Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

Objective To evaluate the efficacy,safety and cost-effectiveness of ertugliflozin in the treatment of type 2 diabetes mellitus by rapid health technology assessment to provide a basis for clinical decision-making.Methods PubMed,Embase,the Cochrane Library,CNKI,WanFang Data,VIP database and health technology assessment(HTA)related websites and databases were searched from the inception date to January 2024.Two researchers independently screened the literature,extracted the data,assessed the quality and carried out the qualitative analysis.Results A total of 27 articles were included,in which 2 HTA reports,24 systematic reviews/meta-analyses and 2 pharmacoeconomic studies.Compared with placebo,ertugliflozin could significantly lower hemoglobin Alc level,fasting plasma glucose,hospitalization for heart failure,body weight and blood pressure levels,but there were no significant difference in all-cause mortality,cardiovascular mortality and composite renal outcome.In terms of safety,there were no significant difference in the risk of urinary tract infections,fracture,amputation and symptomatic hypoglycemia between ertugliflozin and placebo or other hypoglycemic drugs.However,ertugliflozin increased the risk of ketoacidosis,genital mycotic infections and lowered of estimated glomerular filtration rate.Pharmacoeconomic studies showed that ertugliflozin had better cost-utility and cost-effectiveness in type 2 diabetes in China.Conclusion Ertugliflozin is effective and safety in treating type 2 diabetes mellitus,but it's necessary to carry out the head to head studies among efficacy,safety and economics research in China.

Antineoplastic drugs refer to the drugs that act at the cellular and molecular levels to inhibit tumor growth or eliminate tumors through pathways such as cell killing,immune regulation,and endocrine regulation.Antineoplastic drugs generally including chemotherapeutic drugs,molecular targeted therapeutic drugs,immunotherapeutic drugs,and endocrine therapeutic drugs.The management and rational application of antineoplastic drugs in medical institutions are related to the safety of patient treatment.The standard for management of antineoplastic drugs use in clinical is compiled by the Pharmaceutical Affairs Committee of China Hospital Association,which specification requirements 18 key elements in the organizational management and system,medication management,drug monitoring and evaluation of antineoplastic drug management in healthcare institutions.This standard is applicable to all levels and types of healthcare institutions carrying out oncology diagnosis and treatment.This paper describes the methodology and basic content of the standard,hoping to providing a reference for medical institutions to carry out relevant work.

Abstract OBJECTIVE To investigate the effect of isodon ternifolia-containing serum(ITS) on the activation of rat primary hepatic Kupffer cell(KC) induced by lipopolysaccharide(LPS) through TLR4/NF-κB/NLRP3 signal pathway. METHODS The primary KC of rats were isolated and cultured, and the primary KC induced by LPS were divided into blank control group, model control group, blank serum group, positive control group(colchicine containing serum group), ITS group, TLR4 blocker group and TLR4 blocker+ITS group. MTT assay was used to detect the effect of different concentrations of ITS on the proliferation activity of KC. The content of interleukin-1β(IL-1β), interleukin-18(IL-18), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) in KC supernatant were detected by ELISA. Fluorescence quantitative polymerase chain reaction(PCR), Western blotting and immunofluorescence were used to detect the expression of TLR4, nuclear factor κB inhibitor protein α(IκBα), cysteine protease-1(Caspase-1), NLRP3 mRNA and TLR4, IκBα, phosphorylated IκBα(p-IκBα), Caspase-1, NLRP3 and NF-κBp65 in KC. RESULTS Compared with the model control group, the contents of IL-1β, IL-18, TNF-α and IL-6 in the supernatant of KC and the expression of TLR4, IκB α, Caspase-1, NLRP3 mRNA and TLR4, IκBα, p-IκBα, Caspase-1, NLRP3, NF-κBp65 protein in the supernatant of KC in all drug groups were down-regulated or decreased(P<0.05 or P<0.01). Compared with TLR4 blocker group, the improvement of most of the above indexes in TLR4 blocker+ITS group was more obvious. CONCLUSION Isodon ternifolia may inhibit the activation of KC and reduce the expression and release of inflammatory factors by down-regulating TLR4/NF-κB/NLRP3 signal pathway, thus alleviating the inflammatory injury of liver.

OBJECTIVE To investigate the effects of Isodon ternifolius extract on Toll -like receptor 4（TLR4）/nuclear factor - κB（NF-κB）/NOD-like receptor protein 3（NLRP3）pathway in hepatic stellate cells and hepatocytes . METHODS Using primary hepatic stellate cells and primary hepatocytes of rats as subjects ，inflammatory injury model was induced by lipopolysaccharide （LPS，100 ng/mL）. Using colchicine （1 μmol/L）as positive control and TLR 4 inhibitor（TAK-242，1 μmol/L）as reference ，the contents of transforming growth factor -β1（TGF-β1），α-smooth muscle actin （α-SMA），type Ⅰ collagen（COL-Ⅰ），COL-Ⅲ in the supernatant of hepatic stellate cells ，and the contents of alanine aminotransferase （ALT），aspartate aminotransferase （AST），interleukin-1β （IL-1β） and IL -18 in the supernatant of hepatocytes were detected after intervention with I. ternifolius extract（1 mg/mL）. The mRNA expressions of TLR 4，inhibitor α of NF -κB（IκBα），NF-κB p 65，NLRP3，Gasdermin D （GSDMD），apoptosis-associated speck -like protein containing CARD （ASC） and protein expressions of TLR 4， phosphorylated I κBα（p-IκBα），NF-κB p 65，NLRP3，GSDMD，ASC in the above cells were determined . RESULTS Compared with LPS model group ，the contents of TGF -β1，α-SMA， COL-Ⅰ and COL -Ⅲ in the supernatant of hepatic stellate cells and the contents of ALT ，AST，IL-1β and IL -18 in the supernatant of hepatocytes were significantly decreased ；the mRNA expressions of TLR 4，NF-κB p 65，NLRP3，GSDMD，ASC and the protein expressions of TLR 4，p-IκBα，NF-κB p 65，NLRP3，GSDMD，ASC in the two kinds of cells were significantly down - regulated，and the mRNA expression of I κBα was significantly up -regulated in all administration groups （P＜0.05）. Compared with TLR 4 inhibitor group ，the improvement of most of above indexes was more significant in the TLR 4 inhibitor+I. ternifolius extract group （P＜0.05）. CONCLUTIONS I. ternifolius extract could inhibit the activation of TLR 4/NF-κB/NLRP3 pathway， reduce the release of fibrosis factors and inflammatory factors ，alleviate the inflammatory injury of liver cells ，and inhibit the activation of hepatic stellate cells ，so as to protect liver cells and resist liver fibrosis .

