The pathogenesis of recurrent acute exacerbations of bronchiectasis is considered to be "yang floating and yin weakness". Yin weakness refers to the depletion of the water and fire of true yin in the lower jiao （焦）， which is the root of the disease. Yang floating refers to the ministerial fire floating upward and scorching the lung metal due to the failure of true yin to nourish and constrain yang， which is the manifestation of acute exacerbations. Yin weakness and yang floating interact with each other， forming a vicious cycle of "yin depletion leading to fire floating， and floating fire in turn injuring yin"， which leads to recurrent， prolonged， and refractory acute exacerbations of bronchiectasis. Based on the pathogenesis of yang floating and yin weakness， therapeutic formulas are proposed. Yinhuo Decoction （引火汤） can be used to nourish true yin and anchor floating fire， while a combination of Qianyang Pill （潜阳丹） and Fengsui Pill （封髓丹） is applied to warm the kidneys， subdue yang， and secure true fire， and Quanzhen Yiqi Decoction （全真一气汤） is utilized to drastically supplement the primal origin and rescue both yin and yang simultaneously.

Objective To summarize the construction practices of the Shenzhen Yantian Regional Medical Laboratory Center and explore its pathways and outcomes in promoting high-quality discipline development.Methods Using a case study approach,this research analyzes the center's specific measures in organizational structure optimization,information system devel-opment,quality control system improvement,and multi-institutional collaboration.Operational data from 2023-2024(including test menu expansion,ISO 15189 accreditation progress,and training frequency)were used to evaluate implementation effective-ness.Results Through resource integration across district medical institutions,the center established a unified database and lo-gistics system,achieving coordinated management of 484 in-house tests and 354 referred tests with significantly improved testing efficiency.144 test items obtained ISO 15189 accreditation,demonstrating enhanced quality.Standardized training programs,op-timized clinical communication mechanisms,and advanced equipment introduction collectively strengthened testing capabilities,service scope,clinical support capacity,and regional influence.Conclusion By implementing resource centralization,stand-ardized management,and technological innovation,regional medical laboratory centers can effectively improve primary healthcare service quality and promote disciplinary development,providing a reference model for similar institutions nationwide.

This article focuses on neuroendocrine neoplasms and early cancer of the digestive system,and explores the relationship between rare and common diseases.By comparing the similarities and differences in clin-ical manifestations,endoscopic manifestations,biological behaviors and clinical outcomes between neuroendocrine neoplasms and early cancer of the digestive system,the potential association between rare and common diseases was revealed.This article aims to deepen the understanding of these two diseases,improve the detection rate of rare diseases such as neuroendocrine neoplasms,and promote their accurate diagnosis,thereby creating more op-portunities for early intervention and treatment,and ultimately improving the prognosis of patients.

Objective To summarize the construction practices of the Shenzhen Yantian Regional Medical Laboratory Center and explore its pathways and outcomes in promoting high-quality discipline development.Methods Using a case study approach,this research analyzes the center's specific measures in organizational structure optimization,information system devel-opment,quality control system improvement,and multi-institutional collaboration.Operational data from 2023-2024(including test menu expansion,ISO 15189 accreditation progress,and training frequency)were used to evaluate implementation effective-ness.Results Through resource integration across district medical institutions,the center established a unified database and lo-gistics system,achieving coordinated management of 484 in-house tests and 354 referred tests with significantly improved testing efficiency.144 test items obtained ISO 15189 accreditation,demonstrating enhanced quality.Standardized training programs,op-timized clinical communication mechanisms,and advanced equipment introduction collectively strengthened testing capabilities,service scope,clinical support capacity,and regional influence.Conclusion By implementing resource centralization,stand-ardized management,and technological innovation,regional medical laboratory centers can effectively improve primary healthcare service quality and promote disciplinary development,providing a reference model for similar institutions nationwide.

Objective:To evaluate the effect of value orientation brief therapy(VBT)combined with selective serotonin reuptake inhibitors(SSRIs)on clinical symptoms,rumination,decision-making ability,and cognitive func-tion in patients with mild to moderate depression.Methods:Eighty patients meeting the DSM-5 diagnostic criteria for mild to moderate depression were randomly assigned to either a medication(SSRIs)group(36 completed)or a VBT combined group(38 completed)for a 6-week intervention.Baseline and post-intervention assessments includ-ed the Hamilton Depression Scale(HAMD),Hamilton Anxious Scale(HAMA),Ruminative Response Scale-Chi-nese Version(RRS-CV),Iowa Gambling Test(IGT),number of eye fixation(NEF),responsive search score(RSS)in exploratory eye trajectory movement were used to evaluate patients'anxiety and depression symptoms,ru-minative thinking,decision-making function,and cognitive function.Results:The VBT combined group showed sig-nificantly better therapeutic effects than the medication group(P＜0.05).Compared to baseline and the medication group,the VBT combined group had significantly lower post-intervention scores in HAMD,HAMA,symptom rumi-nation,introspective reflection,compulsive meditation,and RRS-CV total scores after intervention(Ps＜0.05),and significantly higher scores in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Compared with the medica-tion group,the VBT combined group demonstrated a greater reduction in HAMD,HAMA,symptom rumination,in-trospective reflection,compulsive meditation,and RRS-CV total scores before and after intervention(Ps＜0.05),and a larger increase in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Conclusion:VBT combined with SSRIs effectively improves the symptoms of depression,anxiety,decision-making ability,rumination thinking,and cognitive function in patients with mild to moderate depression.

