Objective To determine the molecular mechanism of Yuchang granule (YCG) against ulcerative colitis （UC） by network pharmacology-based approach combined with molecular docking. Methods TCMSP and HIT database were utilized to search the active components and potential targets of YCG. The effective targets of UC were obtained by GeneCards, CTD, and DisGeNET databases. Venn Diagram was exploited to receive common targets of YCG and UC. Network maps of the TCM of YCG-active component-common targets were constructed by the Cytoscape software to gain key active components. Protein-protein interaction （PPI） of common targets was constructed by the STRING database obtaining core common targets. The mechanism and therapeutic effects of YCG on UC were explored via gene ontology （GO） and the biological pathway （KEGG） enrichment analyses. Molecular docking technology was carried out to verify the combination of core active components with key common targets. Results 98 active components and 237 potential targets were sieved from YCG, and 1061 effective targets were screened from UC. 94 common targets of YCG and UC were regarded as potential therapeutic targets. Bioinformatics analysis revealed that quercetin, luteolin, β-quebrachol, stigmasterol, and kaempferol may be the potential candidate agents. Tumor necrosis factor （TNF）, serine/threonine-protein kinase （AKT1）, tumor protein p53 （TP53）, interleukin-6 （IL-6） and IL-1β could become potential therapeutic targets. KEGG showed pathways in cancer, AGE-RAGE signaling pathway in diabetic complications, TNF signaling pathway, and IL-17 signaling pathway might play an important role in YCG against UC. Molecular docking results showed that quercetin combined well with TNF, AKT1, and TP53. And stigmasterol did well with AKT1. Conclusion This study comprehensively illustrated the potential candidate agents, potential therapeutic targets, and pathways of YCG against UC. It also illustrated that YCG could act on multiple targets through multi-pathway treating UC.

Objective:To evaluate the impact of Diagnosis-Intervention Packet(DIP)payment reform on medical service costs and efficiency for inpatients in public hospitals,and to compare differences between surgical and medical groups.Methods:A quasi-experimental design was employed,using 605 636 discharged patients from a tertiary hospital in Hebei Province between January 2020 and March 2025 as the sample.The difference-in-differences(DID)model was used to analyze the changes in key indicators between the DIP settlement group(intervention group)and the non-DIP settlement group(control group).Results:Total hospitalization costs,out-of-pocket expenses,and medication costs were significantly reduced in the DIP settlement group(P<0.05),while costs for examinations,nursing,laboratory tests,and treatments increased significantly(P<0.05).Material costs increased by 30.7%in the surgical group(P<0.1)and decreased by 19.8%in the medical group(P<0.01).In terms of efficiency,the average length of stay,time,and cost consumption index all decreased(P<0.01),while the proportion of medical services increased(P<0.01).The case mix index(CMI)showed no significant changes.Conclusion:The DIP reform effectively controlled costs and improved efficiency,but it also resulted in cost shifting and departmental disparities.Therefore,it is necessary to optimize cost control and departmental management policies.

OBJECTIVE: This study reports the first imported case of Lassa fever (LF) in China. Laboratory detection and molecular epidemiological analysis of the Lassa virus (LASV) from this case offer valuable insights for the prevention and control of LF. METHODS: Samples of cerebrospinal fluid (CSF), blood, urine, saliva, and environmental materials were collected from the patient and their close contacts for LASV nucleotide detection. Whole-genome sequencing was performed on positive samples to analyze the genetic characteristics of the virus. RESULTS: LASV was detected in the patient's CSF, blood, and urine, while all samples from close contacts and the environment tested negative. The virus belongs to the lineage IV strain and shares the highest homology with strains from Sierra Leone. The variability in the glycoprotein complex (GPC) among different strains ranged from 3.9% to 15.1%, higher than previously reported for the seven known lineages. Amino acid mutation analysis revealed multiple mutations within the GPC immunogenic epitopes, increasing strain diversity and potentially impacting immune response. CONCLUSION The case was confirmed through nucleotide detection, with no evidence of secondary transmission or viral spread. The LASV strain identified belongs to lineage IV, with broader GPC variability than previously reported. Mutations in the immune-related sites of GPC may affect immune responses, necessitating heightened vigilance regarding the virus.
Humans ; China/epidemiology* ; Genome, Viral ; Lassa Fever/virology* ; Lassa virus/classification* ; Molecular Epidemiology ; Phylogeny

