ObjectiveTo combine metabolomics， proteomics， and transcriptomics to analyze the biological characteristics of damp-heat toxin accumulation syndrome and damp-heat accumulation syndrome in acute gout. MethodsBlood samples were collected from 15 patients with damp-heat toxin accumulation syndrome and 15 patients with damp-heat accumulation syndrome in acute gout in clinical practice. Metabolomics technology was applied to detect serum metabolites， and an orthogonal partial sample least squares discriminant analysis model was constructed to screen for metabolites with significant intergroup changes， and enrichment pathway analysis and receiver operating characteristic （ROC） curve analysis were performed. Astral data independence acquisition （DIA） was used to detect serum proteins， perform principal component analysis and screen differential proteins， demonstrate differential ploidy by radargram， apply subcellular localisation to analyse protein sources， and finally apply weighted gene co-expression network analysis （WGCNA） to find key proteins. Transcriptome sequencing technology was also applied to detect whole blood mRNA， screen differential genes and perform WGCNA， and construct machine learning models to screen key genes. ResultsMetabolome differential analysis revealed 62 differential metabolites in positive ion mode and 26 in negative ion mode. These differential metabolites were mainly enriched in the mTOR signaling pathway and FoxO signaling pathway， with trans-3,5-dimethoxy-4-hydroxycinnamaldehyde， guanabenz， 4-aminophenyl-1-thio-beta-d-galactopyranoside showing the highest diagnostic efficacy. The proteome differential analysis found that 55 proteins up-regulated and 20 proteins down-regulated in the samples of damp-heat toxin accumulation syndrome. Notably， myelin basic protein （MBP）， transferrin （TF）， DKFZp686N02209， and apolipoprotein B （APOB） showed the most significant differences in expression. Differential proteins were mainly enriched in pathways related to fat digestion and absorption， lipid and atherosclerosis， and cholesterol metabolism. WGCNA showed the highest correlation between damp-heat toxin accumulation syndrome and the brown module， with proteins in this module primarily enriched in the hypoxia-inducible factor 1 （HIF-1） signaling pathway and lipid and atherosclerosis. Transcriptomic differential analysis identified 252 differentially expressed genes， with WGCNA indicating the highest correlation between damp-heat toxin accumulation syndrome and the midnight blue module. The random forest （RF） model was identified as the optimal machine learning model， predicting apolipoprotein B receptor （APOBR）， far upstream element-binding protein 2 （KHSRP）， POU domain class 2 transcription factor 2 （POU2F2）， EH domain-containing protein 1 （EHD1）， and family with sequence similarity 110A （FAM110A） as key genes. Integrated multi-omics analysis suggested that damp-heat toxin accumulation syndrome in the acute phase of gout is closely associated with lipid metabolism， particularly APOB. ConclusionCompared to damp-heat accumulation syndrome in the acute phase of gout， damp-heat toxin accumulation syndrome is more closely associated with lipid metabolism， particularly APOB， and lipid metabolism disorders contribute to the development of damp-heat toxin accumulation syndrome in patients with acute gout.

Refractory rheumatoid arthritis belongs to the category of "stubborn bi （痹）" and "lame bi" in traditional Chinese medicine. It is believed that pathogenic toxin is an important pathogenic factor of refractory rheumatoid arthritis， and "healthy qi deficiency and toxins accumulation" is its core pathogenesis. Pathogenic toxin can be divided into latent and internal toxin， among which latent toxin includes congenital latent toxin and acquired exogenous and drug-induced latent toxin； and internal toxin is directly produced by the dysfunction of the body's zang-fu （脏腑） organs， or is transformed from dampness， turbidity， phlegm and stasis. Pathogenic toxin can flow into the meridians and collaterals， quickly corrode the bones and joints， harm the five zang organs， secretly consume the body's healthy qi， and accumulate and entrench. Based on this， the treatment principle of "reinforcing healthy qi and resolving toxins" has been established， emphasizing that the key is to strengthen the origin of the body's healthy qi and to attack the pathogenic toxin from its weakness. In clinical practice， it is suggested to trace the root cause， and treat the disease based on the cause. Besides reinforcing the body's healthy qi， the methods such as clearing heat to resolve toxins， draining dampness to resolve toxins， dispelling wind to remove toxins， dispersing cold to resolve toxins， dissolving phlegm to resolve toxins， and dispersing stasis to resolve toxins can be supplemented， so as to reinforce the healthy qi and dispel pathogens simultaneously and thereby improving the clinical efficacy.

