Atherosclerotic plaques arise within the vessels， yet their morphological evolution parallels that of carbuncles and abscesses. Drawing on the pathomechanism progression of carbuncles and abscesses， this paper proposes a dynamic pathogenesis model of "constraint-putrefaction-ulceration" for atherosclerotic plaques. The formation of atherosclerotic plaque begins with phlegm-turbidity obstruction and qi-blood stagnation （constraint stage）； prolonged constraint transforms into heat that scorches the vessels and forms plaques （putrefaction stage）； ultimately， toxin invades inward and ruptures the vessels， injuring the heart （ulceration stage）. Accordingly， staged differentiation and treatments are proposed. During the constraint stage， the focus is venting constraint and unblocking collaterals， clearing and relieving constraint-heat， for which Yue Jyu Pills （越鞠丸） and Danzhi Xiaoyao Powder （丹栀逍遥散） with modifications can be used. During the putrefaction stage， the method is clearing heat and dispelling abscesses， resolving stasis and dissipating knot， with modified Wuwei Xiaodu Beverage （五味消毒饮） and Xuefu Zhuyu Decoction （血府逐瘀汤）. During the ulceration stage， it is suggested to expell toxin and stasis， benefit qi and nourish yin using modified Gualou Xiebai Banxia Decoction （瓜蒌薤白半夏汤） and Sheng Mai Powder （生脉散）. This framework offers new perspectives for the differentiation and treatment of atherosclerotic plaques in traditional Chinese medicine.

Objective:To evaluate the characteristic manifestations of lumbar fusion following oblique lateral interbody fusion (OLIF), determine the specific incidence of these patterns, and the identify factors associated with fusion characteristics.Methods:This retrospective study analyzed 209 patients who underwent OLIF surgery at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between July 2017 and September 2023. The cohort had a mean age of 64.2±9.8 years and included 125 males and 84 females. A total of 338 lumbar segments were assessed, comprising 159 segments treated with stand-alone OLIF (OLIF-SA) and 179 segments treated with OLIF combined with posterior pedicle screw fixation (OLIF-PSF). Inclusion criteria were: patients aged 18-80 years who underwent OLIF with complete radiographic records. Surgical parameters, including fixation method, number of fused segments, surgical approach, and cage dimensions (height and width), were obtained from operative records. Radiographic evaluation included preoperative osteophytes, Hounsfield unit (HU) values of endplates, and cage positioning. Fusion rate, fusion pattern (lateral vs. central), cage subsidence, and related influencing factors were assessed. Clinical outcomes were measured via the Oswestry disability index (ODI) and visual analog scale (VAS) preoperatively, immediately postoperatively, and at 1-year follow-up. Results:The overall fusion rate was 98.2% (332/338), with a non-union rate of 1.8% (6/338). The incidence of lateral fusion was 40.2% (136/338). In the OLIF-SA group, lateral and central fusion rates were 50.3% (80/159) and 49.7% (79/159), respectively, with no cases of non-union. In the OLIF-PSF group, lateral fusion occurred in 31.3% (56/179), central fusion in 65.4% (117/179), and non-union in 3.3% (6/179), with statistically significant differences between groups ( P<0.05). Preoperative osteophytes and higher endplate HU values were significantly associated with lateral fusion ( P<0.05). However, cage dimensions and cage position (anterior-posterior and lateral placement) were not significantly associated with fusion pattern ( P>0.05). Overall, 61.5% (208/338) of segments showed no cage subsidence; 24.5% (83/338) had settling, and 14.0% (47/338) had grade 1 or higher subsidence. Among lateral fusion cases, the rates of no subsidence, anchoring, grade 1, grade 2, and grade 3 subsidence were 67.6%, 21.3%, 7.4%, 3.9%, and 0.7%, respectively. In the central fusion group, these rates were 59.2%, 27.6%, 9.2%, 2.5%, and 1.3%, respectively. In the non-union group, grade 2 and 3 subsidence occurred in 50% (3/6) each, significantly higher than in the other fusion groups ( P<0.05). Post hoc analysis confirmed that grade 2 and 3 subsidence rates were significantly elevated in the non-union group compared to the lateral and central fusion groups, while other subsidence categories showed no significant differences across groups. Clinically, patients showed significant improvements in ODI and VAS scores following surgery ( P<0.05). Conclusions:Lateral fusion occurred in 40.2% of OLIF cases. The OLIF-SA technique, preoperative osteophytes, and elevated preoperative HU values were significantly associated with lateral fusion. In contrast, surgical approach, number of fused segments, cage height, width, and cage positioning did not significantly influence the occurrence of lateral fusion.

