OBJECTIVE To address the management challenges encountered by inpatient pharmacy of our hospital in undertaking “internet-based medicine delivery” （IMD） services， and to improve service efficiency and medication safety. METHODS SWOT analysis method was applied to systematically examine both internal and external factors， formulate comprehensive management strategies， and restructure the service processes. Process optimization included： establishing a closed-loop process for dispensing and returning drugs based on the drug traceability codes； unifying the drug inventory of the inpatient pharmacy with that of IMD， optimizing the management of storage locations； improving the inventory management function of the hospital information system， and adjusting the inventory counting plan and shift scheduling rules. The indicators of the inpatient pharmacy， including inventory structure， dispensing efficiency， inventory checks accuracy rate， the rationality rate of prescription， and consistency rate of human-machine review， were compared before and after the implementation of the strategies to evaluate the implementation effects. RESULTS After implementation， the structure of the drug inventory was significantly optimized. The proportion of drugs approaching their expiration dates decreased by 35.55%， the proportion of unsold drugs decreased by 64.52%， and the proportion of drugs that had been accumulated for more than 4 weeks decreased by 33.26%. The speed of prescription dispensing increased by 34.92%， and the daily drug requisition time was shortened by 62.03%. The accuracy rate of inventory checks rose from 86.33% to 90.33%， while the rationality rate of prescriptions and the consistency rate of human-machine review rose from 86.00% and 89.33% to 95.00% and 97.00% respectively. Furthermore， the launch of the drug traceability system reduced external dispensing errors from 4 to 1. CONCLUSIONS The comprehensive management strategy based on SWOT analysis can effectively improve the quality of drug management in the inpatient pharmacy and the operational efficiency of IMD， ensuring timely and safe medication for patients.

OBJECTIVE To explore the mechanism of the active ingredient compatibility（quercetin， quercitrin and kaempferol at a mass ratio of 2∶9∶3）of Dimocarpus longan Lour. leaves（abbreviated as CDL） on ameliorating glucose and lipid metabolism disorders in type 2 diabetes mellitus （T2DM） rats. METHODS SD rats were randomly divided into blank control group， model group， metformin hydrochloride group （100 mg/kg）， and CDL high-， medium- and low-dose groups （280， 140， 75 mg/kg）， with 10 rats in each group. Rats in the blank control group were fed with standard chow， while rats in the other groups were given high-sugar and high-fat diet combined with intraperitoneal injection of streptozotocin to establish the T2DM rat model. After successful modeling， rats in each administration group were given corresponding drug solution， and rats in the blank control group and model group were intragastrically administered with equal volume of pure water， once a day， for consecutive 4 weeks. Fasting blood glucose （FBG） was detected at fixed time every week. The curves of oral glucose tolerance test （OGTT） and intraperitoneal insulin tolerance test （IPITT） were plotted， and the area under curve （AUC） was calculated. The pancreatic islet function indexes [fasting insulin （FINS）， homeostasis model assessment of insulin resistance （HOMA-IR）， insulin sensitivity index （ISI）]，blood lipid indexes [total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）] and hepatic glycogen content were determined. The pathological morphological changes of liver and pancreatic tissues were observed. The protein and mRNA expression levels of molecules related to phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway in liver tissues were detected. RESULTS Compared with the blank control group， the FBG， AUC of IPITT curve， AUC of OGTT curve， HOMA-IR， the levels of FINS， TC， TG and LDL-C， as well as the protein and mRNA expression of phosphatase and tensin homolog， forkhead box protein O1 and glycogen synthase kinase-3β in liver tissues were significantly increased in the model group （ P ＜0.05）. ISI， the levels of HDL-C and hepatic glycogen content， along with the protein and mRNA expression of PI3K， insulin receptor substrate-1， Akt and protein expression of phosphorylated Akt in liver tissues were markedly decreased （ P ＜0.05）. In model group rats， the arrangement of hepatocytes was irregular， the overall structure of pancreatic lobules was disordered， and a large number of inflammatory cell infiltration was observed. Compared with the model group， most of the above quantitative indexes were significantly reversed in the CDL high-dose group （ P ＜0.05）， and the pathological lesions of liver and pancreas were obviously alleviated. CONCLUSIONS CDL can regulate glucose and lipid metabolism disorders， elevate insulin sensitivity and relieve insulin resistance in T2DM rats. Its mechanism may be related to the activation of the PI3K/Akt signaling pathway.

