Huanglian Jiedutang （HLJDT）， a traditional Chinese herbal formula， is known for its heat-clearing and detoxifying effects. This article reviewed the material basis， pharmacological mechanism of action， and research on HLJDT. Modern research has shown that HLJDT is rich in alkaloids， flavonoids， glycosides， and other active ingredients. In terms of pharmacological mechanisms of action， HLJDT has anti-inflammatory and antibacterial effects， and it can regulate intestinal flora and cell disorder， improve iron metabolism disorder， control glucose and lipid metabolism， and exert vascular endothelial functions， with anti-tumor effects， thus improving cerebral ischemia and reducing liver damage. Its therapeutic actions are multi-layered， multi-faceted， and multi-targeted， showing significant efficacy in treating various diseases. Interdisciplinary research， such as the combined application of network pharmacology with molecular docking technology， as well as metabolomics with proteomics， has revealed the potential mechanism of HLJDT in treating various diseases. However， the research on HLJDT still faces some challenges， including the need for an in-depth exploration of its complex pharmacological mechanism of action， evaluation of its efficacy and safety across different diseases and populations， and quality control of traditional Chinese medicine. Future research should integrate modern scientific and technological approaches with traditional Chinese medicine principles to further investigate HLJDT's complex pharmacological mechanism of action， providing theoretical and practical support for its clinical use.

Huanglian Jiedutang （HLJDT）， a traditional Chinese herbal formula， is known for its heat-clearing and detoxifying effects. This article reviewed the material basis， pharmacological mechanism of action， and research on HLJDT. Modern research has shown that HLJDT is rich in alkaloids， flavonoids， glycosides， and other active ingredients. In terms of pharmacological mechanisms of action， HLJDT has anti-inflammatory and antibacterial effects， and it can regulate intestinal flora and cell disorder， improve iron metabolism disorder， control glucose and lipid metabolism， and exert vascular endothelial functions， with anti-tumor effects， thus improving cerebral ischemia and reducing liver damage. Its therapeutic actions are multi-layered， multi-faceted， and multi-targeted， showing significant efficacy in treating various diseases. Interdisciplinary research， such as the combined application of network pharmacology with molecular docking technology， as well as metabolomics with proteomics， has revealed the potential mechanism of HLJDT in treating various diseases. However， the research on HLJDT still faces some challenges， including the need for an in-depth exploration of its complex pharmacological mechanism of action， evaluation of its efficacy and safety across different diseases and populations， and quality control of traditional Chinese medicine. Future research should integrate modern scientific and technological approaches with traditional Chinese medicine principles to further investigate HLJDT's complex pharmacological mechanism of action， providing theoretical and practical support for its clinical use.

OBJECTIVE To clarify the institutional logics of the dilemma of the use of national medical insurance negotiation drugs（referred to as “national negotiation drugs”）， and promote the implementation and use of these drugs in medical institutions. METHODS Based on the complex institutional environment in which medical institutions were situated， the theory of multiple institutional logics was used to construct an analytical framework for the behavioral choices of medical institutions， and reveal the mechanism of the difficulty in the use of national negotiation drugs by clarifying the interaction and conflict of multiple logics in this process， so as to put forward some measures. RESULTS & CONCLUSIONS There were contradictions and coupling among the state logic， market logic， social logic and professional logic in the use of national negotiation drugs. In the game of multiple logics， the market logic and professional logic tended to be risk-averse， the failed “pressure-type system” of state logic， and the social logic was weakened， which caused the lack of action in the use of national negotiation drugs with the goal of completing performance evaluations in the current medical institutions. Thus， it is suggested to unbundle the invisible policy restrictions on the use of national negotiation drugs， form the pressure and motivation of medical institutions by incentive and constraint mechanisms， respond to the clinical demand by establishing a green procurement channel， and construct the supervision mechanism on the use of national negotiation drugs by social force， etc.， so as to enhance the effect of the national negotiation drugs.

