In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

Objective To evaluate the feasibility of using noninvasive ultrasonic cardiac output monitor USCOM velocity time integral (VTI) as the observation index of PLR.Methods This prospective study recruited 36 septic shock or acute pancreatitis patients from October 2014 to October 2016 in the resuscitation room and EICU of Peking Union Medical College Hospital.The change of VTI and plus pressure before and after PLR (⊿VTIplr and ⊿pp),and the change of VTI and stroke volume before and after 500 mL of volume expansion (⊿VTIve and ⊿SV) were recorded.Fluid response positive was defined as stroke volume increase more than 15％ after volume expansion.Results ⊿VTIplr was positively correlated with ⊿SV (Spearman correlation coefficient r=0.888,P＜0.01).The predicting value of⊿VTIve,⊿VTIplr and ⊿PP in fluid response were as follows:the sensitivity of ⊿VTIve in ＞15％ was 94.7％,the specificity was 94.1％,area under the ROC curve was 0.989;the sensitivity of⊿ VTIplr in ＞12％ was 84.2％,the specificity was 88.2％,area under the ROC curve was 0.916;and the sensitivity of⊿ PP in ＞10.5％ was 78.9％,the specificity was 88.2％,the area under the ROC curve was 0.870.Conclusions ⊿ VTIplr measured by USCOM before and after the PLR is a sensitive and specific index.It is better than the classic index ⊿ PP.⊿ VTIplr measured by USCOM is completely noninvasive,which has very good application prospect in the emergency department.

Objective To compare the efficacy of two rapid lipid lowering methods as plasma exchange and insulin in the treatment of hyperlipidemic acute pancreatitis.Methods The clinical data of 98 patients with hyperlipidemic acute pancreatitis in Peking Union Medical College Hospital from January 2014 to December 2016 were retrospectively analyzed.All patients were divided into plasma exchange group (n =42) and insulin group (n=56) according to rapid lipid lowering method.Results There were no significant differences in the onset-to-treatment time,the proportion of patients with diabetes,the proportion of patients with pregnancy,the initial triglyceride level,Acute Physiology,Age and Chronic Health Evaluation l score and modified CT severity index score score and conditioning-test stimulus interval (CTSI) score between the plasma exchange group and the insulin group (P＞0.05).In addition,there were also no significant differences in the incidences of acute respiratory distress syndrome,acute kidney injury,shock and pancreatic abscess,and the proportion of moderate pancreatitis and severe pancreatitis,oral / jejunum nutrition tolerating start time,hospitalization time and mortality between the two groups (P＞0.05).The plasma exchange group had significantly less time to achieve the target triglyceride level and to reach normal free fatty acids level than the insulin group [(13.09±12.50) hvs.(46.92±20.92) h,t=3.291,P=0.001;(15.75±14.13) hvs.(73.21±38.49) h,t =3.291,P=0.001].The pancreatic pseudocyst incidence was significantly lower (7.14％ vs.23.21％,t =2.120,P=0.034),and the hospitalization cost was significantly higher [(81 794.92±33 719.69) yuan vs.(56 042.43±30 565.34) yuan,t =2.034,P =0.042] in the plasma exchange group than in the insulin group.Conclusions Both plasma exchange and insulin can rapidly lower blood lipids.Plasma exchange has certain advantages over insulin in lipid-lowering,for it is faster,and has lower incidence of pancreatic pseudocyst,thus can be applied in patients whose financial conditions permit.

Objective To investigate the expression of autophagy-related gene Beclinl and P62 in nasal polyps and its relationship with the pathogenesis of this disease.Methods The specimens were divided into two groups:nasal polyp tissue (n =50) and normal inferior turbinate mucosa (n =20).The general morphology was detected with hematoxylin-eosin(HE) staining,the expression of Beclin1 and P62 was examined with immunohistochemistry(IHC) and real-time fluorescent quantitative reverse transcription-polymerase chain reaction (RT-PCR).SPSS 20.0 software was used to analyze the data.Results Protein level:The expression of Beclinl in nasal polyp tissue was lower than inferior turbinate mucosa (U =-13.36,P ＜0.01),in contrast,P62 in experimental group was higher than control group(U =12.99,P ＜0.01).mRNA level:The relative quantity of Beclinl and LC3B expressions in nasal polyp were 0.46 ±0.17and 0.46 ± 0.11,which was lower than those in turbinate mucosa 1.11 ± 0.47 and 0.96 ± 0.25.The differences were significant(t value was-4.61,-4.61,both P ＜0.01).But the relative quantity of P62 expression in nasal polyp was 2.19 ± 0.44,which was higher than that in turbinate mucosa (1.05 ± 0.33).The difference was all significant (t =6.16,P ＜ 0.01).Conclusions Compared with control group,the expression of Beclin1 was deficient and P62 was much more.Autophagy was deficient in nasal polyps,which might be in connection with the pathogenesis of the disease.

