OBJECTIVE To investigate the clinical efficacy and mechanism of Gongliuxiao capsule combined with dienogest （DNG） in the treatment of refractory/recurrent endometriosis （EMT）. METHODS A retrospective analysis was conducted on the clinical data of 94 patients with refractory/recurrent EMT admitted to Qingdao TCM Hospital from January 2022 to January 2025. According to different treatment methods， they were divided into a monotherapy group （47 cases， receiving DNG monotherapy） and a combination group （47 cases， receiving Gongliuxiao capsule combined with DNG）. The cl inical efficacy， symptom and sign scores [Visual Analog Scale （VAS） and Pictorial Blood Loss Assessment Chart （PBAC） scores ] ， vascular endothelial function indicators [serum transforming growth factor-β 1 （TGF-β 1 ）， vascular endothelial growth factor （VEGF）， matrix metalloproteinase-2 （MMP-2）， MMP-9， basic fibroblast growth factor （bFGF） ] ， serum pathological factors [carbohydrate antigen 125 （CA125）， CA199， anti-endometrial antibody （EMAb） ] ， and Th1/Th2 drift indicators [interferon-γ （IFN-γ）， interleukin-4 （IL-4） ] were compared between the two groups before and after 6 months of treatment. RESULTS After treatment， the VAS and PBAC scores， serum levels of TGF-β 1 ， VEGF， MMP-2， MMP-9， bFGF， CA125， CA199， EMAb， and IL-4 in both groups were significantly lower than those before treatment， while IFN-γ levels were significantly higher than those before treatment （ P ＜0.05）. Moreover， the magnitude of increase or decrease in the combination group was significantly greater than that in the monotherapy group （ P ＜0.05）. The total effective rate in the combination group was significantly higher than that in the monotherapy group （93.62% vs. 76.60%， P ＜0.05）. CONCLUSIONS The combination of Gongliuxiao capsule and DNG is effective in treating refractory/recurrent EMT， and can effectively improve the degree of dysmenorrhea and abnormal menstrual volume in patients. The mechanism may be related to improving vascular endothelial function， inhibiting the expression of tumor pathological factors， and correcting Th1/Th2 drift.

Objective To evaluate the clinical efficacy of Huanglian Heye Formula(composed of Nelumbinis Folium,Coicis Semen,Atractylodis Rhizoma,Glycyrrhizae Radix et Rhizoma,Coptidis Rhizoma,Crataegi Fructus,and Atractylodis Macrocephalae Rhizoma)combined with insulin aspart in treating obese patients with type 2 diabetes mellitus(T2DM)presenting damp-heat obstructing middle jiao syndrome.Methods A total of 94 obese T2DM patients with damp-heat obstructing middle jiao syndrome were treated at the Endocrinology Department of the First Affiliated Hospital of Henan University of Chinese Medicine from April 2022 to January 2024.The patients were randomly assigned to the control group and the observation group,with 47 patients in each group.The control group was treated with insulin aspart,and the observation group was treated with Huanglian Heye Formula plus insulin aspart,both groups were treated for 12 weeks.Changes in traditional Chinese medicine(TCM)syndrome scores,lipid metabolism parameters[total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C)],obesity indicators[waist-to-hip ratio(WHR),body mass index(BMI),glucose metabolism markers[glycated hemoglobin(HbA1c),2-hour postprandial glucose(2hPG),fasting plasma glucose(FPG)],and serological indicators(visceral adipose tissue-derived serine protease inhibitor[VASPIN],homeostasis model assessment of[3-cell function(HOMA-β)]were observed before and after treatment.Clinical efficacy and safety were evaluated.Results(1)The observation group demonstrated significantly higher total efficacy[93.62％(44/47)]compared to the control group[78.72％(37/47);the intergroup comparison(by chi-square test)showed that the efficacy in the observation group was superior to the control group(P＜0.05).(2)Both groups showed reduced TCM syndrome scores(heaviness in head/body,epigastric fullness,sticky/foul-smelling stools,halitosis,dry/bitter mouth,heartburn/vomiting,yellowish urine,and emotional distress;all P＜0.05),with greater improvements in the observation group(P＜0.01).(3)Lipid profiles of TC,TG and LDL-C were improved in both groups(P＜0.05),with more significant reductions in the observation group(P＜0.01).(4)Obesity indicators(WHR,BMI)decreased in both groups(P＜0.05),showing superior reductions in the observation group(P＜0.05 or P＜0.01).(5)Glucose metabolism markers(HbA1c,2hPG,FPG)were significantly lowered in both groups(P＜0.05),with the observation group achieving better outcomes(P＜0.01).(6)Serological analysis revealed increased VASPIN and HOMA-[3 levels in both groups(P＜0.05),with more pronounced elevations in the observation group(P＜0.01).(7)No severe adverse events occurred.The incidence of adverse reactions was 8.51％(4/47)in the observation group versus 6.38％(3/47)in the control group(P＞0.05).Conclusion Huanglian Heye Formula combined with insulin aspart significantly improves clinical outcomes in obese T2DM patients with damp-heat obstructing middle jiao syndrome by protecting pancreatic[3-cell function,reducing body mass,ameliorating glucose/lipid metabolism,and modulating VASPIN expression,with demonstrated safety.

