This paper summarizes professor LI Guolie's clinical experience in treating orthostatic hypotension （OH） based on the theory of "raising the clear and directing the turbid downward". It is considered that the core pathogenesis of OH lies in the body's transition from a supine to an upright position， during which dysfunction of the middle jiao （焦） transformation and transportation， along with impaired pivot function， hinders the ascending of clear yang and the descending of turbid yin. Treatment should follow the general principle of "ascending the clear and directing the turbid downward"， placing emphasis on distinguishing the primary and secondary aspects. For cases where the clear yang fails to ascend， the self-formulated Li's Shengqing Jiangzhuo Decoction （李氏升清降浊汤）is used to supplement qi， raise the clear， and strengthen the middle jiao. For cases where the turbid yin fails to descend， the self-formulated Wuxiang Qingzhuo Beverage（五香清浊饮）with modifications is applied to resolve phlegm， eliminate stasis， harmonize the middle， and descend the turbid.

This paper summarizes professor LI Guolie's clinical experience in treating orthostatic hypotension （OH） based on the theory of "raising the clear and directing the turbid downward". It is considered that the core pathogenesis of OH lies in the body's transition from a supine to an upright position， during which dysfunction of the middle jiao （焦） transformation and transportation， along with impaired pivot function， hinders the ascending of clear yang and the descending of turbid yin. Treatment should follow the general principle of "ascending the clear and directing the turbid downward"， placing emphasis on distinguishing the primary and secondary aspects. For cases where the clear yang fails to ascend， the self-formulated Li's Shengqing Jiangzhuo Decoction （李氏升清降浊汤）is used to supplement qi， raise the clear， and strengthen the middle jiao. For cases where the turbid yin fails to descend， the self-formulated Wuxiang Qingzhuo Beverage（五香清浊饮）with modifications is applied to resolve phlegm， eliminate stasis， harmonize the middle， and descend the turbid.

OBJECTIVE To establish a hospital preparation cost item library， providing a reference for the refined accounting management of preparation costs in medical institutions. METHODS Based on literature analysis and practical work experience， a preliminary list of cost items was drafted. The Delphi method was employed to screen and optimize the items by analyzing the questionnaire recovery rate， expert authority coefficient， item importance score， coefficient of variation， and Kendall’s W of concordance. RESULTS The questionnaire recovery rates for the two rounds of expert consultation were 95.7% and 100%， respectively； the expert authority coefficients were 0.937 and 0.939， respectively； Kendall’s W of concordance were statistically significant （ P ＜0.001）. The finally established hospital preparation cost item library included 6 first-level items （such as raw material and packaging material costs， human resource costs， and production operation costs） and 29 second-level items （including main drug raw material costs， production personnel compensation， and finished product full-item testing costs）， comprehensively covering dimensions such as raw materials and packaging materials， fixed asset depreciation and equipment maintenance， human resources， production operations， energy and environment， and R & D and other costs. CONCLUSIONS This study successfully establishes a scientific and reliable cost item library for medical institution preparations， which can guide institutions to itemize actual expenditures， provide structured evidence for autonomous pricing， and support data needs for the formulation of insurance access and payment policies for innovative preparations.

Objective:To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] levels and 24-h urinary calcium excretion (24-h UCaE) and hypercalciuria in Chinese adults.Methods:This cross-sectional study was conducted from March 2022 to March 2023 in nine cities in China and included 1 239 residents. Demographic characteristics were collected through questionnaires and physical examinations, fasting blood samples were assessed for bone metabolism indicators, and 24-h urine samples were used to determine the 24-h UCaE. Multiple linear regression analysis was used to explore the relationship between serum 25(OH)D and 24-h UCaE and bone metabolism indexes. The relationship between serum 25(OH)D and hypercalciuria was analyzed using a multiple logistic regression model combined with restricted cubic spline modeling.Results:The mean participant age was (47.9±18.1) years, of which 453 (36.6%) were male. The percentages of vitamin D sufficiency, insufficiency, and deficiency were 7.6% (94/1 239), 29.0% (359/1 239), and 63.4% (786/1 239), respectively. The multiple linear regression model showed that after adjusting for the covariates the 24-h UCaE gradually increased with higher levels of 25(OH)D ( P overall <0.001, P nonlinear <0.001). The logistic regression analysis revealed that compared with the vitamin D deficient group, the OR for the prevalence of hypercalciuria in the vitamin D sufficient and vitamin D insufficient groups were 3.290 (95% CI 1.745 to 6.202) and 3.742 (95% CI 2.458 to 5.697), respectively. The results of the restricted cubic spline modeling showed a positive nonlinear relationship between 25(OH)D and the prevalence of hypercalciuria ( P overall <0.001, P nonlinear <0.001). The prevalence of hypercalciuria increased when 25(OH)D was >17.00 μg/L and peaked at 26.71 μg/L, after which there was a decreasing trend in the prevalence of hypercalciuria with increasing 25(OH)D. Conclusion:Associations between serum 25(OH)D levels and urinary calcium excretion and the prevalence of hypercalciuria were observed in the Chinese adult population.

