A 66-year-old man was admitted with acute left heart failure and hyponatremia.On the first day of admission,15 mg tolvaptan tablets were given orally.On the second day of admission,alanine transaminase and aspartate transaminase were significantly increased to 916.76 U·L-1 and 1 857.1 U·L-1,respectively,which met the diagnostic criteria of severe acute liver injury.The drug was immediately stopped and hepatoprotective therapy was given,and on the 10th day of admission,the patient's liver function improved significantly,and on the 12th day of admission,the patient was discharged after his condition stabilised.The results of the correlation evaluation indicated that the development of acute liver injury in this patient is likely related to tolvaptan.This article discusses the mechanism,time of occurrence,population and treatment of tolvaptan-induced liver function injury,suggesting that clinical use of tolvaptan should be highly vigilant for acute liver function injury and routine monitoring of patients' liver function to ensure the safe use of the drug.

A male patient,51 years old,was diagnosed as follows:① type 2 diabetes mellitus;② grade 2 hypertension(extremely high risk).To improve circulation,the patient was administered pentoxifylline injection 0.2 g mixed with 250 mL of 0.9％sodium chloride injection via an intravenous drip,once daily(qd).After 4 days of treatment,liver function tests showed the following results:alanine aminotransferase(ALT)at 2 390.80 U·L-1,aspartate aminotransferase(AST)at 948.28 U·L-1,and gamma-glutamyltransferase(GGT)at 517.81 U·L-1.It was highly probable that pentoxifylline caused abnormally elevated liver enzymes,with a clear drug-related association.After discontinuing pentoxifylline injection and initiating liver-protecting and en-zyme-lowering treatment,the liver function indicators gradually improved.Enhanced monitoring during the clinical use of pentoxi-fylline is essential to ensure patient safety.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To investigate the acquisition of the"standard for intubation and maintenance of nasointestinal tube in adult patients"of Chinese Nursing Association,and its influencing factors,so as to provide a basis for targeted training programs.Methods A multi-centered,cross-sectional study was performed in 31 provinces from September to November 2023,and nurses from different departments which use nasointestinal tubes like intensive care units,gastroenterology,neurology,geriatrics were included by a convenient sampling method.The tool was a self-designed questionnaire based on the group standard and the survey was conducted.Multiple linear regression analysis was used to explore the influencing factors of nurses'knowledge of nasointestinal tubes intubation and maintenance.Results 1 350 valid questionnaires were collected.Only 61.63％of the respondents knew about the publishing of the standard.The score of knowledge of tube intubation and maintenance was(61.09±13.56).The results of multiple linear regression analysis showed the influencing factors of the score of knowledge of intubation and maintenance were as follows:education level,professional title,job position,intubation experience within half a year,and corresponding achievements(P＜0.05).Conclusion The acqui-sition level of nurses for the standard calls for continuous promotion.Nursing managers should establish targeted training programs based on the related influencing factors,so as to advance the implementation of the group standard.

Objective To introduce a case of elevated blood pressure with chills caused by Urinary Kallidinogenase.Methods The diagnosis and treatment of a patient with hypertension and chills induced by uracillin were analyzed retrospectively,and the correlation of adverse drug reactions(ADR)was analyzed The Chinese and English databases of CNKI,Vip,PubMed and Web of Science were searched to analyze the ADR case reports related to yurekline.Results The patient experienced a sudden increase in blood pressure with chills and sweats during the use of uracillin,and the adverse reaction was relieved gradually after withdrawal.According to Naranjo's ADR assessment scale and our manual of ADR reporting and monitoring,the association between uracillin and increased blood pressure with chills was"Probably".Conclusions The increase of blood pressure is a rare side effect of uracillin,so it is necessary to monitor the patients'blood pressure actively during the course of medication.Once the patients have the symptoms of blood pressure fluctuation,body shivering and mental abnormality,the clinic should judge and stop the medication in time to ensure the safety of the patients'medication.

Objective To introduce a case of elevated blood pressure with chills caused by Urinary Kallidinogenase.Methods The diagnosis and treatment of a patient with hypertension and chills induced by uracillin were analyzed retrospectively,and the correlation of adverse drug reactions(ADR)was analyzed The Chinese and English databases of CNKI,Vip,PubMed and Web of Science were searched to analyze the ADR case reports related to yurekline.Results The patient experienced a sudden increase in blood pressure with chills and sweats during the use of uracillin,and the adverse reaction was relieved gradually after withdrawal.According to Naranjo's ADR assessment scale and our manual of ADR reporting and monitoring,the association between uracillin and increased blood pressure with chills was"Probably".Conclusions The increase of blood pressure is a rare side effect of uracillin,so it is necessary to monitor the patients'blood pressure actively during the course of medication.Once the patients have the symptoms of blood pressure fluctuation,body shivering and mental abnormality,the clinic should judge and stop the medication in time to ensure the safety of the patients'medication.

