ObjectiveTo study the effect and mechanism of Shentong Zhuyutang in treating intervertebral disc degeneration （IDD） in rats. MethodsIn the cell experiment， male rats were administrated with normal saline or low-， medium-， and high-dose （3.38， 6.75，13.5 g·kg^-1， respectively） Shentong Zhuyutang by gavage， respectively， and serum samples were collected after 7 days of continuous administration. Another 10 male rats were selected for the isolation of nucleus pulposus cells. The cell model of IDD was established by treatment with interleukin （IL）-1β. The modeled cells were then treated with Shentong Zhuyutang-containing serum and the ferroptosis inhibitor ferrostatin-1 （Fer-1）， respectively， to investigate the effects of Shentong Zhuyutang-containing serum on the proliferation and ferroptosis of nucleus pulposus cells. To study the role of silent information regulator 1 （SIRT1）/nuclear factor erythroid 2-related factor 2 （Nrf2） in the regulation of ferroptosis in nucleus pulposus cells by Shentong Zhuyutang-containing serum， this study treated the cells with the SIRT1 inhibitor Ex 527 and the Nrf2 inhibitor ML385， respectively， in addition to the treatment with IL-1β and high-dose Shentong Zhuyutang-containing serum. The cell-counting kit-8 （CCK-8） assay and EdU staining were employed to measure the cell viability and proliferation， respectively. The Fe²⁺， glutathione （GSH）， and malondiadehyde （MDA） levels were measured by colorimetric assay. Western blot was employed to determine the protein levels of glutathione peroxidase 4 （GPX4）， acyl-CoA synthetase long-chain family 4 （ACSL4）， Collagen Ⅱ， Aggrecan， SIRT1， and Nrf2. Immunofluorescence was used detect SIRT1 expression. In the animal experiment， male rats were treated with anulus puncture for the modeling of IDD. Rats were randomly assigned into sham operation， model， Shentong Zhuyutang-containing serum （13.5 g·kg^-1）， and positive control （nimesulide dispersible tablets， 0.18 mg·kg^-1） groups. Rats in the drug intervention groups were administrated with corresponding agents at 1 mL·kg^-1， and those in the sham operation and model groups were administrated with equal volumes of normal saline， once daily for 28 consecutive days. At the end of the last administration， the histopathological changes in the intervertebral discs of rats were observed by hematoxylin-eosin staining and scored by the Masuda method. Western blot was employed to determine the protein levels of SIRT1， Nrf2， GPX4， and Collagen Ⅱ in the nucleus pulposus tissue. ResultsCompared with the control group， the IL-1β group of nucleus pulposus cells showed elevated levels of Fe²⁺， MDA， and ACSL4 （P<0.05）， decreased cell viability， lowered GSH level， and down-regulated protein levels of GPX4， Collagen Ⅱ， and Aggrecan （P<0.05）. Shentong Zhuyutang-containing serum and Fer-1 reversed the effects of IL-1β on the viability and ferroptosis of nucleus pulposus cells and up-regulated the protein levels of Collagen Ⅱ and Aggrecan in nucleus pulposus cells （P<0.05）. Compared with the control group， the IL-1β group showcased down-regulated expression of Sirt1 and Nrf2 in nucleus pulposus cells （P<0.05）. Compared with the IL-1β group， the high-dose Shentong Zhuyutang-containing serum+IL-1β group showed up-regulated expression of SIRT1 and Nrf2 in nucleus pulposus cells （P<0.05）. Compared with the high-dose Shentong Zhuyutang-containing serum+IL-1β group， the ML385 group showed down-regulated protein levels of Nrf2 and GPX4， lowered GSH level， and elevated Fe²⁺ and MDA levels （P<0.05）. In addition， the Ex 527 group showed down-regulated protein levels of SIRT1， Nrf2， and GPX4 （P<0.05）. The results of the animal experiment showed that compared with the sham operation group， the model group had severe degeneration of the intervertebral disc tissue with increased pathological score， up-regulated protein level of ACSL4 （P<0.05）， and down-regulated protein levels of SIRT1， Nrf2， GPX4， and Collagen Ⅱ （P<0.05）. Compared with the model group， the Shentong Zhuyutang group showed alleviated IDD with declined pathological score， down-regulated protein level of ACSL4 （P<0.05）， and up-regulated protein levels of SIRT1， Nrf2， GPX4， and Collagen Ⅱ （P<0.05）. ConclusionShentong Zhuyutang may activate the SIRT1/Nrf2 signaling pathway to inhibit the ferroptosis of nucleus pulposus cells， thereby delaying the process of IDD in rats.

