Metabolic dysfunction-associated fatty liver disease （MAFLD） is a chronic liver disease closely related to metabolic dysfunction. Its global prevalence is increasing year by year and shows a trend toward younger onset. It is closely associated with cardiovascular and cerebrovascular diseases， chronic kidney disease， and extrahepatic malignant tumors， and has become a major public health problem affecting the health of the Chinese population. At present， the treatment of MAFLD mainly focuses on lifestyle intervention. When metabolic cardiovascular risk factors and liver injury are present， pharmacological intervention is required. However， there is still no specific drug therapy for MAFLD. In recent years， many studies have found that the pathogenesis of MAFLD involves interactions among multiple factors， including insulin resistance， oxidative stress， endoplasmic reticulum stress， programmed cell death， immune dysregulation， inflammasomes， gut microbiota imbalance， and bile acid metabolism. Traditional Chinese medicine （TCM） has advantages in integrated regulation with multiple components and multiple targets， and shows significant efficacy in the treatment of MAFLD. Active components of Chinese medicinal herbs and Chinese medicine compound formulas exert definite therapeutic effects by regulating multiple signaling pathways to improve lipid metabolism disorders， inhibit inflammatory responses， and regulate the gut microbiota， thereby effectively improving clinical symptoms and delaying the occurrence and development of MAFLD. Therefore， strengthening research on the mechanisms of action of TCM in MAFLD is of crucial importance and significance for its treatment. This article summarizes the mechanisms by which Chinese medicine monomers and compound formulas intervene in MAFLD through the regulation of related signaling pathways， based on the retrieval and analysis of relevant literature from multiple databases， with the aim of providing theoretical support and a reference basis for the clinical application of TCM in the treatment of MAFLD.

Objective: To evaluate the safety and efficacy of therapeutic whole blood exchange combined with lymphoplasmapheresis in the treatment of refractory autoimmune hemolytic anemia (AIHA). Methods: A retrospective analysis was performed on the clinical data of AIHA patients who underwent therapeutic whole blood exchange combined with lymphoplasmapheresis at our hospital from March 2022 to May 2025. Efficacy was assessed by comparing changes in hemoglobin, platelet count, and bilirubin levels before and after treatment. Safety was evaluated by analyzing vital signs before and after the procedure, parameters during the exchange, and adverse reactions. Results: A total of 12 AIHA patients were enrolled, completing 19 exchange procedures. The number of procedures per patient ranged from 1 to 3. The median treatment duration was 67 (65-73) minutes, with a median exchange volume of 2 025 (1 851-2 121) mL, comprising 4.5 (4-6) units of red blood cells and 1 350 (1 200-1 400) mL of plasma. Ten patients achieved partial remission, one achieved complete remission, and one showed no response, yielding an response rate of 91% (11/12). After a single session, hemoglobin increased significantly by 17.58±9.85 g/L (P<0.01), while platelets counts decreased by 45 (17.5, 79)×10 /L (P<0.05), and both systolic and diastolic blood pressure showed a significant elevation (P<0.05). However, no statistically significant differences were observed in total bilirubin, indirect bilirubin, white blood cell count, or heart rate. During the procedures, 4 adverse reactions occurred in 3 patients: one child experienced severe heart rate fluctuation twice consecutively, and two adults developed plasma allergies. All reactions resolved spontaneously without pharmacological intervention. Conclusion: The combination of therapeutic whole blood exchange and lymphoplasmapheresis appears to be a safe and effective treatment for refractory AIHA patients.