OBJECTIVE To explore the mechanism of the active ingredient compatibility（quercetin， quercitrin and kaempferol at a mass ratio of 2∶9∶3）of Dimocarpus longan Lour. leaves（abbreviated as CDL） on ameliorating glucose and lipid metabolism disorders in type 2 diabetes mellitus （T2DM） rats. METHODS SD rats were randomly divided into blank control group， model group， metformin hydrochloride group （100 mg/kg）， and CDL high-， medium- and low-dose groups （280， 140， 75 mg/kg）， with 10 rats in each group. Rats in the blank control group were fed with standard chow， while rats in the other groups were given high-sugar and high-fat diet combined with intraperitoneal injection of streptozotocin to establish the T2DM rat model. After successful modeling， rats in each administration group were given corresponding drug solution， and rats in the blank control group and model group were intragastrically administered with equal volume of pure water， once a day， for consecutive 4 weeks. Fasting blood glucose （FBG） was detected at fixed time every week. The curves of oral glucose tolerance test （OGTT） and intraperitoneal insulin tolerance test （IPITT） were plotted， and the area under curve （AUC） was calculated. The pancreatic islet function indexes [fasting insulin （FINS）， homeostasis model assessment of insulin resistance （HOMA-IR）， insulin sensitivity index （ISI）]，blood lipid indexes [total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）] and hepatic glycogen content were determined. The pathological morphological changes of liver and pancreatic tissues were observed. The protein and mRNA expression levels of molecules related to phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway in liver tissues were detected. RESULTS Compared with the blank control group， the FBG， AUC of IPITT curve， AUC of OGTT curve， HOMA-IR， the levels of FINS， TC， TG and LDL-C， as well as the protein and mRNA expression of phosphatase and tensin homolog， forkhead box protein O1 and glycogen synthase kinase-3β in liver tissues were significantly increased in the model group （ P ＜0.05）. ISI， the levels of HDL-C and hepatic glycogen content， along with the protein and mRNA expression of PI3K， insulin receptor substrate-1， Akt and protein expression of phosphorylated Akt in liver tissues were markedly decreased （ P ＜0.05）. In model group rats， the arrangement of hepatocytes was irregular， the overall structure of pancreatic lobules was disordered， and a large number of inflammatory cell infiltration was observed. Compared with the model group， most of the above quantitative indexes were significantly reversed in the CDL high-dose group （ P ＜0.05）， and the pathological lesions of liver and pancreas were obviously alleviated. CONCLUSIONS CDL can regulate glucose and lipid metabolism disorders， elevate insulin sensitivity and relieve insulin resistance in T2DM rats. Its mechanism may be related to the activation of the PI3K/Akt signaling pathway.

