To summarise the clinical experience of Professor TONG Xiaolin in treating prediabetes combined with overweight or obesity using the method of relieving depression and reducing turbidity. It is believed that prediabetes belongs to the category of "spleen-heat syndrome" in traditional Chinese medicine， and its core pathogenesis is center fullness with internal heat， while obesity is the initiating factor for exacerbating center fullness and internal heat， therefore， it is of great significance to reduce the risk of diabetes by interrupting the transformation between overweight， obesity and glucose metabolism abnormality. It is proposed that the main pathogenesis of prediabetes combined with overweight or obesity is qi depression and turbidity obstruction in middle jiao， with qi depression as the root and turbidity obstruction as the cause， forming a treatment idea with the method of relieving depression and reducing turbidity as the core. In clinic， Dahuang Huanglian Xiexin Decoction （大黄黄连泻心汤） is used as the basic prescription， with a primary focus on directing the turbid downward， supplemented by regulating qi， which embodies the concept of "promoting movement through descent， then figuring out the root of spleen-heat syndrome. Furthermore， the treatment is flexibly modified based on the patient's deficiency-excess syndrome to ensure individualized therapy.

Objective To explore the value of curvature value of liver surface nodularity(LSN)based on MRI in evaluating liver function in patients with liver cirrhosis.Methods A retrospective analysis was made on the patients who underwent upper abdomen MR examination at 3.0T.The normal liver function patients and cirrhosis patients were enrolled in the study and then the Child-Pugh score of the patients were calculated.The patients were divided into three groups:normal liver group,compensated cirrhosis group and decompensated cirrhosis group.The water phase imaging of 3D modified Dixon fast field echo(mDixon-FFE)sequence was copied in DICOM format.ITK software was used to manually draw the full-thickness liver edge by two observers.The curvature value of LSN was obtained by using matlab self compiled code for follow up analysis.Kruskal-Wallis H test was used to compare the curvature value between the groups.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was obtained.Spearman test was used for the correlation analysis.Results The curvature values of LSN among the normal liver,compensated cirrhosis and decompensated cirrhosis groups gradually increased(P<0.05).Comparing normal liver with compensated cirrhosis,the AUC of diagnosing compensated cirrhosis was 0.84,with the sensitivity of 72.7%and the specificity of 89.3%.Comparing compensated cirrhosis with decompensated cirrhosis,the AUC of diagnosing decompensated cirrhosis was 0.91,with the sensitivity of 80%and the specificity of 90.9%.There was a moderate positive correlation between the curvature value of LSN and liver function score in patients with cirrhosis(r=0.63,P=0.002).Conclusion The curvature value of LSN based on MRI can be used for preliminary evaluation of liver function of liver cirrhosis,with the AUC more than 0.80 and higher sensitivity and specificity.

OBJECTIVE To evaluate the consistency between the quetiapine LC-MS/MS kit and the laboratory-built method(reference method) in the detection results of quetiapine therapeutic drug monitoring. METHODS A total of 120 remaining plasma samples were collected from patients receiving quetiapine therapeutic drug monitoring from March to October in 2021. The plasma concentration of quetiapine was detected by kit and reference method respectively. The analysis of correlations and consistency was performed by outlier analysis, linear regression and Bland-Altman method. RESULTS No outliers were detected. The linear regression equation was Y=1.018X+4.400(r=0.998), indicating a good correlation. The Bland-Altman plot analysis showed good agreement between the two measurements. CONCLUSION The detection results of quetiapine LC-MS/MS kit and reference method are in good agreement. The kit can be used for clinical quetiapine treatment drug monitoring.