Metformin has been demonstrated to attenuate hyperglycaemia by modulating the gut microbiota. However, the mechanisms through which the microbiome mediates metformin monotherapy failure (MMF) are unclear. Herein, in a prospective clinical cohort study of newly diagnosed type 2 diabetes mellitus (T2DM) patients treated with metformin monotherapy, metagenomic sequencing of faecal samples revealed that Phocaeicola vulgatus abundance was approximately 12 times higher in nonresponders than in responders. P. vulgatus rapidly hydrolysed taurine-conjugated bile acids, leading to ceramide accumulation and reversing the improvements in glucose intolerance conferred by metformin in high-fat diet-fed mice. Interestingly, C22:0 ceramide bound to mitochondrial fission factor to induce mitochondrial fragmentation and impair hepatic oxidative phosphorylation in P. vulgatus-colonized hyperglycaemic mice, which could be exacerbated by metformin. This work suggests that metformin may be unsuitable for P. vulgatus-rich T2DM patients and that clinicians should be aware of metformin toxicity to mitochondria. Suppressing P. vulgatus growth with cefaclor or improving mitochondrial function using adenosylcobalamin may represent simple, safe, effective therapeutic strategies for addressing MMF.

Hospital pharmacy research is significant in enhancing the level of rational drug use,improving the quality of pharmacy services,and promoting the improvement of drug treatment effects.To guarantee the standardization of hospital pharmacy research,the compilation team of"Hospital Pharmacy Research Standards"adheres to the principles of scientificity,universality,guidance,and operability,combs through the key management contents from three aspects,namely,relevant national policy docu-ments,relevant domestic and international standards and norms,and literature analysis,combines with the actual working condition of hospital pharmacy research,and formulates the standards after several rounds of opinion collection and expert argumentation.This paper analyzes the key contents of the standard,including basic requirements,research process management,and research re-sults management,to provide guidance and reference for hospital pharmacy researchers to understand the standard in-depth and further improve the standardization of hospital pharmacy research.

Objective:To evaluate the characteristic manifestations of lumbar fusion following oblique lateral interbody fusion (OLIF), determine the specific incidence of these patterns, and the identify factors associated with fusion characteristics.Methods:This retrospective study analyzed 209 patients who underwent OLIF surgery at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between July 2017 and September 2023. The cohort had a mean age of 64.2±9.8 years and included 125 males and 84 females. A total of 338 lumbar segments were assessed, comprising 159 segments treated with stand-alone OLIF (OLIF-SA) and 179 segments treated with OLIF combined with posterior pedicle screw fixation (OLIF-PSF). Inclusion criteria were: patients aged 18-80 years who underwent OLIF with complete radiographic records. Surgical parameters, including fixation method, number of fused segments, surgical approach, and cage dimensions (height and width), were obtained from operative records. Radiographic evaluation included preoperative osteophytes, Hounsfield unit (HU) values of endplates, and cage positioning. Fusion rate, fusion pattern (lateral vs. central), cage subsidence, and related influencing factors were assessed. Clinical outcomes were measured via the Oswestry disability index (ODI) and visual analog scale (VAS) preoperatively, immediately postoperatively, and at 1-year follow-up. Results:The overall fusion rate was 98.2% (332/338), with a non-union rate of 1.8% (6/338). The incidence of lateral fusion was 40.2% (136/338). In the OLIF-SA group, lateral and central fusion rates were 50.3% (80/159) and 49.7% (79/159), respectively, with no cases of non-union. In the OLIF-PSF group, lateral fusion occurred in 31.3% (56/179), central fusion in 65.4% (117/179), and non-union in 3.3% (6/179), with statistically significant differences between groups ( P<0.05). Preoperative osteophytes and higher endplate HU values were significantly associated with lateral fusion ( P<0.05). However, cage dimensions and cage position (anterior-posterior and lateral placement) were not significantly associated with fusion pattern ( P>0.05). Overall, 61.5% (208/338) of segments showed no cage subsidence; 24.5% (83/338) had settling, and 14.0% (47/338) had grade 1 or higher subsidence. Among lateral fusion cases, the rates of no subsidence, anchoring, grade 1, grade 2, and grade 3 subsidence were 67.6%, 21.3%, 7.4%, 3.9%, and 0.7%, respectively. In the central fusion group, these rates were 59.2%, 27.6%, 9.2%, 2.5%, and 1.3%, respectively. In the non-union group, grade 2 and 3 subsidence occurred in 50% (3/6) each, significantly higher than in the other fusion groups ( P<0.05). Post hoc analysis confirmed that grade 2 and 3 subsidence rates were significantly elevated in the non-union group compared to the lateral and central fusion groups, while other subsidence categories showed no significant differences across groups. Clinically, patients showed significant improvements in ODI and VAS scores following surgery ( P<0.05). Conclusions:Lateral fusion occurred in 40.2% of OLIF cases. The OLIF-SA technique, preoperative osteophytes, and elevated preoperative HU values were significantly associated with lateral fusion. In contrast, surgical approach, number of fused segments, cage height, width, and cage positioning did not significantly influence the occurrence of lateral fusion.