ObjectiveTo construct and validate a clinical prediction model for Qi deficiency and blood stasis syndrome in chronic heart failure （CHF），aiming to assist clinical diagnosis and provide tools and methods for individualized treatment of CHF. MethodsThe clinical data of patients with chronic heart failure treated at Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2022 to January 2024 were retrospectively collected. The patients were randomly divided into a training group and a validation group with a ratio of 7∶3. First， the least absolute shrinkage and selection operator （LASSO） regression analysis was used to preliminarily screen the predictive factors affecting the diagnosis of Qi deficiency and blood stasis syndrome in CHF. Subsequently， the Logistic regression method was applied to conduct a more in-depth and detailed analysis of these factors. Variables with P<0.05 in the results of the multi-factor Logistic regression were carefully selected and included. Based on the regression coefficients obtained from this analysis， a model was constructed， and a nomogram was accurately drawn. Using R software，the receiver operating characteristic （ROC） curve，calibration curve，and decision curve analysis （DCA） were precisely drawn. These analyses were used to comprehensively evaluate the model from three crucial aspects： discrimination，calibration，and clinical applicability. Additionally， the accuracy，specificity，sensitivity，positive predictive value，and negative predictive value of the model were meticulously calculated to conduct a more all-round and comprehensive assessment. ResultsIn total， 168 cases were successfully obtained in the training group， and 71 cases were included in the validation group. After a thorough comparison， it was found that there were no statistically significant differences in the baseline data between the two groups. After being rigorously screened by the LASSO-multivariate logistic regression method， dark red tongue，smoking history，cardiac troponin I，and N-terminal pro-B-type natriuretic peptide （NT-ProBNP） were identified as the influencing factors for diagnosing patients with the Qi deficiency and blood stasis syndrome in CHF. The constructed model demonstrated an area under the curve （AUC） of 0.812 in the training group and 0.719 in the validation group. The calibration curve showed that the predicted curve of the model was close to the actual observed curve. DCA indicated that the model could provide substantial clinical benefits for patients at the decision thresholds ranging from 0.2 to 0.9. ConclusionThe clinical prediction model for Qi deficiency and blood stasis syndrome in chronic heart failure constructed in this study shows good performance. It has certain application value in clinical practice， which may contribute to the improvement of the diagnosis and treatment of CHF patients with this syndrome.

ObjectiveTo observe the effectiveness and safety of Jiuzihuichun decoction combined with spleen- strengthening moxibustion in patients with asthenospermia infertility with spleen-kidney deficiency pattern. MethodsA total of 82 patients with asthenospermia of spleen-kidney deficiency pattern in Shanghai Seventh People's Hospital were included. The patients were randomly divided into an observation group and a control group， with 41 patients in each group. The control group received oral administration of WuziYanzong pills combined with spleen-strengthening moxibustion. The dosage of Wuzi Yanzong pills was 1 bag each time， and it was taken twice a day. The spleen-strengthening moxibustion was carried out once a week. The observation group， on the other hand， took Jiuzi Huichun decoction orally combined with spleen-strengthening moxibustion. The Jiuzi Huichun Decoction was taken 200 mL each time， twice a day， with one dose in the morning and one in the evening. The spleen-strengthening moxibustion for the observation group was also performed once a week. The treatment course for both groups was 12 weeks， and they were followed up for an additional 12 weeks. During the treatment process，12 cases were either lost to follow-up or excluded. Eventually， 70 cases were available for evaluation，with 35 cases in the control group and 35 cases in the observation group. The pregnancy status of the patients' spouse within 6 months was recorded. The traditional Chinese medicine （TCM） syndrome scores of spleen-kidney deficiency pattern before and after treatment were evaluated. The semen volume，semen routine parameters，normal sperm morphology，sperm DNA fragmentation index，seminal plasma fructose，seminal plasma acid phosphatase， and seminal plasma α-glucosidase levels of the two groups were detected before and after treatment. In addition， the safety indicators related to liver and kidney functions of the two groups were detected before and after treatment. ResultsDuring the 6-month observation period， when compared with the situation before treatment in their respective groups，the semen volume of the observation group and the control group increased. In contrast， the sperm concentration，sperm motility，proportion of a+b-grade sperm，normal sperm morphology，seminal plasma fructose，seminal plasma acid phosphatase，seminal plasma α-Glucosidase，the proportion of a-grade sperm，linear sperm motility，linear sperm concentration， and linear sperm count all increased significantly（P<0.05）. At the same time， the sperm DNA fragmentation index and the TCM syndrome scores of the spleen-kidney deficiency pattern decreased significantly（P<0.05）. When the observation group was compared with the control group after treatment， the clinical efficacy of the observation group was better（Z=-2.276，P<0.05）. The pregnancy rate of the observation group's spouses was 14.3%，which was higher than the 2.9% of the control group. The sperm motility， the proportion of a+b-grade sperm，seminal plasma fructose，the proportion of a-grade sperm，normal sperm morphology，α-glucosidase， and linear sperm motility in the observation group were higher than those in the control group （P<0.05）. Moreover， the sperm DNA fragmentation index and the TCM syndrome scores of spleen-kidney deficiency pattern in the observation group were lower than those in the control group （P<0.01）. No serious adverse reactions occurred in the two groups，and no abnormalities were found in the safety indicators after treatment. ConclusionJiuzi Huichun decoction combined with spleen-strengthening moxibustion can enhance sperm viability and sperm concentration. It can also improve the TCM-related symptoms of asthenospermia of spleen-kidney deficiency pattern and sperm morphology. Additionally， it can reduce the sperm DNA fragmentation index and regulate the level of seminal plasma bioenzyme in patients with male asthenospermia infertility of spleen-kidney deficiency pattern. Therefore， it is worthy of further promotion and application in clinical practice.

