OBJECTIVE To establish the UPLC fingerprint and the method for multi-component content determination in Jingangteng capsules， and to evaluate its quality by combining chemical pattern recognition analysis. METHODS An UPLC method was established. Separation was performed on a Zorbax SB-C 18 Rapid Resolution HD column， with acetonitrile-0.1% formic acid as the mobile phase for gradient elution.Using the Similarity Evaluation System for Chromatographic Fingerprints of Traditional Chinese Medicines （2012 edition）， UPLC fi ngerprints were established for 10 batches of Jingangteng capsules， and similarity was evaluated. SPSS 22.0 and SIMCA 14.1 software were used to perform hierarchial-cluster analysis and orthogonal partial least squares discriminant analysis （OPLS-DA）， respectively. The same UPLC method was employed to determine the contents of chlorogenic acid， 3，5-dihydroxy-2-methylbenzoic acid-3- O -glucoside （M1）， caffeic acid， astilbin， oxyresveratrol， quercitrin and resveratrol in the 10 batches of samples. RESULTS A total of 17 common peaks were identified in UPLC fingerprints of the 10 batches of samples， of which 7 were identified as chlorogenic acid， M1， caffeic acid， astilbin， oxyresveratrol， quercitrin， and resveratrol. The similarities of 10 batches of samples ranged from 0.820 to 0.985. The results of hierarchial-cluster analysis showed that 10 batches of samples were grouped into four categories： S1-S4 formed one group， S5 and S6 formed another， S7， S8 and S10 formed a third， and S9 formed a fourth， consistent with the OPLS-DA results； the variable importance projection values for peaks 7， 10， 2， 16 （resveratrol）， 13 （oxyresveratrol）， 11， 6 （caffeic acid）， 5 （M1） and 15 （quercitrin） were ＞1. Quantitative analysis results showed that the contents of chlorogenic acid， M1， caffeic acid， astilbin， oxyresveratrol， quercitrin， and resveratrol were 1.650 8-4.213 7， 0.636 2-2.161 7， 0.031 0-0.086 5， 0.239 1-1.069 3， 0.211 9-1.104 0， 0.488 8-2.399 2， and 0.164 0-0.699 8 mg/g， respectively. CONCLUSIONS UPLC fingerprint and content determination methods established in this study are simple to operate， accurate， reliable and reproducible； when combined with chemical pattern recognition analysis， they can be used to evaluate the quality of Jingangteng capsules. Nine components， such as resveratrol， oxyresveratrol， caffeic acid， M1 and quercitrin， may serve as markers of quality variation.

ObjectiveStarting from the etiology， pathogenesis， and treatment strategies of endometriosis and adenomyosis， to integrate and sort out the academic characteristics of contemporary renowned experts and schools in the field of traditional Chinese medicine gynecology. MethodsAccording to the systematic review of text and opinion （SrTO） process developed by the Joanna Briggs Institute （JBI） in Australia， this paper determined literature screening criteria by searching China National Knowledge Infrastructure （CNKI）， VIP， Wanfang， and China Biomedical Literature Database. Information was extracted after literature screening， and quality evaluation was conducted using the JBI Narrative， Text， and Opinion Systematic Review Strict Evaluation Checklist. The JBI Narrative， Opinion， Text Evaluation， and Review Tool Summary Table was used for information synthesis， and data analysis and display were conducted in the form of text and charts. ResultsThe 146 articles related to 39 renowned experts and 19 articles related to 10 schools of thought were included. Research has found that contemporary experts and schools in traditional Chinese medicine gynecology consider blood stasis as the core pathogenesis in understanding the etiology and pathogenesis of two diseases and related infertility. Their viewpoints varied from multiple aspects such as clinical symptom characteristics， meridian circulation location， pathological product evolution， disease duration， emotional psychology， lifestyle habits， preference for food and drink， innate endowment， and acquired injury. In terms of treatment， it was advocated to divide the stage， treat according to different types， adapt to the times， integrate nature and humans， and combine multiple methods to treat comprehensively when necessary. It was also recommended to skillfully use insects， make good use of classic formulas and small prescriptions， pay attention to protecting the spleen and stomach and regulating emotions， and make good use of self-formulated empirical formulas for internal or external use. Besides， individualized long-term management of patients was also advocated. ConclusionThis study applies the SrTO process to systematically summarize the academic ideas of contemporary renowned experts and schools in traditional Chinese medicine gynecology regarding the causes， mechanisms， diagnosis， and treatments of endometriosis， providing a scientific and standardized reference for future theoretical exploration.

