Puerariae Lobatae Radix and Puerariae Thomsonii Radix are the dried roots of Pueraria lobata and Pueraria thomsonii of the Leguminosae family， respectively. Since their separate inclusion in the 2005 edition of Pharmacopoeia of the People's Republic of China， the two herbs have been individually recorded. Although they share the same functions and indications， the required content of puerarin differs by a factor of up to eightfold between them. The current quality standard relies solely on a single indicator， puerarin， which fails to reflect the correlation between chemical constituents and core therapeutic effects. This has resulted in prominent issues of mixed use in clinical practice and production， thereby constraining the high-quality development of the industry. Modern research has demonstrated that Puerariae Lobatae Radix contains a comprehensive range and higher content of isoflavonoid constituents， while Puerariae Thomsonii Radix is rich in starch and polysaccharides. Puerariae Lobatae Radix exhibits stronger effects in antipyresis， cardiovascular and cerebrovascular protection， and central analgesia， while Puerariae Thomsonii Radix demonstrates greater advantages in anti-inflammation， hypoglycemia， and peripheral analgesia. Based on this， the chemical material bases of Puerariae Lobatae Radix and Puerariae Thomsonii Radix at both the macromolecule and micromolecule levels were systematically reviewed and compared. The pharmacodynamic material bases and mechanisms of action underlying their three core therapeutic effects， namely "relieving exterior syndrome and clearing heat"， "promoting fluid production to quench thirst"， and "dredging channels and activating collaterals"， were summarized. The most highly correlated common metabolic pathway shared by both herbs for these three therapeutic effects is the arachidonic acid metabolic pathway， and their common core target is prostaglandin-endoperoxide synthase 2 （PTGS2）. This review provided clinical application recommendations based on the therapeutic differences between the two herbs， elucidated the scientific connotation of their "same origin but different effects"， and， grounded in the quality marker （Q-Marker）， proposed the concept of efficacy-related Q-Marker based on "substance-efficacy-syndrome" association， as well as a novel strategy for efficacy-oriented quality evaluation. Preliminary screening of quality markers associated with different therapeutic effects was also conducted. This study aims to provide critical scientific evidence for the precise clinical application of Puerariae Lobatae Radix and Puerariae Thomsonii Radix， the improvement of quality standards， and the high-quality development of the industry.

Poly(ADP-ribosyl)ation (PARylation) is a specific form of post-translational modification (PTM) predominantly triggered by the activation of poly-ADP-ribose polymerase 1 (PARP1). However, the role and mechanism of PARylation in the advancement of acute kidney injury (AKI) remain undetermined. Here, we demonstrated the significant upregulation of PARP1 and its associated PARylation in murine models of AKI, consistent with renal biopsy findings in patients with AKI. This elevation in PARP1 expression might be attributed to trimethylation of histone H3 lysine 4 (H3K4me3). Furthermore, a reduction in PARylation levels mitigated renal dysfunction in the AKI mouse models. Mechanistically, liquid chromatography-mass spectrometry indicated that PARylation mainly occurred in receptor for activated C kinase 1 (RACK1), thereby facilitating its subsequent phosphorylation. Moreover, the phosphorylation of RACK1 enhanced its dimerization and accelerated the ubiquitination-mediated hypoxia inducible factor-1α (HIF-1α) degradation, thereby exacerbating kidney injury. Additionally, we identified a PARP1 proteolysis-targeting chimera (PROTAC), A19, as a PARP1 degrader that demonstrated superior protective effects against renal injury compared with PJ34, a previously identified PARP1 inhibitor. Collectively, both genetic and drug-based inhibition of PARylation mitigated kidney injury, indicating that the PARylated RACK1/HIF-1α axis could be a promising therapeutic target for AKI treatment.

