Renal ischemia-reperfusion injury （RIRI） is a major cause of acute kidney injury during kidney transplantation and peri-operative settings， and there is still a lack of safe and effective targeted preventive and therapeutic drugs in clinical practice. Specifically， xanthohumol， luteolin， dracorhodin C， naringin， senkyunolide Ⅰ， verbascoside， and shikonin enhance antioxidant defenses， and inhibit lipid peroxidation and ferroptosis via the nuclear factor-erythroid 2-related factor 2/heme oxygenase-1 pathway. Apigenin， nobiletin， tanshinone Ⅱ A ， and salidroside activate the phosphatidylinositol 3-kinase/protein kinase B pathway to inhibit mitochondria- dependent apoptosis and facilitate renal repair. Quercetin， methyleugenol， cyanidin-3-glucoside， and platycodin D promote autophagy and improve mitochondrial homeostasis through the adenosine monophosphate-activated protein kinase（AMPK）/mTOR or AMPK/phosphatase and tensin homolog-induced kinase 1/Parkin pathways. In addition， hesperidin， curcumin， ganoderic acid， pulsatilla saponin B4， capsaicin， and diosgenin mitigate inflammatory responses and decrease renal tubular injury markers by inhibiting the Toll-like receptor 4/nuclear factor κB， high mobility group box 1， Janus kinase/signal transducer and activator of transcription pathways， thereby exerting multi-target， multi-stage renoprotective effects.

An HPLC analytical method was developed to determine the related substances in carbetocin injection. The method was performed on a Waters Xbridge C18 column (150 mm×3 mm, 3.5 μm) with 0.30 mg/mL ammonium acetate-19% acetonitrile aqueous solution as mobile phase A and mobile phase A-acetonitrile (1∶1) as mobile phase B. The detection wavelength was 220 nm. Gradient elution was performed at the flow rate of 0.8 mL/min and the column temperature of 60℃. The method was validated for system applicability, specificity, linearity and range, accuracy, with the results that the 9 impurities of carbetocin injection showed good linearity (R²>0.999) with peak area in their respective concentration range, and that the method had good precision (RSD<5%). This method is suitable for the simultaneous determination of carbetocin and its 9 impurities in carbetocin injection and can provide a theoretical basis for the quality control of the carbetocin injection.

OBJECTIVE To evaluate the influence of pharmaceutical quality control on the efficiency and outcomes of standardized medication therapy management （MTM） services for patients with coronary heart disease by using Economic， Clinical and Humanistic Outcomes （ECHO） model. METHODS This study collected case data of coronary heart disease patients who received MTM services during January-March 2023 （pre-quality control implementation group， n＝96） and June-August 2023 （post-quality control implementation group， n＝164）. Using propensity score matching analysis， 80 patients were selected from each group. The study subsequently compared the economic， clinical， and humanistic outcome indicators of pharmaceutical services between the two matched groups. RESULTS There were no statistically significant differences in baseline data between the two groups after matching （P＞0.05）. Compared with pre-quality control implementation group， the daily treatment cost （16.26 yuan vs. 24.40 yuan， P＜0.001）， cost-effectiveness ratio [23.12 yuan/quality-adjusted life year （QALY） vs. 32.32 yuan/QALY， P＜0.001]， and the incidence of general adverse drug reactions （2.50% vs. 10.00%， P＝0.049） of post-quality control implementation group were decreased significantly； the utility value of the EuroQol Five-Dimensional Questionnaire （0.74± 0.06 vs. 0.71±0.07， P＝0.003）， the reduction in the number of medication related problems （1.0 vs. 0.5， P＜0.001）， the medication adherence score （[ 6.32±0.48） points vs. （6.10±0.37） points， P＝0.001]， and the satisfaction score （[ 92.56±1.52） points vs. （91.95±1.56） points， P＝0.013] all showed significant improvements. Neither group experienced serious adverse drug reactions. There was no statistically significant difference in the incidence of new adverse reactions between the two groups （1.25% vs. 3.75%， P＝0.310）. CONCLUSIONS Pharmaceutical quality control can improve the quality of pharmaceutical care， and the ECHO model can quantitatively evaluate the effect of MTM services， making pharmaceutical care better priced and more adaptable to social needs， thus being worthy of promotion.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective To investigate the mechanism of Fuzheng Yangxin Prescription in improving cardiac function in rats with heart failure with reduced ejection fraction(HFrEF)through regulation of AMPK/mTOR signaling pathway.Methods An HFrEF rat model was established via left anterior descending coronary artery ligation.Rats were randomized divided into sham-operation group,model group,Fuzheng Yangxin Prescription group and Entresto group,followed by 28 days of intervention.Echocardiography was used to measure left ventricular internal dimension at end-systole(LVIDs),left ventricular internal dimension at end-diastole(LVIDd),left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),HE staining and Masson staining were used to observe myocardial morphology and fibrosis,serum contents of NT-proBNP and inflammatory factors(TNF-α,IL-1β,IL-6)were detected by ELISA,Western blot was performed to analyze p-AMPK,p-mTOR and protein expressions of autophagy markers(Beclin1,LC3,p62).Results Compared with sham-operation group,the LVIDs and LVIDd in model group significantly increased(P<0.05),while LVEF and LVFS significantly decreased(P<0.05),the structure of myocardial cells was disordered and arranged loosely,the deposition of collagen fibers in the infarct area was increased,and the contents of NT-proBNP,TNF-α,IL-1β and IL-6 in serum significantly increased(P<0.05),the protein expressions of p-AMPK,Beclin1 and LC3Ⅱ/LC3Ⅰ in myocardial tissue significantly decreased(P<0.05),while the protein expressions of p-mTOR and p62 significantly increased(P<0.05);compared with the model group,the LVIDs and LVIDd of rats in Fuzheng Yangxin Prescription group significantly decreased(P<0.05),the LVEF and LVFS were significantly increased(P<0.05),the disorder of myocardial cell arrangement and fibrosis were alleviated,the contents of NT-proBNP,TNF-α,IL-1β and IL-6 in serum significantly decreased(P<0.05),the protein expressions of p-AMPK,Beclin1 and LC3Ⅱ/LC3Ⅰ in myocardial tissue significantly increased(P<0.05),while the protein expressions of p-mTOR and p62 significantly decreased(P<0.05).Conclusion Fuzheng Yangxin Prescription may regulate autophagy by activating AMPK/mTOR pathway and improve cardiac function in HFrEF rats.