Objective To explore the clinical effect of the elderly far lateral lumbar disc herniation via Quadrant channel system under the Wiltse approach. Methods Thirty-three elderly patients suffering from far lateral lumbar disc herniation were treated by surgery, among whom 18 patients were treated by Quadrant minimally invasive channel system (Quadrant group), and 13 patients were treated by percutaneous transforaminal endoscopic discectomy (PTED group). The patients were followed up for 12 months, and the operation time, blood loss and length of incision were investigated. The JOA scores were compared preoperatively and postoperatively. Results The patients in two groups were followed up for 24 months, except 1 patient withdrew in Quadrant group. The incision length and blood loss in PTED group were superior to those in the Quadrant group:2.0-2.5 cm vs. 0.7 cm, (46.50± 15.20) ml vs.(23.87±6.58) ml, P<0.01, but the operation time in PTED group was longer than that in Quadrant group: (77.17 ± 8.71) min vs. (63.20 ±10.87) min, P<0.01.The two groups had achieved good curative effect, while JOA score in PTED group was superior to the Quadrant group 1 week after operation ( P<0.05), but in 3 month and 12 month two groups had no significant difference ( P>0.05). Conclusion Surgical treatment on elderly far lateral lumbar disc herniation via quadrant channel under wiltse approach is an effective method, and can achieve similar effect with PTED.

Based on traditional Chinese medicine (TCM) herb data of inpatient department and senior famous TCM doctors from many TCM hospitals in China. Existing problems of TCM herb data standardization preprocessing were analyzed in order to explore scientific and reasonable preprocessing program which can provide technical support for the accurate analysis of herbal information. Clinical medicine doctors and herbal pharmacists collaborated and analyzed the real-world TCM herb data collected from multi-regions. In connection with characteristics of TCM, data mining was combined in the analysis of requirement to identify existing problems and explore appropriate problem-solving solutions. The results showed that based on the Pharmacopoeia of the People's Republic of China (PPRC, 2010 version) and regional herb preparing and dispensing guidelines, the herb collection rules, methods and processes were made for the herb data standardization. Herbal data processing program for different regions were formulated. It was concluded that herb data standardization rules and methods made by this plan solved standardization and accuracy of TCM herb data analysis and utilization in multi-area.

Traditional Chinese medicine (TCM) clinical symptoms, which were main evidences in syndrome differentiation and treatment, were also main data in the clinical individual diagnosis and treatment. However, the absence of high-quality symptom ontology was still obvious in TCM clinical and data using. By analyzing the research and data of clinical phenotype ontologies associated with symptoms, this paper was aimed to introduce and sort the existing ontologies, in order to discuss related problems. Furthermore, we provided ideas and expound the importance of building data network of symptoms, diseases, genes, drugs, chemicals, side effects with the data we collected and disposed around symptoms, in order to construct TCM clinical phenotype ontology. We believed that our work will help the development of individual treatment and precision medicine in TCM. It was also the key of individual big data analysis which was urgent need to promote.

Real world clinical diagnosis and treatment activity is a complicated decision-making task. The effective clinical cases of traditional Chinese medicine (TCM) of highly experienced physicians play an important role in the routine diagnosis and treatment and the formulation of medical knowledge . Based on TCM electronic medical record data, this paper proposed a decision support prototype system on TCM clinical diagnosis and treatment based on TCM effective clinical cases and case-based reasoning (CBR) algorithm, which is used to assist inexperienced clinicians to make more reliable clinical decisions, and thereafter to improve the clinical curative effectiveness. The system integrates TCM clinical cases data set from a TCM clinical data warehouse, and retrieves the similar cases based on CBR method. In particular, according to the underlying personalized diagnosis and treatment for patients in TCM, this system implemented a flexible diagnosis and treatment modification mechanism based on correlation analysis among symptoms, diagnoses (syndrome or pattern in TCM) and medicine. Finally, through a demonstration of clinical application, we made an initial evaluation of the usefulness and practical effects of the system.

Due to the importance of molecular mechanisms of drug actions, network pharmacology has become a new perspective on drug mechanism research and novel drug discovery. Drug target prediction using computational methods, is one of the key research topics in network pharmacology. This paper reviewed the related research on drug target prediction methods. Furthermore, general principles of drug target prediction methods and key steps of them in recent years were summarized. Given the diversity of Chinese medicine ingredients, the network controlla-bility of herbs and the lack of high-quality pharmacological data, the network regulation mechanism of Chinese herb research will meet even more difficulties than modern drug research. Therefore, this paper also discussed main is-sues and research trends of Chinese herb target prediction. Finally, combining with the actual consolidated network data of Chinese herbs, chemical structure similarity computation and link prediction methods, the network-based herb target prediction method was proposed to demonstrate key research steps. Furthermore, we discussed the most significant research topics that we should addressed to enhance the high quality results of herb target prediction.