Chronic heart failure （CHF） is the terminal stage of various heart diseases， with high morbidity， mortality， and hospitalization rate. According to the theory of collateral diseases， the core pathogenesis of CHF is blood stasis of collaterals， water retention and stagnation， and pathogen accumulation in collaterals. Accordingly， the treatment should focus on reinforcing healthy Qi to warm Yang， activating blood to dredge collaterals， and excreting water to alleviate edema. On this basis， Qili Qiangxin capsules （QLQX） are created. This prescription can effectively treat chronic heart failure. Modern studies have shown that QLQX contains a variety of pharmacological components such as flavonoids， alkaloids， terpenoids， phenylpropanoids， phenolic acids， and cardiac glycosides. QLQX can improve the cardiac function， inhibit myocardial fibrosis， improve hemodynamics， mitigate inflammation， reduce cardiomyocyte apoptosis， and regulate the nervous system， with mild adverse reactions. This study analyzed the etiology and pathogenesis of CHF based on the theory of collateral diseases， explored the relationship between the prescription and syndrome， and delved into the material basis and mechanism of QLQX in the treatment of CHF， aiming to provide reference for the clinical application and scientific research of QLQX.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

Objective To investigate the virulence and drug resistance characteristics of diarrheagenic Escherichia coli isolated from patients with infectious diarrhea in our hospital.Methods The preliminary identification of microbes was carried out by the VITEK-MS microbial mass spectrometry detection system and virulence genes were detected by the multiplex real-time PCR.Five types of diarrhea-genic Escherichia coli(DEC)clinically isolated from patients with infectious diarrhea in our hospital were identified.The drug resist-ance characteristics of DEC strains were detected by the microbroth dilution and E-test.The drug-resistant molecular characteristics were analyzed by the next-generation sequencing and bioinformatics.The Fisher exact probability method was used for statistical analy-sis.Results The detection rate of DEC in our hospital was 11.9%,with enteroaggregative E.coli(EAEC)accounting for 37.5%,a-typical enteropathogenic Escherichia coli(EPEC)accounting for 34.38%,enterotoxigenic E.coli(ETEC)accounting for 25.0%,and enteroinvasive E.coli(EIEC)accounting for 3.12%.None of enterohemorrhagic E.coli(EHEC)strain was detected.The resistance rates of 32 DEC strains to ampicillin,tetracycline,and trimethoprim/sulfamethoxazole were 53.12%,43.75%,and 37.5%,respec-tively.ESBLs(+)strains accounted for 18.75%,and the detection rate of multidrug-resistant strains was 83.83%,significantly higher than that of ESBLs(-)strains(P=0.042).A total of 25 ST genotypes were obtained from 32 DEC strains.The dominant genotypes were ST10(4 strains,12.5%),followed by ST28(2 strains,6.25%),ST31(2 strains,6.25%),ST3153(2 strains,6.25%),and the other 21 genotypes(1 strain,3.13%).One carbapenem resistant strain carrying the blaNDM-1 gene was detected in EAEC.Conclu-sion Four virulence genes such as aggR,pic,astA,and eae,are more common in the DEC of patients with infectious diarrhea in our hospital,with EAEC and EPEC as the main subtypes.The genotypes are highly polymorphic,and multidrug-resistant strains have been detected.

