Metformin has been demonstrated to attenuate hyperglycaemia by modulating the gut microbiota. However, the mechanisms through which the microbiome mediates metformin monotherapy failure (MMF) are unclear. Herein, in a prospective clinical cohort study of newly diagnosed type 2 diabetes mellitus (T2DM) patients treated with metformin monotherapy, metagenomic sequencing of faecal samples revealed that Phocaeicola vulgatus abundance was approximately 12 times higher in nonresponders than in responders. P. vulgatus rapidly hydrolysed taurine-conjugated bile acids, leading to ceramide accumulation and reversing the improvements in glucose intolerance conferred by metformin in high-fat diet-fed mice. Interestingly, C22:0 ceramide bound to mitochondrial fission factor to induce mitochondrial fragmentation and impair hepatic oxidative phosphorylation in P. vulgatus-colonized hyperglycaemic mice, which could be exacerbated by metformin. This work suggests that metformin may be unsuitable for P. vulgatus-rich T2DM patients and that clinicians should be aware of metformin toxicity to mitochondria. Suppressing P. vulgatus growth with cefaclor or improving mitochondrial function using adenosylcobalamin may represent simple, safe, effective therapeutic strategies for addressing MMF.

Objective:To evaluate the characteristic manifestations of lumbar fusion following oblique lateral interbody fusion (OLIF), determine the specific incidence of these patterns, and the identify factors associated with fusion characteristics.Methods:This retrospective study analyzed 209 patients who underwent OLIF surgery at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between July 2017 and September 2023. The cohort had a mean age of 64.2±9.8 years and included 125 males and 84 females. A total of 338 lumbar segments were assessed, comprising 159 segments treated with stand-alone OLIF (OLIF-SA) and 179 segments treated with OLIF combined with posterior pedicle screw fixation (OLIF-PSF). Inclusion criteria were: patients aged 18-80 years who underwent OLIF with complete radiographic records. Surgical parameters, including fixation method, number of fused segments, surgical approach, and cage dimensions (height and width), were obtained from operative records. Radiographic evaluation included preoperative osteophytes, Hounsfield unit (HU) values of endplates, and cage positioning. Fusion rate, fusion pattern (lateral vs. central), cage subsidence, and related influencing factors were assessed. Clinical outcomes were measured via the Oswestry disability index (ODI) and visual analog scale (VAS) preoperatively, immediately postoperatively, and at 1-year follow-up. Results:The overall fusion rate was 98.2% (332/338), with a non-union rate of 1.8% (6/338). The incidence of lateral fusion was 40.2% (136/338). In the OLIF-SA group, lateral and central fusion rates were 50.3% (80/159) and 49.7% (79/159), respectively, with no cases of non-union. In the OLIF-PSF group, lateral fusion occurred in 31.3% (56/179), central fusion in 65.4% (117/179), and non-union in 3.3% (6/179), with statistically significant differences between groups ( P<0.05). Preoperative osteophytes and higher endplate HU values were significantly associated with lateral fusion ( P<0.05). However, cage dimensions and cage position (anterior-posterior and lateral placement) were not significantly associated with fusion pattern ( P>0.05). Overall, 61.5% (208/338) of segments showed no cage subsidence; 24.5% (83/338) had settling, and 14.0% (47/338) had grade 1 or higher subsidence. Among lateral fusion cases, the rates of no subsidence, anchoring, grade 1, grade 2, and grade 3 subsidence were 67.6%, 21.3%, 7.4%, 3.9%, and 0.7%, respectively. In the central fusion group, these rates were 59.2%, 27.6%, 9.2%, 2.5%, and 1.3%, respectively. In the non-union group, grade 2 and 3 subsidence occurred in 50% (3/6) each, significantly higher than in the other fusion groups ( P<0.05). Post hoc analysis confirmed that grade 2 and 3 subsidence rates were significantly elevated in the non-union group compared to the lateral and central fusion groups, while other subsidence categories showed no significant differences across groups. Clinically, patients showed significant improvements in ODI and VAS scores following surgery ( P<0.05). Conclusions:Lateral fusion occurred in 40.2% of OLIF cases. The OLIF-SA technique, preoperative osteophytes, and elevated preoperative HU values were significantly associated with lateral fusion. In contrast, surgical approach, number of fused segments, cage height, width, and cage positioning did not significantly influence the occurrence of lateral fusion.

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.