Objective:To evaluate the clinical outcomes of posterior approach vertebral column resection (VCR) osteotomy combined with titanium mesh bone-graft fusion and internal fixation for the treatment of special type stage IIIb Kummell disease.Methods:Twelve patients (3 males, 9 females) diagnosed with special type stage IIIb Kummell disease at Zhengzhou Orthopedics Hospital between October 2015 and June 2021 were enrolled. The mean age was 59.1±5.6 years (range, 53-67 years). All patients underwent VCR osteotomy, pedicle screw fixation, and posterior bone-graft fusion using titanium mesh. Preoperative and postoperative outcomes were assessed using visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, American Spinal Injury Association (ASIA) grading, Cobb angle correction, and bone graft fusion rate. Intraoperative and postoperative complications were also recorded.Results:All surgeries were completed successfully. The average follow-up duration was 11.6±1.8 months (range, 10-13 months). Significant improvements were observed in VAS scores, ODI, JOA scores, and Cobb angles at both two weeks postoperatively and at the final follow-up ( P<0.05), with no significant differences between the two time points ( P>0.05). The final recovery rates were 79.5% for VAS score, 73.2% for ODI, 72.1% for JOA score, and 77.3% for Cobb angle correction. Neurological function showed marked improvement. One patient developed delayed incision healing due to fat liquefaction but recovered following physical therapy. The remaining 11 patients experienced uneventful wound healing without infection or internal fixation loosening. One patient developed postoperative deep venous thrombosis of the lower limbs, which resolved with drug therapy. Conclusion:Posterior approach VCR combined with titanium mesh bone-graft fusion and internal fixation provides an effective surgical option for stage IIIb Kummell disease characterized by fractured vertebral bodies with only the broken upper and lower endplates remaining.

Objective:To investigate the clinicopathological characteristics and prognostic influencing factors in young breast cancer patients.Methods:A retrospective case series study was conducted. The clinical data of 408 young patients with breast cancer in the Fifth Medical Center of Chinese PLA General Hospital from January 2005 to December 2020 were retrospectively analyzed. The clinical characteristics and prognostic influencing factors of patients were observed. The Kaplan-Meier method was used to analyze overall survival (OS) and disease-free survival (DFS) of patients. Univariate analysis of prognostic factors was conducted by using the log-rank test, and multivariate analysis was performed by using Cox proportional risk model.Results:The median age [ M ( Q1, Q3)] of 408 young female patients with breast cancer was 36 (33, 39) years; the 5-year OS and 5-year DFS rates were 89.9%, 84.0% of 387 breast cancer patients in early and middle stage (except for stage Ⅳ). There were statistically significant differences in the 5-year OS and 5-year DFS rates (excluding stage Ⅳ of DFS) of patients with different clinical staging and molecular subtypes (all P < 0.05). The differences were statistically significant in the 5-year DFS rate of patients with different pathological types and histological grades (all P < 0.05). There were no statistically significant differences in the 5-year OS and DFS rates between the patients receiving breast-conserving surgery or mastectomy (all P > 0.05). The results of multivariate Cox regression analysis indicated that clinical staging ( HR = 3.121, 95% CI: 2.301-4.233, P < 0.001) and molecular classification ( HR = 1.441, 95% CI: 1.126-1.845, P = 0.004) were independent prognostic factors for OS. Additionally, clinical staging ( HR = 3.001, 95% CI: 2.174-4.141, P < 0.001) was identified as an independent prognostic factor for DFS. Conclusions:The prognosis of young breast cancer patients is closely related to clinical staging and molecular subtype. The later the clinical stage is, the poorer prognosis is. Luminal-type breast cancer has a better prognosis than other subtypes. For early-stage breast cancer patients who meet the criteria for breast-conserving surgery, breast-conserving surgery is the first-choice alternative.

