for T2DM combined with PAD was 0.860(95％CI:0.824～0.896,P＜0.001);The optimal RLP-C threshold for predicting the development of PAD was 0.67 mmol/L.Conclusion RLP-C level was positively associated with the occurrence and severity of PAD in patients with T2DM,and RLP-C was an independent risk factor for the development of PAD.In addition,RLP-C＞0.67 mmol/L increased the risk of PAD in T2DM patients.

Procurement constitutes a cornerstone of daily operations in public hospitals,involving medical equipment,medical materials,pharmaceuticals,infrastructure projects,office supplies,and service-oriented projects.The responsibility for procurement used to rest on various functional departments overseeing business management,a situation that often led to a lack of transparency and standardization due to decisions made by a single department or a few key cadres.To standardize procurement practices,the national policy has introduced a"procurement"and"management"separation model.In public hospitals,pro-curement includes two main aspects:"procurement"entails the actual execution of purchasing activities,including market re-search,price negotiation,tender document formulation,and contract signing;and"management"involves the preliminary re-search,budgeting and project initiation,installation and commissioning,inventory acceptance,maintenance quality control,and usage management of procured items.The separation of"procurement"and"management"is an important part of the procure-ment management unit in the modern hospital administration.This process-based division ensures the functional distinction be-tween procurement and management,fostering interdepartmental collaboration and mutual oversight,thereby mitigating procure-ment integrity while safeguarding procurement quality.

Objective:To investigate the changes and clinical significance of vascular endothelial growth factor (VEGF) and vascular cell adhesion molecule-1 (VCAM-1) levels in patients undergoing breast cancer resection before and after radiotherapy.Methods:A total of 110 patients who were treated in our hospital from Jun. 2022 to Jun. 2023 for breast cancer and were to receive radiotherapy after surgery were prospectively selected as the observation group. Another 110 healthy volunteers were selected as the control group. The levels of VEGF and VCAM-1 in peripheral blood were compared, and the relationship among general data, tumor pathology and peripheral blood VEGF and VCAM-1 in the observation group was analyzed, and their relationship with disease and prognosis was analyzed.Results:VEGF and VCAM-1 levels in peripheral blood in the observation group were significantly higher ( F=1288.37, 309.32, P<0.05). The levels of VEGF and VCAM-1 in peripheral blood in the observation group were significantly lower than before radiotherapy ( t=23.45, 11.88, P<0.05). Before and after radiotherapy, VEGF and VCAM-1 levels in peripheral blood in the observation group were correlated with tumor stage, tumor differentiation degree and Ki-67 proliferation index ( ttumor stage=7.05, 2.14, 4.52, 4.76, ttumor differentiation degree=7.12, 6.62, 2.81, 3.15, tKi67 proliferation index=7.25, 4.60, 4.24, 2.48, P<0.05) ; Of 110 patients in the observation group, 73 were effective and 34 were ineffective. VEGF and VCAM-1 in effective group were significantly lower ( t=7.27, 9.08, P<0.05). Spearman correlation coefficient analysis showed that VEGF and VCAM-1 levels were significantly positively correlated with tumor stage and Ki67 proliferation index before and after radiotherapy ( rbefore radiotherapy=0.64, 0.54, 0.52, 0.52, rafter radiotherapy=0.32, 0.39, 0.37, 0.24, P<0.05), and negatively correlated with tumor differentiation degree ( rbefore radiotherapy=-0.41, -0.31, rafter radiotherapy=-0.68, -0.41, P<0.05). The prognostic value of combined radiotherapy was 0.801 [95% CI (0.714-0.871) ], which was higher than that of VEGF and VCAM-1 alone 0.690 [95% CI (0.5955-0.775) ] and 0.734 [95% CI (0.641-0.814) ]. Conclusion:The changes of VEGF and VCAM-1 levels in peripheral blood have a certain value in evaluating the short-term prognosis of patients undergoing breast cancer resection by radiotherapy.

