OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

ObjectiveTo establish consensus on Chinese Herbal Medicine (CHM) for rheumatoid arthritis (RA) among 21 Singaporean experts, this study addressed the lack of CHM clinical practice guidelines (CPGs) in Singapore. Despite advancements in RA therapies, the disease's progressive nature and high costs of novel treatments worsen disparities in management and outcomes. The initiative aimed to bridge this gap by developing expert-backed recommendations for CHM use in RA care.MethodsThe group of experts conducted two rounds of Delphi surveys containing 29 items identified from a literature review. Consensus was defined as ≥75% of votes in dichotomized ratings on a five-point ordinal scale for recognition. Items that did not reach consensus were discussed in a focus group with four selected experts.ResultsNineteen experts completed both rounds of Delphi surveys. A consensus was reached for 27 items, which encompassed Chinese medicine rationale, pattern differentiation, management, CHM prescription, and co-effectiveness with pharmacological therapy. Collective expert opinions were formed for the two remaining items. All items received a recognition score 3.5.ConclusionsThe consensus derived from this study provides a foundation for CHM CPGs for RA in Singapore. However, the findings are limited by the demographic composition of the experts and the representativeness of the patient pool.

With the development of preimplantation genetic testing (PGT) technology, the application of third-generation sequencing technology in PGT has been increasing. This article reports the pregnancy outcome of a patient with autosomal dominant polycystic kidney disease who underwent PGT using the third-generation sequencing technology. It summarizes the technical characteristics of third-generation sequencing technology, as well as its significant advantages and limitations in PGT for families with de novo mutations.

With the development of preimplantation genetic testing (PGT) technology, the application of third-generation sequencing technology in PGT has been increasing. This article reports the pregnancy outcome of a patient with autosomal dominant polycystic kidney disease who underwent PGT using the third-generation sequencing technology. It summarizes the technical characteristics of third-generation sequencing technology, as well as its significant advantages and limitations in PGT for families with de novo mutations.

Objective To explore the clinical value of chitinase 3-like protein 1(CHI3L1)in the diagnosis of lung cancer.Methods A total of 106 patients with lung cancer admitted to the North District of the First Affiliated Hospital of Anhui Medical University from January to December 2022 were selected as the lung cancer group,76 patients with benign lung disease admitted during the same period were selected as the benign lung disease group and 20 healthy subjects were selected as the control group.Enzyme-linked immunosorbent assay was used to detect CHI3L1 levels.The levels of carcinoembryonic antigen(CEA),neuron-specific eno-lase(NSE),cytokeratin-19 fragment(CYFRA21-1),squamous cell carcinoma antigen(SCC-Ag)and gastrin-releasing peptide precursor(ProGRP)were determined by chemiluminescence assay.Results The levels of CEA,ProGRP,NSE,CYFRA21-1 and CHI3L1 in lung cancer group were significantly higher than those in control group,and the differences were statistically significant(P＜0.05).Serum CEA in lung cancer group was significantly higher than that in benign lung disease group,while serum CHI3L1 was significantly lower than that in benign lung disease group,with statistical significance(P＜0.05).Serum levels of NSE and Pro-GRP were higher in patients with small cell lung cancer than those with lung adenocarcinoma and lung squa-mous cell carcinoma(P＜0.05).Compared with patients with lung adenocarcinoma and small cell lung canc-er,the serum CYFRA21-1 level in patients with lung squamous cell carcinoma was higher,and the difference was statistically significant(P＜0.05).Compared with the control group,the serum levels of NSE,CY-FRA21-1 and CHI3L1 in patients with stage Ⅰ to Ⅱ lung cancer group were significantly increased,and the difference was statistically significant(P＜0.05).Multivariate Logistic stepwise regression analysis was per-formed for CEA,ProGRP,NSE,CYFRA21-1 and CHI3L1,and it was found that NSE and CHI3L1 had an effect on the occurrence of lung cancer.The sensitivity,specificity and area under the curve of CHI3L1 and NSE were 96.2％,90.0％and 0.965 respectively.Conclusion Serum CHI3L1 can assist in the diagnosis and differential diagnosis of lung cancer.The combined detection of CHI3L1 and NSE is helpful for the early de-tection of lung cancer and has good clinical application value.

