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Pill image recognition is an important field in computer vision. It has become a vital technology in healthcare and pharmaceuticals due to the necessity for precise medication identification to prevent errors and ensure patient safety. This survey examines the current state of pill image recognition, focusing on advancements, methodologies, and the challenges that remain unresolved. It provides a comprehensive overview of traditional image processing-based, machine learning-based, deep learning-based, and hybrid-based methods, and aims to explore the ongoing difficulties in the field. We summarize and classify the methods used in each article, compare the strengths and weaknesses of traditional image processing-based, machine learning-based, deep learning-based, and hybrid-based methods, and review benchmark datasets for pill image recognition. Additionally, we compare the performance of proposed methods on popular benchmark datasets. This survey applies recent advancements, such as Transformer models and cutting-edge technologies like Augmented Reality (AR), to discuss potential research directions and conclude the review. By offering a holistic perspective, this paper aims to serve as a valuable resource for researchers and practitioners striving to advance the field of pill image recognition.

In de patiëntenzorg gaat het niet alleen om goede geneesmiddelen. Ziekenhuisapothekers zijn geneesmiddeldeskundigen bij uitstek. Loraine Lie-A-Huen schetst een toekomstbeeld waarin ziekenhuisapothekers en leden van een zogeheten klinisch apotheekteam op de verpleegafdeling, dicht bij de patiënt, een cruciale rol spelen op het gebied van patiëntveiligheid. Door betrouwbaar en innovatief leiderschap weten ziekenhuisapothekers binnen en buiten het ziekenhuis de kans op schade door geneesmiddelen bij patiënten te reduceren. Lie-A-Huen doet in haar rede enkele voorstellen aan minister Klink van Volksgezondheid, Welzijn en Sport voor zijn langetermijnvisie op de intramurale geneesmiddelenvoorziening.

Medication errors account for a large proportion of all medical errors. In most homes, patients take a variety of medications for a long period. However, medication errors frequently occur because patients often throw away the containers of their medications. We proposed a deep learning-based system for reducing medication errors by accurately identifying prescription pills. Given the pill images, our system located the pills in the respective pill databases in South Korea and the United States. We organized the system into a pill recognition step and pill retrieval step, and we applied deep learning models to train not only images of the pill but also imprinted characters. In the pill recognition step, there are 3 modules that recognize the 3 features of pills and their imprints separately and correct the recognized imprint to fit the actual data. We adopted image classification and text detection models for the feature and imprint recognition modules, respectively. In the imprint correction module, we introduced a language model for the first time in the pill identification system and proposed a novel coordinate encoding technique for effective correction in the language model. We identified pills using similarity scores of pill characteristics with those in the database. We collected the open pill database from South Korea and the United States in May 2022. We used a total of 24,404 pill images in our experiments. The experimental results show that the predicted top-1 candidates achieve accuracy levels of 85.6% (South Korea) and 74.5% (United States) for the types of pills not trained on 2 different databases (South Korea and the United States). Furthermore, the predicted top-1 candidate accuracy of our system was 78% with consumer-granted images, which was achieved by training only 1 image per pill. The results demonstrate that our system could identify and retrieve new pills without additional model updates. Finally, we confirmed through an ablation study that the language model that we emphasized significantly improves the pill identification ability of the system. Our study proposes the possibility of reducing medical errors by showing that the introduction of artificial intelligence can identify numerous pills with high precision in real time. Our study suggests that the proposed system can reduce patients' misuse of medications and help medical staff focus on higher-level tasks by simplifying time-consuming lower-level tasks such as pill identification.

Hormonal contraception is known to precipitate or perpetuate depression in some patients. The link between oral contraceptive pills and depression relates to the amount and type of progestogen contained in these pills. Many of the older oral contraceptive pills, which contain ethinylestradiol, are linked to severe mood problems. Newer oral contraceptive pills containing physiological forms of oestrogen may be better tolerated with a purported weaker link to mood problems. Clinicians should consider the temporal relationship between the use of hormonal contraception and development of new or worsened depression or mood changes.Hormonal contraception is known to precipitate or perpetuate depression in some patients. The link between oral contraceptive pills and depression relates to the amount and type of progestogen contained in these pills. Many of the older oral contraceptive pills, which contain ethinylestradiol, are linked to severe mood problems. Newer oral contraceptive pills containing physiological forms of oestrogen may be better tolerated with a purported weaker link to mood problems. Clinicians should consider the temporal relationship between the use of hormonal contraception and development of new or worsened depression or mood changes.