Morita therapy has been bom for more than 100 years.Inpatient Morita therapy is highly oper-able and easy to master.It can improve many refractory neuroses through four-stage treatment.But more neuroses are treated in outpatient clinics,and Morita therapy cannot be used in hospitalized patients.Therefore,the formula-tion of expert opinions on outpatient operations is particularly important.This paper is based on domestic and for-eign references,and after many discussions by domestic Morita therapy experts,and then drew up the first version of the expert opinions on operation of outpatient Morita therapy.Meanwhile the operation rule of Morita therapy in three stages of outpatient treatment was formulated:in the etiological analysis stage,under the theoretical guidance of Morita therapy,analyze the pathogenic factors,to improve treatment compliance and reduce resistance;during the operating stage,guide patients to engage in constructive and meaningful actions,realizing the achievement of letting nature take its course principle;in the cultivating character and enriching life stage,pay attention to positive infor-mation,expanding the scope and content of actions,improving the ability to adapt to complex life,and preventing recurrence caused by insufficient abilities.It will lay a foundation for the promotion of Morita therapy in domestic outpatient clinics,so that more patients with neurosis and other psychological diseases could receive characteristic Morita therapy treatment in outpatient clinics.

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 analyze the retrieval rate of inferior vena cava filter(IVCF)and its safety,and to make a histological analysis of the filter attachment substances.Methods The clinical data of 234 patients with IVCF,who were admitted to Affiliated Tenth People's Hospital,Tongji University,to retrieve IVCF between June 2020 and May 2023,were retrospectively analyzed.The retrieval success rate,complications and filter attachment substances were statistically analyzed,and the nature of the attachment substances was examined by using histological staining.Results The retrieval success rate in the 234 patients was 91.03％(213/234).In 17 patients the retrieval of IVCF was abandoned due to the filter capturing the thrombus,and in 4 patients the retrieval of IVCF failed due to tilting of the filter.No complications such as vena cava perforation,symptomatic pulmonary embolism and hemorrhage occurred in all patients during perioperative period.Of the 213 patients whose filter was successfully removed,the filter attachment substances was found in 156 patients.Histological staining of the filter attachment substances demonstrated that the main component of these substances was a mixed thrombus with a small amount of cellulose degeneration.Further analysis revealed that the incidence of filter attachment substances in ≤14-day group was lower than than that in＞14-day group,and the difference between the two groups was statistically significant(x2=6.791,P=0.009);and the incidence of filter attachment substances in the non-anticoagulant group was lower than that in the anticoagulant group,and the difference between the two groups was statistically significant(x2=7.774,P=0.005).Conclusion The retrieval rate of retrievable IVCFs is quite high and the retrieval procedure carries less complications,therefore,it is safe to use retrievable IVCFs in clinical practice.However,the formation of tiny thrombosis within the filter after the placement of filter cannot be ignored,which should be seriously considered in the clinical work.

Objective To investigate the readmission of male schizophrenia patients in a hospital of Zhoushan and its influencing factors,and to build a nomogram model.Methods A total of 183 male schizophrenics patients admitted to the Second People's Hospital of Zhoushan from January to December 2022 were analyzed retrospectively.Patients were divided into readmission group (hospitalization frequency ≥ 2 times) and non-readmission group (hospitalization was once) based on the number of hospitalization.Perform univariate analysis on the data of two groups of patients using t test or x2 test.Multivariate Logistic regression model was used to investigate the influencing factors of readmission in schizophrenia patients within one year,and a nomogram prediction model was established.Results The rate of readmission was 49.18％ in 183 schizophrenic patients.Course of disease,duration of first hospitalization,and history of tobacco and alcohol consumption were independent risk factors for readmission (P<0.05).The area under the curve (AUC) of the receiver operating characteristic curve in the column chart model is 76.53.Conclusion The readmission rate of male schizophrenia patients in the Second People's Hospital of Zhoushan is high,and the course of disease,duration of first hospitalization,and history of tobacco and alcohol consumption are independent risk factors for the readmission of schizophrenia patients within one year.The establishment of the nomogram prediction model is expected to evaluate the high risk factors for the readmission of schizophrenia patients and implement targeted interventions to improve the quality of life of patients.

