ObjectiveTo investigate the effect and potential mechanism of caffeic acid （CA） on severe acute pancreatitis （SAP） induced by caerulein combined with lipopolysaccharide （LPS）， and to provide a basis for the research on novel drugs for the treatment of SAP. MethodsC57BL/6J mice， aged 6 weeks， were divided into control group， model group， CA group， and octreotide acetate （OA） group， with 6 mice in each group. The mice in the control group were given injection of normal saline， and those in the other groups were given intraperitoneal injection of caerulein combined with LPS to establish a mouse model of SAP. At 1 hour after the first injection of caerulein， the mice in the CA group and the OA group were given intraperitoneal injection of CA or subcutaneous injection of OA at an interval of 8 hours. The general status of the mice was observed after 24 hours of modeling， and serum， pancreas， lung， and colon samples were collected. HE staining was used to observe the histopathological changes of the pancreas and lungs， and the serum levels of α-amylase， lipase， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， alanine aminotransferase， aspartate aminotransferase， and creatinine were measured. RT-PCR was used to measure the expression of proinflammatory factors in the pancreas and lungs； myeloperoxidase （MPO） immunohistochemistry was used to observe the degree of neutrophil infiltration； Western blot was used to measure the activation of nuclear factor-kappa B （NF-κB） and the level of citrullinated histone H3 （CitH3）， a marker for the formation of neutrophil extracellular traps （NETs）， in the pancreas and lungs， as well as the expression level of ZO-1 in colon tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the Dunnett’s t-test was used for further comparison between two groups. ResultsCompared with the control group， the model group had severe injury in the pancreas and lungs and significant increases in the activity of serum α- amylase and lipase and the levels of the proinflammatory cytokines IL-6， interleukin-1β （IL-1β）， and TNF-α in serum and lung tissue （all P<0.05）， as well as significant increases in NF-κB activation， neutrophil infiltration， and the formation of NETs in the pancreas and lungs （all P<0.05）. Compared with the model group， the CA group had alleviated pathological injury of the pancreas and lungs and significant reductions in the activity of serum α-amylase and the levels of the proinflammatory cytokines IL-6， IL-1β， and TNF-α in serum and lung tissue （all P<0.05）， as well as significant reductions in NF-κB activation， neutrophil infiltration， and the formation of NETs in the pancreas and lungs （all P<0.05）. ConclusionCA can alleviate SAP induced by caerulein combined with LPS in mice， possibly by inhibiting neutrophil recruitment and the formation of NETs.

Improving the construction of new mechanisms for the operation of public hospitals is an important task in promoting the comprehensive reform of public hospitals and the construction of modern hospital management systems.It analyzes the background of constructing new operational mechanisms based on policy evolution,histori-cal evolution,and practical needs,and analyzes the problems of imbalanced management resource allocation struc-ture,one-sided pursuit of economic benefits,low input-output efficiency,and low personnel enthusiasm in hospital operation.It proposes to grasp the key path and main measures to improve the construction of new operating mecha-nisms for public hospitals while respecting industry characteristics,adhering to government leadership,and improving market regulation.