Objective:To evaluate the characteristic manifestations of lumbar fusion following oblique lateral interbody fusion (OLIF), determine the specific incidence of these patterns, and the identify factors associated with fusion characteristics.Methods:This retrospective study analyzed 209 patients who underwent OLIF surgery at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between July 2017 and September 2023. The cohort had a mean age of 64.2±9.8 years and included 125 males and 84 females. A total of 338 lumbar segments were assessed, comprising 159 segments treated with stand-alone OLIF (OLIF-SA) and 179 segments treated with OLIF combined with posterior pedicle screw fixation (OLIF-PSF). Inclusion criteria were: patients aged 18-80 years who underwent OLIF with complete radiographic records. Surgical parameters, including fixation method, number of fused segments, surgical approach, and cage dimensions (height and width), were obtained from operative records. Radiographic evaluation included preoperative osteophytes, Hounsfield unit (HU) values of endplates, and cage positioning. Fusion rate, fusion pattern (lateral vs. central), cage subsidence, and related influencing factors were assessed. Clinical outcomes were measured via the Oswestry disability index (ODI) and visual analog scale (VAS) preoperatively, immediately postoperatively, and at 1-year follow-up. Results:The overall fusion rate was 98.2% (332/338), with a non-union rate of 1.8% (6/338). The incidence of lateral fusion was 40.2% (136/338). In the OLIF-SA group, lateral and central fusion rates were 50.3% (80/159) and 49.7% (79/159), respectively, with no cases of non-union. In the OLIF-PSF group, lateral fusion occurred in 31.3% (56/179), central fusion in 65.4% (117/179), and non-union in 3.3% (6/179), with statistically significant differences between groups ( P<0.05). Preoperative osteophytes and higher endplate HU values were significantly associated with lateral fusion ( P<0.05). However, cage dimensions and cage position (anterior-posterior and lateral placement) were not significantly associated with fusion pattern ( P>0.05). Overall, 61.5% (208/338) of segments showed no cage subsidence; 24.5% (83/338) had settling, and 14.0% (47/338) had grade 1 or higher subsidence. Among lateral fusion cases, the rates of no subsidence, anchoring, grade 1, grade 2, and grade 3 subsidence were 67.6%, 21.3%, 7.4%, 3.9%, and 0.7%, respectively. In the central fusion group, these rates were 59.2%, 27.6%, 9.2%, 2.5%, and 1.3%, respectively. In the non-union group, grade 2 and 3 subsidence occurred in 50% (3/6) each, significantly higher than in the other fusion groups ( P<0.05). Post hoc analysis confirmed that grade 2 and 3 subsidence rates were significantly elevated in the non-union group compared to the lateral and central fusion groups, while other subsidence categories showed no significant differences across groups. Clinically, patients showed significant improvements in ODI and VAS scores following surgery ( P<0.05). Conclusions:Lateral fusion occurred in 40.2% of OLIF cases. The OLIF-SA technique, preoperative osteophytes, and elevated preoperative HU values were significantly associated with lateral fusion. In contrast, surgical approach, number of fused segments, cage height, width, and cage positioning did not significantly influence the occurrence of lateral fusion.

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.