Objective To explore the clinical efficacy of three dimensional (3D) laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity combined with type 2 diabetes mellitus.Methods The retrospective cross-sectional study was conducted.The clinical data of 28 patients with obesity combined with type 2 diabetes mellitus who were admitted to the Qinghai Red Cross Hospital between January 2013 and April 2016 were collected.All the patients underwent 3D LSG.Observation indicators:(1) surgical and postoperative recovery situations;(2) follow-up and metabolic indexes changes.Follow-up using outpatient examination and telephone interview was performed to detect complications of patients after discharge and usages of antidiabetic drugs or insulin up to February 2017.Body mass,body mass index (BMI),hemoglobin (Hb),albumin (Alb),fasting serum C-peptide,fasting blood sugar,2-hours postprandial blood glucose (2HPBG) and glycosylated hemoglobin (GHb) were detected at month 1,3,6 and 12 postoperatively.Measurement data with normal distribution were represented as (x)±s.Repeated measurement data were analyzed by the repeated measures ANOVA.Count data were evaluated by the proportion.Results (1) Surgical and postoperative recovery situations:28 patients underwent successful 3D LSG,without conversion to open surgery.Operation time,volume of intraoperative blood loss,time of postoperative gastrointestinal function recovery and time of postoperative drainage tube removal were (133 ± 20) minutes,(45 ± 22) mL,(2.5 ± 1.2) days and (3.4 ± 0.9) days,respectively.There were no postoperative complications and perioperative death.Duration of hospital stay was (7.1 ± 1.5) days.(2) Follow-up and metabolic indexes changes:28 patients were followed up for 6-12 months,with a median time of 8 months.During the follow-up,there was no death or severe complications.Body mass,BMI,Hb,Alb,fasting serum C-peptide,fasting blood sugar,2HPBG and GHb from pre-operation to month 1,3,6 and 12 post-operatively were decreased from (113±26) kg to (78± 14) kg,from (44±6) kg/m2 to (35±5) kg/m2,from (157±19) g/L to (140±13) g/L,from (43±5)g/L to (40±4)g/L,from (2.50±0.37) μg/L to (1.20±0.33) μg/L,from (10.5±2.0)mmol/L to (5.6±0.5)mmol/L,from (16.3±3.1)mmol/L to (7.9±0.9) mmol/L,from 9.2％± 0.9％ to 6.8％ ±0.6％ with statistically significant differences between preoperative and postoperative indicators (F=396.47,328.20,111.10,21.28,161.06,127.80,243.40,234.64,P＜0.05),and showing a downward trend.Of 28 patients,25 had complete remission of type 2 diabetes mellitus at 12 months postoperatively and 3 had partial remission,with an effective rate of 100.0％ (28/28).The excess weight loss was 63％± 16％.Conclusion 3D LSG is safe and effective in the treatment of obesity combined with type 2 diabetes mellitus,with a good shortterm outcome.

Objective To explore the feasibility and safety of carotid artery stenting (CAS) via right transradial approach (TRA).Methods A retrospective analysis was made on 46 cases undergoing the CAS via right TRA.Patients were divided into the right carotid artery group (RCA),bovine left carotid artery group (B-LCA),nonbovine carotid artery group (NB-LCA) according to the lesion location.Low TRA or high TRA were selected to overcome the difficulties of insufficient supporting power,using techniques such as catheter looping and retrograde engagement technique(CLRET).Results CAS were successful in all cases (100％),the differences of the operation time and fluoroscopy time among RCA group,B-LCA group and NB-LCA group were not significant.In NB-LCA group,CLRET were applied in 10 cases (55.56％,10/18),includeing 8 cases with type Ⅲ aortic arch(100％,8/8)and 2 cases with type Ⅱ aortic arch (33.33％,2/6).The CLRET prolonged the operation time and fluoroscopy time [(39.45 ±7.27) min vs.(30.80±4.66) min;(11.84 ± 2.05) min vs.(9.91 ± 1.45) min,P ＜0.05).There was no cerebrovascular events and puncture point complications in perioperative period.Conclusion Right transradial approach for carotid artery stenting is safe and technically feasible,especially in RCA stenosis and LCA stenosis with type Ⅰ or Ⅱ aortic arch.

Objective To investigate the clinical efficacy of ziprasidone in the treatment of first-episode schizophrenia.Methodsfrom January 2014 to June 2016to receive the treatment of patients with first-episode schizophrenia in 156 cases as the research object in the psychiatric hospital, which were randomly divided into two groups, the control group were given risperidone treatment, the observation group was treated with ziprasidone treatment, compared two groups of clinical curative effect of the treatment of patients after.ResultsThe patients in the observation group the total effective rate was 97.4%, the control group total effective rate was 89.7%;group after treatment in patients with negative symptoms score were significantly lower than the control group, with statistical significance between the two groups (P<0.05).ConclusionThe application of ziprasidone in the treatment of first-episode schizophrenia has achieved good clinical efficacy, the total effective rate of treatment is higher, and the negative symptoms are effectively controlled.