ObjectiveTo describe the medical services quality and safety of rehabilitation medicine departments in general hospitals and rehabilitation hospitals in 2022 from the aspects of structure, link and outcome quality. MethodsThrough the National Clinical Improvement System of the National Health Commission, all secondary and above general hospitals and rehabilitation hospitals were investigated in 2022, the relevant data from 7 250 hospitals, including traditional Chinese medicine hospitals and integrated traditional Chinese and Western medicine hospitals in 2022. A total of 3 153 sampling hospitals that equipped with rehabilitation medicine wards were included for analysis. ResultsAmong the 7 250 general hospitals surveyed this year, only 3 277 equipped with rehabilitation wards. In general hospitals, the average number of physicians per bed in 56.46% hospitals, the average number of rehabilitation therapists per bed in 77.67% hospitals, and the average number of nurses per bed in 51.18% hospitals did not meet the national requirements. The rates of early rehabilitation intervention were 13.98%, 20.82% and 21.36% respectively in the department of orthopedics, department of neurology and department of intensive care in general hospitals. The average activity of daily living improvement rate of discharged patients from rehabilitation departments of general hospitals was 77.69%, and that of discharged patients from rehabilitation specialized hospitals was 66.78%. ConclusionThere are insufficient allocation of wards and facility scales in the department of rehabilitation medicine, a shortage of human resources for rehabilitation services, inadequate integration of rehabilitation services with clinical services, and there is still scope for enhancing the effect and efficiency of rehabilitation services. It is recommended to expand the scale of rehabilitation services and improve discipline construction; increase the quantity and quality of rehabilitation human resources; incorporate rehabilitation services into the health service system; establish and modify clinical rehabilitation guidelines and technical specifications; and construct a rehabilitation medical information platform.

OBJECTIVE To report a case of hepatitis B virus （HBV） reactivation induced by iparomlimab and tuvonralimab， summarize the clinical characteristics and potential mechanisms of such adverse reactions induced by immune-checkpoint inhibitors （ICIs）， and provide references for clinical application. METHODS From the perspective of a clinical pharmacist， a retrospective analysis was conducted on the treatment course of a patient with metastatic cervical cancer who experienced HBV reactivation after receiving iparomlimab and tuvonralimab. Additionally， an analysis of the correlation with adverse reactions was performed， and the clinical characteristics， risk factors， potential mechanisms， key points of treatment approaches and pharmaceutical care associated with HBV reactivation induced by ICIs were summarized. RESULTS & CONCLUSIONS The patient developed HBV reactivation and severe liver injury after using iparomlimab and tuvonralimab. The condition improved following drug discontinuation， and symptomatic treatment such as glucocorticoids. According to Naranjo’s Assessment Scale and China’s Measures for the Reporting and Monitoring of Adverse Drug Reactions， the association between iparomlimab and tuvonralimab and HBV reactivation was judged as “highly probable”， and it was identified as a new adverse reaction； the correlation between iparomlimab and tuvonralimab， paclitaxel and liver injury was “highly probable”. HBV reactivation in hepatitis B patients receiving standardized antiviral therapy is very rare after ICIs treatment； HBV reactivation is related to the overactivation of the immune system and disruption of immune balance induced by ICIs. For such patients， glucocorticoids should be administered for treatment， accompanied by pharmaceutical care， including pre- medication risk assessment and monitoring of relevant indicators during treatment.

