OBJECTIVE To investigate the clinical characteristics of euglycemic diabetic ketoacidosis （euDKA） induced by empagliflozin， and provide references for safe medication. METHODS Case reports of euDKA induced by empagliflozin were retrieved and analyzed from PubMed， Web of Science， CNKI， and Wanfang Data. The Naranjo’s scale was adopted to assess the causal relationship between empagliflozin and euDKA. RESULTS A total of 29 patients were enrolled， including 16 males and 13 females，with a median age of 58 years. All patients were diagnosed with type 2 diabetes mellitus； 22 patients had at least one comorbidity. The median time to euDKA onset was 60 days after administration， and 7 cases occurred within 2 weeks of treatment. Perioperative periods，fasting，and low-carbohydrate or ketogenic diets were the main predisposing factors. Common presentations included nausea，vomiting， fatigue， tachypnea，and tachycardia. The causal relationship between empagliflozin and euDKA was assessed as “probable” in all cases. According to adverse reaction severity grading， 13 cases were grade 3 （severe） and 16 cases were grade 4 （life-threatening）. All patients discontinued empagliflozin and recovered after corresponding treatment. CONCLUSIONS euDKA is a serious adverse reaction to empagliflozin， which mostly occurs early in treatment. Perioperative periods， fasting， and ketogenic diets are prone to induce euDKA. Elderly patients and those with comorbidities are at higher risk. Risk assessment should be conducted before clinical administration； blood ketones and acid-base monitoring should be strengthened in the early medication period； withhold the drug before elective surgery， avoid prolonged fasting；upon diagnosis， discontinue empagliflozin and initiate intravenous insulin， provide fluid resuscitation promptly， and use other treatments to improve patient prognosis.

Objective To study the antitumor effects of dendritic cell vaccine induced by astragalus polysaccha?rides on S180 tumor-bearing mice, and its possible mechanism. Methods Dendritic cells derived from mouse bone marrow were induced maturation by astragalus polysaccharides and loaded with S180 tumor antigen to prepare tumor vaccine. Tu?mor-bearing mice were divided into four groups and treated on day-5 and day-10 respectively. Group A was injected with NS, Group B with CTX (50 mg/kg), Group C with dendritic cells induced by astragalus polysaccharides and Group D with dendritic cells induced by tumor necrosis factor (TNF)-α. After 12 days of tumor-bearing, the animals were killed. The sub?cutaneous sarcoma, thymus and spleen were separated and weighted. The inhibitory rate, thymus index and spleen index were then calculated. ELISA assay was used to detect the levels of interleukin (IL)-4, interferon (IFN)-γin serum of tumor bearing mice. Results The tumor inhibition rate was higher in astragalus polysaccharide group and cytokine group than that of CTX group (64.25%, 64.10%vs 35.11%). The thymus index was higher in astragalus polysaccharide group and cyto?kine group than that of CTX group (1.69 ± 0.26, 1.74 ± 0.38 vs 1.45 ± 0.22). The spleen index was higher in astragalus poly?saccharide group and cytokine group than that of CTX group (5.44 ± 0.76, 5.31 ± 0.81 vs 3.54 ± 0.52). The level of IL-4 was lower in astragalus polysaccharide group and cytokine group than that of CTX group (15.66±2.57, 14.72 ± 4.84 vs 23.95 ± 6.07). The level of IFN-γwas higher in astragalus polysaccharide group and cytokine group than that of CTX group (16.54 ± 3.71, 17.20 ± 2.03 vs 10.37 ± 2.19). All the differences were statistically significant (P<0.05). Conclusion Dendritic cell vaccine induced by astragalus polysaccharides can effectively inhibit tumor growth. Its mechanism may be associated with the promotion spleen index and thymus index of S180 tumor-bearing mice, the effective correction of Th1/Th2 imbalance in?duced by tumor, and the enhancement of antitumor immune responses.