OBJECTIVES: To assess the preliminary efficacy and safety of a dose-intensified C5VD regimen (cisplatin, 5-fluorouracil, vincristine, and doxorubicin) in children with locally advanced hepatoblastoma. METHODS: This prospective study enrolled 24 children with newly diagnosed, locally advanced hepatoblastoma who received the dose-intensified C5VD regimen at Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, and Shanghai Children's Hospital between January 2020 and December 2023. Clinical characteristics, treatment outcomes, and chemotherapy-related toxicities were analyzed. RESULTS: Of the 24 patients, 13 were male and 11 were female, with a median age at diagnosis of 18.7 months (range: 3.5-79.4 months). All patients achieved complete macroscopic resection of hepatic lesions without liver transplantation. Serum alpha-fetoprotein levels decreased significantly after two chemotherapy cycles. During a median follow-up of 38.4 months (range: 15.8-50.7 months), all patients maintained continuous complete remission, with 3-year event-free survival and overall survival rates of 100%. Across 144 chemotherapy cycles, the incidence rates of grade 3-4 neutropenia, thrombocytopenia, and infections were 97%, 77%, and 71%, respectively; no treatment-related deaths occurred. Notably, 5 patients (21%) developed Brock grade ≥3 hearing loss, of whom 1 required a hearing aid. CONCLUSIONS The dose-intensified C5VD regimen demonstrates significant efficacy with an overall favorable safety profile in the treatment of newly diagnosed, locally advanced pediatric hepatoblastoma. Grade 3-4 myelosuppression and infection are the predominant toxicities. However, high‑dose cisplatin-induced ototoxicity remains a concern, highlighting the need for improved otoprotective strategies.
Humans ; Hepatoblastoma/pathology* ; Male ; Female ; Infant ; Liver Neoplasms/pathology* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Child, Preschool ; Prospective Studies ; Doxorubicin/adverse effects* ; Child ; Cisplatin/adverse effects* ; Vincristine/adverse effects* ; Fluorouracil/adverse effects*

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

Objective:To assess the preliminary efficacy and safety of modified Société Internationale d′Oncologie Pédiatrique Epithelial Liver Tumor Study Group (SIOPEL)-4 protocol for pediatric hepatoblastoma (HB) with lung metastases.Methods:This prospective cohort study enrolled 27 newly diagnosed pediatric HB with lung metastases who received the modified SIOPEL-4 protocol at Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, and Shanghai Children′s Hospital between January 2020 to December 2023. Clinical characteristics, lung response rates to induction chemotherapy, treatment outcomes, prognostic factors and sever chemotherapy toxicities at different stages were analyzed. Survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by Log-Rank test.Results:Of the 27 patients, there were 17 males and 10 females, with the age of 21 (15, 33) months. During the follow-up of 31 (12, 45) months for 17 continuous complete remission patients, 4 cases disease progression (2 cases death) and 6 cases relapse were observed. The 2-year event free survival (EFS) and overall survival (OS) rate was (58±11)% and (89±7)%, respectively. All the 27 patients had response to block 1-3 induction chemotherapy (cisplatin+doxorubicin), with 14 cases (52%) achieving complete response and 13 cases (48%) achieving partial response of lung metastatic lesions, the 2-year EFS rate was (81±12)% and (34±14)%, respectively ( χ 2=6.76, P=0.009), the 2-year OS rate was 100% and (79±13)%, respectively ( χ2=2.12, P=0.145). Patients with caudate lobe tumors or ≥10 pulmonary metastatic nodules had significantly lower EFS rates ( χ2=5.36, 7.84, P=0.021, 0.005, respectively). The incidence of grade 3/4 neutropenia after block 1-3 induction chemotherapy, CD (carboplatin+doxorubicin), and VI (vincristine+irinotecan) consolidation chemotherapy was 90% (73/81), 75% (58/77), and 31% (11/35), respectively. The incidence of grade 3/4 thrombocytopenia was 77% (62/81), 69% (53/77), and 14% (5/35), respectively. The incidence of grade 3/4 infections was 64% (52/81), 25% (19/77), and 20% (7/35), respectively. The differences between the groups were statistically significant ( χ2=43.51, 42.69, 33.00, all P<0.001). Two patients (10%) of the 20 evaluable patients for ototoxicity occurred grade 3 and higher hearing impairment, with 1 patient requiring a hearing aid. Conclusions:The modified SIOPEL-4 regimen shows good preliminary efficacy and safety in treating pediatric HB with lung metastases. The prognosis for patients with residual lesions in the lungs after induction chemotherapy needs to be improved. Attention should be given to the ototoxicity induced by high-dose cisplatin chemotherapy.

