This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

OBJECTIVE To analyze the prototype components absorbed into blood and brain of Lithocarpus litseifolius leaves， so as to provide a reference for clarifying the pharmacological material basis of its prevention and treatment of central nervous system dis eases. METHODS The ethanol extract of L. litseifolius leaves， as well as the gastric lavage fluid and perfusion solution were prepared. Using rats as subjects， plasma samples of intestinal wall metabolism， intestinal flora metabolism and hepatic metabolism were prepared via in situ intestinal perfusion and closed intestinal loop method； while comprehensive metabolic plasma samples， brain tissue samples， and cerebrospinal fluid samples were collected after intragastric administration. UPLC-HRMS technology was utilized to analyze and identify chemical components and prototype components absorbed into blood and brain of L. litseifolius leaves. RESULTS A total of 66 chemical constituents were identified in L. litseifolius leaves， primarily consisting of flavonoids， organic acids， and others. A total of 16， 13， 11， and 5 prototype components were identified in intestinal wall metabolism， intestinal flora metabolism， hepatic metabolism， and comprehensive metabolic plasma samples， respectively. Additionally， 4 prototype components were detected in brain tissue and 9 in cerebrospinal fluid. Phloridzin， trilobatin， phloretin-2- O -malonyl hexoside， and phloretin were identified as common components across all sample types. CONCLUSIONS Prototype components absorbed into blood and brain of L. litseifolius leaves， such as phloridzin， trilobatin， phloretin， and other components may serve as the pharmacological material basis for their therapeutic effects on central nervous system diseases.

Autosomal dominant polycystic kidney disease （ADPKD） is a systemic hereditary renal disorder and can affect multiple organs， and congenital hepatic fibrosis is one of the manifestations of liver involvement and is an important complication of ADPKD. Symptomatic management is currently the main treatment method for this disease， and disease-specific drugs such as tolvaptan have limited indications and cannot correct the underlying genetic defect. This article reports a case of ADPKD with congenital hepatic fibrosis， and sirolimus was identified as the individualized treatment regimen based on peripheral blood functional genomic analysis and drug sensitivity prediction platform. The patient achieved significant improvements in symptoms and quality of life after treatment， with a stable kidney volume. This case shows that functional genomics has a potential value in guiding individualized treatment of rare genetic disorders， which provides new treatment ideas and practice paths for similar patients.

The abnormal accumulation of neutrophil extracellular traps （NETs） can promote the initiation and progression of pancreatic cancer， which is considered a potential therapeutic target for this disease. The Miraculous Pivot·Inquiry About Statement （《灵枢·口问》） have recorded the concept of "defensive qi stagnation". Based on the recognition that the function of defensive qi is similar to the immune function of neutrophils， and combining traditional Chinese medicine theory with clinical practice， it is proposed that the abnormal accumulation of NETs may be a pathological product of "defensive qi stagnation"， with the spleen being the critical site of pathology. Further exploring the application strategy of cleaning spleen and restoring defensive qi method in pancreatic cancer treatment， it is proposed to employ three approaches such as dredging method to eliminate spleen stagnation and inhibit pancreatic cancer proliferation， cleaning method to remove spleen dampness and suppress the inflammatory micro-environment， and tonifying method to strengthen Weiqi and to improve the immune microenvironment， which aims to provide new insights for the clinical treatment of pancreatic cancer with traditional Chinese medicine.

ObjectiveThis paper aims to systematically collect and organize ancient and modern clauses and studies containing Xieqingwan， excavate and analyze the key information of Xieqingwan， and provide a reference for facilitating the development of the classic formula Xieqingwan. MethodsThe composition， dosage， decocting methods， usage， and other key information of Xieqingwan in ancient traditional Chinese medicine books were collected and analyzed by means of literature research and metrological methods. The modern clinical application of Xieqingwan was summarized. ResultsA total of 42 pieces of effective data involving 32 ancient traditional Chinese medicine books were collected. Xieqingwan was first recorded in Xiaoer Yaozheng Zhijue. The drug origin of this formula is basically clear in the ancient traditional Chinese medicine books. The modern drug usage and decocting method were as follows： Angelicae Sinensis Radix， Gentianae Radix et Rhizoma， Chuanxiong Rhizoma， Gardenia seeds， Radix et Rhizoma Rhei， Notopterygii Rhizoma et Radix， and Saposhnikoviae Radix were grounded to fine powder， decocted with honey， and finally formed into pills with the size of a chicken head （1.5 g）. It was suggested that half a pill or one pill were taken for one dose with warm Lophatheri decoction and sugar. The indications and clinical application had developed from the recordings in Xiaoer Yaozheng Zhijue and evolved from pediatrics to ophthalmic otolaryngology， neurology， dermatology， digestion， and respiratory diseases. The main pathogenesis of these diseases is heat in the liver meridian and is treated. The effect of Xieqingwan is "clearing away heat and toxicity， removing fire and relaxing the bowels， and dispersing swelling and relieving pain". It is recommended to use the corresponding preparation methods in the 2020 Edition of Pharmacopoeia of the People's Republic of China. Modern clinical studies are centered around the clinical application of Xieqingwan， which is often modified and used in treating Tourette syndrome， herpes， febrile convulsion， sleepwalking， and insomnia. ConclusionThis paper conducts a thorough textual research of the key information of Xieqingwan， induces its historic evolution， and confirms its key information， so as to provide a reference for the future development of Xieqingwan.