The chronic disease management of rheumatoid arthritis has been popularized and applied in China. This article will review the application and research progress of different chronic disease management models, including chronic care mode, chronic disease self-management, transitional care mode, community-based chronic disease management, and "internet + chronic disease management" in rheumatoid arthritis patients in China, and compare the advantages and disadvantages of different intervention models, in order to provide a theoretical basis for exploring the chronic management of rheumatoid arthritis under different regional medical resources.

Objective To investigate the changes of T cell subsets including Th1,Th2,Th17 and Treg in the hand,foot and mouth disease(HFMD) patients.Methods 35 EV71 induced HMFD patients and 12 non-infectious children were included in this study.Patients were divided into mild symptoms group and severe symptoms group.The ratios of Th1,Th2,Th17 and Treg were analyzed by flow cytometry.Results Sixteen mild cases and 19 severe cases were included in the 35 patients.No statistical difference of children′s age and sex were found among the groups(P>0.05).The proportion[M(P25,P75)] of Th1 cells of mild and severe groups were 10.65%(8.73%,14.08%) and 15.51% (13.47%,18.31%),respectively,which were significantly higher than normal control group 5.51% (3.61%,8.61%)(P<0.05).The proportion of Th2 cells of mild and severe groups were 4.32%(2.60%,5.32%) and 3.87% (2.34%,5.32%),no significant difference from control group 2.11% (1.02%,5.11%)(P<0.05).The proportion of Th17 cells of mild and severe groups were 8.32%(5.25%,12.33%),7.36% (5.05%,11.9%),significantly higher than that of normal control group 4.23% (2.44%,6.22%)(P<0.05).The proportion of Treg cells of mild and severe groups were 1.46% (0.31%,2.73%),1.59%(0.35%,2.62%),no significant difference from the control group 1.78% (0.31%,2.77%)(P<0.05).Conclusion The Th1/Th2 and Th17/Treg ratios of HFMD patients with EV71 virus infection were changed,and the Th1 and Th17 cells may play an important role in the in the disease and body′s resistance.

BACKGROUND: Diabetes can lead to many complications. Of them, retinopathy is a common type. To explore the effect of erythropoietin in diabetic retinopathy, it is necessary to establish an animal model of similar pathologic features and high reproducibility in clinical retinal neovascularization.
OBJECTIVE: To investigate the protective effect of vitreous cavity injection of erythropoietin on optic nerve of rats with diabetic retinopathy.
METHODS: Rat models of diabetic retinopathy were established and injected with erythropoietin through vitreous space for 14 consecutive days. Results were compared between the model and normal control groups.
RESULTS AND CONCLUSION: (1) Transmission electron microscope: compared with the model group, retinal ganglion cel nucleus presented uniform red; cel membrane was intact; endoplasmic reticulum exhibited slight swel ing. A smal number of vacuoles were found in mitochondria around the nuclei. (2) Western blot assay and RT-PCR: compared with the model group, Caspase-3 and Bax protein expression was lower in the erythropoietin group (P < 0.05). Caspase-3 protein and Bcl-2 protein expression was significantly higher in the erythropoietin group than in the model group (P < 0.05). Significant differences in nuclear factor κB and Survivn gene expression were detected between the model and erythropoietin groups (P < 0.05). (3) Results verified that vitreous cavity injection of erythropoietin had neuroprotective effect on rats with diabetic retinopathy, which may be associated with the inhibitory effect on apoptosis.

OBJECTIVE:To establish a method for content determination of phosphatidylcholine in eustachian tube lavage fluid of patients with secretory otitis media. METHODS:HPLC was used. The samples were pretreated by liquid-liquid extraction. It was performed on the column of Hypersil CN with mobile phase of acetoneitril-methanol-phosphoric acid (100∶10∶0.6,V/V/V)at the flow rate of 1.8 ml/min,the detection wavelength was 205 nm,temperature was 30 ℃ and volume was 20 μl. RESULTS:The lin-ear range of phosphatidylcholine was 11.99-119.9 μg/ml(r=0.999 6);RSDs of precision tests of intra-day and inter-day were no more than 15%;average recovery was 97.54%(RSD=9.36%,n=9);the average content of phosphatidylcholine in eustachian tube lavage fluid of patients was(24.43±3.61)μg/ml. CONCLUSIONS:The method is simple and accurate,and can be used for the content determination of phosphatidylcholine in eustachian tube lavage fluid of patients with secretory otitis media.