OBJECTIVE To construct a scientific and systematic quality control index system for intravenous medication admixture， so as to ensure the safety of drug use and improve the quality of medical service. METHODS Based on literature analysis and cross-sectional survey， an initial indicator framework was formulated. Opinions were then gathered through two rounds of Delphi expert consultations， and the expert authority coefficient and Kendall’s coefficient of concordance were calculated to evaluate the consistency. Ultimately， the analytic hierarchy process was employed to determine the weights of each indicator and test for consistency in order to establish a scientific and systematic quality control indicator system for intravenous medication admixture. RESULTS The study conducted two rounds of expert consultation with an average positive coefficient of 95.92% and an average authority coefficient of 0.983. In the second round of the Delphi consultation， the Kendall’s coefficients of concordance for the first-， second-， and third-level indicators were 0.306， 0.440， and 0.394， respectively， all significantly higher than those in the first round （0.211， 0.274， 0.379）. The final quality control system for intravenous medication admixture consisted of 6 first-level indicators （personnel， medicines and consumables， facilities and equipment， process management， environmental hygiene， and outcomes）， 17 second-level indicators （e.g.， education and training， staffing structure， workload， medication management， consumables management， and equipment maintenance）， and 44 third-level indicators （e.g.， average daily workload per person， proportion of pharmacy professionals， competency assessment pass rate， work system assessment pass rate， continuing education frequency and pass rate， and medication inventory accuracy）. CONCLUSIONS The quality control system for intravenous medication admixture developed in this study demonstrates strong authority and scientific rigor， providing a theoretical basis and practical tool for the standardized management of intravenous medication admixture quality in hospitals.

By examining the records related to the Fengfu （GV 16） acupoint in BIAN Que Heart Book （《扁鹊心书》） compiled by the Song Dynasty physician DOU Cai， this study analyzed various aspects， including the differentiation of conditions treated with Fengfu （GV 16） acupoint， the theoretical foundation for selection of Fengfu （GV 16） acupoint， the application of needling manipulation， and the sensation of obtaining qi during acupuncture. The findings suggest that DOU Cai's approach to utilizing Fengfu （GV 16） acupoint differs from traditional methods， particularly emphasizing the effectiveness of achieving a sensation of heat and numbness. His unique techniques include transverse insertion at Fengfu （GV 16） acupoint and penetrated insertion to Fengchi （GB 20） and Yifeng （TE 17） acupoints. The records of Fengfu （GV 16） acupoint in BIAN Que Heart Book provide a valuable reference for its modern clinical application and further development.

ObjectiveTo explore the mechanism of herbal cake-separated moxibustion using the classical formula Xiaoyaosan in alleviating neuroimmune inflammatory responses in chronic fatigue syndrome （CFS） rats， based on the regulation of the toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear transcription factor-κB （NF-κB） signaling pathway. MethodsFifty SPF-grade SD rats aged 6-8 weeks were randomly divided into five groups： Normal group， model group， sham herbal cake moxibustion group， Chinese medicine intragastric administration group， and herbal cake-separated moxibustion group， with 10 rats in each group. Except for the normal group， all other groups underwent a 21-day modeling process， followed by behavioral testing. The herbal cake-separated moxibustion and sham herbal cake moxibustion groups received interventions at the Shenque （CV8）， Guanyuan （CV4）， Zusanli （ST36）， and Qimen （LR14） acupoints. The Chinese medicine intragastric administration group was treated with a Xiaoyaosan suspension via gavage. Behavioral tests were conducted after 10 days of continuous intervention. Serum levels of interleukin （IL）-1β， IL-6， and tumor necrosis factor-α （TNF-α）， as well as hippocampal levels of IL-1β， IL-6， TNF-α， and NF-κB， were detected by enzyme-linked immunosorbent assay （ELISA）. Morphological changes in the hippocampus were observed using hematoxylin-eosin （HE） staining. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to detect mRNA expression levels of TLR4， MyD88， and NF-κB in the hippocampus. Western blot analysis was performed to detect the relative expression levels of TLR4， MyD88， NF-κB， and p65 proteins in the hippocampus. ResultsCompared with the normal group， the model group showed a significant decrease in upright times during the open field test （P<0.01）， as well as significant reductions in total movement distance， resting time， and center region duration （P<0.01）. In the tail suspension test， immobility time increased （P<0.01）， and struggle times decreased （P<0.01）. Serum and hippocampal levels of IL-1β， IL-6， and TNF-α， as well as hippocampal NF-κB levels and TLR4， MyD88， and NF-κB mRNA expression， were significantly elevated （P<0.01）. After treatment， compared with the model group， the total movement distance and upright times in the open field test were significantly increased in all treatment groups （P<0.01）， while resting time and center region duration were notably prolonged （P<0.05， P<0.01）. Immobility time in the tail suspension test was significantly shortened （P<0.01）， and struggle times significantly increased （P<0.05）. Serum and hippocampal levels of IL-1β， IL-6， TNF-α， hippocampal NF-κB levels， and TLR4 and NF-κB mRNA expression were significantly reduced （P<0.05， P<0.01）. Compared with the sham herbal cake moxibustion group， the herbal cake-separated moxibustion group showed a significant extension in center region duration during the open field test （P<0.05） and a significant increase in upright times （P<0.01）. In the tail suspension test， immobility time was reduced （P<0.01）， and struggle times increased （P<0.01）. Serum TNF-α levels in the Chinese medicine intragastric administration group were significantly reduced （P<0.01）， while serum IL-6 levels， as well as hippocampal levels of IL-1β， TNF-α， NF-κB， and TLR4， MyD88， and NF-κB mRNA expression， were significantly decreased in both the Chinese medicine intragastric administration group and the herbal cake-separated moxibustion group （P<0.05， P<0.01）. Compared with the Chinese medicine intragastric administration group， the herbal cake-separated moxibustion group exhibited significantly increased upright times in the open field test （P<0.01）. In the tail suspension test， immobility time was reduced （P<0.01）， and struggle times increased （P<0.01）. Serum IL-1β， hippocampal TNF-α levels， and TLR4， MyD88， and NF-κB mRNA expression were significantly decreased （P<0.05， P<0.01）. ConclusionHerbal cake-separated moxibustion effectively improves fatigue and memory function in CFS rats， regulates neuroimmune inflammatory responses， and its mechanism may be related to the modulation of the TLR4/MyD88/NF-κB signaling pathway.

Objective To explore the effects and mechanisms of human umbilical cord mesenchymal stem cell (HUC-MSC)-derived exosomes (Exo) pretreated with Huangkui capsules on renal ischemia-reperfusion injury (IRI). Methods HUC-MSCs were cultured in media containing different concentrations of Huangkui capsules for 24 hours to determine cell viability and select an appropriate concentration for subsequent experiments. HUC-MSCs were pretreated with 50 μg/mL Huangkui capsules for 24 hours, and Exo were extracted using an exosome extraction kit. The morphology was observed under a transmission electron microscope, particle size was measured by nanoparticle tracking analysis, and the expression of exosomal membrane surface marker proteins was detected by Western blot. Human renal tubular epithelial cells (HK-2 cells) were randomly divided into hypoxia/reoxygenation group (M group), hypoxia/reoxygenation + Exo group (E group), and hypoxia/reoxygenation + Huangkui capsules pretreated Exo group (H group). Western blotting was used to measure the expression of endoplasmic reticulum stress (ERS)-related proteins, and real-time fluorescent quantitative reverse transcription polymerase chain reaction was used to measure the expression of ERS-related gene messenger RNA (mRNA). Mice were randomly divided into sham operation group (Sham group), ischemia-reperfusion group (I/R group), ischemia-reperfusion + Exo group (E group), and ischemia-reperfusion + Huangkui capsules pretreated Exo group (H group). Renal histological assessment, serum creatinine (Scr), blood urea nitrogen (BUN) measurement and inflammatory factor detection were performed 24 hours later. Results Both Exo and Huangkui capsules prereated Exo had a bilayer membrane structure and a cup-shaped morphology; their average particle sizes were 116.8 nm and 81.3 nm, respectively. Both expressed CD9, CD63, TSG101. Compared with the M group, the E group had decreased relative expression of transcription factor 6 (ATF6) and protein kinase R-like endoplasmic reticulum kinase (PERK) proteins, increased mRNA relative expression, increased relative expression of C/EBP homologous protein (CHOP) protein, and decreased mRNA relative expression. Compared with the E group, the H group had decreased relative expression of ATF6, PERK, CHOP proteins, and decreased mRNA relative expression of ATF6 and PERK (all P<0.05). Animal experimental results showed that compared with the Sham group, the I/R group had increased renal tubular injury scores, Scr, BUN, interleukin (IL)-1β, IL-10, IL-18, tumor necrosis factor (TNF)-α levels. Compared with the I/R group, the E and H groups had decreased renal tubular injury scores and Scr, BUN, IL-1β, IL-10, IL-18, TNF-α levels. Compared with the E group, the H group had decreased renal tubular injury scores and Scr, BUN, IL-1β, IL-10, IL-18, TNF-α levels (all P<0.05). Conclusions Huangkui capsules pretreatment HUC-MSC-derived Exo may alleviate renal IRI by inhibiting ERS.