This paper introduces Tibetan pill traditions and examines two exceptional pill formulas that emerged from an early Buddhist–medical interface in Tibet, but followed different trajectories due to the increased specialization of religious and medical knowledge. “Black pills” are the most revered consecrated healing compound of the Karmapas (the incarnate heads of the Karma Kagyü School of Tibetan Buddhism), while the “Cold Compound Black Pill”—a precious pill known as Rinchen Drangjor—is one of Tibetan medicine’s most complex formulas still produced today. Based on both textual research and ethnographic fieldwork in India, I critically explore the principal factors that link these black pill traditions. I argue that parallels in the use of potent substances and their processing offer examples of how strongly entangled medical and religious approaches are with respect to healing practices that include blessings, protection, spiritual support, and medical treatment. My findings reveal that although there are distinct areas of medical and religious specialized practices in the black pill traditions, consecrated multi-compounds are added to both types of black pills to enhance potency and ensure the continuation of lineage affiliations to certain Buddhist schools. I also show how political and sectarian conflicts within certain Buddhist schools may affect some of these rare pill practices.

In this paper, I begin by defending permissivism: the claim that, sometimes, there is more than one way to rationally respond to a given body of evidence. Then I argue that, if we accept permissivism, certain worries that arise as a result of learning that our beliefs were caused by the communities we grew up in, the schools we went to, or other irrelevant influences dissipate. The basic strategy is as follows: First, I try to pinpoint what makes irrelevant influences worrying and I come up with two candidate principles. I then argue that one principle should be rejected because it is inconsistent with permissivism. The principle we should accept implies that it is sometimes rational to maintain our beliefs, even upon learning that they were caused by irrelevant influences.

Diabetic nephropathy (DN) is a common microvascular complication of diabetes. (LW) has significant clinical efficacy in the treatment of DN, but its pharmacological mechanism and material basis remain poorly understood. This study aimed to explore the substance basis and mechanism of action of LW in treating DN. The potential mechanism of LW was investigated through UPLC/LTQ-Orbitrap-MS and network pharmacology. The activity of LW and its constituent herbs was evaluated in human renal glomerular endothelial cells (HRGEC) and HK2 cells. Key pathways and targets were identified by transcriptomics and validated by qRT-PCR. Molecular docking was employed to screen for active ingredients of LW. The results showed that LW, Cornus Officinalis (CO), Moutan Cortex (MC), Rhizoma Dioscoreae (RD), and Alismatis Rhizoma (AR) mitigated oxidative damage in HRGEC cells. LW primarily targeted VEGFA and EGR1, thereby modulating the AGE-RAGE signaling pathway in diabetic complications. LW also reduced fibrosis in HK2 cells by up-regulating BMP4 and modulating the TGF-beta signaling pathway. Rehmanniae Radix Praeparata (RRP), CO, MC, RD, and Poria Cocos (PC) were identified as key contributors to improving renal fibrosis. Additionally, 43 potential active ingredients were identified in LW, 13 of which exhibited favorable ADMET properties. Six key ingredients, including taxifolin, cianidanol, gallic acid, caffeic acid, 5-hydroxymethylfurfural, and paeonol were found to be primarily responsible for the effects of LW on microvascular endothelial injury and renal fibrosis. In summary, these findings reveal the material basis and mechanism of LW against DN, providing a foundation for its clinical application.