Huangqintang， with its accurate efficacy， is a classic formula specialized in treating dysentery recommended and promoted by medical experts from successive generations， and it was included in the Catalogue of Ancient Classic Prescriptions （the Second Batch， Han Chinese medicine prescriptions） published by the National Administration of Traditional Chinses Medicine （TCM） in 2023. The method of bibliometrics was applied in this study to conduct textual research on the classic formula Huangqintang and provide a literature reference for the development of modern preparations of Huangqintang. A total of 2 026 pieces of ancient literature were searched with "Huangqintang" as the key word， and 23 pieces of effective data were selected， involving 15 ancient TCM books. The historic evolution， composition， dosage， origin， processing methods， preparation and decocting methods， efficiency， and application of Huangqintang were carefully reviewed. The results showed that Huangqintang was first recorded in the Treatise on Febrile Diseases written by ZHANG Zhongjing. It has the effect of clearing heat， stopping dysentery， regulating the middle， and downbearing counterflow and has become one of the classic formulas widely used in clinical practice. Because of its accurate efficacy， medical experts from later generations have modified it from its original composition. Though many prescriptions have different names， it is the manifestation of physicians' inheritance and development of the thought of ZHANG Zhongjing. Ancient literature showed this prescription had wide indications yet centered on digestive system diseases such as dysentery and abdominal pain. Modern applications of Huangqintang involve digestive， respiratory， ophthalmology and otolaryngology， gynecological， skin， musculoskeletal system， and connective tissue， and this prescription has great potential in treating ulcerative colitis， diarrhea， acute enteritis， and damp-heat dysentery. Through a systematic textual excavation and review of the ancient literature about Huangqintang， the paper has confirmed its key information， so as to provide a scientific basis for the clinical application and new drug development of classic formulas.

Lipid turbidity disease is a metabolic disease featuring lipid metabolism disorders caused by many factors such as social environment， diet， and lifestyle， which is closely related to many diseases in modern medicine， such as hyperlipidemia， obesity， fatty liver， atherosclerosis， metabolic syndrome， and cardiovascular and cerebrovascular diseases， with a wide range of influence and far-reaching harm. According to the Huangdi Neijing， lipid turbidity disease reflects the pathological change of the body's physiologic grease. Grease is the thick part of body fluids， which has the function of nourishing， and it is the initial state and source of important substances in the human body such as brain， marrow， essence， and blood. Once the grease of the human body is abnormal， it can lead to lipid turbidity disease. The Huangdi Neijing also points out the physiological relationship between the transportation and transformation of body fluids and the rise and fall of the spleen and stomach， which can deduce the pathological relationship between the occurrence of lipid turbidity disease and the abnormal rise and fall of the spleen and stomach functions. Lipid turbidity disease is caused by overconsumption of fatty and sweet foods or insufficient spleen and stomach endowments， leading to disorders of the function of promoting clear and reducing turbidity in the spleen and stomach. This leads to the transformation of thick grease in body fluids into lipid turbidity， which accumulates in the body's meridians， blood vessels， skin pores， and organs， forming various forms of metabolic diseases. The research team believed that the pathological basis of lipid turbidity disease was the abnormal rise and fall of the spleen and stomach and the obstruction of the transfer of grease. According to the different locations where lipid turbidity stays， it was divided into four common pathogenesis types： ''inability to distinguish between the clear and turbid， turbid stagnation in the Ying blood''， ''spleen not rising clear， turbid accumulation in the vessels''， ''spleen dysfunction， lipid retention in the pores''， ''spleen failure to transportation and transformation， and grease accumulation in the liver''. According to the pathogenesis， it could be divided into four common syndromes， namely， turbid stagnation in the Ying blood， turbid accumulation in the vessels， lipid retention in the pores， and grease accumulation in the liver， and the corresponding prescriptions were given for syndrome differentiation and treatment， so as to guide clinical differentiation and treatment of the lipid turbidity disease.