Objective:To predict pre-treatment clinical parameters that are associated with poor response and prognosis to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC) and to use second-line treatment drugs in the early stages to delay the progression of the disease so that patients can benefit from early-stage treatment.Methods:Patients diagnosed with PBC at the Second Affiliated Hospital of Kunming Medical University from 2013 to 2022 were collected. Two hundred fifty-seven cases were screened in accordance with the inclusion and exclusion criteria. The response and prognosis conditions one year after treatment were followed up in outpatient and inpatient departments, as well as through telephone calls. Statistical analyses were performed using t-tests, Mann-Whitney U test, χ2 test, Fisher's exact test, and logistic regression analysis according to different data. Results:A total of 257 PBC cases were included, with 223 females (86.80%) and 34 males (13.20%). Univariate and multivariate binary logistic regression analyses showed that baseline high albumin levels [odds ratio ( OR): 0.882, 95% confidence interval ( CI): 0.805～0.967, P=0.008] were a protective factor for PBC patients' response to UDCA treatment after adjusting for different confounding factors, while baseline high alkaline phosphatase ( OR: 1.012, 95% CI: 1.008～1.016, P<0.001) and baseline high neutrophil/lymphocyte ratio (NLR) level ( OR: 1.462, 95% CI:1.079～1.981, P=0.014) were risk factors for a poor response to UDCA. Trend analysis showed that the baseline NLR quantile was positively correlated with the risk of poor response to UDCA ( OR: 5.512, 95% CI: 1.040～29.216, P=0.045) in patients with PBC. Cox proportional hazards regression analysis identified that age [hazard ratio ( HR): 1.050, 95% CI: 1.019～1.082] and NLR value ( HR:1.089, 95% CI:1.021～1.161) were independent influencing risk factors for all-cause mortality in PBC patients ( P<0.05). Conclusion:Baseline high albumin levels are protective factors against a poor biochemical response to UDCA, while baseline high alkaline phosphatase levels and high NLR are risk factors for a poor biochemical response to UDCA in patients with PBC. Additionally, baseline high NLR values are positively correlated with poor biochemical response to UDCA treatment.

Objective:To construct a temperature-sensitive hydrogel (PF-CA@AS-IV hydrogel) composed of Pluronic F-127 (PF-127)/calcium alginate (CA) loaded with astragaloside IV (AS-IV), and to explore its repair effect and potential mechanism on diabetic skin ulcers (DSU).Methods:The PF-CA@AS-IV hydrogel loaded with AS-IV and gelling at 37 ℃ was prepared. Its temperature sensitivity, rheological properties, and morphology were characterized. A rat model of DSU was established, and the rats were randomly divided into blank control group, model group, AS-IV spray group, PF-CA hydrogel group, and PF-CA@AS-IV hydrogel group ( n=5 each). After 21 days of intervention, the wound healing rate of each group was evaluated. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of granulation tissue, and immunohistochemistry was applied to detect the expression level of CD34, a marker of new blood vessels. Results:Rheological analysis showed that the storage modulus (G′) of PF-CA@AS-IV hydrogel began to exceed the loss modulus (G″) at 33 ℃, and a stable three-dimensional network structure was formed at 37 ℃. Scanning electron microscopy confirmed its loose and porous microstructure. Animal experiment results indicated that compared with the blank control group, the model group had a significantly lower wound healing rate, massive infiltration of inflammatory cells, and fewer new capillaries and CD34 expression (all P<0.05). Compared with the model group, each treatment group can promote wound healing, reduce inflammatory infiltration and increase the positive expression of CD34 to varying degrees (all P<0.05), and the curative effect of PF-CA@AS-IV hydrogel group is the most significant, which is better than that of AS-IV spray group and PF-CA hydrogel group (all P<0.05). Conclusions:PF-CA@AS-IV hydrogel can effectively regulate inflammatory response and promote angiogenesis through sustained release of AS-IV, thereby accelerating DSU healing, and has good translational potential in the field of chronic wound repair.