ObjectiveTo identify the characteristic exhaled volatile organic compounds （VOCs） associated with postoperative pulmonary complications （PPCs） in patients after abdominal surgery. MethodsThis study prospectively enrolled 76 patients with tracheal intubation who were transferred to intensive care unit （ICU） after abdominal surgery at Peking University People's Hospital between December 10， 2022 and June 30， 2023. The patients' basic information was collected during their perioperative period， and their exhaled VOCs were collected within 24 hours after their admission to the ICU， and then analyzed by gas chromatography and mass spectrometry （GC-MS）. According to whether PPCs occurred 24 hours after surgery， the patients were divided into PPCs group （n=44） and non-PPCs group （n=32）， and the differences of VOCs were compared between the two groups. Lasso regression analysis was used to screen the valuable variables of VOCs， and Logistics regression analysis to determine the characteristic VOCs associated with the occurrence of PPCs. ResultsAmong the 76 patients， 44 had PPCs and 32 had no PPCs. Lasso regression analysis screened 4 PPCs-related compounds from exhaled VOCs of two groups for further analysis and Logistics regression analysis showed that the increase of 1-Hexadecanol content in exhaled breath was significantly correlated with the occurrence of PPCs （OR： 1.000， P=0.002）. ConclusionThis study indicated that the increased content of 1-Hexadecanol in patients' exhaled breath after abdominal surgery may be associated with the occurrence of PPCs.

Diagnosis and treatment of refractory hydrocephalus are the keys in reflecting the overall level of diagnosis and treatment of hydrocephalus. However, there is currently no clear definition of refractory hydrocephalus; moreover, treatment of these patients is difficult, with high failure rate. This article focuses on the definition, common causes and classification of refractory hydrocephalus, the treatment strategies of infectious refractory hydrocephalus, the treatment dilemmas of negative pressure or low-pressure hydrocephalus, and treatment future directions of refractory hydrocephalus, in order to attract attention of clinicians to the diagnosis and treatment of refractory hydrocephalus.

Perioperative rehabilitation aims to alleviate symptoms,restore function,and improve quality of life.These goals largely involve subjective patient experiences,which are not fully captured by traditional outcome measures.In recent years,patient-reported outcomes(PROs)have emerged as essential tools to quantify patients'perceptions of health and have been widely used in drug and device clinical trials.This review summarizes the current applications of PROs in general surgery,including symptom description,comparison of surgical methods,complication warning,and patient management.Practical cases and evidence from domestic and international studies are discussed.With the integration of electronic PROs(ePROs),artificial intelligence,and natural language processing,future efforts should focus on developing localized,specialty-specific tools and establishing stronger correlations between PROs and clinical outcomes to support the transition from disease-centered to patient-centered surgical care.

Objective:This study aims to investigate the differences in emotional status and cognitive function among patients with vestibular migraine (VM), Meniere′s disease (MD), and their comorbidity (VMMD), and to analyze key factors influencing cognitive function.Methods:This cross-sectional study included 96 outpatients (32 males, 64 females, aged 21-73 years) from the Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between December 2022 and December 2023. The study population consisted of 31 VM patients (VM group), 36 MD patients (MD group), and 29 VMMD patients (VMMD group), along with 32 healthy controls (16 males, 16 females, aged 19-74 years). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), while emotional status and somatization symptoms were evaluated through the Generalized Anxiety Disorder scale, Patient Health Questionnaire Depression scale, Symptom Checklist-90, and the Self-rating Somatization Symptom scale. Multiple linear regression analysis was conducted to explore the influence of different variables on cognitive function.Results:The total MoCA score in the VMMD group (26.0 [24.5, 28.0]) was significantly lower than that in the control group (28.0 [27.0, 29.0]) and the MD group (28.0 [26.0, 30.0]) ( P=0.006). VMMD patients exhibited significant impairments in specific cognitive domains, including visuospatial/executive function, delayed recall, and orientation ( P<0.05). Patients with VM, MD, and VMMD showed higher rates of anxiety, depression, and somatization symptoms compared to the control group ( P<0.05), with the VMMD group experiencing the most severe emotional distress. Multiple linear regression analysis identified education level and vestibular disease type as key factors affecting cognitive function, with a university-level education predicting higher MoCA scores ( P<0.001), while VMMD was associated with cognitive decline ( P<0.01). Conclusions:Patients with VM and MD, particularly those with comorbid VMMD, exhibit significant emotional distress. Cognitive impairments are present in VM and VMMD patients, affecting different cognitive domains. These factors should be comprehensively considered in clinical assessments to develop more effective treatment strategies.