Objective:To explore the efficacy and safety of tetrandrine in the treatment of rheumatoid arthritis.Methods:Randomized controlled studies of tetrandrine in the treatment of rheumatoid arthritis were searched in CNKI,VIP,Wanfang database,SinoMed,PubMed,Springer,Web of Science and Cochrane Central Register of Controlled Trails databases.A meta-analysis was conducted using R 3.5.3 software to evaluate the clinical outcomes,including the total effective rate,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF),visual analogue scale(VAS),disease activity score(DAS),tender joint count(TJC),swollen joint count(SJC),and morning stiffness duration,as well as adverse events of rheumatoid arthritis patients.Results:A total of 10 articles were included in the study.The meta-analysis indicated that tetrandrine significantly improved the total effective rate(OR=3.27,95%CI:2.01-5.37,P<0.01),ESR(SMD=1.12,95%CI:0.06-2.19,P<0.05),CRP(SMD=0.75,95%CI:0.28-1.22,P<0.01),VAS(SMD=0.64,95%CI:0.29-1.00,P<0.01),TJC(SMD=1.16,95%CI:0.58-1.74,P<0.01),SJC(SMD=0.85,95%CI:0.40-1.31,P<0.01),and morning stiffness(SMD=1.09,95%CI:0.68-1.50,P<0.01).However,no statistical significance was found in RF(SMD=1.70,95%CI:-1.10-4.51,P>0.05)and DAS(SMD=0.26,95%CI:-0.59-1.11,P>0.05).The overall incidence of adverse events associated with tetrandrine treatment for rheumatoid arthritis was 20%(95%CI:12%-27%,I2=60%,P<0.05),with mild severity and favorable outcomes.Conclusion:Tetrandrine is effective in the treatment of RA patients with a mild degree of adverse events.

Objective:To analyze clinical characteristics of primary pancreatic lymphoma (PPL) patients.Methods:Clinical features of 22 patients diagnosed as PPL admitted to Peking Union Medical College Hospital from January 2002 to May 2023 were analyzed retrospectively.Results:The median age was 56.4±13.3 years. The median time from onset to diagnosis was 1.0 (1.0, 3.0) months. The main clinical manifestations were abdominal pain (15/22), weight loss (14/22) and jaundice (10/22). Elevated lactate dehydrogenase (LDH) was observed in 15/20 (75%) patients. Only 2 (2/9, 22.2%) patients had increased CA199 levels and 2 (2/9, 22.2%) patients had increased CEA levels. The maximum tumor diameter was 5.0 (3.8, 6.9) cm. Contrast-enhanced CT mostly showed low enhancement lesions. Major pancreatic duct dilatation were rare on CT scan (4/20). Fifteen patients were confirmed by pancreatic pathology, of which 8 were obtained by surgery, 4 were obtained by CT or ultrasound-guided percutaneous biopsy, and 3 were obtained by EUS-FNA. The main pathological type was diffuse large B-cell lymphoma (14/22). 19 patients received chemotherapy, and 6 patients died with a median follow-up of 5.0 (1.5, 35.5) months.Conclusions:PPL is rare and easy to be misdiagnosed. Elevated LDH levels, normal tumor markers, and non-dilatation of main pancreatic duct are important diagnostic clues. It is important to obtain pathology by EUS-FNA and other methods for definite diagnosis.

Objective To investigate the efficacy and safety of a single induction dose of cyclopofol in painless four-dimensional hysterosalpingography,this study aims to assess its academic significance and adherence to Nature journal's publication standards.Methods A total of 120 patients admitted to Guangdong Reproductive Hospital between February 2022 and December 2022,requiring painless vaginal four-dimensional ultrasound hysterosalpin-gography,were selected as the study population.Random selection was performed with 40 patients in each group.The dosage of cyclopofol administered was 0.3 mg/kg(C1 group),0.5 mg/kg(C2 group),and 0.7 mg/kg(C3 group).Heart rate(HR),mean arterial pressure measured non-invasively using a cuff,time to wake after surgery,and incidence of adverse reactions were observed at three time points:before examination(T1),during contrast agent injection(T2),and after examination(T3).Results There were no significant differences in heart rate(HR)and mean arterial pressure(MAP)between T1 and T3 among the three groups(P>0.05).However,at T2,group C1 exhibited significantly higher HR and MAP compared to group C2(P<0.05),while there was no statistically significant difference in HR and MAP between group C2 and C3 at T2(P>0.05).The duration of wakefulness was shorter in group C2 than in group C3(P<0.05),but there was no statistical significance in wakefulness duration between group C1 and C2(P>0.05).The incidence of adverse reactions was lower in group C2(10.0%)compared to both group C1(32.5%)and group C3(37.5%)with statistical significance(P<0.05).Conclusion The admin-istration of cyclopofol at a dosage of 0.5 mg/kg exhibits notable advantages in painless four-dimensional hysterotubal ultrasonography,including effective sedation,prompt wakefulness,and a low occurrence rate of adverse reactions.

