OBJECTIVE To analyze the potential adverse drug interactions （pADIs） of clarithromycin， and establish refined prescription pre-review rules. METHODS Outpatient prescriptions of clarithromycin in combination with other drugs were collected from January 1， 2024 to June 30， 2024 through hospital information system of the Third People’s Hospital of Bengbu. pADIs were identified and their risk severities were graded according to Lexicomp and Micromedex databases. Then， refined prescription pre- review rules for clarithromycin pADIs-related drugs were established according to the identification and risk level results. RESULTS Among 3 046 clarithromycin combined drug prescriptions， 946 cases of pADIs occurred in 812 prescriptions. There were 6， 415 and 525 cases classified as “contraindicated”，“ major” and “moderate”， respectively. The combination drugs with “contraindicated” levels were tamsulosin， rupatadine， domperidone and ticagrelor， while those with “major” levels were mainly theophylline， dexamethasone and amlodipine. Accordingly， 26 refined rules were established， including 4 items of “warning information→prescription interception”， 11 items of “warning information→prescription double signature” and 11 items of “attention information→prescription approval”. CONCLUSIONS There are “contraindicated” and “major” risks associated with clarithromycin and its combination drugs in the hospital， and refined prescription pre-review rules for clarithromycin combined drug prescription have been established successfully.

To introduce and analyze guideline terminology related to clinical question formulation, evidence retrieval and appraisal, and recommendation development.

ObjectiveTo establish steroid-induced osteonecrosis of the femoral head （SANFH） cell model by using dexamethasone （DEX）-induced bone marrow mesenchymal stem cells （BMSCs） and demonstrate that Gushing Granules （GSNs） exert an improving effect by activating the phosphatidylinositol-3-kinase/protein kinase B/B-lymphoma-2 gene related promoter （PI3K/Akt/Bad） signalling pathway. MethodsFirstly， SD rats were orally administered with drugs at a dose of 0.9 g·kg^-1 to prepare GSN-containing serum， and CCK-8 screening was used to determine the optimal dosage and duration of action. Then， BMSCs were cultured and treated with 1×10^-6 mol·L^-1 DEX， 10% GSN-containing serum， and inhibitor LY294002 of PI3K/Akt signalling pathway for 24 hours to model and group SANFH cells. Cell viability and proliferation were detected by using CCK-8 assay kit and EdU staining kit. Flow cytometry was used to detect cell apoptosis. An alkaline phosphatase （ALP） assay kit was employed to detect ALP expression. In order to detect the PI3K/Akt/Bad signalling pathway and protein and mRNA expression of apoptosis-related proteins such as apoptosis regulatory factors B-cell lymphoma-2 gene （Bcl-2）， and Bcl-2-associated X protein （Bax）， osteocalcin （OCN）， and Collagen Ⅰ， we used Western blot and Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultsThe CCK-8 assay kit determined that the optimal dosage for GSN-containing serum is 10%， and the duration of action is 48 hours. After modelling and grouping the cells in each group， the detection results showed that the SANFH model group had significantly lower cell viability， cell proliferation， and ALP expression， as well as protein and mRNA expressions of PI3K， Akt， Bad， Bcl-2， OCN， and Collagen I compared to the blank group. The nucleic acid and protein levels of the Bax index and the cell apoptosis rate detected by flow cytometry significantly increased （P<0.05，P<0.01）. After treatment with GSN-containing serum， cell viability， cell proliferation， and ALP expression， as well as expressions of PI3K， Akt， Bad， Bcl-2， OCN， and Collagen Ⅰ nucleic acids and proteins were significantly increased， while the nucleic acid and protein levels of the Bax index and the cell apoptosis rate detected by flow cytometry significantly decreased（P<0.05，P<0.01）. Compared with the GSN drug-containing serum group， the simultaneous treatment with the inhibitor LY294002 and GSN drug-containing serum reversed the improvement effect of GSN. Specifically， the cell viability， cell proliferation， ALP expression， and the nucleic acid and protein levels of PI3K， Akt， Bad， Bcl-2， OCN， and Collagen Ⅰ were all significantly decreased， while the nucleic acid and protein levels of the Bax index and the cell apoptosis rate detected by flow cytometry were significantly increased （P<0.05， P<0.01）. ConclusionGSNs antagonize DEX-induced apoptosis of BMSCs by activating the PI3K/Akt/Bad signalling pathway， providing a scientific theoretical basis for the clinical treatment of SANFH with GSNs.