Objective:To investigate the expression and clinical significance of gamma-aminobutyric acid receptor-associated protein-like 1 (GABARAPL1) in patients with gouty arthritis (GA).Methods:Differentially expressed genes (DEGs) between GA patients and healthy controls were identified by the Gene Expression Omnibus (GEO) database, followed by the screening of autophagy-related DEGs (au-DEGs) associated with GA. Peripheral blood single nucleated cells (PBMCs) were collected from 80 male GA patients and 60 healthy controls treated at the Affiliated Taizhou People′s Hospital of Nanjing Medical University between March to December 2023. Real-time quantitative PCR (qRT-PCR) was employed to assess the expression of au-DEGs, bisulfite sequencing PCR (BSP) was used to determine the methylation status of the GABARAPL1 promoter, and chromatin immunoprecipitation combined with qPCR (ChIP-qPCR) was used to analyze the binding activity of histone H3 to the GABARAPL1 promoter. Spearman ′s Correlations between GABARAPL1 expression and clinical indicators such as serum uric acid (UA) were analyzed. The diagnostic efficacy of GABARAPL1 in PBMCs for GA was evaluated using receiver operating characteristic (ROC) curves. Results:The relative expression of GABARAPL1 in PBMCs was significantly higher in GA patients compared to healthy controls (1.91±0.72 vs. 0.84±0.39, t=11.27, P<0.001). Spearman correlation analysis revealed that GABARAPL1 expression was positively correlated with UA, white blood cell count, neutrophil count, monocyte count, globulin, urea, and creatinine ( r=0.61, 0.40, 0.46, 0.32, 0.28, 0.22, 0.34; P<0.05 for all), and negatively correlated with lymphocyte count, albumin, high-density lipoprotein cholesterol, apolipoprotein A1, and estimated glomerular filtration rate ( r=-0.18, -0.34, -0.33, -0.50, -0.22; P<0.05 for all). ROC curve analysis showed that GABARAPL1 in PBMCs had high diagnostic efficacy for GA, with an area under the curve of 0.936. No significant differences in the methylation levels of GABARAPL1 promoter regions MC1 and MC2 were observed between GA patients and healthy controls ( t=2.28、1.43, P<0.05 for all), whereas histone H3 acetylation levels were significantly elevated in GA patients ( t=11.19, P<0.001). Conclusion:The expression of GABARAPL1 in PBMCs is significantly upregulated in GA patients, which may be associated with increased histone H3 acetylation at its promoter. The high expression of GABARAPL1 may contribute to the pathogenesis of GA by regulating autophagy and holds promise as a diagnostic biomarker and potential therapeutic target for GA.

A total of 269 non-diabetic chronic kidney disease (CKD) patients were enrolled in this study. Among them, 175 patients (65.1%) were assigned to the control group and received conventional therapy with maximally tolerated doses of renin-angiotensin-aldosterone system inhibitors, while 94 patients (34.9%) were assigned to the dapagliflozin group and received oral dapagliflozin 10 mg/day in addition to the conventional therapy. The results showed that the urine protein quantity in the dapagliflozin group was lower than those in the control group at 3, 6, 12, 18, and 24 months of follow-up (all P<0.05), and the blood albumin level was higher than those in the control group at 18 and 24 months of follow-up (all P<0.05). The Kaplan-Meier survival curve analysis results showed that the cumulative renal survival rate of the dapagliflozin group was significantly higher than that of the control group (Log-rank test, χ2=5.078, P=0.024). Multivariable Cox regression analysis results revealed that using dapagliflozin was independently associated with a reduced risk of the composite endpoint in non-diabetic CKD patients ( HR=0.400, 95% CI 0.163-0.983, P=0.046). There was no statistical difference in adverse reactions between the two groups (all P>0.05). It is indicated that dapagliflozin has a renal protective effect independent of hypoglycemic action and good safety.