Background: Inhalation-based combination therapy has gained increasing attention for local treatments. However, a key challenge remains in ensuring the sustained pulmonary release of multiple active ingredients, particularly in traditional Chinese medicine (TCM) formulations. Objective: This study investigates a novel PulmoSphere-based inhalable carrier designed for the sustained pulmonary release of multiple active ingredients, using Shuang-Huang-Lian as a model TCM formulation containing three chemical markers. Materials and methods: The carrier was developed using PulmoSphere technology, incorporating phospholipid complexes of the chemical markers and hyaluronic acid (HA) into spray-dried microparticles. The aerodynamic properties, release characteristics, pulmonary distribution, and anti-inflammatory efficacy of different formulations were evaluated in vitro and in mice. Results: The microparticles retained the excellent aerodynamic properties of conventional PulmoSphere particles, with a mass median aerodynamic diameter of approximately 3.1 μm and a fine particle fraction of approximately 55%. Compared to free Shuang-Huang-Lian or phospholipid complex-loaded PulmoSphere particles, the HA-containing particles prolonged the retention of chemical markers in the lung epithelial lining fluid, demonstrating sustained release in vivo. Additionally, the HA-containing formulation enhanced the exposure of the three chemical markers to immune cells and lung tissues, leading to improved and prolonged anti-inflammatory effects, even at decreased doses. Conclusion: This novel inhalable particle system represents a promising approach for sustained pulmonary co-delivery of multiple active ingredients, offering enhanced and extended local therapeutic efficacy.

Objective To explore the effects and mechanism of Jianpi Shuyi Decoction in improving pancreatic fibrosis in chronic pancreatitis(CP)based on network pharmacology and animal experiments.Methods TCMSP was used to screen the active components and targets of Jianpi Shuyi Decoction.GeneCards was used to obtain the disease targets of pancreatic fibrosis,and the intersection of drug and disease targets was used to construct the protein interaction network and the drug-component-target network,and the core target genes were screened out.GO and KEGG pathway enrichment analysis was performed on the intersecting targets.Caerulein was used to induce CP mouse model,and Jianpi Shuyi Decoction was given for gavage.HE and Sirius red staining were used to observe pancreatic tissue inflammation and collagen deposition,respectively.RT-qPCR was used to observe the mRNA expression levels of Acta2,COL1A1,PI3K and Akt1 in pancreatic tissue.Immunohistochemistry staining was used to observe the protein expression levels of α-SMA,COL-1,p-PI3K and p-Akt in pancreatic tissues.Results A total of 181 active components were screened from Jianpi Shuyi Decoction,corresponding to 284 targets,with 240 targets overlapping between drugs and disease and the core targets were PTGS2,HSP90AA1,etc.193 signaling pathways were obtained from KEGG pathway enrichment analysis,primarily involving lipids and atherosclerosis,chemical carcinogenic-receptor activation,PI3K-Akt signaling pathway and others.The results of animal experiments showed that,compared with the normal group,the model group showed a large number of inflammatory cell infiltration and collagen deposition in pancreatic tissue,the mRNA expression of Acta2,COL1A1,PI3K and Akt1 in pancreatic tissue significantly increased(P<0.01),and the protein expression of α-SMA,COL-1,p-PI3K,p-Akt significantly increased(P<0.01);Jianpi Shuyi Decoction significantly reduced the inflammation and collagen deposition in pancreas of mice,reduced the mRNA expression of Acta2,COL1A1,PI3K and Akt1(P<0.05),and attenuated the protein expression of α-SMA,COL-1,p-PI3K and p-Akt in pancreatic tissue(P<0.05).Conclusion Jianpi Shuyi Decoction may exert a therapeutic effect on CP pancreatic fibrosis by regulating the PI3K/Akt signaling pathway,attenuating inflammation and collagen deposition in the pancreas,and reducing the levels of α-SMA and COL-1.