Objective:To investigate the relationship between metabolic syndrome and 1-year poor outcome in elderly patients with acute cerebral infarction (ACI).Methods:The clinical data of elderly patients with ACI admitted to Renqiu Kangjixintu Hospital from January 2014 to November 2018 were selected and divided into metabolic syndrome group (931 cases) and non-metabolic syndrome group (1 851 cases). The clinical data of the two groups of elderly patients with ACI were compared, and the effect of metabolic syndrome on poor outcome (modified Rankin scale>2 scores) of elderly patients with ACI in 1 year was analyzed by multivariate Logistic regression.Results:The proportion of female, hypertension, diabetes, hyperlipidemia, coronary heart disease, smoking, excessive alcohol consumption and antiplatelet drug use in the metabolic syndrome group were higher than those in the non-metabolic syndrome group: 52.74%(491/931) vs. 32.58%(603/1 851), 79.16%(737/931) vs. 64.29% (1 190/1 851), 42.32% (394/931) vs. 6.43% (119/1 851), 17.19% (160/931) vs. 11.62% (215/1 851), 18.90% (176/931) vs. 14.10% (261/1 851), 62.73% (584/931) vs. 50.89% (942/1 851), 3.73% (69/931) vs. 1.61% (15/1 851), 19.23% (179/931) vs. 15.51% (287/1 851), the levels of body mass index, systolic blood pressure, diastolic blood pressure, fasting plasma glucose (FPG), fasting plasma glucose (TG), total cholesterol (TC), platelet (PLT), fibrinogen (FIB), fall score were higher than those in non-metabolic syndrome group: 26.67 (25.31, 28.60) kg/m 2 vs. 23.30 (21.48, 24.91) kg/m 2, (167.17 ± 22.96) mmHg (1 mmHg = 0.133 kPa) vs. (164.21 ± 24.90) mmHg, (87.06 ± 13.10) mmHg vs. (85.76 ± 12.99) mmHg, (7.33 ± 2.64) mmol/L vs. (5.35 ± 1.38) mmol/L, (2.12 ± 1.51) mmol/L vs. (1.13 ± 0.78) mmol/L, (4.97 ± 1.31) mmol/L vs. (4.65 ± 0.99) mmol/L, 213.00 (179.00, 256.00) × 10 9/L vs. 203.00 (172.00, 241.00) × 10 9/L, 3.07 (2.63, 3.52) g/L vs. 2.94 (2.55, 3.37) g/L, (6.12 ± 1.70) scores vs. (5.93±1.74) scores, the levels of age, high density lipoprotein cholesterol (HDL-C), homocysteine (Hcy) and pressure ulcer score were lower than those of non-metabolic syndrome group: (69.29 ± 6.96) years vs. (71.28 ± 7.66) years, (0.98 ± 0.34) mmol/L vs. (1.31 ± 0.88) mmol/L, (18.93 ± 13.07) mmol/L vs. (21.66 ± 16.39) mmol/L, (18.55 ± 2.42) vs. (19.02 ± 2.43), with statistical significance ( P<0.05). After 1-year follow-up, the proportion of poor outcomes in the metabolic syndrome group was higher than that in the non-metabolic syndrome group: 21.70%(202/931) vs. 18.69% (346/1 851), with statistical significance ( P<0.05). Multivariate Logistic regression analysis showed that age, stroke, national institutes of health stroke scale (NIHSS) score at admission, systolic blood pressure, Hcy, pressure ulcer score, fall score, metabolic syndrome were independent risk factors for poor outcome of ACI in 1 year ( OR = 1.056, 1.309, 1.138, 1.005, 1.006, 0.882, 1.076 and 1.285; 95% CI 1.040 to 1.072, 1.037 to 1.652, 1.097 to 1.180, 1.000 to 1.010, 1.000 to 1.013, 0.834 to 0.933, 1.004 to 1.152 and 1.001 to 1.657; P<0.05). Conclusions:Multiple risk factors for stroke are closely related to poor outcome of ACI in the elderly. And metabolic syndrome is an independent risk factor for poor outcome of ACI in the elderly in 1 year.

