Flexible ureteral lithotripsy (FURL) under general anesthesia (GA) is the dominant method in the treatment of renal and upper ureteral calculi，but some patients cannot tolerate GA.In recent years，there has been a growing interest in the use of local anesthesia (LA) as a safe and effective alternative.And it is also an option for patients who have calculi ≤20 mm with high fragility，lower CT value and better compatibility.Before surgery，it is important to conduct relevant examinations，evaluate the status of patients，prevent infections，and indwell ureteral stents.During surgery，lithotomy position，scissors position，prone leg position and other positions should be selected according to the specific conditions of patients.LA drugs should be used to control physiological pain and relieve psychological anxiety.Patients' breathing state should be carefully monitored，and appropriate ureteroscope and lens sheath should be selected for the success and safety of the operation.In this paper，the perioperative management of FURL under LA is briefly summarized，so as to provide reference for clinical practice.

To implement the Opinions of the State Council of the Central Committee of the Communist Party of China on Promoting the Inheritance and Innovative Development of Traditional Chinese Medicine， delve into the diseases specifically responding to traditional Chinese medicine （TCM）， and serve the building of advantageous specialties， clinical talent cultivation， national research layout， and academic innovation， the Chinese Association of Chinese Medicine sponsored the salons in multiple fields to discuss the diseases specifically responding to TCM. On August 26， 2023， the 25^th salon on the diseases specifically responding to TCM was held in Shanghai. In view of the advantages of TCM and integrated traditional Chinese and Western medicine in the diagnosis and treatment of psoriasis， Chinese and western medicine experts and interdisciplinary researchers carried out extensive and in-depth discussions and formed specific suggestions and consensus on the diagnosis and treatment of psoriasis with TCM and integrated traditional Chinese and Western medicine. However， there was still a lack of detailed research path. Under the guidance of the Chinese Association of Chinese Medicine， this paper analyzes the problems in the diagnosis and treatment of psoriasis from the occurrence and development of psoriasis. According to the advantages and characteristics of TCM and integrated traditional Chinese and Western medicine in the diagnosis and treatment of psoriasis， this paper puts forward the main points of research layout for psoriasis from the three aspects of psoriasis diagnosis and treatment， comorbidity prevention， and chronic disease management as follows： ① optimization of the syndrome differentiation system for psoriasis， ② optimization of assessment indicators for psoriasis， ③ recurrence mechanisms of psoriasis， ④ construction and research of TCM prevention and treatment of psoriasis recurrence， ⑤ construction of the comorbidity spectrum and TCM theoretical system of psoriasis， ⑥ comorbidity mechanisms of psoriasis. Furthermore， this article proposed the research layout and directions， expected goals and values， and funding priorities. Therefore， on the basis of the series of salons about psoriasis as a disease specifically responding to TCM， this article puts forward the research paradigm of psoriasis， aiming to facilitate the high-quality development of TCM and provide reference for the national research layout， the research and development of new TCM preparations， the selection of research topics， and the formulation of guidelines and consensus.

Objective: To determine the main components of Astragalus membranaceus (Fisch.) Bge (A. membranaceus, Huang Qi), Astragaloside IV (AIV) and Astragalus polysaccharides (AP), to characterize their properties, evaluate their in vivo efficacy, and to analyze drug diffusion using dissolving microneedle (DMN) technology in vivo. Methods: Respectively, AIV- and AP-loaded DMNs comprising chitosan (CTS) and polyvinyl alcohol (PVA) were prepared via dual-mold forming. Their morphology, mechanical properties, in vivo solubility, and skin irritation characteristics were tested. In vivo efficacy was assessed in cyclophosphamide-induced immunosuppressed mice, in vivo diffusion of AIV and AP by DMNs and conventional methods was compared, and the rheological properties of AIV-CTS-PVA and AP-CTS-PVA mixtures were measured. Results: Subcutaneous dissolution and absorption of AIV-CTS-PVA and AP-CTS-PVA microneedles (MNs) at low doses (50%–17% of intraperitoneal AIV injection and 12%–4% of intravenous AP injection) reduced the spleen index and acid phosphatase activity in immunosuppressed mouse models, increased the thymus index, and achieved equivalent or better systemic therapeutic effects. Compared with injections, AIV and AP achieved controllable solid-liquid conversion through delivery with CTS-PVA MNs, resulting in highly localized aggregation within 48 h, reducing the initial explosive effect of the drug, and achieving stable and slow drug release. Conclusion The present study enhances our understanding of the efficacy and remote effects of drug-loaded DMNs from a traditional Chinese medicine (TCM) perspective, thereby promoting the development of precise and efficient delivery of TCM and further expanding the drug-loading range and application scenarios for DMNs.