Through data collection and collation combined with bibliometrics， this study conducted a series of textual research on Yanghetang， such as the name and origin， the evolution of prescription composition and modern clinical application. Yanghetang was first recorded in Bencao Yidu of WANG Ang in the Qing dynasty. In addition to Yanghetang， there were 3 bynames of Jiawei Yanghetang， Quanshengji Yanghetang and Zhenjun Yanghetang. Regarding the composition of the formula， a total of 4 versions of Yanghetang were collected. The first version is the 5 medicines version of Cervi Cornus Colla， Rehmanniae Radix Praeparata， Cinnamomi Cortex， Zingiberis Rhizoma and Ephedrae Herba in Bencao Yidu. The second version is the 7 medicines version of Waike Zhengzhi Quanshengji， changing Zingiberis Rhizoma to Zingiberis Rhizoma Praeparatum Carbonisata（ZRPC） and adding Sinapis Semen and Glycyrrhizae Radix et Rhizoma（GRR） on the basis of Bencao Yidu， and most of the Yanghetang is of this version. The third version is the 6 medicines version of Wushi Yifang Huibian， that is， on the basis of Bencao Yidu， Zingiberis Rhizoma is changed into ZRPC， and Sinapis Semen is added. The fourth version is the 6 medicines version in Yifang Jiedu， that is， on the basis of Bencao Yidu， Zingiberis Rhizoma is changed into Zingiberis Rhizoma Praeparatum， and GRR Praeparata cum Melle is added. Regarding the dose of Yanghetang， the doses of the medicines in Waike Zhengzhi Quanshengji was converted into the modern doses as follows：37.3 g of Rehmanniae Radix Praeparata， 1.87 g of Ephedrae Herba， 11.19 g of Cervi Cornus Colla， 7.46 g of Sinapis Semen， 3.73 g of Cinnamomi Cortex， 3.73 g of GRR， and 1.87 g of ZRPC. The origins of the above medicines are consistent with the 2020 edition of Chinese Pharmacopoeia. The processing specification of Rehmanniae Radix Praeparata is steaming method， ZRPC is ginger charcoal， Sinapis Semen is the fried products， and the rest of the medicines are raw products. The decoction method was verified by the decoction method in Chonglou Yuyao， which is similar in the time， and it is recommended that the above medicines should be added with 600 mL of water， decocted to 100 mL， and taken warmly 30 min after meal. For each dose， it is recommended to use 1-3 doses per day according to the doctor's advice in combination with clinical practice. The diseases involved in the ancient applications involved 42 diseases in 11 departments， including orthopedics， dermatology and gynecology， which were dominated by Yin-cold syndrome. However， the diseases involved in modern research also include 148 related diseases in 10 departments， such as orthopedics， obstetrics and gynecology， which is consistent with the ancient books. In recent years， the research hotspots of Yanghetang have focused on more than 10 fields， including osteoblasts， malignant tumors， wound healing， traditional Chinese medicine fumigation and so on， which are widely used. It is suitable for comprehensive research and development because of its rational formula composition， clear origin， processing and decoction method， and wide clinical application.