Malignant tumor metastasis is the key factor leading to poor prognosis of patients， and it is a difficult problem to be overcome in the field of tumor therapy. Metabolic reprogramming， as a key link in the regulation of tumor metastasis activity， affects the growth， invasion， and metastasis of tumor cells by changing the metabolic pathways of intracellular substances （such as glucose， amino acids， lipids， and nucleotides）. In particular， metabolic reprogramming plays a key role in the multistage linked steps related to tumor metastasis and can play a crucial role in several key stages of tumor tissue dissociation in situ， hematogenous metastasis， and remote colonization. Malignant tumor cells can selectively adjust their own metabolic state to adapt to the growth conditions of different metastatic microenvironments and colonization sites and then choose the most favorable growth and metabolism strategy. According to the holistic concept of traditional Chinese medicine （TCM）， the metastasis of malignant tumors is generally closely related to the metabolic state of the whole body. One of the advantages of TCM in the treatment of malignant tumors is systemic regulation. With its multi-pathway， multi-target， and multi-component therapeutic characteristics， TCM can effectively control the metastasis of malignant tumors by regulating the degradation of tumor epithelial mesenchymal transformation （EMT） and extracellular matrix （ECM）， anchoring the independent growth of tumor cells and the tumor microenvironment. In this paper， the potential regulatory effects of metabolic reprogramming on the metastasis of malignant tumors were discussed， and the latest research progress of the regulation of metabolic reprogramming by TCM on tumor metastasis was reviewed. At the same time， the key targets of TCM and its bioactive components in the process of tumor metastasis intervention were reviewed. This study aims to provide a more valuable basis and clearer idea for the treatment of malignant tumor metastasis by regulating metabolic reprogramming with TCM.

Building on the theory of "state-target differentiation and treatment" proposed by Academician TONG Xiaolin， diabetic foot ulcers （DFUs） are considered to belong to the "collateral injury" stage， characterized by the interplay of five states，i.e. dampness， heat， stasis， deficiency， and impairment. The dynamic biological process of epithelial-mesenchymal transition （EMT） is closely associated with the healing process of DFUs. The treatment of DFUs through staged differentiation under the "state-target differentiation and treatment" theory not only provides a basis for precise clinical treatment， but also offers insights into the regulatory roles of EMT in different states and potential intervention targets. The dampness state typically exits during the inflammatory phase， local inflammation and fluid metabolism disorders inducing EMT. Treatment focuses on draining dampness and alleviating edema， promoting local microcirculation， and improving tissue hypoxia. The heat state often reflects acute local inflammatory responses. Treatment emphasizes clearing heat and resolving toxins， regulating the EMT process to reduce inflammation， control infection， and alleviate redness， swollen， heat， and pain in the affected area. The stasis state mainly occurs during the proliferation phase. Treatment centers on invigorating blood and dissolving stasis， and unblocking the channels and quickening the collaterals. EMT plays a role in remodeling the extracellular matrix， promoting tissue repair and angiogenesis. The deficiency state is common in chronic phase， where treatment prioritizes tonifying qi and nourishing blood while reinforcing healthy qi and dispelling pathogens. EMT regulation focuses on restoring local tissue metabolism and improving the micro-environment to enhance tissue repair capacity. The impairment state represents the progression of disease deterioration. Treatment should focus on supplementing qi， blood， yin， and yang， and also promoting muscle growth and strengthening bones， supplementing by resolving toxins and stasis. EMT plays a role by regulating the activity of extracellular matrix-degrading enzymes to prevent excessive tissue repair and scarring， thereby facilitating the reconstruction of normal tissue structures.