Objective:To explore the expression of lncRNA ARHGAP5-AS1 in renal cancer tissues and cell lines, and the effect of ARHGAP5-AS1 on the proliferation and invasion of renal cancer cell lines and its molecular mechanism.Methods:The GEPIA database was used to analyze the expression of ARHGAP5-AS1 in renal cancer tissues, and its relationship with clinical stage, overall survival and disease-free survival of renal cancer patients was analyzed. Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) was used to detect the expression level of ARHGAP5-AS1 in renal cancer cells (786-O, Caki-1, OS-RC-2, ACHN, A-498). Renal carcinoma OS-RC-2 cells were transfected with pcDNA3.1-ARHGAP5-AS1 plasmid or pcDNA3.1 plasmid, denoted as ARHGAP5-AS1 group and control group. Colony formation assay and Transwell assay were used to detect changes in the proliferation and invasion ability of OS-RC-2 cells. Dual-luciferase reporter gene experiment was used to verify the targeting relationship between ARHGAP5-AS1 and miR-155-5p. The Starbase v3.0 online database was used to analyze the correlation between the expression of ARHGAP5-AS1 and miR-155-5p in renal cancer tissues. RT-qPCR was used to detect the expression level changes of miR-155-5p. Western blotting was used to detect the expression changes of Raf/MEK/ERK molecular pathway proteins p-Raf, p-MEK, p-ERK, p-FBW7, and c-MYC. The measurement data were expressed as mean ± standard deviation ( ± s), the independent sample t-test was used for comparison between two groups, and one-way analysis of variance was used for comparison between multiple groups. Results:ARHGAP5-AS1 was lowly expressed in renal cancer tissues ( P<0.01), and its expression level was related to the clinical stage, overall survival and disease-free survival of patients with renal cancer ( P<0.01). ARHGAP5-AS1 showed low expression in renal cancer cell lines (786-O, Caki-1, OS-RC-2, ACHN, A-498) ( P<0.01). Compared with the control group, the proliferation and invasion abilities of OS-RC-2 cells in ARHGAP5-AS1 group were significantly reduced ( P<0.01). Dual-luciferase reporter gene experiment confirmed that ARHGAP5-AS1 targets and binds to miR-155-5p ( P<0.01). The expression of ARHGAP5-AS1 and miR-155-5p in renal cancer tissues was negatively correlated ( P<0.01). Compared with the control group, the expression of miR-155-5p in OS-RC-2 cells in the ARHGAP5-AS1 group was significantly reduced ( P<0.01). Compared with the control group, the expression levels of Raf/MEK/ERK molecular pathway proteins p-Raf, p-MEK, p-ERK, p-FBW7, and c-MYC in OS-RC-2 cells in the ARHGAP5-AS1 group were reduced. Conclusions:lncRNA ARHGAP5-AS1 is lowly expressed in renal cancer tissues and is related to the clinical stage and survival of renal cancer patients. ARHGAP5-AS1 inhibits the proliferation and invasion of renal cancer cells by targeting the expression of miR-155-5p.