Objective:To explore the early clinical effect of arthroplasty with rotating hinge knee prosthesis in the treatment of severe knee deformity.Methods:A retrospective study was conducted on 55 patients who underwent primary rotating hinge knee arthroplasty at Shanghai Sixth People's Hospital from January 2017 to October 2023, including 19 male patients and 36 female patients, with an average age of 60.9±9.0 years (ranging from 31 to 74 years). The four main indications were end-stage deformity of osteoarthritis (valgus/varus>20°, 16 cases), post-traumatic joint deformity (15 cases), severe joint ligament instability (12 cases), and neuromuscular or immune diseases (12 cases). The patients were divided into two age groups: ≥60 years old group (32 cases) and <60 years old group (23 cases). Various pre-operative and post-operative data, including knee society score (KSS), range of motion (ROM), forgotten joint score (FJS), degree of force line offset and post-operative complications, were collected and compared.Results:All the 55 cases successfully underwent the operation. The operation time was 102.3±15.8 min. The intraoperative blood loss was 63±23.7 ml. The follow-up time was 37.2±7.9 months. KSS clinical score increased from 27.5(12, 45) before surgery to 90.5(85, 95) after surgery ( P<0.001) and the mean score of KSS function increased from 50.4(45, 60) before surgery to 84.3(85, 95) after surgery ( P<0.001), both with significant difference ( P<0.05). Similarly, the average postoperative ROM improved from 97.2°±34.4° to 120.1°±10.9°with significant difference ( P<0.05). The postoperative FJS was 81.0±6.6. Up to the last follow-up, the implant survival rate was 98%[95% CI(90.4%, 99.6%)]. For the all four groups of end-stage deformity of osteoarthritis, post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases, both the KSS score and the ROM of the knee joint were significantly improved. There was no significant difference in neither the KSS score or the ROM of the knee joint between the ≥60 years old group and the <60 years old group ( P>0.05). The incidence of complications was 24% (13/55). The complication rates for patients with end-stage deformity of osteoarthritis, post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases were 12.5% (2/16), 20% (3/15), 25% (3/12), and 41.7% (5/12) respectively, without significant difference. The incidence of complications in elderly patients (85%, 11/13) was much higher than that in younger patients (5%, 2/42),with significant difference ( P<0.05). Conclusions:For end-stage deformity of osteoarthritis (valgus or varus >20°), post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases, the rotating hinge knee can provide good clinical improvement effects. For neuromuscular or immune diseases, the incidence of complications was relatively high. The therapeutic effect of patients over 60 years old showed no significant difference in the early postoperative efficacy compared with younger patients, but the complications of elderly patients were much higher than those of younger patients.

Objective To develop a Treatment Burden Scale for patients with chronic heart failure(CHF)and evaluate its reliability and validity,aiming to provide an effective tool for assessing treatment burden levels in this population.Methods According to Cumulative Complexity Model,the study was conducted in 2 phases.A preliminary item pool was established through literature review and semi-structured interviews,from August 2022 to March 2023,followed by expert consultation to finalize the initial scale.A convenience sample of CHF patients from 4 tertiary A hospitals in Hunan and Hubei provinces was conducted to refine scale items and assess psychometric properties,from June 2023 to April 2024.Results The final scale contained 26 items.Exploratory factor analysis revealed 6 domains,including family financial support burden,healthcare utilization burden,the challenges patients face in acquiring knowledge about proper medication use and water/sodium dietary management,the behavioral burden associated with tracking daily water/sodium intake and symptom patterns,psychological burden,and medication management burden,cumulatively explaining 68.661％of variance.Confirmatory factor analysis demonstrated satisfactory model fit;the x2/df was 2.076;the root mean square error of approximation was 0.070;the normed fit index was 0.912;the content validity score was 0.974.The total Cronbach's α coefficient of the scale was 0.903;the split-half reliability was 0.785;the test-retest reliability was 0.936.Conclusion The Treatment Burden Scale for CHF patients developed in this study has good reliability and validity psychometric properties,and it can be used to evaluate treatment burden levels and influencing factors in clinical practice.