Objective:To compare the efficacy of minimally invasive steel plate combined with percutaneous hollow nail fixation through the sinus tarsi incision versus "L"-shaped incision steel plate fixation in the treatment of calcaneal fractures.Methods:A retrospective analysis was conducted on 103 cases of Sanders type II-IV calcaneal fractures treated with minimally invasive steel plate combined with percutaneous hollow nail fixation through sinus tarsi incision from January 2017 to March 2024 at the orthopedic department of Hangzhou Sir Run Run Shaw Hospital (minimally invasive group). An additional 103 cases treated with "L"-shaped incision steel plate fixation during the same period were included as controls (open group). The preoperative hospital stay, surgical time, postoperative hidden blood loss, postoperative hospital stay, postoperative infection rate, postoperative Bohler angle, Gissane angle, calcaneal mid-width, sustentacular effective fixation rate, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at 6 and 12 months postoperatively were compared between the two groups.Results:There were no statistically significant differences in age, gender, diabetes, smoking history, and body mass index between the minimally invasive group and the open group ( P>0.05). In the minimally invasive group, the preoperative hospital stay (3.1±1.5 days), postoperative hospital stay (3.5±1.5 days), hidden blood loss (293.3±71.4 ml), surgical time (64.4±13.2 min), and AOFAS score at 6 months postoperatively (79.9±3.9) were superior to those in the open group (7.1±0.7 days, 5.6±0.9 days, 408.3±101.7 ml, 91.5±24.3 min, and 70.5±6.1, respectively) ( P<0.05), with no significant difference in AOFAS score at 1 year postoperatively ( P>0.05). Additionally, the preoperative hospital stay (3.7±1.5 days), postoperative hospital stay (4.0±2.0 days), hidden blood loss (336.3±75.3 ml), and AOFAS score at 6 months postoperatively (77.4±3.8) in the minimally invasive group were superior to those in the open group (7.6±0.9 days, 8.2±2.6 days, 441.3±89.2 ml, and 64.6±8.4, respectively) ( P<0.05), with no significant difference in surgical time and AOFAS score at 1 year postoperatively ( P>0.05). Within-group comparisons indicated that as fracture severity increased, preoperative ( P<0.05) and postoperative hospital stays ( P<0.05) increased in the open group, while surgical time increased in the minimally invasive group ( P<0.05). AOFAS scores at 6 months postoperatively varied between complex and simple fractures in both groups ( P<0.05). There were no statistically significant differences in postoperative Bohler angle, Gissane angle, and calcaneal mid-width between the two groups ( P>0.05). The sustentacular effective fixation rate in the minimally invasive group was 85.4%, superior to 47.4% in the open group for simple fractures ( P<0.05), with no statistically significant difference for complex fractures ( P>0.05). The incision infection rate was 0 in the minimally invasive group compared to 3 cases (3%) in the open group, with no statistically significant difference ( P=0.246). Conclusion:Minimally invasive steel plate combined with percutaneous hollow nail fixation through sinus tarsi incision for calcaneal fractures offers the advantages of shorter hospital stay, reduced surgical trauma, lower incision infection rate, and better short-term efficacy compared to open incision. It is suitable for most Sanders type II-IV calcaneal fractures.

Objective To retrieve,evaluate and summarize the best evidence on the management of ocular complications in intensive care patients ventilated in prone position,and to provide references for clinical practice.Methods Evidence on management of ocular complications in intensive care patients ventilated in prone position was systemically retrieved in the guideline websites,professional association websites and databases,such as the BMJ Best Practice,UpToDate,Cochrane Library,Joanna Briggs Institute,PubMed,Web of Science,Science Direct,Embase,CNKI,Wanfang and other databases,including guidelines,clinical decisions,evidence summaries,expert consensuses,group standards,systematic reviews and scoping reviews,published from January 2013 to June 2023.The guidelines were individually evaluated by 4 researchers,and the remaining literature was individually evaluated by 2 researchers.The literature that met the criteria was extracted and graded.Results A total of 15 articles were involved,including 6 guidelines,2 clinical decisions,2 evidence summaries,3 systematic reviews,1 scoping review and 1 group standard.Finally,6 evidence topics and 16 pieces of best evidence were formed,including organization and training,risk identification,eye assessment,eye protection,position management and regular observation.Conclusion This study summarized the best evidence on the management of ocular complications in intensive care patients ventilated in prone position.In the application,the best evidence should be selected according to the clinical situation,so as to reduce the incidence of ocular complications and improve the quality of life of patients.

Objective To explore the predictive value of CXC chemokine receptor 2(CXCR2)and Zonula occluden-1(ZO-1)for postoperative cerebral vasospasm in subarachnoid hemorrhage(SAH)patients with ruptured intracranial aneurysm.Methods A total of 215 SAH patients with ruptured intracranial aneurysm admitted to our hospital between May 2020 and October 2023 were recruited,and according to occurrence of postoperative cerebral vasospasm or not,they were separated into a spasm group(70 cases)and a non-spasm group(145 cases).The spasm group was further divided into mild,moderate and severe subgroups(14,38 and 18 cases,respectively).ELISA was applied to detect the serum levels of CXCR2 and ZO-1;Spearman and Pearson corre-lation analyses,multivariate logistic regression analysis,and ROC curve analysis were applied to test the correlation,influencing factors,and predictive value of indicators,and their AUC values were calculated.Results The spasm group had significantly higher CXCR2 and ZO-1 levels,inci-dence of intracranial hemorrhage,and larger proportions of Glasgow coma scale(GCS)score of 3-8 at admission,Hunt-Hess grade Ⅲ,and Fisher grades m and Ⅳ than the non-spasm group(P＜0.01).Intracranial hemorrhage volume,Hunt-Hess grade and Fisher grade were positively correlated with CXCR2 and ZO-1 levels,and the GCS score at admission was negatively correlated with the levels of the two indicators in the SAH patients with ruptured intracranial aneurysm(P＜0.01).CXCR2 and ZO-1 were independent risk factors for postoperative cerebral vasospasm in these patients(P＜0.01).The AUC value of CXCR2,ZO-1 and their combination in predicting postoperative cerebral vasospasm was 0.839(95％CI:0.780-0.898),0.813(95％CI:0.750-0.876),and 0.910(95％CI:0.869-0.951),with the combination showing better predictive per-formance(Z=2.391,Z=3.266,P＜0.05).The serum levels of CXCR2 and ZO-1 in the severe subgroup were significantly higher than those in the moderate subgroup and then followed by the mild subgroup in order,with statistical differences(P＜0.01).Conclusion Serum CXCR2 and ZO-1 levels are associated with postoperative cerebral vasospasm in SAH patients with ruptured intracranial aneurysm,and can be used as potential biomarkers for prognosis prediction.