Objective To explore the function of olfactomedin domain family protein 3(OLFM3)in neuroblastoma(NB).Methods The relationship between the expression of OLFM3 mRNA and v-myc avian myelocytomatosis viral oncogene neuroblastoma derived homolog(MYCN)amplification status and the prognosis of patients in NB clin-ical samples were clarified by using R2 Genomics Analysis and Visualization Platform.Depmap database was used to examine the expression level of OLFM3 in different tumors cell lines and to identify the correlation between OLFM3 expression and MYCN amplification status in various NB cell lines.RT-qPCR and Western blot were used to detect the knockdown level of OLFM3.Cell proliferation was monitored using crystal violet staining and real?time cellular analysis.The colony formation ability of NB cells was assessed using colony?forming unit assay.Results Analysis of R2 database revealed higher level of OLFM3 expression in MYCN?amplified NB clinical samples(P<0.001).Patients with high OLFM3 expression showed a significantly lower overall survival probability compared to those with low OLFM3 expression(P<0.05).Analysis with Depmap database revealed that the expres?sion level of OLFM3 was higher in NB than that in other kind of tumor.The expression level of OLFM3 was signifi?cantly higher in the MYCN?amplified cell lines than in the MYCN?non?amplified cell lines(P<0.01).In MYCN?am?plified NB cells,knockdown of OLFM3 inhibited cells proliferation(P<0.001)and colony formation(P<0.001),but there was no noticeable changes observed in MYCN?non?amplified cells.Conclusions OLFM3 specifically pro?motes the proliferation of MYCN?amplified NB cells,but has a less effect on MYCN?non?amplified cells,indicating it is a potential biomarker for high?risk MYCN?amplified NB.

Objective To investigate the mechanism of argon-helium cryotherapy in regulating the tyrosine-protein kinase 2/signal transducer and activator of transcription 3(JAK2/STAT3)path-way,thereby inhibiting the inflammatory response in rats with atherosclerotic occlusive disease(ASO)of the lower extremities.Methods Forty rats were randomly divided into sham group,lower extremity ASO group,Ar-He Cryo group and Ar-He Cryo+p-JAK group,with 10 rats in each group.The average blood flow velocity of the lower extremity artery,lipid profile and inflammation levels were measured in each group.Hematoxylin-eosin(HE)staining was used to examine histopathologi-cal changes in arterial vessel tissues.Western blotting was performed to detect the expression levels of JAK2,p-JAK2,STAT3,p-STAT3 and suppressor of cytokine signaling 3(SOCS3)proteins in arterial vessel tissues.Results The average blood flow velocity of the lower extremity artery in the lower extremity ASO group was significantly lower than that in the sham group(P＜0.05).The average blood flow velocity in the Ar-He Cryo group was significantly higher than that in the ASO group(P＜0.05).The average blood flow velocity in the Ar-He Cryo+p-JAK group was significantly lower than that in the Ar-He Cryo group(P＜0.05).Serum total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C)levels,tumor necrosis factor-alpha(TNF-α),interleukin-1 β(IL-1β),interleukin-6(IL-6)levels and endothelin-1(ET-1)content in the lower extremity ASO group were significantly higher than those in the sham group,while serum high-densi-ty lipoprotein cholesterol(HDL-C)levels and nitric oxide(NO)content were significantly lower than those in the sham group(P＜0.05).In the Ar-He Cryo group,serum TC,TG,LDL-C levels as well as TNF-α,IL-1β,IL-6 levels and ET-1 content were significantly lower than those in the lower extremity ASO group,while serum HDL-C levels and NO content were significantly higher(P＜0.05).In