ObjectiveTo investigate the effect of dapagliflozin on liver lipid metabolism and gut microecology in mice with metabolic associated fatty liver disease （MAFLD）， and to clarify its potential mechanism. MethodsA total of 50 male C57 mice were randomly divided into Control group， type 2 diabetes+MAFLD group （MAFLD group）， dapagliflozin group （DAPA group）， meldonium group （THP group）， and dapagliflozin+meldonium group （DAPA+THP group）， with 10 mice in each group. High-fat diet combined with streptozotocin was used to establish a mouse model of MAFLD. Treatment outcomes were assessed based on histopathology and biochemical parameters such as blood glucose and blood lipid levels， and the transcriptomic and metagenomic analyses were used to identify differentially expressed genes and the changes in gut microbiota. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test was used for comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups， and the Nemenyi test was used for comparison between two groups. ResultsHistopathological examination showed that the mice in the MAFLD group had excessive lipid deposition and hepatocyte steatosis； compared with the MAFLD group， the DAPA group had a significant improvement in hepatocyte steatosis， while the THP group and the DAPA+THP group had a less significant improvement compared with the DAPA group. Compared with the Control group， the MAFLD group had a significant increase in fasting blood glucose （P<0.05）， significant increases in the serum levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， malondialdehyde， total cholesterol， triglyceride， and low-density lipoprotein cholesterol （P<0.05）， and a significant reduction in high-density lipoprotein cholesterol （P<0.05）. Compared with the MAFLD group， the DAPA group， the THP group， and the DAPA+THP group had significant reductions in the serum levels of ALT and AST （P<0.05）. The results of 16S rRNA sequencing showed that compared with the Control group， the MAFLD group had significant changes in gut microbiota， with an increase in Firmicutes and a reduction in Bacteroidetes， as well as reductions in S24-7 and Erysipelotrichaceae and an increase in Lactobacillaceae. The levels of the above flora were upregulated to normal levels in the DAPA group， the THP group， and the DAPA+THP group. The liver transcriptomic analysis showed that the enriched metabolic pathways included steroid hormone biosynthesis， bile secretion， inflammatory mediator regulation of TRP， fatty acid elongation， and lipid biodegradation processes， and the related genes mainly involved the key targets of lipid metabolism such as Acot2， Angptl4， Scd2， and Npc1l1. ConclusionDapagliflozin can alleviate MAFLD through the pathways such as steroid hormone biosynthesis， bile secretion， inflammatory mediator regulation of TRP， and fatty acid elongation， as well as by regulating gut microbiota homeostasis.

Objective To establish the argatroban drug use evaluation(DUE)criteria and provide reference for the rational use of argatroban in clinical practice.Methods Based on the domestic and foreign drug instructions of argatroban,referring to relevant guidelines and literature,the DUE standard rules were established by expert consultation.Using the established standard rules,the medical records of argatroban in the Fuzhou First Hospital Affiliated with Fujian Medical University from August 2020 to August 2022 were evaluated for the rationality of medication.Results A total of 368 medical records were included,the rational rate of drug use was 48.64％,and the irrational drug use was mainly without indications(46.19％)and inappropriate combination of drugs(4.35％).Conclusion The rational rate of argatroban clinical use in the hospital is not high,and the problems mainly include off-indication drug use and unreasonable combination drug use.Through the establishment and clinical application of DUE standard rules,the clinical use of argatroban can be further standardized and the ability of rational drug use can be improved.

A 17-year-old female patient developed fever after novel coronavirus infection and took ibuprofen sustained-release capsules 0.3 g 4 times within 3 days by herself. During the medication, the patient developed the symptoms such as chest tightness, shortness of breath, limbs fatigue, sweating, muscle soreness, and dark urine successively. Laboratory tests showed creatine kinase (CK) 583 800 U/L, CK-MB 45 μg/L, lactate dehydrogenase 4 772 U/L, serum creatinine (Scr) 392 μmol/L, myoglobin 87 μg/L, and urea nitrogen 32.8 mmol/L. It was considered that rhabdomyolysis with acute kidney injury might be related to ibuprofen. The patient was given symptomatic treatments such as renal replacement therapy, hemodialysis, blood transfusion, rehydration, diuresis, etc. Thirty-three days later, the patient′s muscle soreness and other symptoms disappeared, the urine color returned to normal, laboratory tests showed CK 168 U/L, myoglobin 24 μg/L, and Scr 52 μmol/L.

A 17-year-old female patient developed fever after novel coronavirus infection and took ibuprofen sustained-release capsules 0.3 g 4 times within 3 days by herself. During the medication, the patient developed the symptoms such as chest tightness, shortness of breath, limbs fatigue, sweating, muscle soreness, and dark urine successively. Laboratory tests showed creatine kinase (CK) 583 800 U/L, CK-MB 45 μg/L, lactate dehydrogenase 4 772 U/L, serum creatinine (Scr) 392 μmol/L, myoglobin 87 μg/L, and urea nitrogen 32.8 mmol/L. It was considered that rhabdomyolysis with acute kidney injury might be related to ibuprofen. The patient was given symptomatic treatments such as renal replacement therapy, hemodialysis, blood transfusion, rehydration, diuresis, etc. Thirty-three days later, the patient′s muscle soreness and other symptoms disappeared, the urine color returned to normal, laboratory tests showed CK 168 U/L, myoglobin 24 μg/L, and Scr 52 μmol/L.