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

Hospital pharmacy research is significant in enhancing the level of rational drug use,improving the quality of pharmacy services,and promoting the improvement of drug treatment effects.To guarantee the standardization of hospital pharmacy research,the compilation team of"Hospital Pharmacy Research Standards"adheres to the principles of scientificity,universality,guidance,and operability,combs through the key management contents from three aspects,namely,relevant national policy docu-ments,relevant domestic and international standards and norms,and literature analysis,combines with the actual working condition of hospital pharmacy research,and formulates the standards after several rounds of opinion collection and expert argumentation.This paper analyzes the key contents of the standard,including basic requirements,research process management,and research re-sults management,to provide guidance and reference for hospital pharmacy researchers to understand the standard in-depth and further improve the standardization of hospital pharmacy research.

Purpose To investigate the clinicopathological features,immunophenotypic profile,differential diag-noses,and prognostic implications of liver metastatic solid pseudopapillary neoplasm(LMSPN).Methods A retro-spective analysis was conducted on the clinicopathological features,immunohistochemical profile,and clinical outcomes of of 15 cases of LMSPN cases,supplemented by a literature review.Results Of the 15 patients,12 were female and 3 were male,with a mean age of 43 years(range 25-67 years).Multiple hepatic lesions were observed in 9 cases,some of which were accompanied by abdominal or omental metastasis.The tumors exhibited a cystic-solid appearence on gross examination,ranging from 0.5 to 15 cm in diameter.Histologically,the tumors showed typical cystic-solid and pseudopapillary areas,with tumor cells arranged around small blood vessels forming characteristic pseudopapillary structures.Tumor cells exhibited relatively uniform morphology,however,some cases presented with tumor necrosis(5/15),cytologic/nuclear atypia(4/15),mitotic figures(5/15),lymphovascular invasion(6/15),perineural inva-sion(3/15),and lymph node metastasis(2/15).Immunohistochemically,tumor cells showed variable expression ofβ-catenin,LEF1,vimentin,CD10,α1-ACT,PR,E-cadherin,NSE,CD56,Syn and Ki67.Notably,the nuclear ex-pression level of Ki67 and PR were significantly associated with prognosis(P＜0.05).β-catenin,LEF1,PR,and Ki67 were predominantly expressed in the nuclei,while markers such as CKpan,CgA,Hep Par-1,Arginase-1,CK7,and CK19 were negative or only weakly expressed.Follow-up data were available for 11 patients(range 10-157 months).Four patients died of widespread hepatic and abdominal metastases,while 7 remained alive.Conclusion The liver is the most most frequent site of distant metastasis for solid pseudopapillary neoplasms of the pancreas.High expression of Ki67 and PR is associated with unfavorable prognosis in LMSPN.

Hospital pharmacy research is significant in enhancing the level of rational drug use,improving the quality of pharmacy services,and promoting the improvement of drug treatment effects.To guarantee the standardization of hospital pharmacy research,the compilation team of"Hospital Pharmacy Research Standards"adheres to the principles of scientificity,universality,guidance,and operability,combs through the key management contents from three aspects,namely,relevant national policy docu-ments,relevant domestic and international standards and norms,and literature analysis,combines with the actual working condition of hospital pharmacy research,and formulates the standards after several rounds of opinion collection and expert argumentation.This paper analyzes the key contents of the standard,including basic requirements,research process management,and research re-sults management,to provide guidance and reference for hospital pharmacy researchers to understand the standard in-depth and further improve the standardization of hospital pharmacy research.