Objective To investigate the cognition level and behavior compliance of blood pressure measurement in community residents and analyze the related influencing factors, and to provide evidence for community health management and blood pressure control. Methods A questionnaire survey was conducted to investigate 4470 community patients. Questionnaires included basic personal information，blood pressure measurement cognition, and blood pressure measurement behavior related issues. SPSS 19.0 was used to analyze the basic information, blood pressure measurement cognition, and pressure measurement behavior of the survey subjects. Logistic regression was performed to analyze relevant factors affecting blood pressure measurement cognition and behavior compliance. Results The overall cognitive compliance rate for blood pressure measurement among the visiting community patients was 31.52%. Age, education level, and chronic disease had a statistically significant impact on the cognitive knowledge (P<0.05). The overall behavior compliance rate of blood pressure measurement among the community patients was 23.69%. The cognition, age and education had a statistically significant impact on the overall behavior compliance rate of blood pressure measurement (P<0.05). Conclusion The cognitive level and standardized behavior of blood pressure measurement of community patients need to be improved. More attention should be paid to the elderly, low education level residents and community residents without chronic diseases, to promote community residents to form correct and standardized behavior of blood pressure measurement through health education.

ObjectiveTo explore the mechanism of moxibustion with the classical prescription Xiaoyaosan as the herbal cake in improving cognitive function in the rat model of chronic fatigue syndrome （CFS） by regulating autophagy via phosphatidylinosiol 3-kinase （PI3K）/autophagy key molecule yeast Atg6 homologue 1 （Beclin1） signaling pathway. MethodsFifty SPF-grade SD rats aged 6-8 weeks were randomly grouped as follows： control， model， sham cake-separated moxibustion， intragastric administration with Chinese herbs， and herbal cake-separated moxibustion， each with 10 rats. The other groups except the control group were subjected to modeling by exhaustive swimming and chronic restraint stress for 21 days， and the behavioral test was performed after modeling. Herbal cake-separated moxibustion and sham cake-separated moxibustion were carried out at Shenque （CV8）， Guanyuan （CV4）， Zusanli （ST36）， and Qimen （LR14）. The rats in the intragastric administration with Chinese herbs group were treated with Xiaoyaosan suspension by gavage. After continuous intervention for 10 days， rat behaviors were observed and the levels of interleukin （IL）-4， IL-10， blood urine nitrogen （BUN）， and malondiadehyde （MDA） in the serum and hippocampal tissue of rats in each group were determined by enzyme-linked immunosorbent assay. The morphological changes of the hippocampal tissue were observed by hematoxylin-eosin staining. The relative mRNA and protein levels of PI3K and Beclin1 in the hippocampal tissue were determined by Real-time quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultsCompared with the normal group， the model group showed reduced crossings， shortened residence time in the target quadrant， and prolonged average escape latency on days 1， 2， 3， and 4 （P<0.01） in the Morris water maze test. In the new object recognition test， the model group showed decreased recognition index of exploration time and recognition index of exploration times （P<0.01）， lowered levels of IL-4 and IL-10 and elevated levels of BUN and MDA in the serum and hippocampus （P<0.01）， and down-regulated mRNA and protein levels of PI3K and Beclin1 （P<0.01）. After treatment， compared with the model group， each treatment group showed increased crossings， prolonged residence time in the target quadrant， and shortened average escape latency on days 1， 2， 3， and 4 （P<0.05， P<0.01）. In addition， the treatment elevated the levels of IL-4 and IL-10 and lowered the levels of BUN and MDA in the serum and hippocampus （P<0.05， P<0.01）， and up-regulated the mRNA and protein levels of PI3K and Beclin1 （P<0.05， P<0.01）. Compared with the sham cake-separated moxibustion group， the herbal cake-separated moxibustion group and the intragastric administration with Chinese herbs group showed increased crossings， prolonged residence time in the target quadrant （P<0.05）， elevated level of IL-4， lowered level of MDA， and up-regulated relative mRNA and protein levels of PI3K and Beclin1 in the hippocampus （P<0.05， P<0.01）. The serum levels of MDA and BUN in the intragastric administration with Chinese herbs group were significantly decreased. The average escape latency of the herbal cake-separated moxibustion group was significantly shortened on days 2 and 3 （P<0.05， P<0.01）. In addition， this group showed elevated serum level of IL-4， lowered serum level of MDA， and declined BUN level in the hippocampus （P<0.05， P<0.01）. Compared with the intragastric administration with Chinese herbs group， the herbal cake-separated moxibustion group presented risen serum level of IL-4 and up-regulated mRNA level of Beclin1 （P<0.05） and relative protein levels of PI3K and Beclin1 （P<0.05， P<0.01）. ConclusionHerbal cake-separated moxibustion can effectively alleviate fatigue and improve the memory， reduce inflammatory response and oxidative stress， and decrease autophagy of hippocampal neurons in CFS rats by regulating the PI3K/Beclin1 signaling pathway.