Objective:To explore the effect of Danggui Shaoyao Powder(DGSYP)on the Toll-like receptor 4(TLR4)/Myeloid differen-tiation factor 88(MyD88)/Nuclear factor-κB(NF-κB)signaling pathway in ulcerative colitis(UC)rats.Methods:Forty-eight male SD rats were randomly divided into 6 groups:normal group,model group,DGSYP low-dose group(11.61 g/kg),medium-dose group(23.22 g/kg),high-dose group(46.44 g/kg)and salazosulapyridine group(0.36 g/kg).There were 8 rats in each group.In addition to the normal group,the rats in other groups were induced by 5%sodium trinitrobenzene sulfonate(TNBS)to establish a UC rat model.After successful modeling,each drug treatment group continued to administer the intervention for 14 days.At the same time,the rats in the normal group and the model group were given equal volume of nor-mal saline.The disease activity index(DAI)score was calculated.hematoxylin-eosin(HE)staining was used to observe the histo-pathological changes in the colon of rats.The levels of interleukin-6(IL-6),IL-1β,and tumor necrosis factor α(TNF-α)in colon tissue were measured by enzyme-linked immunosorbent assay(ELISA).Real-time fluorescence quantitative polymerase chain re-action(RT-qPCR)was used to detect the mRNA expression levels of TLR4,MyD88 and NF-κB p65 in colon tissues.The expression levels of TLR4,MyD88 and NF-κB in colon tissues were detected by Western blot(WB).Results:Compared with the normal group,the DAI score of the model group was increased,the colon was shortened,the histopathological changeswere obvious.The levels of in-flammatory factors IL-6,IL-1β and TNF-α in colon tissue of model group were significantly increased(P<0.01),the mRNA and pro-tein expressions of TLR4,MyD88 and NF-κB p65 were also significantly increased(P<0.05,P<0.01).Compared with the model group,the above disease-related conditions of rats in each treatment group of DGSYP were improved to varying degrees,DAI fraction decreased significantly(P<0.05),colon growth,no obvious edema or edema degree decreased,the histopathological changes of colon were improved to varying degrees.The levels of inflammatory factors IL-6,IL-1β and TNF-α in colon tissues were significantly de-creased(P<0.01),and the mRNA and protein expressions of TLR4,MyD88 and NF-κB p65 were significantly decreased(P<0.05,P<0.01).Conclusion:DGSYP can regulate the TLR4/MyD88/NF-κB signaling pathway,thereby reducing the release of inflammatory fac-tors,and then alleviating the degree of inflammatory damage in the colon of UC rats.

Objective:To analyze the application value of evaluation model for dimension of safe management in standardized management for medical equipment in department of orthopedics.Methods:The management objectives were refined from the aspects of management objects,goal refinement,problem analysis,index screening,and evaluation feedback in the safe management for medical equipment in department of orthopedics,and an evaluation model for dimension of safe management was constructed to conduct whole-process management for medical equipment in department of orthopedics.A total of 73 clinically medical equipment that were used in department of orthopedics of Beijing Chao-yang Hospital,Capital Medical University from January 2022 to December 2023 were selected.In them,36 equipment during January to December 2022 were managed by adopting conventional management model,and 37 equipment during January to December 2023 were managed by adopting the evaluation model for dimension of safe management(model management mode).The clinical service quality,incidence of risk,and scores of quality management capability for equipment between the two management modes were compared.Results:The mean values of consistency rate of the requirement for average configuration,compliance rate of performance parameter,stability rate of quality detection,and qualification rate of cleaning and disinfection of the equipment of adopting the model management mode were respectively(91.69±4.36)%,(92.36±3.54)%,(91.80±3.54)%and(92.36±4.20)%,all of which were higher than those of adopting the conventional management mode,with statistically significant differences(t=15.003,14.545,11.529,11.921,P<0.05).The failure rate,defect rate of components,unqualified rate of cleaning and disinfection,and improper rate of managing equipment of the 37 equipment of adopting the model management mode were respectively 5.41%,5.41%,2.70%and 8.11%,all of which were lower than those of adopting the conventional management model,with statistically significant differences(x2=9.182,10.538,11.696,9.667,P<0.05).The scores of resource allocation,technical support,and information foundation for equipment of adopting the model management mode were all higher than those of adopting the conventional management mode,with statistically significant differences(t=11.494,10.089,13.831,P<0.05).Conclusion:The application of evaluation model for dimension of safe management for medical equipment in department of orthopedics can improve the operational quality of equipment,and reduce safety hazards and failure rates of equipment,and enhance use efficiency of equipment.