Objective    To systematically evaluate the effects of telemedicine on the management of warfarin therapy. Methods    We searched PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, Wanfang Database (from inception to February 2020) and conducted retrospective literature searching to identify studies about the management of warfarin using telemedicine intervention techniques. R language software was used to evaluate the efficacy and safety of telemedicine on warfarin management. Results    A total of 7 239 articles were retrieved, and 12 articles were finally included according to inclusion and exclusion criteria, totaling 8 112 patients, including 3 726 patients in the intervention group and 4 386 patients in the control group. The results of meta-analysis showed that there was a statistical difference in the accurate international normalized ratio (INR) treatment target range time ratio between the intervention group and the control group (MD=6.52, 95%CI 2.13 to 10.92, P<0.01, I2=89%). The incidence of bleeding events (RR=0.61, 95%CI 0.46 to 0.81, P=0.97, I2=0%) and the incidence of thromboembolic events (RR=0.50, 95%CI 0.29 to 0.85, P=0.63, I2=0%) were not statistically different between the two groups. Conclusion    Existing evidence indicates that telemedicine management has a benefit in anticoagulant efficacy compared with conventional anticoagulant management in patients with thrombotic diseases, but there is no statistical difference in safety. Limited by the quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.

Objective? To explore the effects of fast track surgery (FTS) nursing on fatigue and quality of life among hepatocellular carcinoma patients. Methods? From June 2017 to June 2018, we selected 80 primary hepatic carcinoma patients with hepatocellular carcinoma resection of hepatobiliary surgery at Peking Union Medical College Cancer Hospital as subjects by convenience sampling. All of the patients were divided into control group and observation group with the method of random number table, 40 cases in each group. Observation group carried out FTS, while control group adopted routine nursing. The intervention effects were compared with the Cancer Fatigue Scale (CFS) and the Quality of Life Questionnaire Core 30 (QLQ-C30). Results? Before intervention, there was no statistical difference in the score of CFS between two groups (P＞0.05). After intervention, the total score and dimension scores of CRF of observation group were lower than those of control group with statistical differences (P＜ 0.01). Before intervention, there was no statistical difference in the score of QLQ-C30 between two groups (P＞ 0.05). After intervention, the total score of QLQ-C30 of observation group was higher than that of control group with a statistical difference (P＜ 0.01). Conclusions? FTS can effectively improve the postoperative fatigue of hepatocellular carcinoma patients and quality of life of patients which is worthy of clinical popularization and application.

Objective To explore the clinical effect of neuronavigation assisted endoscopic surgery in treatment of patients with hypertensive intracerebral hemorrhage. Methods Fifty patients with hypertensive cerebral hemorrhage, admitted to our hospital from June 2014 to June 2016, were selected. All patients were treated with neuronavigation guided endoscopic surgery. Their clinical data and surgical efficacies were retrospectively analyzed. Results Patients' head CT was reviewed 6 h after operation, and residual hematoma volume was less than 15％among 31 patients, and in the ranges of 15％-30％among 14 patients. Re-bleeding occurred in 4 patients, and death in one patient. Glasgow outcome scale (GOS) of 49 patients 6 months after operation indicated vegetative state in 5 patients, severe disability in 9, moderate disability in 10, and good recovery in 25. Conclusion Neuronavigation assisted endoscopic surgery has good clinical effect on patients with hypertensive intracerebral hemorrhage in terms of few complications and high safety, so it is worthy of promotion and application in clinical practice.

Objective To explore the brain biochemical changes in the frontal lobe of adolescents with depression using proton magnetic resonance spectroscopy (1H-MRS). Methods Twenty-four patients and twenty-three healthy subjects matched for age, sex and education level were enrolled in the study. All the subjects underwent multivoxel 1H MRS to measure the bilateral metabolic levels of N-acetylaspartate (NAA), choline (Cho), creatine (Cr) in the prefrontal lobes. Results The NAA/Cr and Cho/Cr ratios in the left dorsolateral prefrontal white matter of the depressive adolescents were significantly lower than those of the healthy subjects [NAA/Cr: 1.67 ± 0.32, t = 3.126, P = 0.004; Cho/Cr: 1.28 ± 0.30, t = 2.362, P = 0.024], and the ratios of NAA/Cr in the right dorsolateral prefrontal white matter of the depressive adolescents was also significantly lower than that of the healthy subjects [NAA/Cr:1.65 ± 0.26, t=2.969, P=0.006]. There was no significant difference in the metabolic ratios in the bilateral anterior cingulate gray matter between the depressive adolescents and the healthy controls. Conclusions Biochemical abnormalities in prefrontal white matter are involved in the pathophysiology of depression. Importantly , these abnormalities are already present early in the course of the disorder.