Objective:To investigate the influence of potentially inappropriate medication (PIM) on emergency treatment or hospitalization events due to heart failure in elderly outpatients.Methods:The data of outpatient, emergency patient, and inpatient above 65 years old collected in Beijing Medical Insurance Affairs Management Center database from July 1, 2016 to September 30, 2016 were retrospectively analyzed. PIM in the outpatient western medicine prescription was identified using the 2015 Beers Criteria ?. PIM exposure was defined as at least one PIM was prescribed within 3 months and patients were divided into the PIM exposure and non-PIM exposure groups accordingly. Clinical outcome events were defined as experiencing emergency treatment or hospitalization events due to heart failure after ≥14 days of PIM exposure. Clinical characteristics in patients between the 2 groups were compared and the exposure of specific PIM (PIM with the 3 highest use frequency) in the PIM exposure group was described. Influencing factors of clinical outcome events were analyzed using logistic regression analysis. Results:A total of 506 214 patients were entered in the study, including 252 604 males (49.90%) and 253 610 females (50.10%), aged from 65 to 105 years with a median age of 74 (68, 80) years. Definition of PIM exposure was met in 192 740 patients (38.07%); clinical outcome events occurred in 249 patients, of which 131 patients (0.03%) received emergency treatment and 118 patients (0.02%) hospitalized due to heart failure. Incidences of emergency treatment and hospitalization due to heart failure in patients of the PIM exposure group were higher than those of the non-PIM exposure group [0.04% (78/192 740) vs. 0.02% (53/313 474), P<0.001; 0.04% (71/192 740) vs. 0.01% (47/313 474), P<0.001]. The 3 PIM that used most frequently were vasodilators, diuretics, and central nervous system drugs. Multivariate analysis showed that PIM exposure and use of vasodilators and central nervous system drugs had no significant effects on the occurrence of emergency treatment and hospitalization events due to heart failure, while age ≥75 years old and use of diuretics had significant effects. Compared with the 65-74 age group, the risk of emergency treatment for heart failure in patients of the 75-84 age group and ≥85 age group increased by 3.00 times ( OR=4.00, 95 %CI: 2.46-6.51) and 7.14 times ( OR=8.14, 95 %CI: 4.64-14.29), respectively, and the risk of hospitalization for heart failure increased by 1.33 times ( OR=2.33, 95 %CI: 1.52-3.57) and 2.59 times ( OR=3.59, 95 %CI: 2.03-6.36), respectively. Compared with patients without diuretics treatment, patients treated with diuretics had a 1.91-fold increase in the risk of emergency treatment and hospitalization events due to heart failure ( OR=2.91, 95 %CI: 1.72-4.93) and 1.72-fold increase ( OR=2.72, 95 %CI: 1.56-4.74), respectively. Conclusions:PIM increases the risk of emergency treatment or hospitalization due to heart failure in elderly outpatients, but it is not an independent influencing factor. Age ≥75 years and diuretics use were independent influencing factors of emergency treatment or hospitalization in elderly patients.

Objective:To investigate the influence of potentially inappropriate medication (PIM) on emergency treatment or hospitalization events due to heart failure in elderly outpatients.Methods:The data of outpatient, emergency patient, and inpatient above 65 years old collected in Beijing Medical Insurance Affairs Management Center database from July 1, 2016 to September 30, 2016 were retrospectively analyzed. PIM in the outpatient western medicine prescription was identified using the 2015 Beers Criteria ?. PIM exposure was defined as at least one PIM was prescribed within 3 months and patients were divided into the PIM exposure and non-PIM exposure groups accordingly. Clinical outcome events were defined as experiencing emergency treatment or hospitalization events due to heart failure after ≥14 days of PIM exposure. Clinical characteristics in patients between the 2 groups were compared and the exposure of specific PIM (PIM with the 3 highest use frequency) in the PIM exposure group was described. Influencing factors of clinical outcome events were analyzed using logistic regression analysis. Results:A total of 506 214 patients were entered in the study, including 252 604 males (49.90%) and 253 610 females (50.10%), aged from 65 to 105 years with a median age of 74 (68, 80) years. Definition of PIM exposure was met in 192 740 patients (38.07%); clinical outcome events occurred in 249 patients, of which 131 patients (0.03%) received emergency treatment and 118 patients (0.02%) hospitalized due to heart failure. Incidences of emergency treatment and hospitalization due to heart failure in patients of the PIM exposure group were higher than those of the non-PIM exposure group [0.04% (78/192 740) vs. 0.02% (53/313 474), P<0.001; 0.04% (71/192 740) vs. 0.01% (47/313 474), P<0.001]. The 3 PIM that used most frequently were vasodilators, diuretics, and central nervous system drugs. Multivariate analysis showed that PIM exposure and use of vasodilators and central nervous system drugs had no significant effects on the occurrence of emergency treatment and hospitalization events due to heart failure, while age ≥75 years old and use of diuretics had significant effects. Compared with the 65-74 age group, the risk of emergency treatment for heart failure in patients of the 75-84 age group and ≥85 age group increased by 3.00 times ( OR=4.00, 95 %CI: 2.46-6.51) and 7.14 times ( OR=8.14, 95 %CI: 4.64-14.29), respectively, and the risk of hospitalization for heart failure increased by 1.33 times ( OR=2.33, 95 %CI: 1.52-3.57) and 2.59 times ( OR=3.59, 95 %CI: 2.03-6.36), respectively. Compared with patients without diuretics treatment, patients treated with diuretics had a 1.91-fold increase in the risk of emergency treatment and hospitalization events due to heart failure ( OR=2.91, 95 %CI: 1.72-4.93) and 1.72-fold increase ( OR=2.72, 95 %CI: 1.56-4.74), respectively. Conclusions:PIM increases the risk of emergency treatment or hospitalization due to heart failure in elderly outpatients, but it is not an independent influencing factor. Age ≥75 years and diuretics use were independent influencing factors of emergency treatment or hospitalization in elderly patients.