Objective:To explore the effect of prognosis appearance of the combination of microneedle array radiofrequency and CO2 array laser on psychological stress response of patients with facial acne scar.Methods:A total of 100 patients with facial acne scar,who admitted to Chengdu Second People's Hospital from August 2020 to August 2020,were selected,and they were divided into study group and control group,with 50 cases in each group.Study group adopted combined treatment with microneedle array radiofrequency and CO2 array laser,and control group adopted microneedle array radiofrequency to conduct treatment.The curative effect after treatment was compared between two groups.The Vancouver scar scale(VSS)was adopted to score the scar condition of patients,and Hamilton anxiety(HAMA)rating scale,Hamilton depression(HAMD)of rating scale and self-esteem scale(SES)were adopted to evaluate the psychological stress response of patients,and the score of the comprehensive evaluation questionnaire of quality of life(GQOLI-74 score)was adopted to evaluate the difference of quality of life of patients between before and after treatment.Results:After treatment,the overall curative effect of study group was 92.00%,which was better than 72.00%of control group,and the difference was significant(x2=6.775,P<0.05).The VSS scores of study group after received treatment of 2,4 times were significantly lower than those before treatment,and were lower than those of control group,and the differences of those between two groups were significant(t=5.850,9.040,P<0.05),respectively.After treatment,the SES scores of two groups all rose,and the HAMD and HAMA scores of two groups all reduced,and the three scores of study group were all better than those of control group,and the differences of them between two groups were significant(t=3.456,3.909,6.063,P<0.05).Pearson correlation showed that the VSS score was negatively correlated with the SES score(r=-0.249,P<0.05),and was positively correlated with the HAMD score and the HAMA score(r=0.653,0.695,P<0.05),respectively.After treatment,the GQOLI-74 scores of each indicator(material and life,physical function,psychological function,and social function)of two groups rose all,and the GQOLI-74 scores of study group were all better than those of control group,and the differences of them between two groups were significant(t=4.324,7.497,3.870,4.534,P<0.05),respectively.Conclusion:The combination of microneedle array radiofrequency and CO2 array laser has better curative effect in treating facial acne scar,which can effectively promote prognosis appearance,and relieve psychological stress response,and improve the quality of life.

Objective To investigate the effects of Liuwei Dihuang Wan(LWDHW)combined with prednisone on immunoglobulin levels,coagulation function,and renal function in children with nephrotic syndrome(NS).Methods A total of 86 children diagnosed with NS and liver-kidney yin deficiency syndrome at the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2019 to January 2024 were randomly divided into a control group and an observation group,with 43 cases in each group.Both groups of children received conventional symptomatic treatment,including a low-salt diet,diuresis,anticoagulation,and lipid-lowering therapy.In addition,the control group received standard treatment with prednisone,while the observation group received the same treatment as the control group plus LWDHW in decoction for 3 months.Traditional Chinese medicine(TCM)syndrome scores,immunoglobulins(IgA,IgG,IgM),coagulation parameters[fibrinogen(FBG),activated partial thromboplastin time(APTT),prothrombin time(PT)],and renal function markers[serum creatinine(Scr),blood urea nitrogen(BUN)]were observed before and after treatment.Clinical efficacy and adverse events were compared.Results(1)After 3 months of treatment,the overall response rate in the observation group was 95.35％(41/43),while that in the control group was 79.07％(34/43).The intergroup comparison(by chi-square test)revealed that the therapeutic efficacy of the observation group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the TCM syndrome scores for soreness/weakness of waist/knees,dizziness/tinnitus,feverish sensation in the chest,palms and soles,and afternoon tidal fever in both groups of children were significantly lower than thsoe before treatment(P＜0.05).Additionally,the reduction in scores for all TCM syndromes in the observation group was significantly greater than that in the control group(P＜0.05 or P＜0.01).(3)After treatment,the IgA and IgG levels in both groups of children increased compared to before treatment(P＜0.05).There was a trend of increased IgM levels in both groups after treatment,but the differences were not statistically significant(P＞0.05);the post-treatment intergroup comparison showed that the increase in IgA and IgG levels in the observation group was significantly greater than that in the control group(P＜0.05 or P＜0.01).(4)After treatment,the PT levels of both groups of children were prolonged compared to before treatment(P＜0.05),the FBG levels were reduced compared to before treatment(P＜0.05),and the APTT levels showed no significant changes compared to before treatment(P＞0.05).After treatment,the improvement in PT and FBG levels in the observation group was significantly better than that in the control group(P＜0.01).(5)After treatment,the Scr and BUN levels in both groups decreased compared to before treatment(P＜0.05),and the reduction in Scr and BUN levels in the observation group was significantly greater than that in the control group(P＜0.01).(6)In terms of adverse reactions,the incidence rates in the observation group and control group were 6.97％(3/43)and 2.32％(1/43),respectively.There was no statistically significant difference between the two groups(x2=1.049,P＞0.05).Conclusion LWDHW combined with prednisone effectively improves clinical efficacy,alleviates TCM syndromes,modulates immune function,reduces hypercoagulability,and enhances renal function in children with NS and liver-kidney yin deficiency,with good safety.