Objective:To analyze the evolution of China′s national-level healthcare sector regulatory policies between 2003 and 2021, and explore the characteristics and patterns of the use of policy instruments at different stages, for references in policy optimization.Methods:The policy documents related to the regulation of the healthcare sector released by the central government were searched from 2003 to 2021 from the policy document database of the State Council using the keywords " medical" " regulation" and " health" " regulation". Based on the analysis framework of " formulation subject-implementation subject-policy tools", such methods as content analysis, social network analysis, and policy tool analysis were used to analyze policy documents and conduct descriptive analysis of data.Results:A total of 236 policies were included in the study.From 2003 to 2008, according to the time progression, a total of 27 documents were issued, with the State Council as the main formulation subject (77.78%, 21/27), and the government as the main implementation subject (100.00%, 27/27). 191 policy tools were used, and the composition ratios of supply-based, demand-based, and environment-based policy instruments were 21.46% (41/191), 30.37% (58/191), and 48.17% (92/191). From 2009 to 2017, a total of 48 policies were issued, the formulation subject was mostly the State Council (93.75%, 45/48), and the implementation subject was still mostly the government (100.00%, 48/48), but the proportion of institutions (25.00%, 12/48), industry organizations (43.75%, 21/48) and the society (37.50%, 18/48) has increased. 500 policy tools were used, and the composition ratios of supply-based, demand-based, and environment-based policy instruments were 17.40% (87/500), 32.00% (160/500), and 50.60% (253/500), respectively.From 2018 to 2021, a total of 161 documents were issued, with the formulation subjects featuring multiple subjects (38.51%, 62/161), with a decrease in the percentage of the State Council′s issuance (22.36%, 36/161), and 157 (97.52%) policies were implemented by the government. 1 140 policy tools were used, and the composition ratios of supply-based, demand-based, and environment-based policy instruments being 18.42% (210/1 140), 34.74% (396/1 140), and 46.84% (534/1 140), respectively.Conclusions:From 2003 to 2021, there was an upward trend in the number of policies issued in the field of healthcare sector regulation in China, and the subjects of formulation and implementation were diversified. But the use of different types of policy instruments was uneven.

Objective To analyse the differential metabolites and related metabolic pathways in stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndrome by serum metabolomics.Methods This study observed 60 patients with stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndrome and 60 healthy volunteers in the same period.Liquid chromatography-mass spectrometry(LC-MS)was performed on the serum metabonomics.The differential metabolites were identified by multivariate statistical analysis of the original spectrogram and original data,and enrichment analysis of KEGG metabolic pathway was analyzed.Results A total of 60 patients in the group of stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndrome participated in the study,and a total of 60 healthy volunteers in the control group participated in the study.There was no statistical difference in general information and biochemical indicators between the two groups(P>0.05);Eighteen differential metabolites were found respectively,including phenylacetaldehyde,orthophosphate,guanosine,diethyl phosphate,2-dehydro-d-gluconate,guanine and 5-(2-hydroxyethyl)-4-methylthiazole down-regulated expression,taurocholate,2-propylglutaric acid,8-amino-7-oxononanoate,l-tyrosine,s-sulfo-l-cysteine,cyclohexanecarboxylic acid,porphobilinogen,(r)-acetoin,octanoylglucuronide,melatonin and solanine up-regulated expression,involving phenylalanine metabolism,thiamine metabolism,purine metabolism.Conclusion The differential metabolites reveal the metabolic essence of stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndrome from the micro level,and can provide clues for clinical early warning of patients with stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndromet.

Objective:To evaluate the predictive efficacy of a nomogram in patients with acute hypoxemic respiratory failure (AHRF) undergoing treatment with a high-flow nasal cannula (HFNC).Methods:We conducted a retrospective observational study of patients with AHRF who received HFNC treatment. Data on complications, vital signs on the first day after enrollment, use of vasoactive drugs, Glasgow Coma Scale scores, and clinical respiratory parameters (respiratory rate, pulse oximetry oxygen saturation, and fraction of inspired oxygen) were meticulously recorded. The risk ratio for HFNC failure was computed using an online calculator.Results:Overall, 62 patients were included, of which 29 (46.77%) experienced HFNC failure. No significant differences were observed in age, sex, body mass index, complications, or sequential organ failure assessment scores between the two groups. However, compared with those who responded positively to HFNC treatment, individuals experiencing HFNC failure demonstrated a significant increase in acute physiology and chronic health evaluation Ⅱ scores [ (15.15±5.01)score vs. (21.00±5.76)score; P<0.001 ]. Furthermore, HFNC treatment failure was associated with significantly higher ICU mortality rates [0 vs. 34.48%(10/29), P<0.01] and in-hospital mortality rates [3.03%(1/33) vs. 37.93%(11/29), P<0.01], as well as a marked prolongation of ICU stay [6(4,10)d vs. 11(6,17)d, P=0.012]. In the failure group, the nomogram-derived risk ratio was 0.80±0.18, which was significantly higher than that in the success group (0.65±0.18; P=0.009). The area under the receiver operating characteristic curve of the nomogram for predicting HFNC failure was 0.76, with a sensitivity of 54.8% and a specificity of 93.6%. Conclusion:The nomogram, along with the online calculator, offers a straightforward and effective means for assessing the risk of treatment failure in patients with AHRF undergoing HFNC therapy.