OBJECTIVE：To est ablish the working mode of the first pharmaceutical ward rounds of clinical pharmacists in our hospital，in order to provide a useful reference for establishing a national standardized pharmaceutical ward rounds model. METHODS：By sharing the clinical cases of the first pharmaceutical ward rounds ，the work content and process of the first pharmaceutical ward rounds in our hospital were introduced. RESULTS & CONCLUSIONS ：The clinical pharmacist ’s first pharmaceutical ward round in our hospital mainly includes self introduction of clinical pharmacists ，diagnosis of patients ’condition under the guidance of doctors ，collection and evaluation of patients ’previous medication information （including previous medication varieties ，usage methods ，efficacy and safety evaluation ），assistance for doctors in formulating initial treatment plan ， carrying out initial medication and diet education ，and intensive communication and cooperation with nurses. The development of first pharmaceutical ward rounds promotes the rational use of drugs in clinic ，elevates the hospitalization satisfaction of patients and improves the professional quality of clinical pharmacists.

Objective:To investigate the predictive value of pressure ulcer score and fall score and NIHSS scale for discharge outcome in patients with acute ischemic stroke (AIS).Methods:From January 2014 and November 2018, 4 468 patients with AIS who were treated in Hebei Province Renqiu Kangjixintu Hospital were selected as the research object. According to the modified Rankin scale (mRS) score standard discharge, mRS score in 0 to 2 scores was defined as good discharge outcome, and mRS score ≥3 scores defined as bad discharge outcome. Predictive value of pressure ulcer score, fall score and NIHSS score for the discharge outcome of AIS was analyzed.Results:The score of pressure ulcer in the group with bad discharge outcome was significantly lower than that in the group with good discharge outcome: (16.96 ± 2.89) scores vs. (19.91 ± 1.71) scores, the score of fall and NIHSS in the group with bad discharge outcome were higher than that in the group with good discharge outcome, with statistical significance: (6.66 ± 1.77) scores vs. (5.21 ± 1.64) scores, (7.34 ± 5.08) scores vs. (3.15 ± 2.21) scores ( P<0.01). The cutoff values of pressure sore score, fall score and NIHSS score for predicting adverse discharge outcome were 18.5, 5.5 and 3.5 scores, respectively. The area under the curve (AUC) was 0.809, 0.731 and 0.863, respectively. The sensitivity was 86.00%, 76.200% and 78.30%, and the specificity was 64.00%, 59.50% and 80.60%. The pressure ulcer score, fall score and NIHSS score had statistical difference in predicting the adverse outcome of discharge ( P<0.01). Conclusions:The pressure ulcer score, fall score and NIHSS score have good predictive value for the discharge outcome of AIS. The lower the pressure ulcer score and the higher fall score and NIHSS score are, the higher the risk of poor discharge outcome of AIS is. Actively controlling the occurrence of pressure ulcers and falls can effectively reduce the risk of poor discharge outcome of AIS.

【Objective】 To analyze the characteristics of peripheral blood mononuclear cells (PBMC) collection in healthy children, and explore the factors affecting collection efficiency (CE). 【Methods】 The PBMC data, involving 70 episodes of apheresis from 42 children during January 2017 and June 2020 were retrospectively analyzed All children were collected in Zhujiang Hospital of Southern Medical University. 【Results】 Multiple linear regression analysis showed that mononuclear cells (MNC) in donor collections from healthy children were positively correlated with anticoagulant dosage, lymphocyte count and monocyte count (P<0.05), meanwhile, negatively correlated with age and platelet count. The PBMC CE was negatively correlated with age, platelet count, and processed whole blood volume (P<0.05). CD34⁺ cells (×10⁷ /kg)was negatively correlated with age, meanwhile, positively correlated with numbers of collection and processed whole blood volume(r=-0.79). No statistical differences in red blood cell count, platelet count, lymphocyte count, monocyte count of healthy child donors were notable before versus after apheresis. 【Conclusion】 MNC can be collected effectively in children of different ages. The PBMC collection efficiency was related to age. Meanwhile, the higher the lymphocytes and monocytes were before apheresis, the more MNC were collected. The efficiency of MNC collection would decrease when the apheresis volume of the children exceeded their total blood volume twice. However, the absolute value of CD34+ cells in the final yields would increase.