ObjectiveTo explore the mechanism of moxibustion with the classical prescription Xiaoyaosan as the herbal cake in improving cognitive function in the rat model of chronic fatigue syndrome （CFS） by regulating autophagy via phosphatidylinosiol 3-kinase （PI3K）/autophagy key molecule yeast Atg6 homologue 1 （Beclin1） signaling pathway. MethodsFifty SPF-grade SD rats aged 6-8 weeks were randomly grouped as follows： control， model， sham cake-separated moxibustion， intragastric administration with Chinese herbs， and herbal cake-separated moxibustion， each with 10 rats. The other groups except the control group were subjected to modeling by exhaustive swimming and chronic restraint stress for 21 days， and the behavioral test was performed after modeling. Herbal cake-separated moxibustion and sham cake-separated moxibustion were carried out at Shenque （CV8）， Guanyuan （CV4）， Zusanli （ST36）， and Qimen （LR14）. The rats in the intragastric administration with Chinese herbs group were treated with Xiaoyaosan suspension by gavage. After continuous intervention for 10 days， rat behaviors were observed and the levels of interleukin （IL）-4， IL-10， blood urine nitrogen （BUN）， and malondiadehyde （MDA） in the serum and hippocampal tissue of rats in each group were determined by enzyme-linked immunosorbent assay. The morphological changes of the hippocampal tissue were observed by hematoxylin-eosin staining. The relative mRNA and protein levels of PI3K and Beclin1 in the hippocampal tissue were determined by Real-time quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultsCompared with the normal group， the model group showed reduced crossings， shortened residence time in the target quadrant， and prolonged average escape latency on days 1， 2， 3， and 4 （P<0.01） in the Morris water maze test. In the new object recognition test， the model group showed decreased recognition index of exploration time and recognition index of exploration times （P<0.01）， lowered levels of IL-4 and IL-10 and elevated levels of BUN and MDA in the serum and hippocampus （P<0.01）， and down-regulated mRNA and protein levels of PI3K and Beclin1 （P<0.01）. After treatment， compared with the model group， each treatment group showed increased crossings， prolonged residence time in the target quadrant， and shortened average escape latency on days 1， 2， 3， and 4 （P<0.05， P<0.01）. In addition， the treatment elevated the levels of IL-4 and IL-10 and lowered the levels of BUN and MDA in the serum and hippocampus （P<0.05， P<0.01）， and up-regulated the mRNA and protein levels of PI3K and Beclin1 （P<0.05， P<0.01）. Compared with the sham cake-separated moxibustion group， the herbal cake-separated moxibustion group and the intragastric administration with Chinese herbs group showed increased crossings， prolonged residence time in the target quadrant （P<0.05）， elevated level of IL-4， lowered level of MDA， and up-regulated relative mRNA and protein levels of PI3K and Beclin1 in the hippocampus （P<0.05， P<0.01）. The serum levels of MDA and BUN in the intragastric administration with Chinese herbs group were significantly decreased. The average escape latency of the herbal cake-separated moxibustion group was significantly shortened on days 2 and 3 （P<0.05， P<0.01）. In addition， this group showed elevated serum level of IL-4， lowered serum level of MDA， and declined BUN level in the hippocampus （P<0.05， P<0.01）. Compared with the intragastric administration with Chinese herbs group， the herbal cake-separated moxibustion group presented risen serum level of IL-4 and up-regulated mRNA level of Beclin1 （P<0.05） and relative protein levels of PI3K and Beclin1 （P<0.05， P<0.01）. ConclusionHerbal cake-separated moxibustion can effectively alleviate fatigue and improve the memory， reduce inflammatory response and oxidative stress， and decrease autophagy of hippocampal neurons in CFS rats by regulating the PI3K/Beclin1 signaling pathway.