A 70-year-old male patient with T2N2M0 stage Ⅲ A lung squamous cell carcinoma was switched to monotherapy with tislelizumab (200 mg by intravenous infusion on day 1, 21 days as a cycle) after 5 cycles of chemotherapy with paclitaxel protein-bound and cisplatin, one cycle of combined chemotherapy and immunotherapy with tislelizumab, paclitaxel protein-bound and cisplatin. After 10 days of tislelizumab administration in the 4th cycle of monotherapy, the patient developed symptoms such as nausea, vomiting, abdominal pain, and abdominal distension. Laboratory tests showed fasting blood glucose of 26.3 mmol/L, glycated hemoglobin of 12.5%, fasting C-peptide<0.01 μg/L, free triiodothyronine of 3.31 pmol/L, free thyroxine of 4.9 pmol/L, and thyroid stimulating hormone of 49.4 mU/L, urinary ketones (++), and urinary glucose (++). Ketoacidosis and hypothyroidism were diagnosed, which was considered to be caused by tislelizumab. After 7 days of treatments with insulin, fluid replacement, potassium supplementation, and maintenance of electrolytes and acid-base balance, the patient′s fasting blood glucose was 7.6 mmol/L. The hypoglycemic regimen was changed to subcutaneous injection insulin glargine (10 U in the morning) and insulin lispro (6 U before breakfast, 5 U before lunch and dinner), and levothyroxine sodium 100 μg once daily orally was given at the same time. Two weeks later, due to the condition, the patient received tislelizumab again once, and subsequently developed ketoacidosis 3 times. Tislelizumab was not used again thereafter. Follow-up once a month within 6 months showed no significant changes in the patient′s thyroid function compared to before. The patient continued to use insulin to control blood glucose.

A 66-year-old man was admitted with acute left heart failure and hyponatremia.On the first day of admission,15 mg tolvaptan tablets were given orally.On the second day of admission,alanine transaminase and aspartate transaminase were significantly increased to 916.76 U·L-1 and 1 857.1 U·L-1,respectively,which met the diagnostic criteria of severe acute liver injury.The drug was immediately stopped and hepatoprotective therapy was given,and on the 10th day of admission,the patient's liver function improved significantly,and on the 12th day of admission,the patient was discharged after his condition stabilised.The results of the correlation evaluation indicated that the development of acute liver injury in this patient is likely related to tolvaptan.This article discusses the mechanism,time of occurrence,population and treatment of tolvaptan-induced liver function injury,suggesting that clinical use of tolvaptan should be highly vigilant for acute liver function injury and routine monitoring of patients' liver function to ensure the safe use of the drug.

A male patient,51 years old,was diagnosed as follows:① type 2 diabetes mellitus;② grade 2 hypertension(extremely high risk).To improve circulation,the patient was administered pentoxifylline injection 0.2 g mixed with 250 mL of 0.9％sodium chloride injection via an intravenous drip,once daily(qd).After 4 days of treatment,liver function tests showed the following results:alanine aminotransferase(ALT)at 2 390.80 U·L-1,aspartate aminotransferase(AST)at 948.28 U·L-1,and gamma-glutamyltransferase(GGT)at 517.81 U·L-1.It was highly probable that pentoxifylline caused abnormally elevated liver enzymes,with a clear drug-related association.After discontinuing pentoxifylline injection and initiating liver-protecting and en-zyme-lowering treatment,the liver function indicators gradually improved.Enhanced monitoring during the clinical use of pentoxi-fylline is essential to ensure patient safety.

Objective To investigate the acquisition of the"standard for intubation and maintenance of nasointestinal tube in adult patients"of Chinese Nursing Association,and its influencing factors,so as to provide a basis for targeted training programs.Methods A multi-centered,cross-sectional study was performed in 31 provinces from September to November 2023,and nurses from different departments which use nasointestinal tubes like intensive care units,gastroenterology,neurology,geriatrics were included by a convenient sampling method.The tool was a self-designed questionnaire based on the group standard and the survey was conducted.Multiple linear regression analysis was used to explore the influencing factors of nurses'knowledge of nasointestinal tubes intubation and maintenance.Results 1 350 valid questionnaires were collected.Only 61.63％of the respondents knew about the publishing of the standard.The score of knowledge of tube intubation and maintenance was(61.09±13.56).The results of multiple linear regression analysis showed the influencing factors of the score of knowledge of intubation and maintenance were as follows:education level,professional title,job position,intubation experience within half a year,and corresponding achievements(P＜0.05).Conclusion The acqui-sition level of nurses for the standard calls for continuous promotion.Nursing managers should establish targeted training programs based on the related influencing factors,so as to advance the implementation of the group standard.