Purpose To investigate the clinicopathological features,immunophenotypic profile,differential diag-noses,and prognostic implications of liver metastatic solid pseudopapillary neoplasm(LMSPN).Methods A retro-spective analysis was conducted on the clinicopathological features,immunohistochemical profile,and clinical outcomes of of 15 cases of LMSPN cases,supplemented by a literature review.Results Of the 15 patients,12 were female and 3 were male,with a mean age of 43 years(range 25-67 years).Multiple hepatic lesions were observed in 9 cases,some of which were accompanied by abdominal or omental metastasis.The tumors exhibited a cystic-solid appearence on gross examination,ranging from 0.5 to 15 cm in diameter.Histologically,the tumors showed typical cystic-solid and pseudopapillary areas,with tumor cells arranged around small blood vessels forming characteristic pseudopapillary structures.Tumor cells exhibited relatively uniform morphology,however,some cases presented with tumor necrosis(5/15),cytologic/nuclear atypia(4/15),mitotic figures(5/15),lymphovascular invasion(6/15),perineural inva-sion(3/15),and lymph node metastasis(2/15).Immunohistochemically,tumor cells showed variable expression ofβ-catenin,LEF1,vimentin,CD10,α1-ACT,PR,E-cadherin,NSE,CD56,Syn and Ki67.Notably,the nuclear ex-pression level of Ki67 and PR were significantly associated with prognosis(P＜0.05).β-catenin,LEF1,PR,and Ki67 were predominantly expressed in the nuclei,while markers such as CKpan,CgA,Hep Par-1,Arginase-1,CK7,and CK19 were negative or only weakly expressed.Follow-up data were available for 11 patients(range 10-157 months).Four patients died of widespread hepatic and abdominal metastases,while 7 remained alive.Conclusion The liver is the most most frequent site of distant metastasis for solid pseudopapillary neoplasms of the pancreas.High expression of Ki67 and PR is associated with unfavorable prognosis in LMSPN.

Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

Objective The prediction of the fatality rate of COVID-19 pandemic is of great significance for in-depth understanding of the severity of the new coronavirus,rational allocation of medical resources,and targeted epidemic prevention strategies.Methods This study divides the development of the epidemic into four periods based on the dominant strain of the new coronavirus variant.Six countries including the United States,India,Brazil,Mexico,Peru,China,and the global average case fatality rate were selected as study subjects.Six models including the Grey Model,Exponential Smoothing Model,ARIMA,SVM,Prophet and LSTM are used for fitting and forecasting,the advantages,disadvantages and applicability of each model are discussed,and the model with the best effect is selected to forecast the fatality rate in the world and key countries.Results Model comparison shows that various models have their own advantages and disadvantages.It is predicted that the growth rate of the cumulative number of confirmed cases and cumulative deaths in most countries has slowed down,and the development trend has gradually stabilized.Conclusion The study suggests that traditional time series model is suitable for the prediction of stable development trend and limited samples,and the machine learning model is more suitable for fluctuating data,which can be used for large sample predictions.Depending on the features of these models,application can be extended to other fields.

Objective To investigate the risk factors for inflammatory complications after radical gastrectomy for gastric cancer and construct a nomogram model for risk prediction. Methods The clinical data of 402 patients with primary gastric cancer who underwent radical gastrectomy were retrospectively analyzed. All patients underwent preoperative Nutritional Risk Screening 2002 (NRS2002) score, Patient-Generated Subjective Global Assessment (PG-SGA) grading, Lumbar 3 Skeletal Muscle Index (L3-SMI) assessment, and serological index testing. Univariate analysis was used to screen for influencing factors of postoperative inflammatory complications of gastric cancer, and multivariate Logistic regression analysis was conducted to determine independent risk factors. A nomogram model for predicting postoperative inflammatory complications after radical gastrectomy was constructed based on the results of multivariate Logistic regression analysis, and the predictive performance of the model was evaluated using the receiver operating characteristic (ROC) curve and calibration curve. Results Univariate analysis revealed that age, TNM stage, body mass index, preoperative hemoglobin, preoperative albumin, preoperative globulin, NRS2002 score, PG-SGA grade, and L3-SMI were influencing factors of postoperative inflammatory complications in patients undergoing radical gastrectomy (P < 0.05). Multivariate Logistic regression analysis showed that age ≤60 years, preoperative hemoglobin ≤130 g/L(male) or ≤115 g/L(female), TNM staging of Ⅳ stage, NRS2002 score≥3, and L3-SMI ≤52.4 cm²/m²(male) or ≤38.5 cm²/m²(female) were independent risk factors for postoperative inflammatory complications in gastric cancer patients (P < 0.05). A nomogram model was constructed based on age, preoperative hemoglobin, TNM stage, and NRS2002 score. The ROC curve showed that the area under the curve of the nomogram model was 0.930, with sensitivity and specificity of 93.2% and 89.2%, respectively. The calibration curve demonstrated good consistency between the predicted probability of inflammatory complications and the actual outcomes. Conclusion Age≤60 years, low preoperative hemoglobin, TNM staging of Ⅳ stage, NRS2002 score ≥3, and low L3-SMI are independent risk factors for postoperative inflammatory complications in gastric cancer patients. The nomogram model constructed based on age, preoperative hemoglobin, TNM stage, and NRS2002 score can accurately predict postoperative inflammatory complications after gastrectomy for gastric cancer.