This study aims to investigate the changes in blood biochemical indicators of tongue roll-ing(TR)behavior in cattle and their correlation with changes in oral microbiota,laying a founda-tion for further exploring the relationship between animal oral microbiota,biochemical indicators,and behavioral changes.It also provides theoretical basis for preventing and treating TR behavior through regulating oral microbiota.This study intends to analyze and compare the blood biochemi-cal indicators and changes in oral microbiota of cattle with TR behavior and healthy cattle without TR behavior(healthy control,H),in order to explore the blood biochemical indicators of TR cattle and their correlation with changes in oral microbiota.Blood samples from the caudal vein of cattle in each group were collected for the detection of blood biochemical indicators and stress-related hormone indicators.Oral swabs from cattle in each group were collected for 16S rRNA gene se-quencing to analyze the composition,structure,and functional changes of their oral microbiota.The results of blood biochemical indicators in H and TR groups showed that the concentrations of al-bumin(ALB),aspartate aminotransferase(AST),calcium ion(Ca2+),and cortisol in TR group were significantly higher than those in H group(P＜0.05).There were significant differences in beta diversity of oral microbiota between TR and H groups(P＜0.05).At the genus level,the rela-tive abundances of Pseudomonas,Enterobacter,Xanthomonas,and other genera in the oral micro-biota of TR group were significantly higher than those in H group(P＜0.05).However,the rela-tive abundances of Tessaracoccus,Turicibacter,Monoglobus,Dietzia,Bifidobacterium,and other genera in the oral microbiota of TR group were significantly lower than those in H group(P＜0.05).In the KEGG metabolic pathway at the third level,the relative abundances of thiamine me-tabolism,lipoate metabolism,cysteine and methionine metabolism in the oral microbiota of TR group were significantly lower than those in H group(P＜0.05).Spearman correlation analysis showed that ALB and AST were significantly positively correlated with the relative abundances of Pseudomonas and Stenotrophomonas.Therelative abundances of Pseudomonas,Stenotrophomonas,and Sphingomonas were significantly positively correlated with fatty acid metabolism,phosphate and phosphonate metabolism,and lipoate metabolism.ALB was significantly positively correlated with inositol phosphate metabolism and phosphate and phosphonate metabolism.The study found that there were significant differences in blood biochemical indicators and oral microbiota between TR and H groups.In addition,there is a certain correlation between the composition,structure,and function of oral microbiota and the biochemical function of the host.This indicates that TR behav-ior may be associated with changes in the biochemical indicators of the host and the composition,structure,and function of oral microbiota.

Objective To investigate the influence of oxygen supply flow rate in high-flow nasal cannula(HFNC)oxygen therapy on pressure distributions in the upper airway.Methods A three-dimensional(3D)model of the upper airway was reconstructed using CT images from an adult male,and then coupled with a high-flow nasal cannula model to establish a coupled model of the nasal cannula and the upper airway.Subsequently,a physical model of this upper airway,which was combined with a head model,artificial lungs,and a monitoring system was created by 3D printing technology to form a physical simulation platform in vitro.Computational and physical simulations were carried out respectively to determine the air pressure at typical locations in the upper airway under different oxygen supply flow rates.Results Pressures at typical upper airway locations obtained by computational and physical simulations turned out to be in good agreement;both peak inspirational pressure(PIP)and positive end-expiratory pressure(PEEP)increased quadratically with the increase of oxygen supply flow rate;and the air pressure distribution was more uniform in the laryngeal cross-section as compared to the nasal part of the upper airway.Conclusions This study may provide a theoretical support for optimization of the setting of oxygen suppy flow rate and the selection of PEEP effect assessment position in the clinical application of HFNC oxygen therapy.