Endocrine therapy is mainly used as preoperative neoadjuvant therapy and postoperative adjuvant therapy for breast cancer patients and as salvage therapy for advanced breast cancer patients.Osteoporosis is the common adverse reaction of endocrine therapy for breast cancer,which seriously affects the quality of life of the patients.The theory of"liver and kidney sharing the common source"is closely related to the etiology,pathogenesis and therapeutic principle of osteoporosis.It is believed that the pathogenesis of endocrine therapy associated osteoporosis in breast cancer is most closely related to liver and kidney,and is characterized by deficiency in origin and excess in superficiality.Deficiency in origin manifests as deficiency of liver and kidney,and excess in superficiality manifests as blood stasis blocking collaterals.Chinese herbal medicine with the actions of nourishing liver and kidney can be used for interventions of various stages of endocrine therapy for breast cancer.In the stage of preoperative neoadjuvant therapy,Chinese herbal medicine intervention focuses on inhibiting cancer,so as to achieve synergistic anticancer actions with neoadjuvant therapy;the intervention can also be supplemented by medicine for supporting healthy qi with modified Liuwei Dihuang Pills,thus to reduce the incidence of adverse reactions.In the stage of postoperative adjuvant therapy,Chinese herbal medicine intervention focuses on supporting healthy qi,so as to promote the recovery of body functions and prevent the occurrence of osteoporosis,and modified treatment with Duhuo Jisheng Decoction or Zuogui Pills can be chosen.In the advanced stage of salvage treatment,Chinese herbal medicine intervention focuses on supporting healthy qi,and medicines for nourishing liver and kidney,strengthening muscles and bones,and activating qi and blood circulation to relieve pain can be chosen;in addition,medicinals with affinity to flesh and blood can be added to enhance the actions of nourishing liver and kidney.

Objective To explore the effect and mechanism of keratin 17(KRT17)on proliferation of human esophageal squamous cell line KYSE-150.Methods The correlation of KRT17 expression with the disease stage and survival of patients with esophageal squamous cell carcinoma was analyzed by GEPIA2 website.Human esophageal squamous cell line KYSE-150 was divided into control group,si-NC group,si-KRT17 group and activator group.Small interfering RNA of si-NC and si-KRT17 were transfected into cells of si-NC group and si-KRT17 group,re-spectively.Cells in the activator group were transfected with si-KRT17 and treated with 740 Y-P(PI3K/AKT/mTOR pathway activator)with a final concentration of 30 μmol/L in the medium.The cell proliferation was detec-ted by CCK-8 assay.The clonal formation was detected by clonal formation experiment.The apoptosis was detected by TUNEL staining.The cell cycle was detected by flow cytometry.The cell migration and invasion were detected by Transwell assay.The contents of glucose,lactic acid and pyruvate in cell supernatant were detected by commercially available kits.The expression of KRT17 mRNA was detected by qRT-PCR.And the expression of KRT17,GLUT1,PDK1 and LDHA,p-PI3K,PI3K,p-AKT,AKT,p-mTOR and mTOR protein were detected by Western blot.Results The expression level of KRT17 in esophageal squamous cell carcinoma tissues was significantly higher than that in normal tissues(P＜0.05).There was a statistically significant correlation between the expression level of KRT17 and the stage of esophageal squamous cell carcinoma(P＜0.05).The survival prognosis of patients with low KRT17 expression was better than that of patients with high KRT17 expression(P＜0.05).Compared with control group or si-NC group,the mRNA and protein expression of KRT17 in si-KRT17 group were decreased(P＜0.05),and the cell proliferation activity,number of clone formation,migration and invasion cells were de-creased(P＜0.05).And the lactic acid content,protein expression levels of GLUT1,PDK1 and LDHA were de-creased(P＜0.05),values of p-PI3K/PI3K,p-Akt/AKT and p-mTOR/mTOR were decreased(P＜0.05).The proportion of cells in G0/G1 phase,TUNEL positive rate,and contents of glucose and pyruvate were increased(P＜0.05).Compared with si-KRT17 group,the mRNA and protein expression levels of KRT17 in activator group were increased(P＜0.05),and the cell proliferation activity,number of clone formation,migration and in-vasion cells were increased(P＜0.05).And the lactic acid content,protein expression levels of GLUT1,PDK1 and LDHA were increased(P＜0.05),the values of p-PI3K/PI3K,p-Akt/AKT and p-mTOR/mTOR were in-creased(P＜0.05).The proportion of cells in G0/G1 phase,TUNEL positive rate,and contents of glucose and pyruvate were decreased(P＜0.05).Conclusions KRT17 is highly expressed in esophageal squamous cell car-cinoma tissues and cells.Silencing KRT17 inhibits proliferation,migration and invasion of human esophageal squamous cell line KYSE-150,and promotes apoptosis and cell cycle arrest.