Objective: To understand the association between body fat distribution and calcaneal bone mineral density (BMD) in children and adolescents aged 6-16 years in Beijing. Methods: Children and adolescents were selected in 30 schools (8 primary schools, 21 middle schools and one 12-year education school) from Dongcheng, Tongzhou, Fangshan and Miyun districts of Beijing by using a stratified cluster sampling method from November 2017 to January 2018. A total of 15 030 students in grade 1 to 4 of primary school, grade 1 of junior and senior middle school were enrolled after excluding subjects who were not able to participate into this study due to trauma or other uncomfortable physical conditions or with missing key values or with diabetes and kidney diseases. Questionnaire survey, body composition and calcaneus bone mineral density were conducted. The relation of fat mass percentage (FMP), trunk to total fat ratio (TrTFR), trunk to limb fat ratio (TrLFR), limb to total fat ratio (LTFR) and viscera to total fat ratio (VTFR) with calcaneus BMD were assessed using the multivariate linear regression models after adjusting for possible confounding effects. The central fat distribution types were divided into 4 groups including type 1: both trunk fat and visceral fat greater than the sex-and age-specific internal P₇₅; type 2: barely trunk fat greater than P₇₅; type 3: barely visceral fat greater than P₇₅; type 4: both trunk fat and visceral fat greater than P₇₅. The central fat distribution types were included into the model in the form of dummy variables to analyze its relationship with calcaneal BMD. The sex-and age-specific z-scores of fat distribution indicators and BMD were calculated. Results: A total of 15 030 participants aged (11.4±3.3) years (50.2% boys) were involved in the analysis. In both genders, after adjusting for age, height, lean mass index, smoking, drinking, physical activity, milk intake, vitamin D and calcium supplementation, FMP, TrTFR, TrLFR and VTFR were negatively correlated with calcaneal BMD (all P value<0.05), while LTFR was positively associated with calcaneal BMD (all P values<0.05). Compared to the central fat distribution type 1, the regression coefficients (95% CI) of type 2, 3 and 4 were -0.253 (-0.418, -0.087), -0.385 (-0.567, -0.204) and -0.428 (-0.487, -0.369) in boys, respectively; the regression coefficients (95% CI) of type 3 and 4 were -0.158 (-0.301, -0.015) and -0.226 (-0.290, -0.163), respectively. Conclusion Body fat distribution and central fat distribution in children and adolescents were correlated with calcaneus bone mineral density.

Objective: To investigate the association between blood lipid and calcaneus bone mineral density (BMD) in children and adolescents aged 6-16 years in Beijing. Methods: Children and adolescents were selected in 30 schools (8 primary schools, 21 middle schools and one 12-year education school) from Dongcheng, Tongzhou, Fangshan and Miyun districts of Beijing by using a stratified cluster sampling method from November 2017 to January 2018. A total of 14 303 students in grade 1 to 4 of primary school, grade 1 of junior and senior middle school were enrolled after excluding subjects who were not able to participate into this study due to trauma or other uncomfortable physical conditions or with missing key values or with diabetes and kidney diseases. Questionnaire survey, blood lipid and calcaneus BMD were conducted. Multivariate linear regression was applied to quantify the association between calcaneal BMD as a dependent variable and blood lipid level as an independent variable after adjusting for the potential confounding factors. Furthermore, quantile regression was used to analyze the association between blood lipid level and different percentiles (P₂₅, P₅₀ and P₇₅) of ultrasonic velocity values of bone mineral density, and parallel test was conducted for regression coefficients of different percentiles. Results: A total of 14 303 participants aged (11.4±3.3) years (49.9% boys) were involved in the analysis. The mean age of 14 303 participants was (11.0±3.3) years. 7 142 boys accounted for 49.9%. The mean±SD of calcaneal BMD, total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein-cholesterol (HDL-C) were (1 540.9±33.8) m/s, (3.90±0.76), (2.18±0.62), and (1.40±0.32) mmol/L, respectively. The P₅0 (P₂₅, P₇₅) of triglyceride (TG) was 0.69 (0.49-0.94) mmol/L. After the adjustment of age, height, smoking, drinking, vitamin D and calcium supplementation, dairy intake, physical activity, FMI, and MMI, a significantly inverse association (P<0.05) between TG level and calcaneus BMD was observed in both genders, which the regression coefficients (95%CI) in boys and girls were -0.064 (-0.085, -0.044) and -0.073 (-0.094, -0.053), respectively. Conclusion The level of BMD was associated with TG in boys and girls. Therefore, it is important to prevent children from hypertriglyceridemia for the bone health promotion.