BackgroundThe mental health of employees in railway enterprises is related to the safety and stability of railway transportation. As an important factor affecting occupational mental health， job characteristics have attracted the attention of researchers. However， there exists a lack of job characteristic scales with occupational specificity in current researches relevant to the railway industry. ObjectiveTo develop a job characteristics questionnaire oriented to railway employees that takes both Job Demands-Resources Model （JD-R） and Chinese actual conditions into essential consideration， so as provide guidance for the research on the mental health of railway employees. MethodsPurposive and theoretical samplings were used to select 77 employees across 9 railway units as research objects， and interview method was used to conduct qualitative research in order to determine the structural dimensions and items of the questionnaire. The 612 subjects randomly selected from the railway maintenance system went through the preliminary test， then exploratory factor analysis and confirmatory factor analysis were employed to test the questionnaire. After forming a formal questionnaire on the job characteristics of railway employees， it is extended to the other four main industry systems of railway enterprises， responsible for locomotive maintenance， vehicle depot， signal and communication maintenance， and power supply respectively， to verify the stability and effectiveness. Results①Exploratory factor analysis showed that the questionnaire included two factors， job demands and job resources， with a total of 14 items. The factor loading of each item ranged from 0.761 to 0.916， and the two factors accounted for 71.02% of the total variance. The results of confirmatory factor analysis indicated good fitting of the two-factor model （χ²/df=3.310， RMSEA=0.087， GFI=0.892， CFI=0.932， NFI=0.905， IFI=0.932）. ② Confirmatory factor analysis was carried out in four extended samples of locomotive maintenance， vehicle depot， signal and communication maintenance， and power supply， and each result indicated a satisfactory model fit（χ²/df=2.678， 4.741， 4.868， 3.502， RMSEA=0.109， 0.096， 0.093， 0.084，GFI=0.832， 0.878， 0.894， 0.904，NFI=0.874， 0.935， 0.902， 0.928，IFI=0.917， 0.948， 0.920， 0.947）. ③Job demands in five sub-samples can positively predict job burnout and turnover intention （β=0.564~0.686， 0.425~0.554， P<0.01）. Job resources in five sub-samples can positively predict job performance and job satisfaction （β=0.594~0.752， 0.731~0.807， P<0.01）， and it can also negatively predict job burnout and turnover intention （β=-0.247~-0.186， -0.357~-0.175，P<0.05 or 0.01）.In sub-samples of locomotive maintenance and power supply， job demands can positively predict job performance （β=0.242，0.261， P<0.01）.In sub-samples of railway maintenance and signal and communication maintenance， job demands can negatively predict job satisfaction （β=-0.065， -0.091， P<0.01）. ConclusionThe questionnaire has good reliability and validity， and is applicable for the study of occupational mental health research on railway employees. ［Funded by Major Projects of the National Social Science Foundation of China （number， 19ZDA3580）， Scientific Research and Development Program of China Railway Chengdu Group Co.， Ltd （number， CX21099）］

OBJECTIVE To explore the current status and challenges of informatization construction for clinical trial centralized pharmacy based on the relevant experience of The First Affiliated Hospital, Zhejiang University School of Medicine. METHODS Review the development of clinical trial drug management and informatization process, along with the management experience of the hospital where the author works, and then introduce the framework and specific operation details of the informatization system when conducting centralized management method, summarize the problems encountered at present and propose future prospects. RESULTS Informatization construction played a significant role in the management of central pharmacies in clinical trial, enabling them to adapt to the complex management needs of investigational products and meet the high standards and strict requirements of Good Clinical Practice(GCP) and related regulations. However, the development of the current information system was still not perfect, and there were problems that need to be solved. CONCLUSION Each hospital needs to pay attention to the informatization construction of the central pharmacy of the clinical trial, improve and perfect the centralized management method of the investigational products, and explore modern technologies and equipments, which are of immense importance for the construction of the clinical trial pharmacy management that conforms to the development trend of drug clinical trials and GCP.