Hospital pharmacy research is significant in enhancing the level of rational drug use,improving the quality of pharmacy services,and promoting the improvement of drug treatment effects.To guarantee the standardization of hospital pharmacy research,the compilation team of"Hospital Pharmacy Research Standards"adheres to the principles of scientificity,universality,guidance,and operability,combs through the key management contents from three aspects,namely,relevant national policy docu-ments,relevant domestic and international standards and norms,and literature analysis,combines with the actual working condition of hospital pharmacy research,and formulates the standards after several rounds of opinion collection and expert argumentation.This paper analyzes the key contents of the standard,including basic requirements,research process management,and research re-sults management,to provide guidance and reference for hospital pharmacy researchers to understand the standard in-depth and further improve the standardization of hospital pharmacy research.

OBJECTIVE To develop a population pharmacokinetic （PPK） model for mycophenolate mofetil active metabolite mycophenolic acid （MPA） in children with primary IgA nephropathy， explore the factors affecting the pharmacokinetic parameters of MPA， and provide a basis for clinical individualized therapy. METHODS Retrospective collection was conducted on 636 concentrations and clinical data from 47 pediatric patients with primary IgA nephropathy. PPK analysis was carried out by using the nonlinear mixed-effects model； the covariates were tested with a stepwise method. Goodness-of-fit plots， Bootstrap and visual predictive check were employed to evaluate the final model. RESULTS The pharmacokinetics of MPA in children with IgA nephropathy in vivo conformed to the first-order absorption and elimination two-compartment model （objective function value of 3 276.31）. Covariate analysis suggested that body weight and albumin （ALB） levels were significant influencing factors on apparent clearance rate and apparent distribution volume. The typical values of PPK parameters of MPA in the final model were as follows： the central room had a distributed volume of 5.79 L， the clearance rate was 4.06 L/h， the volume of peripheral ventricular distribution was 430.93 L， the clearance rate between compartments was 15.40 L/h， the oral absorption rate constant was 1.29 h－1. After verification， most of the predicted corrected observed concentration points were within the 90% confidence interval of the predicted corrected simulated concentration， indicating that the MPA final model had good predictive performance. CONCLUSIONS The PPK model of MPA in children with primary IgA nephropathy is established in this study， identifying body weight and ALB levels are significant factors affecting MPA metabolism.

Objectives:To explore the clinical use and observe the clinical efficacy of the Pivox system in oblique lateral interbody fusion(OLIF)in treating single-segment lumbar spinal diseases.Methods:The clini-cal data of patients with single-segment lumbar spinal diseases(Discogenic low back pain,lumbar spondylolis-thesis,lumbar spinal stenosis)who underwent OLIF without posterior instrumentation from May 2020 to Jan-uary 2021 in our hospital were collected,including 36 males and 33 females,aged 32-79 years old(59.1±5.9 years).And the patients were divided into OLIF stand-alone group(39 patients)and Pivox+OLIF group(30 pa-tients).The perioperative parameters of the two groups of patients were compared,including incision length,operative time,intraoperative blood loss,and length of hospital stay.The visual analogue scale(VAS)and Os-westry disability index(ODI)were assessed before operation,at 1 week,1,3,6 and 12 months after operation for clinical efficacy.The intervertebral disc height,foraminal height and foraminal area before and after oper-ation,and the fusion rate were evaluated and compared between the two groups.Complications were recorded and compared as well.Results:The patients were followed up for 14.0±0.3 months(12-18 months).No signif-icant differences were found between the two groups in gender,age,disease type,operative level,bone min-eral density(BMD),or body mass index(BMI)(P＞0.05).The operative time in OLIF group was shorter than that in Pivox+OLIF group(P＜0.05),while there were no significant differences in blood loss,incision length and hospital stay(P＞0.05).The VAS score and ODI index in both groups before surgery were higher than those at 1 week,1 month,3 months,6 months,and 12 months after surgery(P＜0.05).No significant differences in VAS and ODI were found at 1 week,1 month,3 months,6 months,and 12 months after surgery between the two groups,respectively(P＞0.05).The intervertebral disc height,foraminal height and foraminal area at postoperative 1 week,6 and 12 months were all greater than those before operation in both groups,while the increase values of intervertebral disc height,foraminal height and foraminal area in Pivox+OLIF group were greater than those in OLIF group at 1 week,and 6 and 12 months after surgery,but without statistical differ-ences(P＞0.05).Cage subsidence occurred in both groups,and cage displacement was noticed in two cases in the OLIF group,while none was there in the Pivox+OLIF group.There were no significant differences in fu-sion rate and incidence of complications between two groups(P＞0.05).Conclusions:The short-term effect of Pivox+OLIF procedure in the treatment of single-segment lumbar degenerative diseases is satisfactory,but comparing with stand-alone OLIF,Pivox+OLIF has no obvious advantage in spinal canal decompression and preventing cage subsidence.