Objective:To analyze the correlation between serum interleukin-6 (IL-6) and osteopontin (OPN) levels and bone metabolism markers in pregnant women with gestational diabetes mellitus.Methods:A total of 89 pregnant women with GDM who were admitted to Shanxi Children’s Hospital from Aug. 2020 to May. 2022 were selected as the observation group, and 85 normal pregnant women who underwent regular health examination were selected as the control group. Clinical data of the two groups were compared and GDM related factors were analyzed. Serum IL-6, OPN, bone metabolic markers β collagen special sequence (β-CTX), type I procollagen N-terminal propeptide (PINP), n-terminal mid-section osteocalcin (N-MID), fasting blood glucose (FBG) and fasting insulin (FINS) levels of the two groups were detected. Insulin resistance index (HOMA-IR) was calculated, and the relationship between serum IL-6, OPN and β-CTX, PINP and N-MID was analyzed.Results:The age, gestational times and pre-pregnancy BMI of the observation group were higher than those of the control group, and the family history of diabetes was more than that of the control group, with statistical significance between the two groups ( t=14.31, 31.46, 9.47, 10.33, P<0.05). Logistic regression analysis showed that the older the age and the more pregnancies, the higher the pre-pregnancy BMI. Independent risk factors for developing GDM were associated with a large family history of diabetes mellitus [ ( OR (95% CI) =1.569 (1.370-1798), 8.533 (5.067-14.367), 1.460 (1.301-1.639), 3.677 (1.611-8.396). P<0.05) ]; Serum levels of IL-6, OPN, FBG, FINS and HOMA-IR in observation group were higher than those in control group ( t=16.64, 24.76, 10.97, 11.01, 55.70, all P<0.05). The β-CTX of observation group was higher than that of control group, and the PINP and N-MID of observation group were lower than that of control group ( t=3.64, 12.19, 12.52, P<0.05). Spearman correlation analysis showed that serum IL-6 and OPN were positively correlated with β-CTX ( r=0.781, 0.746, P<0.05). Serum IL-6 and OPN were negatively correlated with PINP and N-MID ( r=-0.264, -0.305; -0.208, -305, P<0.05) . Conclusions:In pregnant women with GDM, serum IL-6 and OPN are positively correlated with β-CTX, and serum IL-6 and OPN are negatively correlated with PINP and N-MID, respectively. These indicators can be used as indicators of disease monitoring, and play an important role in protecting the health of pregnant women with GDM.

Objective To investigate the relationship between insomnia,gastrointestinal symptoms,and glycosylated hemoglobin(HbA1c)levels in individuals diagnosed with type 2 diabetes mellitus(T2DM),as well as the related influencing factors.Methods A total of 910 T2DM patients treated in our multicenter from January 2022 to December 2022 were enrolled in this study.General information(gender,age,smoking and drinking history,exercise,course of disease,treatment and complications),HbA1c,Athens Insomnia Scale(AIS)scores and Gastrointestinal Symptoms Rating Scale(GSRS)scores of patients were collected.The differences of sleep and gastrointestinal symptoms between groups were analyzed,and the correlation between the differences and HbA1c was analyzed.Furthermore,the risk factors for non-standard HbA1c were analyzed.Results The AIS score and GSRS score in the HbA1c control group were less than those in the non-standard group(P＜0.01).Insomnia was reported by 37.0％of T2DM patients,and the HbA1c level in the insomnia group was significantly higher than that in the non-insomnia group(10.00％±2.38％vs.8.26％±1.73％,P＜0.01).Gastrointestinal symptoms were present in 57.5％of T2DM patients,and the HbA1c levels in the group with gastrointestinal symptoms were significantly higher than those in the group without gastrointestinal symptoms(9.26％±2.23％vs.8.43％±1.98％,P＜0.01).Furthermore,26.3％of T2DM patients experienced both insomnia and gastrointestinal symptoms.Remarkably,the HbA1c levels in the group with both insomnia and gastrointestinal symptoms were significantly higher than those in the group without either condition(10.18％±2.44％vs.8.45％±1.86％,P＜0.01).Correlation analysis demonstrated a significant association between sleep quality,gastrointestinal function,and HbA1c levels(P＜0.01).The logistic regression analysis result revealed that age,GSRS score,AIS score,and the presence of insomnia combined with gastrointestinal symptoms were independent risk factors for predicting HbA1c≥6.5％(P＜0.01).Having both insomnia and gastrointestinal symptoms concurrently was the strongest risk factor for substandard HbA1c control,and the risk of blood sugar control may increase about 5 times when both appear together.Conclusion Insomnia and gastrointestinal symptoms are common comorbidities in T2DM patients,showing a cross-interfering relationship,and they appear together with poor blood sugar control,interact causally,and amplify each other.

Objective To explore the characteristics of apolipoprotein E(APOE)gene polymorphism in patients with Alzheimer's disease(AD)and mild cognitive impairment(MCI)due to AD,as well as its corre-lation with baseline levels of ketone bodies.Methods A total of 110 AD patients from the outpatient and neu-rology wards of the hospital from January 2020 to October 2023 were selected as the AD group,105 patients(none of whom had used anti dementia drugs)were selected as the MCI group,and 110 healthy elderly exami-nees in the physical examination center were selected as the control group.APOE gene polymorphism,and the levels of serum β-hydroxybutyrate(HB)and urine ketone bodies were measured.The distribution of APOE genotype among the three groups was analyzed,and the differences of the levels of serum HB and urine ketone bodies were compared among those carried APOE ε4 allele and those did not.Results Among the three groups,the statistical significance was found in the differences of APOE genotype and ε2,ε3,ε4 allele(P<0.05).The proportion of APOE ε4 allele carriers in the AD group and the MCI group was higher than that in the control group(P<0.05).The levels of serum βHB in the AD group and the MCI group were lower than that in the control group(P<0.05).The levels of serum βHB in those carried APOE ε4 in the AD group were significantly lower than that in the control individuals(P<0.05).There was no statistically significant differ-ence in serum βHB levels between individuals carried and not carried APOE ε4 in the three groups(P>0.05).There was no statistically significant difference in the levels of urinary ketones among the three groups(P>0.05).There was no statistically significant difference in urine ketone bodies levels between individuals carried and not carried APOE ε4 in the three groups(P>0.05).Conclusion The reduced baseline levels of serum βHB in AD patients are associated with APOE ε4 allele.