OBJECTIVE To explore the practice and application effect of lean Six Sigma （LSS） management in the cost- benefit management of PIVAS operation in a tertiary comprehensive hospital （hereinafter referred to as “S Hospital”）， providing reference for the operation and management of PIVAS in hospitals. METHODS The five steps （define， measure， analyze， improve and control， i.e. DMAIC） of LSS management were implemented for PIVAS operation cost-benefit of S Hospital， and lean management was implemented for its cost-benefit management elements （human resource cost， medical and health material cost， and all-in-one parenteral nutrition preparation income）. Several intervention measures including personnel training and performance assessment， refined management system of consumables， and doctor’s advice package of full parenteral nutrition were developed. Finally， the overall improvement effect was evaluated by the total benefit， total cost and net benefit of PIVAS. The effects of human resource allocation optimization and improvement were evaluated by the work efficiency， work quality， job satisfaction， turnover rate and accumulated rest days. The effects of consumables cost management were evaluated by the amount of medical and health materials cost. The improvement effects of all-in-one parenteral nutrition preparation income were evaluated by the profit amount， quantity and the proportion of single bottle of parenteral nutrition. RESULTS After implementing DMAIC in S Hospital， the total benefit of PIVAS was increased from （471 366.50±9 201.5） yuan/month to （479 679.50±14 320.14） yuan/month （P＞ 0.05）， the total cost was decreased from （305 878.88±3 201.75） yuan/month to （294 610.59±5 007.33） yuan/month （P＜0.05）， and the net benefit of PIVAS was increased by 11.83% compared with that before the improvement. The work efficiency， work quality and job satisfaction of employees were significantly improved， the accumulated rest days were significantly reduced， and the turnover rate of third-party employees was reduced from 15.0% before the improvement to 7.5% after the improvement. The cost of medical and health materials significantly decreased from （67 826.42±2 812.76） yuan/month before improvement to （56 384.33±4 607.67） yuan/month after improvement （P＜0.05）. The quantity of all-in-one parenteral nutrition was significantly increased from （1 263.75±135.83） group/month before improvement to （2 061.25±89.04） group/month after improvement （P＜0.05）， and the proportion of users of single bottle of parenteral nutrition in total users decreased from 93.25% before improvement to 58.75% after improvement. The profit of all-in-one parenteral nutrition was 63.18% higher than that before implementing DMAIC. CONCLUSIONS The implementation of PIVAS operation cost-benefit management based on DMAIC is conducive to strengthening the cost control of PIVAS and promoting the healthy development of PIVAS.

OBJECTIVE To optimize the simmering technology of Rheum palmatum from Menghe Medical School and compare the difference of chemical components before and after processing. METHODS Using appearance score， the contents of gallic acid， 5-hydroxymethylfurfural （5-HMF）， sennoside A+sennoside B， combined anthraquinone and free anthraquinone as indexes， analytic hierarchy process （AHP）-entropy weight method was used to calculate the comprehensive score of evaluation indicators； the orthogonal experiment was designed to optimize the processing technology of simmering R. palmatum with fire temperature， simmering time， paper layer number and paper wrapping time as factors； validation test was conducted. The changes in the contents of five anthraquinones （aloe-emodin， rhein， emodin， chrysophanol， physcion）， five anthraquinone glycosides （barbaloin， rheinoside， rhubarb glycoside， emodin glycoside， and emodin methyl ether glycoside）， two sennosides （sennoside A， sennoside B）， gallic acid and 5-HMF were compared between simmered R. palmatum prepared by optimized technology and R. palmatum. RESULTS The optimal processing conditions of R. palmatum was as follows: each 80 g R. palmatum was wrapped with a layer of wet paper for 0.5 h， simmered on high heat for 20 min and then simmered at 140 ℃， the total simmering time was 2.5 h. The average comprehensive score of 3 validation tests was 94.10 （RSD＜1.0%）. After simmering， the contents of five anthraquinones and two sennosides were decreased significantly， while those of 5 free anthraquinones and gallic acid were increased to different extents； a new component 5-HMF was formed. CONCLUSIONS This study successfully optimizes the simmering technology of R. palmatum. There is a significant difference in the chemical components before and after processing， which can explain that simmering technology slows down the relase of R. palmatum and beneficiate it.