It is believed that gout is rooted in spleen-kidney depletion， and damp-heat， turbidity toxin， and phlegm stasis are the sources. The treatment principle should be fortifying the spleen and boosting the kidney to consolidate the root， while draining dampness and removing turbidity， clearing heat and resolving toxins， relieving stasis and dissolving phlegm to clear the source. Staged treatment based on the relationship and transition between healthy qi deficiency and excess pathogen is recommended. For intercritical gout when there is internal accumulation of damp turbidity mainly， the treatment method should be draining dampness and removing turbidity by Chushi Fuling Decoction （除湿茯苓汤） with modifications. During the acute stage of gout when damp-heat toxin accumulation is the most urgent， it is recommended to clear heat and resolve toxins with self-made Qingpi Tongfeng Formula （清皮痛风方） with modifications. During the chronic stage of gout， when spleen deficiency and damp-heat and phlegm-stasis obstruction are the predominant， the method of fortifying spleen， clearing heat and draining dampness， as well as dissolving phlegm and dissipating stasis should be implemented， by using self-made Qingre Shenshi Decoction （清热渗湿汤） with modifications and Erchen Decoction and Taohong Siwu Decoction （二陈汤合桃红四物汤） with modifications， respectively.For gouty nephropathy， when spleen-kidney depletion is the root， and phlegm， stasis and toxin are accompanied， it is recommended to fortify spleen and boost kidney， and dissolve phlegm， move stasis and resolve toxins using self-made Bupi Yishen Decoction （补脾益肾汤） with modifications.

Head and neck squamous cell carcinoma (HNSCC) is the seventh most common malignant tumor in the world, with a 5-year survival rate of only about 50%. Thus, discovering more effective diagnostic and therapeutic approaches is an urgent need. The metabolic reprogramming of tumor cells is a key feature in the development of HNSCC, which widely exhibits alterations in glycolytic metabolism, lipid metabolism, and amino acid metabolism compared with normal cells. Metabolic reprogramming affects the energy supply and biosynthesis of tumor cells. It also participates in the regulation of the tumor microenvironment and promotes key biological processes such as proliferation, invasion, and metastasis of HNSCC. With the progressive understanding of the complexity of tumor biology, targeted-therapy strategies against metabolic reprogramming in HNSCC are emerging as a promising therapeutic approach. These metabolically targeted therapies have performed well in preclinical studies, but their clinical application requires further validation. In the future, we need to deeply explore the more complex features of metabolic reprogramming and its biological significance in HNSCC, with the aim of discovering more effective diagnostic and therapeutic targets, as well as providing new strategies to improve the prognosis of HNSCC patients.

Traditional Chinese medicine is an important part of Chinese traditional culture and has played an increasingly important role in the field of health care in recent years.Shandong Province,as a province with large resources of traditional Chinese medicine,has the natural advantages and deep foundation to develop traditional Chinese medicine health care industry.Based on Strengths,Weaknesses,Opportunities & Threats(SWOT)analysis,the advantages,disadvantages,opportunities and challenges of the development of traditional Chinese medicine health care industry in Shandong Province were deeply analyzed.SWOT matrix model was constructed to put forward targeted countermeasures and suggestions,in order to provide theoretical support and practical guidance for the healthy development of traditional Chinese medicine health care industry in Shandong Province.

Informed consent is an important ethical symbol in clinical research,and researchers have the responsibility to fully inform participants of the research information before conducting clinical research.However,it is difficult to obtain complete informed consent form participants or their guardians within a narrow treatment time period in clinical research conducted in emergency situations.Currently,in addition to traditional general informed consent,there are also reality-accepted informed consent,including exemption of informed consent,broad informed consent,and deferred informed consent.By introducing the origin and development process of deferred informed consent in clinical research,this paper sorted out the current application status of deferred informed consent,proposed the prerequisites for applying deferred informed consent in emergency situations,and explored the issues that need to be noted during the application process of deferred informed consent.It is hoped to provide an ethical defense and ethical procedure for the application of deferred informed consent in clinical research in emergency situations.

Obese patients may have abnormal metabolism of branched-chain amino acids(BCAA).Elevated levels of BCAA can lead to insulin resistance(IR)through various mechanisms,which may make it a sensitive indicator for predicting the occurrence of diabetes mellitus.This article reviews the research progress on the correlation between BCAA metabolism,obesity and IR.