Inflammatory diseases (IDs) are a general term of diseases characterized by chronic inflammation as the primary pathogenetic mechanism, which seriously affect the quality of patient′s life and cause significant social and medical burden. Current drugs for IDs include nonsteroidal anti-inflammatory drugs, corticosteroids, immunomodulators, biologics, and antioxidants, but these drugs may cause gastrointestinal side effects, induce or worsen infections, and cause non-response or intolerance. Given the outstanding performance of metal polyphenol network (MPN) in the fields of drug delivery, biomedical imaging, and catalytic therapy, its application in the diagnosis and treatment of IDs has attracted much attention and significant progress has been made. In this paper, we first provide an overview of the types of IDs and their generating mechanisms, then sort out and summarize the different forms of MPN in recent years, and finally discuss in detail the characteristics of MPN and their latest research progress in the diagnosis and treatment of IDs. This research may provide useful references for scientific research and clinical practice in the related fields.

AIM: To investigate how angles kappa and alpha affect postoperative visual quality in patients with multifocal intraocular lens(mIOLs)implantation.METHODS: Retrospective cases series. A total of 46 patients(46 eyes)who underwent phacoemulsification were subsumed. The correlation between Preoperative angles kappa and alpha, wave-front aberrations and objective visual quality of cornea, internal, and total eye after surgery were analyzed using iTrace.RESULTS: The magnitude of angle kappa was negatively correlated with internal and total modulation transfer function(MTF)at 3 mm; the magnitude of angle kappa was positively correlated with astigmatism, trefoil, higher-order aberrations(HOAs)of both internal and total eye at 3 mm. The magnitude of angle alpha was negatively correlated with total MTF and total Strehl ratio at 3 mm. The magnitude of angle alpha was positively correlated with corneal coma at 5 mm, internal astigmatism at both 3 mm and 5 mm, and total spherical aberration(SA)at 3 mm. Multivariate linear regression analysis showed that, among candidate independent variables(kappa, alpha, astigmatism, SA, coma, trefoil, and HOAs), astigmatism is the only independent factor for altering corneal MTF at 3 mm and 5 mm; astigmatism and HOAs emerged as independent factors for altering internal MTF at 3 mm and 5 mm, and total MTF at 3 mm; astigmatism, SA and HOAs emerged as independent factors for altering total MTF at 5 mm.CONCLUSION: With greater preoperative angle kappa or angle alpha, patients who accept mIOL implantation tend to have larger internal astigmatism and HOAs, which resulting in poor visual quality, especially those with small pupil size.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Background::Gastric cancer (GC), a malignant tumor with poor prognosis, is one of the leading causes of cancer-related deaths worldwide; consequently, identifying novel therapeutic targets is crucial for its corresponding treatment. NUF2, a component of the NDC80 kinetochore complex, promotes cancer progression in multiple malignancies. Therefore, this study aimed to explore the potential of NUF2 as a therapeutic target to inhibit GC progression. Methods::Clinical samples were obtained from patients who underwent radical resection of GC at Lanzhou University Second Hospital from 2016 to 2021. Cell count assays, colony formation assays, and cell-derived xenotransplantation (CDX) models were used to determine the effects of NUF2 on GC progression. Flow cytometry was used to detect the effect of NUF2 or quercetin on cell cycle progression and apoptosis. A live-cell time-lapse imaging assay was performed to determine the effect of NUF2 on the regulation of mitotic progression. Transcriptomics was used to investigate the NUF2-associated molecular mechanisms. Virtual docking and microscale thermophoresis were used to identify NUF2 inhibitors. Finally, CDX, organoid, and patient-derived xenograft (PDX) models were used to examine the efficacy of the NUF2 inhibitor in GC. Results::NUF2 expression was significantly increased in GC and was negatively correlated with prognosis. The deletion of NUF2 suppressed GC progression both in vivo and in vitro. NUF2 significantly regulated the mitogen-activated protein kinase (MAPK) pathway, promoted G2/M phase transition, and inhibited apoptosis in GC cells. Additionally, quercetin was identified as a selective NUF2 inhibitor with low toxicity that significantly suppressed tumor growth in GC cells, organoids, CDX, and PDX models. Conclusions::Collectively, NUF2-mediated G2/M phase transition and apoptosis inhibition promoted GC progression; additionally, NUF2 inhibitors exhibited potent anti-GC activity. This study provides a new strategy for targeting NUF2 to suppress GC progression in clinical settings.

Phosphatidylinositol 4 kinases are the initial and key molecules of the phosphatidyl inositol signaling pathway.Among them,the phosphatidylinositol 4-kinaseⅢ β(PI4KⅢβ)is in-volved in the synthesis of the Golgi PI4P pool,playing a vital role in numerous physiological processes.Meanwhile,the en-zyme is an important host factor mediating the replication of some pathogenic RNA viruses,and participating in other patho-logical processes such as bacterial infection and malaria.In ad-dition,studies have shown that the function of PI4KⅢβ is regu-lated by numerous factors,including host and viral protein bind-ing partners.This review will discuss the structure and the phys-iopathology regulatory mechanism of PI4KⅢβ.