ObjectiveTo explore the process and guidelines for ethical review in decentralized drug clinical trials， promote clinical trial progress， and ensure drug development progress. MethodsThe key points of the ethical review were summarized by studying the relevant laws and regulations on decentralized drug clinical trials， analyzing the advantages and challenges of decentralized drug clinical trials， and combining the experience of the ethics committee of the institution in reviewing decentralized drug clinical trials. ResultsRelevant laws and regulations were the basis for the ethical review， and the ethics committee should adopt appropriate review methods based on regulations and hospital ethical standard operating procedures. The ethics committee should focus on the feasibility， applicability， and rationality， the adequacy of informed consent， the protection of rights and interests and privacy of subjects， as well as the qualification and standard operating procedures of electronic platforms for conducting decentralized drug clinical trials. ConclusionDecentralized drug clinical trials are in their early stages and urgently require guidance from relevant laws and regulations. Ethical review is also constantly being refined through exploration. It is necessary to supervise the implementation of responsibilities by all parties， pay attention to the rights and interests of subjects， and gradually promote the implementation of decentralized drug clinical trials.

In September 2023， the Measures for Scientific and Technological Ethics Review （Trial Implementation） was issued， revising the provisions related to the simplified procedure for ethical review in Chapter 3， Section 3. This revision of these provisions provides systematic guarantees for further optimizing ethical review work， ensuring that ethical review procedure is well-regulated， and improving scientific research efficiency. The “simplified procedure” does not mean reducing the quality and requirements of the review. Instead， based on always following internationally recognized ethical standards and emphasizing not violating national laws and regulations， improving the efficiency of ethical review and subsequent research work， and promoting the development of life sciences and medical research involving humans. In practical work， it introduces numerous new opportunities and challenges for the improvement of ethics review ability， such as new tests on the judgment and decision-making power of ethics committees， how to ensure the reliability and controllability of the conditions related to the simplified review procedure， and how to determine the basic conditions for adopting the simplified review procedure for review. Therefore， to actively respond to the challenges and possible risks brought by the simplified procedure review， efforts should be made to achieve three “unifications”， including the unification of researchers’ moral autonomy and the heteronomy of supervision implemented by relevant departments； the unification of the standard formulation of the simplified procedure review and the review work in practice； and the unification of ethical responsibility and legal responsibility.

It is proposed that both "skin interior-membrane exterior" （the region between the skin and membranes） and "membrane-source" are objective parts of human body. Based on relevant ancient texts， interpretations by physicians， and clinical characteristics of diseases， we analysed the relationship between skin interior-membrane exterior and membrane-source， and proposed that skin interior-membrane exterior is essentially equivalent to membrane-source， with skin interior-membrane exterior offering a clearer expression of the meaning. The medicinal practices and prescriptions recorded in materia medica and classical formulas provide evidence to support that skin interior-membrane exterior is same as membrane-source. Based on the researches on their relationship， the formula groups for the treatment of membrane-source diseases developed， potentially expanding the clinical applications of membrane-source formulas and offering new approaches to the diagnosis and treatment of complex diseases in clinic.