Objective To study the effect of temperature on microleakage of Beautifil Flow Plus F00,FiltekTM Z350 XT,SDR,Tet-ric?N-Flow and Constic,and to provide reference for clinical selection of ideal fluid resins.Methods A total of 60 adult detached premolars removed for orthodontic extraction were divided into 10 groups(n=12),which were divided into F00A group,Z350A group,SDRA group,TetricA group and ConsticA group according to whether they had undergone cold and hot cycle aging test,and F00B group,Z350B group,SDRB group,TetricB group,ConsticB group,a total of 10 groups.The occlusal surface of each isolated tooth was prepared into a type Ⅰhole with the width of 2 mm,length of 4 mm and depth of 2 mm,which was filled with the corresponding fluid resin respectively.Methylene blue staining experiment was performed on specimens in group A,and methylene blue staining experiment was performed on specimens in group B after 5 000 times of cold and hot cycling aging experiment.The crowns of all specimens were dissected longitudinally along the long axis of the tooth body from the direction of buccal tongue(palate).The degree of microleakage in each group was observed under stereomicroscope,and the data were recorded and analyzed statistically.Results ①There was no sig-nificant difference in the degree of microleakage between the F00A group,the Z350A group,the SDRA group,the TetricA group and the ConsticA group(P>0.05).②The degree of microleakage in the SDRB group and TetricB group was significantly higher than that in the F00B group and Z350B group(P<0.05).③Temperature had a significant effect on the microleakage degree of Beautifil Flow Plus F00,FiltekTM Z350 XT,SDR,Tetric? N-Flow and Constic(P<0.05).Conclusion ①There was no significant difference in the de-gree of immediate microleakage of Beautifil Flow Plus F00,FiltekTM Z350 XT,SDR,Tetric?N-Flow,and Constic without cold and hot cycle aging experiments.②After the cold and hot cycle aging experiments,the microleakage degree of SDR fluid resin and Tetric? N-Flow fluid resin was high,and the edge tightness was poor.Beautifil Flow Plus F00 fluid resin and FiltekTM Z350 XT fluid resin had a low degree of microleakage and better edge tightness.③The micro-leakage degree of Beautifil Flow Plus F00，FiltekTM Z350 XT，SDR，Tetric? N-Flow and Constic was aggravated by the cold and hot cycle aging ex-periments.

In order to make the shared traditional Chinese medicine （TCM） pharmacy develop more efficiently and normatively at the grass-roots level， using the “shared TCM pharmacy” as the retrieval word， this paper uses the literature research method to retrieve the reports， documents and policies from CNKI， the websites of people’s governments at all levels， the official websites of the State Administration of Traditional Chinese Medicine， people.com， China News Network， Xinhua News and other platforms before May 20， 2022， sort out the development mode and history of two “Internet plus” TCM pharmacies， namely “shared TCM pharmacies” and “smart TCM pharmacies”， and compare them with each other. Combined with the actual work of community hospitals and community service centers （stations）， the necessity and advantages （such as reducing the costs of the intermediate links of drug circulation and standardizing the grass-roots drug use process） of the development of “shared TCM pharmacy” are obtained from the perspective of primary medical care. Combined with the current situation of the promotion and application of shared TCM pharmacy in county medical communities， it is concluded that the shared TCM pharmacy should be further constructed from four aspects： improving the work process of drug centralized procurement under the background of normalization， improving the compatibility and synchronization of the whole process dispensing information system module， unifying pharmaceutical services and personnel training， defining the authority of data query and clarifying the boundaries of patient privacy to further build a shared TCM pharmacy. Finally， it integrates information technology， summarizes the definition of shared TCM pharmacy and its future construction direction， and provides reference for the next development of shared TCM pharmacy at the grass-roots level.

Objective:To analyze the patterns of intercellular communication in facioscapulohumeral muscular dystrophy (FSHD) by single-cell nuclear transcriptome sequencing.Methods:Bilateral asymmetrical lesions mouth orbicular muscle of two patients with FSHD and mouth orbicular muscle of two healthy patients were selected. Six samples were obtained, and were divided into control group, mild group and severe group. The normal orbicularis muscle sample was collected from 2 healthy individuals (the control group). The muscle samples in the mild group were from two patients with relatively normal muscle sides, and the samples in the severe group were from two patients with more severe muscle damage sides. Single-cell nuclear transcriptome sequencing was performed on all cells of the three groups. Reduced dimension clustering and cell definition were performed to identify differentially expressed genes and enrichment pathways. Intercellular communication patterns among major cell types and key signaling pathways were explored by cellular communication analysis.Results:Differential gene expression analysis of FSHD bilateral muscle samples identified 46 functionally differentially expressed genes associated with the disease in different cell types, related to apoptosis, oxidative stress, immune inflammation, and muscle function. Intercellular communication was generally increased in the severe group. Fibro-adipogenic progenitors (FAPs) and macrophages are important signaling sources in the abnormal muscle microenvironment of FSHD and are closely associated with disease progression. There are six unique signaling pathways in the mild group, including bone morphogenetic proteins (BMP), transforming growth factor-β (TGF-β), CXC motif chemokine ligand (CXCL), adhesion G protein-coupled receptor E5 (ADGRE5), interleukin-16 (IL-16), and wingless-type MMTV integration site family (WNT) signaling pathways. These signaling pathways are mainly involved in the interaction between macrophages, FAPs, and adipocytes and may be involved in the regulation of fat deposition and fibrosis changes in the diseased muscle.Conclusions:Single-cell nuclear transcriptome sequencing provides a relatively comprehensive pattern of intercellular communication between key cell types in FSHD, providing an appropriate reference for understanding the intercellular regulatory mechanisms of the FSHD muscle microenvironment.