Objective: To investigate the effects of plateau environment exposure on the reproductive system of male rats, so as to provide the reference for mechanisms of reproductive damage in plateau environment. Methods: Sixty SPF-grade 12-week-old male Wistar rats were randomly divided into the plain-exposed group, the 1 day-, 3 day-, 7 day-, 14 day- and 28 day- plateau-exposed groups. The rats in the plain-exposed group were raised under normal conditions for 28 days, while the rats in the plateau-exposed groups were raised in a simulated high-altitude plateau chamber. After the completion of the designated feeding periods, the rats were sacrificed under anesthesia, and testicular tissue and abdominal aortic blood were collected to detect the testicular index and evaluate sperm quality. Histological and cellular morphologies of the testicular tissue were analyzed. Additionally, the levels of malondialdehyde (MDA), superoxide dismutase (SOD) and reactive oxygen (ROS) in the testicular tissue were determined, along with serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T). Conclusions Plateau environment may cause a decrease in testicular index and sperm quality, impair mitochondrial function, induce oxidative stress, and thus affect reproductive system of male rats. However, there are signs of self-repair in the reproductive system with the increase of exposure duration.

Objective To investigate the popularization of cardiopulmonary resuscitation(CPR)knowledge and science popularization needs among urban and rural residents in Tonghai County,Yuxi City,Yunnan Province,so as to explore the establishment of an efficient and appropriate science popularization model.Methods A total of 300 residents aged 15-60 years old were selected from Tonghai County,Yuxi City,Yunnan Province using stratified and simple random sampling methods.A self-designed questionnaire was used to conduct an anonymous questionnaire survey.Results Only 20.3%of Tonghai County residents master CPR skills,and 26.2%of Tonghai County residents have never heard of CPR.There is a statistically significant difference in the awareness rate of CPR between rural residents and non-rural residents(P<0.01).There are differences in residents'age and CPR awareness(P<0.01),the age and CPR are inversely proportional.The residents have a higher willingness to perform chest compressions and mouth-to-mouth resuscitation on strangers,66.2%and 68.6%respectively.63.79%of residents have never attended relevant training.But 92.76%of the people said they were willing to participate in the relevant training when they learned the training news.Conclusion Residents in Tonghai County generally lack knowledge of CPR first aid,but the demand for first aid knowledge of residential CPR is high and the attitude towards rescue is positive.It is recommended that relevant departments increase CPR science popularization and training efforts,and popularize CPR into villages.