Objective To strengthen the management of rational medication for patients with rare diseases and improve the level of comprehensive medication support,in order to address the pain points in medication for rare diseases.Methods By leveraging mobile information technology,a mobile application for the Guangdong Shortage Drug Consultation Platform was developed and a smart and multifunctional pharmaceutical service information platform for rare disease patients was established.Results As the first big data platform in China integrating provincial-level rare disease medical resources,it innovatively realizes the closed-loop interaction among"treatment to medication"online and offline by establishing a comprehensive and professional rare disease mobile pharmaceutical service system.Conclusion The pharmaceutical service platform builds a bridge for rare disease patients to seek medical treatment and and medicine,and helps promote the high-quality development of Healthy China strategy.

Objectives:To explore the clinical use and observe the clinical efficacy of the Pivox system in oblique lateral interbody fusion(OLIF)in treating single-segment lumbar spinal diseases.Methods:The clini-cal data of patients with single-segment lumbar spinal diseases(Discogenic low back pain,lumbar spondylolis-thesis,lumbar spinal stenosis)who underwent OLIF without posterior instrumentation from May 2020 to Jan-uary 2021 in our hospital were collected,including 36 males and 33 females,aged 32-79 years old(59.1±5.9 years).And the patients were divided into OLIF stand-alone group(39 patients)and Pivox+OLIF group(30 pa-tients).The perioperative parameters of the two groups of patients were compared,including incision length,operative time,intraoperative blood loss,and length of hospital stay.The visual analogue scale(VAS)and Os-westry disability index(ODI)were assessed before operation,at 1 week,1,3,6 and 12 months after operation for clinical efficacy.The intervertebral disc height,foraminal height and foraminal area before and after oper-ation,and the fusion rate were evaluated and compared between the two groups.Complications were recorded and compared as well.Results:The patients were followed up for 14.0±0.3 months(12-18 months).No signif-icant differences were found between the two groups in gender,age,disease type,operative level,bone min-eral density(BMD),or body mass index(BMI)(P＞0.05).The operative time in OLIF group was shorter than that in Pivox+OLIF group(P＜0.05),while there were no significant differences in blood loss,incision length and hospital stay(P＞0.05).The VAS score and ODI index in both groups before surgery were higher than those at 1 week,1 month,3 months,6 months,and 12 months after surgery(P＜0.05).No significant differences in VAS and ODI were found at 1 week,1 month,3 months,6 months,and 12 months after surgery between the two groups,respectively(P＞0.05).The intervertebral disc height,foraminal height and foraminal area at postoperative 1 week,6 and 12 months were all greater than those before operation in both groups,while the increase values of intervertebral disc height,foraminal height and foraminal area in Pivox+OLIF group were greater than those in OLIF group at 1 week,and 6 and 12 months after surgery,but without statistical differ-ences(P＞0.05).Cage subsidence occurred in both groups,and cage displacement was noticed in two cases in the OLIF group,while none was there in the Pivox+OLIF group.There were no significant differences in fu-sion rate and incidence of complications between two groups(P＞0.05).Conclusions:The short-term effect of Pivox+OLIF procedure in the treatment of single-segment lumbar degenerative diseases is satisfactory,but comparing with stand-alone OLIF,Pivox+OLIF has no obvious advantage in spinal canal decompression and preventing cage subsidence.