Critical care medicine is the last line of defense for people′s lives and health, and it is necessary to attach great importance to the development of critical care medicine and the construction of treatment capabilities. This study analyzed the development effect of critical care medicine and critical care capacity in China, analyzed the shortcomings of the current shortage of talent and treatment capacity reserves in the field of critical care medicine, combed the experience of foreign countries in attaching importance to the reserve of critical care resources, the mechanism of combining peacetime and wartime, and the construction of critical care database. Targeted suggestions were proposed to strengthen development planning, optimize investment mechanism, improve talent cultivation and growth, and build critical care database, so as to provide reference for promoting the development of critical care medicine and improving the ability of critical care in China.

We report on two cases of type C insulin resistance syndrome(TCIRS) admitted to the Department of Endocrinology, Peking Union Medical College Hospital from January 2000 to December 2020. Both patients presented with persistent hyperglycemia, low immunoreactive insulin, extreme insulin resistance, high insulin autoantibodies, high total insulin, and large insulin antibody pool. TCIRS is marked by extreme insulin resistance with ketoacidosis and respond to medium to high doses glucocorticoids rather than plasmapheresis.

Objective:To establish the HPLC fingerprint of Centellae herba and determine the content of asiaticoside, madecassic acid and asiaticoside B simultaneously; To compare the quality differences of Centellae herba collected in different months. Methods:The chromatographic condition was a Shimadzu InertSustain C18 column (4.6 mm×250 mm, 5 μm) with a mobile phase consisting of acetonitrile and 2 mmol/L beta cyclodextrin in gradient elution at the flow rate of 0.8 ml/min. The detection wavelength was 204 nm, and the column temperature was 30 ℃. The different Centellae herba materials of collected in 2-12 months from Chenzhou were studied by the similarity evaluation combined with cluster analysis, principal component analysis and the three contents determination. Results:The HPLC fingerprint of Centellae herba was established and 9 common peaks were designated. The eleven samples were different, which can be aggregated into 4 categories and the quality of Centellae herba collected in July was the best. Conclusion:The established fingerprint and multi-components quantitative method are stable and reliable, which can provide a reference for the quality control and the utilization of Centellae herba resource.

As a recognized and effective decision-making assessment tool, health technology assessment can provide scientific support for scientific decision-making such as medical devices deployment and management. This study highlighted the necessity of medical device health technology assessment by studying the development history of health technology assessment at home and abroad. On this basis, the authors pointed out the necessity of medical device health technology assessment from the perspective of laws and decrees of the country, deepening of the healthcare reform, medical insurance directory, as well as enhancement of medical quality and patient safety. Also analyzed are such problems as development of health technology assessors, system construction, and policy transformation capability.

Centering on the reform practice in Sanming featuring a synergistic reform in public health services,medical insurance and medicine production-circulation (Tripartite-sector reform below),this paper focused on the top-level design of the management system in such a reform and its synergistic operation mechanism.The authors probed into the main reasons for its grounding-breaking success and challenges,to pave way for their discussions on the reproducibility and sustainability of the reform.