Objectives:To investigate the effectiveness and safety of unilateral approach contralateral under-cutting decompression assisted with ultrasonic osteotome in treating severe degenerative lumbar spinal stenosis.Methods:174 patients with severe degenerative lumbar spinal stenosis who were treated with ultrasonic os-teotome assisted unilateral approach contralateral undercutting decompression between June 2018 and June 2021 were collected[unilateral approach bilateral decompression transforaminal lumbar interbody fusion(TLID group,group A],and 129 patients undergone bilateral transforaminal decompression during the same period were randomly selected as control(bilateral small incision TLIF group,group B).The perioperative parameters such as incision length,operative time,intraoperative blood loss,postoperative drainage,and length of hospital stay were recorded and compared between the two groups.Creatine phosphokinase(CPK)test was performed to evaluate muscle damage conditions,and visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the postoperative therapeutic effects.The complications and fusion conditions were compared between the two groups.Results:There wasn't significant difference in average length of bilateral incisions and length of hospital stays between the two groups(P＞0.05).Group A was less significantly than group B in terms of operative time,intraoperative blood loss,and postoperative drainage,with statistical significance(P＜0.05).The preoperative CPK value was comparable between the two groups(P＞0.05),and on postoperative 1d and 3d it was statistically greater in group B than in group A(P＜0.05),but on postoperative 5d it wasn't sig-nificantly different between the two groups(P＞0.05).The postoperative VAS scores and ODI improved com-pared with the preoperative values in both groups on postoperative 3d,at 1 month,3 months,and 12 months(P＜0.05),and there was no statistical difference between the two groups respectively at the same follow-up period(P＞0.05),even though group A was better in ODI and VAS than group B at 12 months after operation.There was no significant difference between the two groups in postoperative complications such as dural tear,incision fat liquefaction,cerebrospinal fluid leakage and postoperative infection.Group A was less in the pro-portion of postoperative worsening lower limb numbness and rebound of hip/lower limb symptoms than in group B(P＜0.05).1 year after operation,12 cases in group A were not fused,and 8 cases in group B were not fused.There was no statistically significant difference in the bone graft fusion between the two groups(P＞0.05).Conclusions:Comparing with bilateral small incision TLIF,ultrasonic osteotome assisted unilateral ap-proach contralateral undercutting decompression also can achieve good treatment results,which features in less trauma,less effects on spinal stability,shorter operative time,and less intraoperative blood loss,and therefore worth in clinical promotion.

Objective To strengthen the management of rational medication for patients with rare diseases and improve the level of comprehensive medication support,in order to address the pain points in medication for rare diseases.Methods By leveraging mobile information technology,a mobile application for the Guangdong Shortage Drug Consultation Platform was developed and a smart and multifunctional pharmaceutical service information platform for rare disease patients was established.Results As the first big data platform in China integrating provincial-level rare disease medical resources,it innovatively realizes the closed-loop interaction among"treatment to medication"online and offline by establishing a comprehensive and professional rare disease mobile pharmaceutical service system.Conclusion The pharmaceutical service platform builds a bridge for rare disease patients to seek medical treatment and and medicine,and helps promote the high-quality development of Healthy China strategy.