the Ar-He Cryo+p-JAK group,serum TC,TG,LDL-C levels as well as TNF-α,IL-1 β,IL-6 levels and ET-1 content were significantly higher than those in the Ar-He Cryo group,while HDL-C levels and NO content were significantly lower(P＜0.05).Compared with the sham group,the lower extremity venous vessels in the lower extremity ASO group showed significant steno-sis;compared with the lower extremity ASO group,the degree of stenosis in the lower extremity ve-nous vessels was significantly reduced in the Ar-He Cryo group;the degree of stenosis in the lower extremity venous vessels in the Ar-He Cryo+p-JAK group was similar to that in the lower extremity ASO group and significantly more severe than that in the Ar-He Cryo group.The ratios of p-JAK2/JAK2 and p-STAT3/STAT3 in arterial vessel tissues of the lower extremity ASO group were signifi-cantly higher than those in the sham group,and SOCS3 protein expression was significantly lower than that in the sham group(P＜0.05).In the Ar-He Cryo group,p-JAK2/JAK2 and p-STAT3/STAT3 in arterial vessel tissues were significantly lower than those in the lower extremity ASO group,and SOCS3 protein expression was significantly higher than that in the lower extremity ASO group(P＜0.05).In the Ar-He Cryo+p-JAK group,p-JAK2/JAK2 and p-STAT3/STAT3 in arte-rial vessel tissues were significantly higher than those in the Ar-He Cryo group,and SOCS3 protein expression was significantly lower than that in the Ar-He Cryo group(P＜0.05).Conclusion Ar-gon-helium cryotherapy can reduce lipid deposition in the arteries of rats with lower extremity ASO,inhibit inflammatory responses,and its mechanism may be related to the inhibition of activation of JAK2/STAT3 signaling pathway.

BACKGROUND: T-cell lymphoblastic lymphoma/acute lymphoblastic leukemia (T-LBL/ALL) is an aggressive form of hematological malignancy associated with poor prognosis in adult patients. Histone deacetylases (HDACs) are aberrantly expressed in T-LBL/ALL and are considered potential therapeutic targets. Here, we investigated the antitumor effect of a novel HDAC inhibitor, chidamide, on T-LBL/ALL. METHODS: HDAC1, HDAC2 and HDAC3 levels in T-LBL/ALL cell lines and patient samples were compared with those in normal controls. Flow cytometry, transmission electron microscopy, and lactate dehydrogenase release assays were conducted in Jurkat and MOLT-4 cells to assess apoptosis and pyroptosis. A specific forkhead box O1 (FOXO1) inhibitor was used to rescue pyroptosis and upregulated gasdermin E (GSDME) expression caused by chidamide treatment. The role of the FOXO1 transcription factor was evaluated by dual-luciferase reporter and chromatin immunoprecipitation assays. The efficacy of chidamide in vivo was evaluated in a xenograft mouse. RESULTS: The expression of HDAC1, HDAC2 and HDAC3 was significantly upregulated in T-LBL/ALL. Cell viability was obviously inhibited after chidamide treatment. Pyroptosis, characterized by cell swelling, pore formation on the plasma membrane and lactate dehydrogenase leakage, was identified as a new mechanism of chidamide treatment. Chidamide triggered pyroptosis through caspase 3 activation and GSDME transcriptional upregulation. Chromatin immunoprecipitation assays confirmed that chidamide led to the increased transcription of GSDME through a more relaxed chromatin structure at the promoter and the upregulation of FOXO1 expression. Moreover, we identified the therapeutic effect of chidamide in vivo . CONCLUSIONS This study suggested that chidamide exerts an antitumor effect on T-LBL/ALL and promotes a more inflammatory form of cell death via the FOXO1/GSDME axis, which provides a novel choice of targeted therapy for patients with T-LBL/ALL.