Objective:To report the nationwide surveillance results of pathogenic profiles and antimicrobial resistance patterns of Gram-positive bloodstream infections in China in 2023.Methods:The clinical isolates of Gram-posttive bacteria from blood cultures were collected in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）during January to December 2023. Antimicrobial susceptibility testing was performed using the dilution method recommended by the Clinical and Laboratory Standards Institute（CLSI）. Statistical analyses were conducted using WHONET 5.6 and SPSS 25.0 software.Results:A total of 4 385 Gram-positive bacterial isolates were obtained from 60 participating center. The top five pathogens were Staphylococcus aureus（ n=1 544，35.2%），coagulase-negative Staphylococci（ n=1 441，32.9%）， Enterococcus faecium（ n=574，13.1%）， Enterococcus faecalis（ n=385，8.8%），and α-hemolytic Streptococci（ n=187，4.3%）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）was 26.2%（405/1 544）and 69.8%（1 006/1 441），respectively. Notably，all Staphylococci remained susceptible to glycopeptide or daptomycin. Staphylococcus aureus demonstrated excellent susceptibility（>97.0%）to cephalobiol，rifampicin，trimethoprim-sulfamethoxazole，linezolid，minocycline，tigecycline，and eravacycline. No Enterococcus exhibiting resistance to linezolid were detected. Glycopeptide resistance was uncommon but more frequent in Enterococcus faecium（resistance to vancomycin and teicoplanin：both 1.7%）compared to Enterococcus faecalis（both 0.3%）. The detection rates of MRSA and MRCNS exhibited significant regional variations across the country（ χ2=17.674 and 148.650，respectively，both P<0.001）. No vancomycin-resistant Enterococci were detected in central China. Institutional comparison demonstrated higher prevalence of MRSA（ χ2=14.111， P<0.001）and MRCNS（ χ2=4.828， P=0.028）in provincial hospitals than that in municipal hospitals. Socioeconomic analysis identified elevated detection rates of both MRSA（ χ2=18.986， P<0.001）and MRCNS（ χ2=4.477， P=0.034）in less developed regions（per capita GDP

Objective:To report the results of bacterial resistant investigation collaborative system（BRICS）on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2023，and provide reference for clinical tretment of bloodstream infections and prevention and control of bacterial resistance.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of BRICS were collected during January 2023 to December 2023. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 were used to analyze the data.Results:During the study period，11 492 strains of Gram-negative bacteria were collected from 60 hospitals，of which 10 098（87.9%）were Enterobacterales and 1 394（12.1%）were non-fermentative bacteria. The top 5 bacterial species were Escherichia coli（50.0%）， Klebsiella pneumoniae（26.1%）， Pseudomonas aeruginosa（5.1%）， Acinetobacter baumannii complex（5.0%）and Enterobacter cloacae complex（4.1%）. The ESBL-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus mirablilis were 46.8%（2 685/5 741），18.3%（549/2 999）and 44.0%（77/175），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（76/5 741）and 15.0%（450/2 999）；32.9%（25/76）and 78.0%（351/450）of CREC and CRKP were sensitive to ceftazidime/avibactam combination，respectively. 94.7%（72/76）and 90.2%（406/450）of CREC and CRKP were sensitive to aztreonam/avibactam combination. Furthermore，57.9%（44/76）and 79.1%（356/450）were sensitive to imipenem/relebactam combination. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 64.6%（370/573），while more than 80.0% of CRAB complex was sensitive to tigecycline，eravacycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 17.0%（99/581）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of important Gram-negative bacteria resistance among different regions in China，with statistically significant differences in the prevalence of CREC，CRKP，CRPA and CRAB complex（ χ2=10.6，28.6，10.8 and 19.3， P<0.05）. The prevalence of ESBL-producing Escherichia coli， CREC，CRAB complex and CRKP were higher in provincial hospitals than those in municipal hospitals（ χ2=12.5，9.8，12.7 and 57.8，all P<0.01）. Conclusions:Gram-negative bacteria are the main pathogens causing bloodstream infections in China，and Escherichia coli is ranked in the top，while the trend of Klebsiella pneumoniae increases continuously with time. CRKP infection shows a slow upward trend，CREC infecton maintains a low prevalence level，and CRAB complex infection continues to exhibit a high prevalence rate. The composition and resistance patterns of pathogens causing bloodstream infections vary to some extent across different regions and levels of hospitals in China.