Objective:To evaluate the impact of Diagnosis-Intervention Packet(DIP)payment reform on medical service costs and efficiency for inpatients in public hospitals,and to compare differences between surgical and medical groups.Methods:A quasi-experimental design was employed,using 605 636 discharged patients from a tertiary hospital in Hebei Province between January 2020 and March 2025 as the sample.The difference-in-differences(DID)model was used to analyze the changes in key indicators between the DIP settlement group(intervention group)and the non-DIP settlement group(control group).Results:Total hospitalization costs,out-of-pocket expenses,and medication costs were significantly reduced in the DIP settlement group(P<0.05),while costs for examinations,nursing,laboratory tests,and treatments increased significantly(P<0.05).Material costs increased by 30.7%in the surgical group(P<0.1)and decreased by 19.8%in the medical group(P<0.01).In terms of efficiency,the average length of stay,time,and cost consumption index all decreased(P<0.01),while the proportion of medical services increased(P<0.01).The case mix index(CMI)showed no significant changes.Conclusion:The DIP reform effectively controlled costs and improved efficiency,but it also resulted in cost shifting and departmental disparities.Therefore,it is necessary to optimize cost control and departmental management policies.

Objective:To investigate the serum metabonomics of pancreatic cancer and chronic pancreatitis patients and screen the differential metabolites for differentiating pancreatic cancer from chronic pancreatis.Methods:From June 2021 to June 2022, the clinical data of 54 patients diagnosed with pancreatic ductal adenocarcinoma in the Department of Hepatobiliary, Pancreatic and Splenic Surgery of the First Affiliated Hospital of Naval Medical University were collected. A total of 54 patients with chronic pancreatitis who were admitted at the same time were selected as the control group. UHPLC/Q-TOF MS-based metabonomics techniques were applied to analyze the difference in serum metabolites in the two groups with multivariate and univariate statistical method, and the different metabolites were screened and identified in accordance with the molecular weight, metabolites databases and mass spectrometry (MS)/MS information. Two-thirds of the cases were randomly selected from patients with pancreatic cancer and chronic pancreatitis as the modeling population, and the remaining population was used as the validation population. In the modeled population, the receiver operating characteristic curve (ROC) of the screened differential metabolites was plotted and the area under the curve (AUC) was calculated. Differential metabolite variables with AUC ≥75%, a VIP value ≥1.5 were selected into the logistic multivariate regression analysis model, and the regression equation and the regression coefficients of each selected independent variable were obtained by stepwise regression by backward method. The final selected differential metabolites were evaluated by the formula P=1/{1+Exp[-(β0+β1X1+β1X1+…+βiXi)]} to establish a diagnostic model and predict the clinical application value of the model by evaluating it compared to the CA19-9 ROC curve. At the same time, the non-parametric Bootstrap method was used to verify the diagnostic performance of the model in the validation population. Results:There were 18 kinds of different serum metabolits in the final screening and identification in the two groups. The level of hypoxanthine, L-carnitine, acetylcarnitine, C16 sphinganine, linoleic acid, palmitoylcarnitine, linoleyl carnitine, uracil deoxynucleotide, glycocholic chenodeoxycholic acid in serum of pancreatic cancer patients were higher than that in the chronic pancreatitis patients; Uric acid, tryptophan, indoxylsulfuric acid, 1-palmitoyl lysophosphatidic acid, LPA(18∶2/0∶0), LysoPE (18∶1/0∶0), LysoPC (14∶0), LysoPC(15∶0), LysoPC(16∶1) in the serum were lower in patients with pancreatic cancer compared with that in chronic pancreatitis patients, and all the differences were statistically significant (all P value <0.05). In the modeled population, the ROC curve was established according to the peak intensity of 18 differential metabolites, and the metabolic differentiators with AUC of ≥75% and VIP value of ≥1.5 were selected for logistic multivariate analysis, and finally linoleoleic carnitine and LPA (18∶2/0∶0) were included in the logistic regression model. The prediction model of pancreatic cancer with two serum metabolites linoleyl carnitine and LPA (18∶2/0∶0) was established. The AUC value (95% CI) of the prediction model was 0.91 (0.85-0.97), which was higher than that of CA19-9 (0.85, 0.76-0.94), the sensitivity and specificity were 86.4% and 80.6%, respectively, and the sensitivity was higher than that of CA19-9 (77.3%), but the specificity was lower than that of CA19-9 (91.7%). Internal validation showed than the AUC value (95% CI) of the prediction model was 0.91 (0.79-0.94), which was higher than that of CA19-9 ( P<0.05). Conclusions:The serum metabolites linolein carnitine and LPA(18∶2/0∶0) may be potential diagnostic markers to distinguish pancreatic cancer from patients with chronic pancreatitis.