Humans ; Pyroptosis/drug effects* ; Forkhead Box Protein O1/genetics* ; Aminopyridines/pharmacology* ; Animals ; Mice ; Benzamides/pharmacology* ; Cell Line, Tumor ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/drug therapy* ; Phosphate-Binding Proteins/metabolism* ; Histone Deacetylase Inhibitors/pharmacology* ; Jurkat Cells ; Histone Deacetylases/metabolism* ; Apoptosis/drug effects* ; Gasdermins

The current transformation of the tripartite linkage of medical treatment has gradually shifted towards collaborative development and governance among medical care,medical insurance,and medicine,necessitating a clear understanding of the internal mechanisms underpinning this collaboration and governance to lay a theoretical foundation for practical exploration.Drawing on synergetics theory,it delves into the self-organizing characteristics of the collaborative development and governance among the tripartite system,grasping its fundamental operational laws.Through a questionnaire survey of the main functional departments in each field of the tripartite system to verify the rationality of the sequence parameters selected for the study.It ultimately identifies the order parameters as the value standard centered on health,the interest contract focused on public interest,new system for mobilizing resources nationwide,the innovative capacity of the pharmaceutical industry,and the rigorous accountability system.Furthermore,it systematically expounds on the self-organizing evolution process of the collaborative development and governance among the tripartite system,thereby revealing the inherent mechanisms of its collaborative development and governance.It proposes countermeasures and suggestions for establishing and improving diversified collaboration mechanisms,innovating monitoring and early warning mechanisms,and fostering positive feedback mechanisms,aiming to facilitate more scientific and efficient collaborative development and governance among the tripartite system.

Objective To explore the correlation between the expression level of serum fibrinogen-like protein 1(FGL1)and the indexes of metabolism and renal function in patients with diabetic nephropathy(DN)and diabetes mellitus(DM),and provide reference for clinical diagnosis and treatment.Methods From January 2017 to April 2023,30 patients with DM and treated in Jiangsu Province Hospital of Chinese Medicine were selected as the DM group,68 patients with DN were selected as the DN group,and 36 healthy subjects were selected as the control group.The DN group was further divided into the early DN(DN-E)group(n=38)and the late DN(DN-A)group(n=30)according to whether there was a large amount of proteinuria and the severity.Clinical data such as serum albumin(ALB),estimated glomerular filtration rate(eGFR)and albumin-to-creatinine ratio(ACR)were collected.Serum FGL1 level was detected by enzyme-linked immunosorbent assay(ELISA).Pearson linear correlation was used for correlation,the diagnostic value was analyzed by ROC curve.Results Compared with the control group,the levels of ACR,FGL1 in patients with DM group increased,the levels of eGFR decreased,and the differences were statistically significant(t=5.686,4.336,-4.683,all P<0.05).Compated with the DM group,the levels of ACR,FGL1 in patients with DN-E group was increased,and the level of eGFR was decreased,and the differences were statistically significant(t=5.275,3.454,-4.969,all P<0.05).Compared with the DN-E group,the levels of ACR,FGL1 in the DN-A group were increased,the levels of eGFR were decreased,and the differences were statistically significant(t=7.881,7.051,-5.596,all P<0.05).Serum FGL1 level was negatively correlated with ALB and eGFR(r=-0.638,-0.547,all P<0.05),and positively correlated with ACR(r=0.691,P<0.05).The AUC(95%CI),specificity and sensitivity of serum FGL1 level in the diagnosis of DN were 0.947(0.908～0.987),100%and 82.4%,respectively.Conclusion The level of serum FGL1 in DN and DM patients is high,and the level of serum FGL1 is closely related to the common metabolic indexes such as ALB,eGFR and ACR in the diagnosis of DN,which may have certain clinical diagnostic value.