Lusha Zhang,1– 3,* Ying Guo,1,* Yuming Fan,1 Ting Liu,1 Tianyu Wang,1 Mengyao Li,1 Shaoxia Wang,1 Qi Yu,2 Hong Wang1 1School of Medical Technology, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People’s Republic of China; 2Shaanxi Key Laboratory of Ischemic Cardiovascular Diseases and Institute of Basic and Translational Medicine, Xi’an Medical University, Xi’an, 710021, People’s Republic of China; 3Graduated School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hong Wang, School of Medical Technology, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, People’s Republic of China, Tel +862259596171, Email wanghongsys@tjutcm.edu.cn Qi Yu, Shaanxi Key Laboratory of Ischemic Cardiovascular Diseases and Institute of Basic and Translational Medicine, Xi’an Medical University, 1, Xinwang Road, Weiyang District, Xi ‘An, 710021, People’s Republic of China, Email qiyu6028@hotmail.comBackground: Clinical evidence suggests that extended treatment with Suxiao Jiuxin Pill (SJP) significantly reduces the recurrence rates of myocardial infarction (MI), primarily through its modulation of cardiac immune-fibrotic responses. Nonetheless, the precise molecular mechanisms underlying this effect remain to be fully elucidated.Methods: Male C57BL/6J mice were randomly assigned to six groups: sham-operated control, MI + saline (vehicle control), MI + SJP (39, 78, and 156 mg/kg), and MI + dapagliflozin (1.5 mg/kg, positive control). Cardiac function and infarct size were assessed using echocardiography and Masson’s trichrome staining. Serum levels of lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase-MB (CK-MB) were measured with a Hitachi 7020 automatic biochemical analyzer, while cardiac troponin T (cTnT) levels were quantified via enzyme-linked immunosorbent assay (ELISA). Gene expression analysis was conducted using reverse transcription polymerase chain reaction (RT-PCR). Immune cell populations within the ischemic heart were analyzed through flow cytometry. Naïve CD4+ T cells were isolated and differentiated into regulatory T cells (Tregs) to assess their immunosuppressive function.Results: The administration of SJP treatment resulted in a significant reduction in infarct size and enhancement of cardiac function in mice with MI. Additionally, SJP modulated the immune profile of the infarcted myocardium by reducing neutrophil infiltration and increasing the presence of CD4+ T cells and CD206+ macrophages. Importantly, SJP markedly expanded the population of regulatory T cells (Tregs) and augmented their immunosuppressive capabilities, as evidenced by the upregulated expression of IL-10, Ctla-4, and Sparc. The cardioprotective effects of SJP were found to be dependent on Tregs, as their depletion negated the therapeutic benefits of SJP. Mechanistically, SJP facilitated Treg expansion within the infarcted myocardium by activating the ST2L/Foxp3 signaling pathway and restoring the balance between Treg and Th17 cytokines. In vitro analyses identified senkyunolide I and levistolide A as the predominant active compounds responsible for these effects.Conclusion: This study elucidates the cardioprotective effects of SJP, which are mediated through the expansion of the Treg population and enhancement of their immunosuppressive function via activation of the ST2L/Foxp3 signaling pathway, with senkyunolide I and levistolide A identified as primary drivers behind the enhanced Treg function. Keywords: Suxiao Jiuxin pill, myocardial infarction, ST2L, Treg

Fangyu Hao,1,2,* Mengyu Guo,1,2,* Yuwei Zhao,1,2 Xingyu Zhu,1,2 Xiaofang Hu,1,2 Weihao Zhu,1,2 Chunmei Mei,1,2 Nong Zhou,3 Kunming Qin,4 Hui Zhu,1,2 Weidong Li1,2 1School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China; 2Jiangsu Key Laboratory of Chinese Medicine Processing, Engineering Center of State Ministry of Education for Standardization of Chinese Medicine Processing, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China; 3College of Biology and Food Engineering, Chongqing Three Gorges University, Chongqing, People’s Republic of China; 4School of Pharmacy, Jiangsu Ocean University, Lianyungang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hui Zhu, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China, Email zhui_0826@njucm.edu.cn Weidong Li, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China, Email liweidong0801@163.comPurpose: Bone metabolism disorders are strongly associated with T helper type 17/regulatory T (Th17/Treg) cell imbalance and inflammatory dysregulation. Qing’e pills (QEP) is a classical prescription for treating osteoporosis with both safety and clinical effectiveness. However, the mechanism of its immune action remains unclear.Methods: QEP components were identified via HPLC. Anti-osteoporotic effects of QEP were assessed through biochemical, micro computed tomography, bone biomechanical and histopathological analyses. Th17/Treg balance and related inflammatory factors were analyzed using flow cytometric, biochemical, immunohistochemical, and quantitative real-time PCR assays. The effects of QEP on gut microbiota and endogenous metabolites were analyzed via 16S rRNA analysis, co-incubation experiments and untargeted metabolomics. Integrative correlations analysis was used to explore the relationships among gut-bone-Th17/Treg balance interactions.Results: QEP improved bone mineral density and bone biomechanical properties and reduced bone conversion in ovariectomized rats. After treatment, QEP restored intestinal barrier integrity, and reduced serum LPS levels. QEP significantly decreased Th17-related inflammatory cytokines TNF-α, IL-17 levels, reduced the transcription of Th17-related genes RORγt and IL-17A and the percentage of CD4+IL-17A+ Th17 cells in the gut-bone axis, and concurrently restored the anti-inflammatory cytokines levels of TGF-β and IL-10, the expression of Foxp3 and the percentage of CD4+ CD25+ Foxp3+ Treg cells in the gut–bone axis. Notably, QEP improved the disorganization of gut microbiota composition and structure in ovariectomized rats. On genus level, QEP can significantly increase the relative abundance of Lactobacillus in vitro and in vivo. Furthermore, gut microbe-derived endogenous metabolites potentially mediating QEP’s regulation of Th17/Treg balance in gut-bone axis and anti-osteoporotic effects.Conclusion: QEP ameliorates osteoporosis by improving the intestinal flora disorders and immune status, and restoring the balance of Th17/Treg in the gut-bone axis, highlighting its clinical potential in the treatment of postmenopausal osteoporosis. Keywords: Qing’e pills, osteoporosis, Th17/Treg, gut microbes, Lactobacillus