BACKGROUND:Synthetic polymers,such as polypropylene and polyester,used for the treatment of abdominal wall defects not only lack biodegradability and bioactivity but also fail to meet the demands of complex and irregular wounds.Therefore,finding bioactive materials with low immunogenicity and good histocompatibility has become a hot spot in the repair of abdominal wall defects. OBJECTIVE:To prepare methacryloyl modified dermal extracellular matrix hydrogel and explore its potential application in abdominal wall defect. METHODS:(1)The porcine dermis was acellular with 0.25%trypsin and 1%Triton X-100 in turn to obtain the dermal extracellular matrix.After pepsin digestion and methacrylic anhydride modification,the methacrylated dermal extracellular matrix hydrogel was formed by photocrosslinking.The microscopic morphology of the hydrogel was observed by scanning electron microscope,and its rheological properties,swelling properties and other physical and chemical properties were tested.(2)Mice fibroblasts(L929)were inoculated into methacrylated dermal extracellular matrix hydrogel to detect the cell compatibility.(3)Totally 12 SD rats were randomly divided into two groups(n=6)to create abdominal wall defect model with peritoneum preserved.The defect site of the polypropylene group was filled with polypropylene material,and the hydrogel group was filled with methacrylated dermal extracellular matrix hydrogel.The wound skin of both groups was covered with polypropylene material.The wound healing was observed and histological analysis was carried out. RESULTS AND CONCLUSION:(1)Enzymatic hydrolysis had a good decellularization effect on porcine dermis after decellularization,and the original glycosaminoglycans and collagen were well retained.Scanning electron microscope observation revealed that the dermal extracellular matrix hydrogel presented loose and porous structure.The aperture was between 70 and 120 μm.The swelling ratio was(16.88±3.24)%and the water absorption was(94.24±1.11)%.The rheological property test showed that the methacrylated dermal extracellular matrix hydrogel was stable and had shear thinning characteristics,with injectability.(2)CCK-8 assay and live/dead staining showed that methacrylated dermal extracellular matrix hydrogel had good cell compatibility.(3)The results of animal experiments showed that the skin wound healing rate of the experimental group was higher than that of the control group at 7,10,and 14 days after operation(P<0.05).Hematoxylin-eosin and Masson staining of skin and muscle tissue exhibited that compared with the polypropylene group,the skin wound epithelialization,hair follicle formation,collagen fiber arrangement,and neovascularization were better in the hydrogel group 14 days after surgery.The skin wound new tissue structure was similar to the normal tissue at 28 days after surgery,and scar hyperplasia was less.A small amount of muscle regeneration was observed on day 28 after operation.(4)The results show that the methacrylated dermal extracellular matrix hydrogel can promote wound skin healing and muscle tissue regeneration in rats with abdominal wall defect.

ObjectiveTo explore a rapid and accurate method for evaluating the quality of Prunus mandshurica (Maxim.) Koehne (P. mandshurica, Ku Xing Ren) during rancidity using machine vision and learning.MethodsSensory evaluation and chemometrics were used to classify P. mandshurica quality grades after rancidity. Chemical indicators of the P. mandshurica quality change were determined to verify the obtained grades and support the subsequent modeling. The International Commission on Illumination color space was used to extract the color features of the P. mandshurica. Discrimination and prediction models based on color features combined with multiple machine learning algorithms were established using 10-fold cross-validation and external test set validation.ResultsThe P. mandshurica rancidity samples were allocated to three quality grades. The Bayes net model based on powder color successfully identified the P. mandshurica at different grades with an accuracy of 88.89% and 100% using two validations, and the naive Bayes model based on section color achieved the same accuracy with an receiver operating characteristic area of 0.979. The instance-based k-nearest neighbors model based on powder color performed best in predicting the amygdalin content [R2 = 0.9801, mean absolute error (MAE) = 0.2071, root mean squared error (RMSE) = 0.4170], followed by the random committee model in predicting the acid value (R2 = 0.9580, MAE = 1.5121, RMSE = 1.9099) and the random forest model in predicting the peroxide value (R2 = 0.8857, MAE = 0.0027, RMSE = 0.0035).ConclusionThis study demonstrates that color digitization analysis is a potential method for rapidly evaluating the quality of P. mandshurica across the rancidity process, providing a new reference for the quality assessment of traditional Chinese medicines.

Objective The purpose of writing the"expert consensus on humanistic care for patients in hospice care"(hereinafter referred to as the"consensus")aims to standardize the practice of humanistic care in the field of hospice care,ensuring that humanistic care is integrated throughout the entire service process for hospice care patients and their families.Methods A systematic search was conducted in domestic and foreign databases for literature related to hospice care and humanistic care,including guidelines,expert consensuses,systematic reviews or Meta-analyses,and evidence summaries.High-quality evidence was evaluated,extracted,and summarized to form the initial draft of the"consensus".From June to October 2024,20 experts from the fields of hospice care,nursing humanities,and evidence-based nursing were invited to participate in 1 round of expert consultation.Among them,13 experts were selected for 2 rounds of expert demonstration meetings.After collating and analyzing the experts' opinions,the initial draft was revised and refined,ultimately resulting in the final version of the"consensus".Results The effective response rate of the consultation questionnaire was 100％,with expert authority coefficient of 0.880,judgment coefficient of 0.935,and familiarity level of 0.825.The Kendall harmony coefficient of the expert consultation was 0.134(P＜0.05).The"consensus"consisted of 13 aspects,including the targets and objectives,principles,institutional guarantees,environmental requirements,etc.Conclusion This"consensus"possesses strong scientific rigor and practicality,which can provide guidance and references for the practice of humanistic care in the field of hospice care,promoting the standardization and humanization of hospice care services.