AIM To establish a UPLC-MS/MS method for the simultaneous content determination of alisol A,23-acetyl alisol B,alisol A-24-acetate,alisol B,alisol C,23-acetyl alisol C,alisol F,alisol G,atractylenolideⅠ,atractylenolide Ⅱ,atractylenolide Ⅲ,atractylon and ferulic acid in Zexie Decoction.METHODS The analysis was performed on a 30 ℃ thermostatic Waters ACQUITY UPLC HSS C18 column(100 mm×2.1 mm,1.8μm),with the mobile phase comprising of water(containing 0.1％formic acid)-acetonitrile(containing 0.1％formic acid)flowing at 0.3 mL/min in a gradient elution manner,and electron spray ionization source was adopted in positive and negative ion scanning with multiple reaction monitoring mode.RESULTS Thirteen constituents showed good linear relationships within their own ranges(r＞0.999 1),whose average recoveries were 95.05％-103.8％with the RSDs of 1.4％-6.7％.CONCLUSION This simple,rapid and accurate method can provide experimental basis for the quality control of Zexie Decoction.

OBJECTIVE To investigate the distribution of Candida and predict the detection trend in the southern and northern campuses of Affiliated Hospital of Jiangnan University,Wuxi,between 2021 and 2024.METHODS A total of 27 056 patients with common Candida infections from the southern and northern campuses of Affiliated Hospital of Jiangnan University between 2021 and 2024 were selected to analyze the distribution of Candida species and predict the detection trend.RESULTS Among the 27 056 patients,there were 11 061 males and 15 995 fe-males,aged from 1 to 101 years,with a median age of 68 years.Over the past four years,the top five most com-monly detected Candida species in the hospital were Candida albicans,Candida glabrata,Candida tropicalis,Candida parapsilosis and Candida krusei.Statistically significant differences were found in infection characteris-tics among patients with C.albicans and C.glabrata in terms of gender,age,specimen source and related diseases(P＜0.05).From 2021 to 2024,the number of detected cases declined in 2022 and then rebounded(P＜0.001).Among the detected patients,those aged 70 and above accounted for the highest proportion.Regarding the distribution of specific diseases,the top three were vaginitis(4 176 cases,15.43％),bacterial pneumonia(1 842 cases,6.81％)and cancer(1 279 cases,4.73％).Patients with vaginitis were mainly infected with C.albicans,while patients with bacterial pneumonia were predominantly infected with C.albicans and C.glabrata.The LSTM model showed a good fit to the training set,with an root-mean-square error(RMSE)of 145.03 and an mean absolute error(MAE)of 131.19.Model predictions indicated that the number of patients with Candida in-fections in the hospital would remain low from Jan.to May 2025,which was basically consistent with actual clini-cal observations(RMSE=94.71,MAE=84.00).CONCLUSIONS The common diseases associated with Candi-da infections in the hospital include vaginitis,bacterial pneumonia and cancer.C.albicans and C.glabrata are the main pathogenic species,and the infection situation is relatively severe.The LSTM model performs well in short-term prediction and dynamic analysis of Candida detection trends.

Objective:To investigate the longitudinal stability of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL).Methods:The longitudinal cognitive assessment results of 68 dementia patients admitted to the Dementia and Leukoencephalopathy Outpatient Clinic, Department of Neurology, Peking Union Medical College Hospital, from January 2021 to January 2024, were retrospectively analyzed, including the total and sub-items scores of the MMSE, MoCA, and ADL. Two different rules were applied to analyze the abnormality rates: rule 1, where the current test result being better than the previous one was considered an abnormality; rule 2, where the current test result being better than the previous average score was considered an abnormality (If a patient had only 2 cognitive assessments, rule 2 was considered the same as rule 1). Two rules were used to analyze the abnormality rates of the scales. The statistical analyses were repeated after excluding patients with possible anxiety and depression status.Results:In assessing the total score stability, MMSE showed the lowest abnormality rates [27.2% (31/114) under rule 1 and 29.8% (34/114) under rule 2], while MoCA had the highest abnormality rates [41.3% (26/63) and 46.0% (29/63), respectively]. The ADL abnormality rates were 27.7% (23/83) and 33.7% (28/83), respectively. Among MoCA sub-items, category cue, multiple choice cue, second memory trial, orientation, and clock showed higher abnormality rates [31.7%(20/63), 30.2%(19/63), 23.8%(15/63), 22.2%(14/63), 22.2%(14/63), respectively]. After excluding population with possible anxiety and depression status, the relative abnormality rates of MMSE and ADL sub-items did not significantly change, while the abnormality rate of orientation in MoCA sub-items decreased relatively.Conclusion:The MMSE and ADL exhibit good stability in long-term monitoring of dementia patients, serving as essential tools for assessing and following up cognitive changes.