ObjectiveThe human angiotensin converting enzyme2 （hACE2） transgenic mouse model was used to clarify the antiviral efficacy of BD-77 against a novel coronavirus SARS-CoV-2 and explore the action mechanism of BD-77 against SARS-CoV-2. MethodSARS-CoV-2 Omicron and Delta variant strains-infected VeroE6 cell models were established and administered with BD-77 to observe the antiviral effect of BD-77 in vitro. A kit was used to detect the effect of BD-77 in vitro on the binding of spike S protein of SARS-CoV-2 virus （Delta/Omicron） to angiotensin converting enzyme2 （ACE2）. Chromatography was adopted to detect the binding of BD-77 to the S protein and N protein of the novel coronavirus. hACE2 transgenic C57BL/6 mice were divided into a blank control group， SARS-CoV-2 infection group， BD-77 administration groups of 37.5 mg·kg^-1 and 75 mg·kg^-1， with eight mice in each group. The pneumonia model of SARS-CoV-2-infected hACE2 transgenic mice was built to observe the survival of the mice， detect the virus titer of the lung tissue of the mice， and observe the lesions in the lung tissue. ResultBD-77 had a certain inhibitory effect on Omicron and Delta variant strains in vitro， with median inhibitory concentration （IC₅₀） of 526.3 mg·L^-1 and 653.0 mg·L^-1， respectively. BD-77 had no significant inhibitory effect on the binding of the S protein of WT， Omicron， and Delta variant strains of SARS-CoV-2 to ACE2 and had no binding effect with the S protein and N protein of the novel coronavirus. No mice in the blank group died， while the mortality rate of SARS-CoV-2-infected mice was 75%. There was a large amount of virus replication in the lung tissue of the mice and large areas of inflammatory infiltration in the lung tissue and interstitium. Compared with the model group， BD-77 administration groups of 37.5 mg·kg^-1 and 75 mg·kg^-1 could reduce the mortality of mice， significantly lower the virus titer in the lung tissue of mice （P<0.05）， and improve lung lesions. ConclusionBD-77 demonstrated significant inhibitory effects against SARS-CoV-2 virus in vitro and in vivo. However， its mechanism of action did not involve direct inhibition of the virus itself or intervention in the virus-host binding process. This finding suggests that the mechanism of action of BD-77 needs to be thoroughly investigated and elucidated by further experiments.

ObjectiveTo observe the therapeutic effect of BD-77 by nebulized inhalation on animal models of various respiratory viral infections and investigate the mechanism of broad-spectrum antiviral action of BD-77 using proteomics. MethodThe influenza virus H1N1/FM1 experiment used ICR mice and divided them into a normal group， model group， Tamiflu group， and BD-77 groups of 75 and 37.5 g·L^-1 for inhalation of 20 min and 25 min. Human coronavirus 229E and OC43 experiment divided the BALB/c mice into a normal group， model group， chloroquine phosphate group， and BD-77 groups of 75， 37.5， 18.75， and 9.375 g·L^-1， with 10 mice in each group. Influenza virus H1N1/FM1 and human coronaviruses 229E and OC43 infection-induced pneumonia models were used to detect mouse lung index， and real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the viral load in lung tissue. Enzyme-linked immunosorbent assay （ELISA） was used to detect related inflammatory factors in lung tissue， and proteomics analysis was performed on the lung tissue of OC43-infected mice. ResultCompared with that in the normal group， the lung index of mice in each infection group was significantly increased （P<0.01）， and viral nucleic acid could be detected in the lung tissue of mice infected with human coronaviruses 229E and OC43. The levels of interleukin-6 （IL-6）， IL-10， and tumor necrosis factor-α （TNF-α） in the lung tissue of mice infected with human coronavirus 229E were all significantly increased （P<0.01）. BD-77 could significantly reduce the lung index of mice infected with influenza virus H1N1/FM1 and human coronaviruses 229E and OC43 （P<0.05， P<0.01）， cut down the viral load in the lungs of mice infected with human coronaviruses 229E and OC43 （P<0.01）， and lower the contents of IL-6， IL-10， and TNF-α in the lung tissue of mice infected with human coronavirus 229E （P<0.01）. Proteomics analysis of the lung tissue of OC43-infected mice showed that BD-77 regulated the AMPK signaling pathway， TNF signaling pathway， NOD-like signaling pathway， IL-17 signaling pathway， Forkhead box protein O （FoxO） signaling pathway， transforming growth factor-β （TGF-β） signaling pathway， and other signaling pathways. ConclusionNebulized inhalation of BD-77 is effective in treating pneumonia caused by influenza virus H1N1/FM1 and human coronaviruses 229E and OC43 infection in mice and may exert its antiviral effects by regulating the balance of cellular metabolism， enhancing the immune function of the host， and attenuating inflammatory responses.