This article focuses on neuroendocrine neoplasms and early cancer of the digestive system,and explores the relationship between rare and common diseases.By comparing the similarities and differences in clin-ical manifestations,endoscopic manifestations,biological behaviors and clinical outcomes between neuroendocrine neoplasms and early cancer of the digestive system,the potential association between rare and common diseases was revealed.This article aims to deepen the understanding of these two diseases,improve the detection rate of rare diseases such as neuroendocrine neoplasms,and promote their accurate diagnosis,thereby creating more op-portunities for early intervention and treatment,and ultimately improving the prognosis of patients.

Objective:To evaluate the effect of value orientation brief therapy(VBT)combined with selective serotonin reuptake inhibitors(SSRIs)on clinical symptoms,rumination,decision-making ability,and cognitive func-tion in patients with mild to moderate depression.Methods:Eighty patients meeting the DSM-5 diagnostic criteria for mild to moderate depression were randomly assigned to either a medication(SSRIs)group(36 completed)or a VBT combined group(38 completed)for a 6-week intervention.Baseline and post-intervention assessments includ-ed the Hamilton Depression Scale(HAMD),Hamilton Anxious Scale(HAMA),Ruminative Response Scale-Chi-nese Version(RRS-CV),Iowa Gambling Test(IGT),number of eye fixation(NEF),responsive search score(RSS)in exploratory eye trajectory movement were used to evaluate patients'anxiety and depression symptoms,ru-minative thinking,decision-making function,and cognitive function.Results:The VBT combined group showed sig-nificantly better therapeutic effects than the medication group(P＜0.05).Compared to baseline and the medication group,the VBT combined group had significantly lower post-intervention scores in HAMD,HAMA,symptom rumi-nation,introspective reflection,compulsive meditation,and RRS-CV total scores after intervention(Ps＜0.05),and significantly higher scores in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Compared with the medica-tion group,the VBT combined group demonstrated a greater reduction in HAMD,HAMA,symptom rumination,in-trospective reflection,compulsive meditation,and RRS-CV total scores before and after intervention(Ps＜0.05),and a larger increase in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Conclusion:VBT combined with SSRIs effectively improves the symptoms of depression,anxiety,decision-making ability,rumination thinking,and cognitive function in patients with mild to moderate depression.

With societal development and accelerated population aging in China, the demand for high-quality nursing services continues to grow, placing the nursing sector in a dual scenario of challenges and opportunities that necessitate parallel advancements in development and reform. Clinical practice guidelines (CPGs), as critical tools for enhancing nursing quality and standardizing evidence-based care, face multifaceted challengesincluding complexities in evidence integration, methodological and reporting irregularities, barriers to multidisciplinary collaboration, and suboptimal clinical adherence. However, emerging opportunities—such as optimized methodological frameworks, the application of implementation science, and the integration of digital and intelligent technologies—are creating new pathways for advancing high-quality nursing practice. This article elaborates on the necessity of developing rigorous nursing CPGs and analyzes the current opportunities and challenges in their formulation, dissemination, and implementation, aiming to provide theoretical insights for strengthening guideline-driven nursing care.