Rapid and ultrasensitive detection of pathogen-associated biomarkers is vital for the early diagnosis and therapy of bacterial infections.Herein,we developed a close-packed and ordered Au@AgPt array coupled with a cascade triggering strategy for surface-enhanced Raman scattering(SERS)and colorimetric identification of the Staphylococcus aureus biomarker micrococcal nuclease(MNase)in serum samples.The trimetallic Au@AgPt nanozymes can catalyze the oxidation of 3,3',5,5'-tetramethylbenzidine(TMB)molecules to SERS-enhanced oxidized TMB(oxTMB),accompanied by the color change from colorless to blue.In the presence of S.aureus,the secreted MNase preferentially cut the nucleobase AT-rich regions of DNA sequences on magnetic beads(MBs)to release alkaline phosphatase(ALP),which subsequently mediated the oxTMB reduction for inducing the colorimetric/SERS signal fade away.Using this"on-to-off"triggering strategy,the target S.aureus can be recorded in a wide linear range with a limit of detection of 38 CFU/mL in the colorimetric mode and 6 CFU/mL in the SERS mode.Meanwhile,the MNase-mediated strategy characterized by high specificity and sensitivity successfully discriminated between patients with sepsis(n=7)and healthy participants(n=3),as well as monitored the prog-nostic progression of the disease(n=2).Overall,benefiting from highly active and dense"hot spot"substrate,MNase-mediated cascade response strategy,and colorimetric/SERS dual-signal output,this methodology will offer a promising avenue for the early diagnosis of S.aureus infection.

OBJECTIVE: To explore the clinical phenotype and genetic characteristics of a Chinese Han pedigree with Darier's disease (DD). METHODS: A DD pedigree, who visited Tongji Hospital of Tongji University on October 22, 2023, was selected as the study subject. Clinical data of the pedigree were collected, and whole exome sequencing was performed on the proband. Suspected variant loci were screened, and Sanger sequencing was used to validate the variant in pedigree members. Bioinformatics analysis was performed on the variant loci. This study was approved by the Medical Ethics Committee of Tongji Hospital of Tongji University Ethics No.K-W-2024-004). RESULTS: The proband is a 67-year-old female with clinical features of DD, such as keratotic papules in sebaceous areas. whole exome sequencing revealed a missense variant, c.68G>A (p.Gly23Glu), in the exon 1 of ATP2A2 gene of the proband. Sanger sequencing showed that the proband's eldest daughter also carried this variant. This variant was not detected in other pedigree members, indicating a co-segregation of the variant with the disease phenotype in the pedigree. According to the interpretation principles of gene variants by the American College of Medical Genetics and Genomics (ACMG), this variant was classified as pathogenic (PS1+PM1+PM2_Supporting+PP1+PP3+PP4). CONCLUSION The c.68G>A (p.Gly23Glu) variant in the ATP2A2 gene may be the genetic cause of the disease in this pedigree. This finding further enriches the genetic variant spectrum in DD patients and provides a basis for clinical diagnosis and genetic counseling for patients.
Aged ; Female ; Humans ; Male ; China ; Darier Disease/genetics* ; Exome Sequencing ; Mutation, Missense ; Pedigree ; Phenotype ; East Asian People ; Sarcoplasmic Reticulum Calcium-Transporting ATPases

Renal fibrosis （RF） is the primary pathological feature of chronic kidney disease （CKD） progression to end-stage renal disease （ESRD）， with glomerulosclerosis and tubulointerstitial fibrosis as core pathological manifestations. It involves abnormal accumulation of extracellular matrix （ECM） components such as collagen and fibronectin， ultimately leading to structural destruction and functional losses of the kidneys. Sirtuins （SIRTs）， a class of nicotinamide adenine dinucleotide （NAD+）-dependent deacetylases， play crucial roles in cellular metabolism， oxidative stress responses， inflammation regulation， and cell survival. In mammals， there are seven distinct SIRT members （SIRT1 to SIRT7）， which collectively ameliorate RF progression through multiple pathways. These include regulating the transforming growth factor （TGF）-β/Smad signaling pathway， suppressing inflammatory responses， reducing oxidative stress， modulating mitochondrial and autophagy functions， and promoting fatty acid oxidation. In recent years， traditional Chinese medicine （TCM） and its active components have demonstrated significant potential in activating or modulating the SIRT protease family and its regulatory networks to ameliorate RF in a multi-target and holistic manner. However， systematic reviews in this area remain lacking. This article elucidates the mechanisms by which the SIRT protease family regulates RF and reviews the latest research advances in TCM modulation of SIRTs for the prevention and treatment of RF， aiming to provide new insights and approaches for the TCM treatment of RF.