Objective:To investigate the clinicopathological characteristics and diagnostic criteria of cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMTCT), and to improve understanding of this entity.Methods:The clinical features, histology, immunohistochemistry (IHC) and molecular characteristics of 3 CMTCT cases were analyzed, supplemented by a literature review.Results:All patients were female, aged 53, 46 and 46 years, respectively. Grossly, the lesions presented as dermal/subcutaneous nodules protruding from the skin surface. Histologically, tumor cells were arranged in nested and fascicular patterns separated by delicate fibrous septa. Tumor cell infiltration was observed in the epidermis of case 1, but not in that of cases 2 and 3. Tumor cells exhibited epithelioid, spindle-shaped, or oval morphology, with eosinophilic or pale cytoplasm and mild to moderate nuclear atypia. Tumor mitotic figure was <5/10 HPF. Scant melanin pigment was observed in case 2. IHC demonstrated diffuse and strong positivity for SOX-10, S-100 protein and MITF. HMB45 was negative in two cases (case 1 and case 3) and focally positive in case 2; Melan A was negative in two cases (case 1 and case 3) and partially positive in case 2. The Ki-67 proliferation index was approximately 5%-8%. Molecular analysis revealed CRTC1::TRIM11 fusion in three cases via RNA sequencing, and CRTC1 rearrangement in two cases (case 1 and case 3) via fluorescence in situ hybridization.Conclusions:CMTCT shares histological and immunophenotypic features with melanoma and clear cell sarcoma but is defined by the presence of CRTC1::TRIM11 fusion, necessitating molecular confirmation for definitive diagnosis. Complete excision with clear margins is recommended. While most of the CMTCTs exhibit indolent biological behaviors, rare cases may recur locally or metastasize, warranting close follow-up.

Objective To investigate the mechanism of Fuzheng Yangxin Prescription in improving cardiac function in rats with heart failure with reduced ejection fraction(HFrEF)through regulation of AMPK/mTOR signaling pathway.Methods An HFrEF rat model was established via left anterior descending coronary artery ligation.Rats were randomized divided into sham-operation group,model group,Fuzheng Yangxin Prescription group and Entresto group,followed by 28 days of intervention.Echocardiography was used to measure left ventricular internal dimension at end-systole(LVIDs),left ventricular internal dimension at end-diastole(LVIDd),left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),HE staining and Masson staining were used to observe myocardial morphology and fibrosis,serum contents of NT-proBNP and inflammatory factors(TNF-α,IL-1β,IL-6)were detected by ELISA,Western blot was performed to analyze p-AMPK,p-mTOR and protein expressions of autophagy markers(Beclin1,LC3,p62).Results Compared with sham-operation group,the LVIDs and LVIDd in model group significantly increased(P<0.05),while LVEF and LVFS significantly decreased(P<0.05),the structure of myocardial cells was disordered and arranged loosely,the deposition of collagen fibers in the infarct area was increased,and the contents of NT-proBNP,TNF-α,IL-1β and IL-6 in serum significantly increased(P<0.05),the protein expressions of p-AMPK,Beclin1 and LC3Ⅱ/LC3Ⅰ in myocardial tissue significantly decreased(P<0.05),while the protein expressions of p-mTOR and p62 significantly increased(P<0.05);compared with the model group,the LVIDs and LVIDd of rats in Fuzheng Yangxin Prescription group significantly decreased(P<0.05),the LVEF and LVFS were significantly increased(P<0.05),the disorder of myocardial cell arrangement and fibrosis were alleviated,the contents of NT-proBNP,TNF-α,IL-1β and IL-6 in serum significantly decreased(P<0.05),the protein expressions of p-AMPK,Beclin1 and LC3Ⅱ/LC3Ⅰ in myocardial tissue significantly increased(P<0.05),while the protein expressions of p-mTOR and p62 significantly decreased(P<0.05).Conclusion Fuzheng Yangxin Prescription may regulate autophagy by activating AMPK/mTOR pathway and improve cardiac function in HFrEF rats.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.