Objective:To investigate the clinical characteristics of first-episode and recurrent acute hypertriglyceridemic pancreatitis (HTGP).Methods:The retrospective cohort study was con-ducted. The clinical data of 313 patients with HTGP admitted to 26 medical centers in China in the Chinese Acute Pancreatitis Clinical Research Group (CAPCTG)-PERFORM database from November 2020 to December 2021 were collected. There were 219 males and 94 females, aged 38(32,44)years. Of the 313 patients, 193 patients with first-episode HTGP were allocated into the first-episode group and 120 patients with recurrent HTGP were allocated into the recurrent group. Observation indica-tors: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) comparison of severity and prognosis in the course of disease within 14 days between the two groups; (3) the association between recurrent HTGP and the risk of persistent organ failure (POF); (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Wilcoxon rank sum test. Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Wilcoxon rank sum test. The Kaplan-Meier method was used to plot the cumulative recurrence rate curve and Log-Rank test was used for survival analysis. The Logistic regression model was used for multivariate analysis, and continuous variables were converted into categorical variables according to the mean value or common criteria. Propensity score matching was performed by 1∶1 nearest neighbor matching method, with caliper value of 0.02. Paired t test or Wilcoxon rank sum test and McNemar′s test were used for comparison between matched groups. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 313 patients,208 cases were successfully matched, including 104 cases in the first-episode group and 104 cases in the recurrent group. After propensity score matching, there was no significant difference in demographic characteristics, severity of illness scores and laboratory test between the two groups ( P>0.05). The elimination of gender, acute physiology and chornic health evaluation (APACHE) Ⅱ score, computed tomography severity index score, systemic inflammatory response syndrome score, sequential organ failure assessment score, apolipoprotein E, C-reactive protein, creatinine, lactic acid dehydrogenase, procal-citonin confounding bias ensured comparability between the two groups. (2) Comparison of severity and prognosis in the course of disease within 14 days between the two groups. There were signifi-cant differences in POF and local complications between the first-episode group and the recurrent group ( P<0.05). (3) The association between recurrent HTGP and the risk of POF. Results of uncor-rected univariate analysis showed that there was no association between recurrent HTGP and the risk of POF ( odds ratio=0.78, 95% confidence interval as 0.46-1.30, P>0.05). Results of multivariate analysis after adjusting for covariates such as gender, age, APACHE Ⅱ score, C-reactive protein, triglyceride and total cholesterol showed that compared with first-episode HTGP, recurrent HTGP was associated with a higher risk of POF ( odds ratio=2.22, 95% confidence interval as 1.05-4.71, P<0.05). Results of subgroup analysis showed that age<40 years was associated with an increased risk of POF ( odds ratio=3.31, 95% confidence interval as 1.09-10.08, P<0.05). (4) Follow-up. Twelve of the 313 patients died during hospitalization, including 9 cases in the first-episode group and 3 cases in the recurrent group. The rest of 301 surviving patients, including 184 cases in the first-episode group and 117 cases in the recurrent group, were followed up for 19.2(15.5, 21.9)months. Results of follow-up showed that for 184 survived patients of the first-episode group, 164 cases were followed up and 24 cases experienced recurrence, for 117 survived patients of the recurrent group,29 cases experienced recurrence, showing a significant difference between the two groups ( χ2=4.67, P<0.05). Conclusion:Compared with first-episode HTGP, patients with recurrent HTGP are more prone to POF and local complications, and are more prone to recurrence after discharge. The risk of POF in recurrent HTGP patients is 2.22 times that of those with first-episode, and the risk is higher in patients with age <40 years.

Traditional Chinese medicine is an important part of Chinese traditional culture and has played an increasingly important role in the field of health care in recent years.Shandong Province,as a province with large resources of traditional Chinese medicine,has the natural advantages and deep foundation to develop traditional Chinese medicine health care industry.Based on Strengths,Weaknesses,Opportunities & Threats(SWOT)analysis,the advantages,disadvantages,opportunities and challenges of the development of traditional Chinese medicine health care industry in Shandong Province were deeply analyzed.SWOT matrix model was constructed to put forward targeted countermeasures and suggestions,in order to provide theoretical support and practical guidance for the healthy development of traditional Chinese medicine health care industry in Shandong Province.

Traditional Chinese medicine is an important part of Chinese traditional culture and has played an increasingly important role in the field of health care in recent years.Shandong Province,as a province with large resources of traditional Chinese medicine,has the natural advantages and deep foundation to develop traditional Chinese medicine health care industry.Based on Strengths,Weaknesses,Opportunities & Threats(SWOT)analysis,the advantages,disadvantages,opportunities and challenges of the development of traditional Chinese medicine health care industry in Shandong Province were deeply analyzed.SWOT matrix model was constructed to put forward targeted countermeasures and suggestions,in order to provide theoretical support and practical guidance for the healthy development of traditional Chinese medicine health care industry in Shandong Province.