Objective To investigate the protective effect of herba artemisiae scopariae extract on multidrug resistance protein 3(MDR3)gene mutation-induced neonatal parenteral nutrition-associated cholestasis(PNAC)and its possible mechanism.Methods ①Human primary hepatocytes were treated with cell culture in vitro,CRISPR/Cas9 lentivirus infection and MDR3 mutant gene lead-in.The levels of hepatic and biliary biochemical indexes[alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBil),direct bilirubin(DBil),indirect bilirubin(IBil),total bile acid(TBA)]in the supernatant of hepatocytes before and after 16,32,48 hours were compared to determine the time required for fatty acid induction of PNAC hepatocyte model with MDR3 gene mutation.② Human primary hepatocytes were divided into blank control group,MDR3 gene wild type group,MDR3 gene mutation group,and herba artemisiae scopariae extract intervention group according to random number table method.The blank control group was treated with culture medium only,the MDR3 gene wild type group was infected with lentivirus and mixed with wild type MDR3 gene and culture medium,the MDR3 gene mutation group was infected with lentivirus and cultured in culture medium with the mutant genes lead-in of LV-MDR3KI(c.485T>A,c.2793insA,c.1031G>A,c.3347G>A)mutation,while the MDR3 mutant gene was lead-in by lentivirus infection and cultured in culture medium,and then pretreated with 100 g/L herba artemisiae scopariae extract in the herba artemisiae scopariae extract intervention group,then the four groups of hepatocytes were induced with 1%fat emulsion,and the treatment time was the time needed to construct the PNAC hepatocytes model with MDR3 gene mutation.The levels of ALT,AST,TBil,DBil,IBil and TBA in the supernatant of hepatocytes were measured by enzyme-linked immunosorbent assay(ELISA).The mRNA expression abundance of adenosine triphosphate binding cassette proteins(ABCB4,ABCB11,ABCC2,ABCC3,ABCC4)encoding MDR3,bile salt export pump(BSEP),multidrug resistance associated protein(MRP)2-4,and tumor necrosis factor-α(TNF-α)genes were detected by real-time fluorescence quantitative polymerase chain reaction(RT-qPCR).Results Compared to the blank control group and MDR3 gene wild type group,there was no significant difference in the levels of ALT,AST,TBil,DBil,IBil,TBA in the supernatant of MDR3 gene mutant group before and 16 hours after induction with 1%fat emulsion,however after treated with 1%fat emulsion for 32 hours and 48 hours,the levels of ALT,AST,TBil,DBil,IBil,TBA in the supernatant of MDR3 mutant hepatocytes were significantly increased(P<0.05),consequently the time required for fatty acid induction of PNAC hepatocyte model was 32 hours.At 32 hours after treatment with fat emulsion,the levels of ALT,AST,TBil,DBil,TBA in the supernatant of hepatocytes in the herba artemisiae scopariae extract intervention group were significantly decreased[ALT(ng/L):148.3±2.3 vs.164.9±7.0,AST(ng/L):2767.4±78.8 vs.3239.4±107.1,TBil(μmol/L):7.6±0.2 vs.13.6±0.3,DBil(μmol/L):1.8±0.1 vs.5.7±0.2,TBA(μmol/L):3.4±0.2 vs.6.7±0.1,all P<0.05].The ABCB4,ABCC2,ABCC3,ABCC4 mRNA expression of MDR3,MRP2,MRP3,MRP4 in the blank control group,MDR3 wild type group,MDR3 gene mutation group and the herba artemisiae scopariae extract intervention group had no significant difference.The expression of TNF gene mRNA was highly expressed in MDR3 gene mutation group(2-??Ct:1.258±0.200 vs.1.001±0.052),and was low expressed in the herba artemisiae scopariae extract intervention group(2-??Ct:0.387±0.247 vs.1.258±0.200),and there was a significant difference between the two groups(both P<0.05).Compared to the MDR3 gene mutation group,the ABCB11 gene encoding BSEP mRNA expression in the herba artemisiae scopariae extract intervention group was significantly increased(2-??Ct:2.955±0.479 vs.1.333±0.529,P<0.05).Conclusion The herba artemisiae scopariae extract has a protective effect on PNAC induced by MDR3 gene mutation,which may be related to antagonizing inflammatory reaction,decreasing the expression of TNF mRNA and improving the expression of ABCB11 gene encoding BSEP.

OBJECTIVE To investigate the in vitro anti-inflammatory effects and mechanisms of oblongifolins A （OA） extracted from Garcinia oblongifolia. METHODS RAW264.7 cells were used as the research subject and divided into control group （0.5% DMSO）， lipopolysaccharide （LPS） group （1 μg/mL）， DEX group （10 µmol/L DEX+1 μg/mL LPS）， and low-， medium-， and high-concentration groups of OA （7.5， 15， 30 µmol/L OA+1 μg/mL LPS）. Except for the control group， the remaining groups were first stimulated with LPS for 1 hour and then mixed with drugs for 24 hours. The morphological changes of cells were observed in each group. The contents of nitric oxide （NO）， reactive oxygen species （ROS）， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， IL-1β， IL-4 and IL-10 were detected in cells of each group； mRNA expression levels of TNF-α， IL-6 and IL-1β were measured. The expression of key proteins in the nuclear factor κB （NF-κB） and nuclear factor-erythroid 2-related factor 2 （Nrf2） signaling pathways in each group， as well as the nuclear translocation of NF-κB p65 and Nrf2 proteins in control group， LPS group and OA high-concentration group， were detected. RESULTS Compared to the LPS group， the number of spindle-shaped and irregular cells gradually decreased in OA groups， the contents of NO， ROS （except for OA low-concentration group）， TNF-α， IL-6 and IL-1β， the mRNA expressions of TNF-α， IL-6 （except for OA low-concentration group） and IL-1β as well as the protein expressions of phosphorylated NF-κB p65 （p-NF-κB p65）， p-IκBα， and Kelch-like ECH-associated protein 1 （Keap1） were decreased significantly （P＜0.05）. The contents of IL-4 and IL-10， protein expressions of IκBα， Nrf2 （except for OA low- and medium-concentration groups）， HO-1 （except for OA low-concentration group） and NQO1 were all increased significantly （P＜0.05）. OA of high concentration could inhibit NF-κB p65 protein nuclear translocation and promote Nrf2 protein nuclear translocation. CONCLUSIONS OA can suppress LPS-induced inflammation in RAW264.7 macrophages. The underlying molecular mechanism likely entails the inhibition of the NF-κB signaling pathway， the activation of the Nrf2 signaling pathway and the reduction of ROS and inflammatory factor release.