Objective:To investigate the risk factors and predictive value on acute kidney injury (AKI) following surgery, and to elucidate the relationship between platelet/white blood cell ratio (PWR) and AKI.Methods:A retrospective case-control study was conducted. The patients who underwent surgery admitted to Honghui Hospital of Xi'an Jiaotong University from January 2019 to January 2023 were enrolled. The patients who developed AKI during the postoperative hospital stay were categorized as the AKI group, while those with normal renal function or not meeting AKI criteria were categorized as the non-AKI group. Demographic information, clinical characteristics, perioperative medication usage, surgical related information, and preoperative and postoperative laboratory indicators were collected. Binary multivariate Logistic regression analysis was used to identify risk factors for postoperative AKI. Receiver operator characteristic curve (ROC curve) was plotted to assess the predictive efficacy of postoperative PWR for postoperative AKI.Results:A total of 420 patients were enrolled finally, with 72 developing AKI during hospitalization and 348 not developing AKI. Compared with the non-AKI group, the patients in the AKI group had a higher proportion of hypertension and coronary heart disease, a more usage of angiotensin converting enzyme inhibitor (ACEI), mannitol and vancomycin but a less usage of hydroxyethyl starch, a longer duration from injury to surgery and postoperative hospital stay, a greater intraoperative blood transfusion volume, a lower preoperative albumin (Alb), blood sodium, blood chlorine but a higher serum creatinine (SCr), blood urea nitrogen (BUN)/Alb ratio and N-terminal pro-brain natriuretic peptide (NT-proBNP), and a higher postoperative white blood cell count (WBC), BUN, SCr, BUN/Alb ratio, blood potassium, and blood phosphorus but a lower platelet count (PLT), PWR, and Alb. Binary multivariate Logistic regression analysis revealed that perioperative usage of hydroxyethyl starch [odds ratio ( OR) = 8.595, 95% confidence interval (95% CI) was 4.112-17.964, P < 0.001], prolonged duration from injury to surgery ( OR = 1.084, 95% CI was 1.034-1.137, P = 0.001), increased intraoperative blood transfusion volume ( OR = 1.001, 95% CI was 1.000-1.002, P = 0.017) were risk factors for AKI following surgery, and increased postoperative PWR was protective factor ( OR = 0.930, 95% CI was 0.894-0.967, P < 0.001). ROC curve analysis indicated that the area under the ROC curve (AUC) of postoperative PWR for predicting postoperative AKI was 0.684 (95% CI was 0.615-0.754); at the optimal cut-off value of 19.34, the sensitivity was 63.8%, and the specificity was 69.8%. Conclusions:Postoperative PWR is an independent risk factor for AKI in patients undergoing surgery. Postoperative PWR reduction in surgical patients can assist in predicting the occurrence of postoperative AKI.

Objective:To explore the differences in dynamic spontaneous brain activity in individuals with subjective cognitive decline (SCD) and its correlation with spatial navigation ability in SCD subjects.Methods:A total of 72 SCD subjects(SCD group) and 67 normal controls (NC group) matched for age, gender and education level were recruited from September 2020 to February 2023 at the Affiliated Drum Tower Hospital, Medical School of Nanjing University. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) examinations, spatial navigation tests and cognitive function assessments. The rs-fMRI time series were segmented using a sliding time window method, and statistical analyses were carried out using SPSS 26.0 software to compare the differences in the dynamic amplitude of low frequency fluctuation (dALFF) between the two groups. Correlation analysis was conducted between dALFF values in different brain regions and scale scores and spatial navigation tests.Results:Compared with the NC group, the dALFF variability in the right precuneus(0.119±0.021, 0.130±0.031) and left cuneus(0.143±0.034, 0.156±0.032) in SCD group decreased ( t=-3.41, -3.12, P<0.05, FDR corrected), and the dALFF variability in the right middle occipital gyrus(0.146±0.023, 0.137±0.020) and right angular gyrus(0.148±0.025, 0.139±0.026) increased ( t=4.51, 3.36, both P<0.05, FDR corrected). The temporal variability of dALFF in the right precuneus in SCD group was negatively correlated with egocentric spatial navigation ( r=-0.341, P=0.025), delayed allocentric spatial navigation ( r=-0.286, P=0.035) and memory function ( r=-0.332, P=0.009). The temporal variability of dALFF in the left middle occipital gyrus was positively correlated with language function ( r=0.339, P=0.015) and visuospatial function ( r=0.343, P=0.008) in SCD group. Conclusions:The temporal variability of dALFF in the right precuneus and the left middle occipital gyrus may be the neurobiological basis of cognitive decline and spatial navigation impairment in SCD subjects, and it can be used as a potential imaging marker for early identification of SCD patients.