OBJECTIVE To provide standardized guidance for the clinical application and management of biosimilars， and promote their widespread and rational use in clinical treatment. METHODS The design， planning， and drafting process as well as the full report of Evidence-based Guideline for the Management of Clinical Application of Biosimilars in China （2024 Edition） followed the WHO Handbook for Guideline Development （2nd edition）， which fully considered the best current evidence from evidence-based medicine， multidisciplinary expert experience， and patient preferences and values. Grading of Recommendations Assessment， Development， and Evaluation （GRADE） approach was adopted to evaluate the quality of evidence and determine the strength of recommendations. RESULTS & CONCLUSIONS Evidence-based Guideline for the Management of Clinical Application of Biosimilars in China （2024 Edition） presented 10 recommendations including 7 strong recommendations and 3 weak recommendations. The recommendations covered the entire process of clinical application and management of biosimilars. Medical institutions and relevant health regulatory departments can refer to this guideline for the scientific management of the extrapolation of unapproved indications of biosimilars. Healthcare providers can refer to this guideline for pre-treatment assessments， patient education， pre-treatment regimen before administration， and dosage regimen adjustments. Multidisciplinary medical teams can refer to this guideline to provide pharmacovigilance and patient management throughout the treatment process.

Objective:To analyze the correlation between serum interleukin-6 (IL-6) and osteopontin (OPN) levels and bone metabolism markers in pregnant women with gestational diabetes mellitus.Methods:A total of 89 pregnant women with GDM who were admitted to Shanxi Children’s Hospital from Aug. 2020 to May. 2022 were selected as the observation group, and 85 normal pregnant women who underwent regular health examination were selected as the control group. Clinical data of the two groups were compared and GDM related factors were analyzed. Serum IL-6, OPN, bone metabolic markers β collagen special sequence (β-CTX), type I procollagen N-terminal propeptide (PINP), n-terminal mid-section osteocalcin (N-MID), fasting blood glucose (FBG) and fasting insulin (FINS) levels of the two groups were detected. Insulin resistance index (HOMA-IR) was calculated, and the relationship between serum IL-6, OPN and β-CTX, PINP and N-MID was analyzed.Results:The age, gestational times and pre-pregnancy BMI of the observation group were higher than those of the control group, and the family history of diabetes was more than that of the control group, with statistical significance between the two groups ( t=14.31, 31.46, 9.47, 10.33, P<0.05). Logistic regression analysis showed that the older the age and the more pregnancies, the higher the pre-pregnancy BMI. Independent risk factors for developing GDM were associated with a large family history of diabetes mellitus [ ( OR (95% CI) =1.569 (1.370-1798), 8.533 (5.067-14.367), 1.460 (1.301-1.639), 3.677 (1.611-8.396). P<0.05) ]; Serum levels of IL-6, OPN, FBG, FINS and HOMA-IR in observation group were higher than those in control group ( t=16.64, 24.76, 10.97, 11.01, 55.70, all P<0.05). The β-CTX of observation group was higher than that of control group, and the PINP and N-MID of observation group were lower than that of control group ( t=3.64, 12.19, 12.52, P<0.05). Spearman correlation analysis showed that serum IL-6 and OPN were positively correlated with β-CTX ( r=0.781, 0.746, P<0.05). Serum IL-6 and OPN were negatively correlated with PINP and N-MID ( r=-0.264, -0.305; -0.208, -305, P<0.05) . Conclusions:In pregnant women with GDM, serum IL-6 and OPN are positively correlated with β-CTX, and serum IL-6 and OPN are negatively correlated with PINP and N-MID, respectively. These indicators can be used as indicators of disease monitoring, and play an important role in protecting the health of pregnant women with GDM.