In March 2020, the outflow of age limited videos from ICU in Spain inspired us to rethink whether there is age discrimination in the allocation of scarce medical resources. This paper frist reflected on the problem of age discrimination caused by this phenomenon from four moral intuitions: the sacred view of life, the quality of life and values, public health ethics and Chinese culture, and then examined whether it is illegal from the legal level, finally pointed out the negative impact on the society, and put forward that taking age as the standard for the allocation of scarce medical resources is not suitable for China’s national conditions.

Objective To quantitatively evaluate the structure and content of the long-term care policy for the older people in the 14th Five-Year Plan in China. Methods The primary indicators were constructed based on multi-source flow model,using Policy Modeling Consisten-cy(PMC)model,and the secondary indicators were constructed based on World Health Organization reports Long-term care for older people:Package for universal health coverage and Decade of healthy ageing:Plan of action.An evaluation system was formed,containing nine primary indicators and 35 secondary indicators.A total of eight policies issued by the nation between November,2021 and January,2024 were included.High-frequency words were extracted using ROSTCM 6.0,a semantic network map of keywords was created using Gephi,and the policies were analyzed using the evaluation system. Results The policies mainly focused on nursing,community,rehabilitation and nursing home,etc.The average PMC in-dex was 6.77.For the policy content coverage,one policy was perfect,five were excellent and two were accept-able.In the dimension of policy content,the indexes of three primary indicators of policy function,policy recep-tors and infrastructure construction were 0.85 or more;while the indexes of three primary indicators of caregiver assistance,support for the elderly and human resources building were 0.7 or less. Conclusion The content of long-term care policies for the older people issued in the 14th Five-Year Plan in China covers well in policy functions,policy recipients and infrastructure,and needs to be upgraded in the three dimensions of caregiver assistance,support for the elderly and human resource building.It is important to strengthen the policy content and measures in three areas,namely,the comprehensive care support network,the creation of an age-friendly environment and support for informal care.

Background and objective The proportion of patients carrying driver gene mutations is notably high among individuals with non-small cell lung cancer(NSCLC)in China.However,the current neoadjuvant treatment strategies for these patients lack evident benefits.This study aims to investigate the efficacy and adverse reactions of neoadjuvant immu-nochemotherapy in patients with driver gene-positive NSCLC,thereby exploring its potential therapeutic value.Methods A total of 50 patients from two centers were retrospectively collected to compare the efficacy and adverse reactions among driver gene-positive NSCLC patients after different treatments and further explore the response to neoadjuvant immunochemo-therapy among different EGFR-sensitive subtypes.Results A total of 50 patients from two centers were included in this study.Among the 40 patients from Peking University People's Hospital(PKUPH),21 received neoadjuvant immunotherapy,with 57.1％ showing partial response on imaging.The major pathological response(MPR)rate after neoadjuvant immunochemo-therapy was 38.1％ ,and pathological complete response(pCR)was only observed in this group.No significant differences were noted in adverse events or their impact on surgical difficulty among different treatments.Additionally,10 patients from Hunan Cancer Hospital(HNCA)were included to analyze the differences in efficiency among EGFR-sensitive subtypes under various neoadjuvant strategies.No significant radiological response differences were observed between neoadjuvant immunotherapy and targeted therapy.However,patients with the L858R mutation exhibited MPR and pCR only after receiving immuno-therapy,surpassing targeted therapy outcomes,while no significant differences were found among 19del patients.Conclusion Under the premise of not exacerbating adverse effects,neoadjuvant immunochemotherapy achieved superior rates of MPR and pCR,with long-term survival comparable to targeted therapy.