Objective:To evaluate the clinical outcomes of posterior approach vertebral column resection (VCR) osteotomy combined with titanium mesh bone-graft fusion and internal fixation for the treatment of special type stage IIIb Kummell disease.Methods:Twelve patients (3 males, 9 females) diagnosed with special type stage IIIb Kummell disease at Zhengzhou Orthopedics Hospital between October 2015 and June 2021 were enrolled. The mean age was 59.1±5.6 years (range, 53-67 years). All patients underwent VCR osteotomy, pedicle screw fixation, and posterior bone-graft fusion using titanium mesh. Preoperative and postoperative outcomes were assessed using visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, American Spinal Injury Association (ASIA) grading, Cobb angle correction, and bone graft fusion rate. Intraoperative and postoperative complications were also recorded.Results:All surgeries were completed successfully. The average follow-up duration was 11.6±1.8 months (range, 10-13 months). Significant improvements were observed in VAS scores, ODI, JOA scores, and Cobb angles at both two weeks postoperatively and at the final follow-up ( P<0.05), with no significant differences between the two time points ( P>0.05). The final recovery rates were 79.5% for VAS score, 73.2% for ODI, 72.1% for JOA score, and 77.3% for Cobb angle correction. Neurological function showed marked improvement. One patient developed delayed incision healing due to fat liquefaction but recovered following physical therapy. The remaining 11 patients experienced uneventful wound healing without infection or internal fixation loosening. One patient developed postoperative deep venous thrombosis of the lower limbs, which resolved with drug therapy. Conclusion:Posterior approach VCR combined with titanium mesh bone-graft fusion and internal fixation provides an effective surgical option for stage IIIb Kummell disease characterized by fractured vertebral bodies with only the broken upper and lower endplates remaining.

In July 2024,the Diagnosis Related Groups(DRG)2.0 is released based on the Notice from the National Healthcare Security Administration on Issuing the DRG 2.0 and Deepening the Relevant Work.Compared with DRG 1.1,version 2.0 was established based on a wider range of suggestions regarding the Adjacent Diagnosis Related Groups(ADRG),Major Comorbidity or Complication(MCC),and Comorbidity or Complication(CC)from various institutions.A list of disease diagnoses and surgical operations that are not used as grouping rules was compiled,and grouping efficacy was further improved by upgrading the algorithms for MCC and CC with the help of AI.Meanwhile,it is necessary to pay more attention to the number of cases of ADRG,the better methods to list the MCC/CC,the suggestions of various doctors and continuously standardize the data and update the grouping scheme of DRG.

Objective:To identify and summarize the best evidence for pelvic floor muscle exercises (PFME) in preventing pelvic floor dysfunction (PFD) during pregnancy.Methods:A systematic search was conducted in databases including UpToData, Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure, VIP, Wanfang Data, SinoMed, Yiigle, and Joanna Briggs Institute Evidence Based Healthcare Center Database and so on. The search spanned from January 1, 2018, to March 16, 2023. Two researchers independently evaluated the quality of clinical decision-making articles, expert consensus, and systematic reviews, while four researchers appraised the quality of guidelines. Evidence extraction and grading were performed independently by two researchers.Results:A total of nine documents were included: three guidelines, two clinical decision-making articles, one expert consensus, and three systematic reviews. A total of 20 evidence-based recommendations were summarized in six categories: indications and contraindications, assessment, implementation plans, supervision and follow-up, management, and outcome evaluation.Conclusions:PFME during pregnancy is effective in preventing PFD. Healthcare providers should integrate best evidence into clinical practice to develop tailored PFME plans for pregnant women, aiming to prevent PFD.

In July 2024,the Diagnosis Related Groups(DRG)2.0 is released based on the Notice from the National Healthcare Security Administration on Issuing the DRG 2.0 and Deepening the Relevant Work.Compared with DRG 1.1,version 2.0 was established based on a wider range of suggestions regarding the Adjacent Diagnosis Related Groups(ADRG),Major Comorbidity or Complication(MCC),and Comorbidity or Complication(CC)from various institutions.A list of disease diagnoses and surgical operations that are not used as grouping rules was compiled,and grouping efficacy was further improved by upgrading the algorithms for MCC and CC with the help of AI.Meanwhile,it is necessary to pay more attention to the number of cases of ADRG,the better methods to list the MCC/CC,the suggestions of various doctors and continuously standardize the data and update the grouping scheme of DRG.