Objective:To investigate the serum metabonomics of pancreatic cancer and chronic pancreatitis patients and screen the differential metabolites for differentiating pancreatic cancer from chronic pancreatis.Methods:From June 2021 to June 2022, the clinical data of 54 patients diagnosed with pancreatic ductal adenocarcinoma in the Department of Hepatobiliary, Pancreatic and Splenic Surgery of the First Affiliated Hospital of Naval Medical University were collected. A total of 54 patients with chronic pancreatitis who were admitted at the same time were selected as the control group. UHPLC/Q-TOF MS-based metabonomics techniques were applied to analyze the difference in serum metabolites in the two groups with multivariate and univariate statistical method, and the different metabolites were screened and identified in accordance with the molecular weight, metabolites databases and mass spectrometry (MS)/MS information. Two-thirds of the cases were randomly selected from patients with pancreatic cancer and chronic pancreatitis as the modeling population, and the remaining population was used as the validation population. In the modeled population, the receiver operating characteristic curve (ROC) of the screened differential metabolites was plotted and the area under the curve (AUC) was calculated. Differential metabolite variables with AUC ≥75%, a VIP value ≥1.5 were selected into the logistic multivariate regression analysis model, and the regression equation and the regression coefficients of each selected independent variable were obtained by stepwise regression by backward method. The final selected differential metabolites were evaluated by the formula P=1/{1+Exp[-(β0+β1X1+β1X1+…+βiXi)]} to establish a diagnostic model and predict the clinical application value of the model by evaluating it compared to the CA19-9 ROC curve. At the same time, the non-parametric Bootstrap method was used to verify the diagnostic performance of the model in the validation population. Results:There were 18 kinds of different serum metabolits in the final screening and identification in the two groups. The level of hypoxanthine, L-carnitine, acetylcarnitine, C16 sphinganine, linoleic acid, palmitoylcarnitine, linoleyl carnitine, uracil deoxynucleotide, glycocholic chenodeoxycholic acid in serum of pancreatic cancer patients were higher than that in the chronic pancreatitis patients; Uric acid, tryptophan, indoxylsulfuric acid, 1-palmitoyl lysophosphatidic acid, LPA(18∶2/0∶0), LysoPE (18∶1/0∶0), LysoPC (14∶0), LysoPC(15∶0), LysoPC(16∶1) in the serum were lower in patients with pancreatic cancer compared with that in chronic pancreatitis patients, and all the differences were statistically significant (all P value <0.05). In the modeled population, the ROC curve was established according to the peak intensity of 18 differential metabolites, and the metabolic differentiators with AUC of ≥75% and VIP value of ≥1.5 were selected for logistic multivariate analysis, and finally linoleoleic carnitine and LPA (18∶2/0∶0) were included in the logistic regression model. The prediction model of pancreatic cancer with two serum metabolites linoleyl carnitine and LPA (18∶2/0∶0) was established. The AUC value (95% CI) of the prediction model was 0.91 (0.85-0.97), which was higher than that of CA19-9 (0.85, 0.76-0.94), the sensitivity and specificity were 86.4% and 80.6%, respectively, and the sensitivity was higher than that of CA19-9 (77.3%), but the specificity was lower than that of CA19-9 (91.7%). Internal validation showed than the AUC value (95% CI) of the prediction model was 0.91 (0.79-0.94), which was higher than that of CA19-9 ( P<0.05). Conclusions:The serum metabolites linolein carnitine and LPA(18∶2/0∶0) may be potential diagnostic markers to distinguish pancreatic cancer from patients with chronic pancreatitis.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.