Objective To investigate the expression of OTU deubiquitinase 3(OTUD3)and interleukin en-hancer binding factor 2(ILF2)in esophageal squamous cell cancer and their correlation with clinicopathologi-cal characteristics and prognosis.Methods A total of 102 patients with esophageal squamous cell cancer who underwent radical resection in Huai'an Fifth People's Hospital between January 2019 and July 2020 were in-cluded in this study.Immunohistochemistry was used to detect OTUD3 and ILF2 expression.Spearman rank correlation analysis was conducted to assess the relationship between OTUD3 and ILF2.Kaplan-Meier surviv-al curves were used to analyze the impact of OTUD3 and ILF2 expression on patient survival prognosis.COX regression analysis was employed to identify prognostic factors.Results Compared with adjacent tissues,the positive rate of OTUD3 was lower and the positive rate of ILF2 was higher in esophageal squamous cell cancer tissues,and the differences were statistically significant(P＜0.05).A significant negative correlation was ob-served between the expression of OTUD3 and ILF2 in esophageal squamous cell cancer(r=-0.712,P＜0.001).Furthermore,patients with TNM stage Ⅲ,low differentiation,and lymph node metastasis exhibited a lower positive rate of OTUD3 and a higher positive rate of ILF2 compared to patients with TNM stage Ⅰ-Ⅱ,medium-high differentiation,and no lymph node metastasis(P＜0.05).The 3-year survival rate for the OTUD3-positive group was significantly higher than that of the OTUD3-negative group(Log-rank x2=5.869,P=0.015).The 3-year survival rate for the ILF2-positive group was significantly lower than that of the ILF2-negative group(Log-rank x2=16.257,P＜0.001).TNM staging,lymph node metastasis,degree of differentiation,OTUD3,and ILF2 were independent factors affecting the prognosis of esophageal squamous cell cancer patients.Conclusion Decreased expression of OTUD3 and increased expression of ILF2 in esopha-geal squamous cell cancer tissues are implicated in the malignant progression of esophageal squamous cell cancer and serve as independent factors affecting patient outcomes.

Objective:To investigate the effect of rebiopsy blastocyst on clinical pregnancy and neonatal outcomes in patients with preimplantation genetic testing (PGT) before embryo implantation.Methods:A retrospective cohort study analyzed the clinical pregnancy and neonatal outcomes of one biopsy and rebiopsy patients (453 and 60 patients, respectively) with PGT in the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2019 to December 2022. The 2∶1 propensity score matching (PSM) method was used to match the age, body mass index (BMI) and infertility duration of women in the two groups, and the laboratory indexes and related indexes of transplant fertility and neonatal outcomes of PGT patients were compared between the two groups. The rebiopsy patients with PGT were divided into PGT for aneuploidy (PGT-A) subgroup, PGT for structural rearrangements (PGT-SR) subgroup and PGT for monogenic (PGT-M) subgroup according to PGT types, and the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo were compared between each two subgroups.Results:After PSM, there were no significant differences in women's age, female body mass index, infertility type, ovulation induction program, PGT type and laboratory-related indexes between the two groups (all P>0.05). At the same time, the implantation rate, the clinical pregnancy rate and the live birth rate of rebiopsy embryos decreased, and the miscarriage rate increased, but the differences were not statistically significant (all P>0.05). The rate of day 3 available embryo in the rebiopsy PGT group [87.50% (434/496)] was significantly increased, and the number of blastocyst [4.00 (2.25,6.75)] was significantly decreased compared with one biopsy PGT group [82.19% (812/980), P=0.020; 5.50 (3.00,8.00), P=0.028]. Then the chromosomal euploidy rate of the rebiopsy embryo [35.9% (28/78)] decreased and the abnormality rate [9.0% (7/78)] increased in the rebiopsy PGT group compared with one biopsy PGT group [49.3% (226/458), P=0.028; 0.9% (4/458), P<0.001], and the differences were statistically significant. The aneuploidy rate and multi-chromosome mosaic rate in the rebiopsy PGT group were higher than those in the one biopsy PGT group, but the difference was not statistically significant (all P>0.05). There were no significant differences in birth weight, gestational age, sex ratio, low birth weight infants, macrosomia, small-for-gestational-age infants, large-for-gestational-age infants, and incidence of birth defects between the two groups (all P>0.05). There was no significant difference in the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo between the subgroups of the PGT group (all P>0.05). Conclusion:For patients who fail the first biopsy, the clinical pregnancy rate, the live birth rate, the neonatal birth weight, and the birth defect incidence rate after the second biopsy of PGT are comparable to those of the patients with the first biopsy of PGT.

Objective:To investigate the effect of rebiopsy blastocyst on clinical pregnancy and neonatal outcomes in patients with preimplantation genetic testing (PGT) before embryo implantation.Methods:A retrospective cohort study analyzed the clinical pregnancy and neonatal outcomes of one biopsy and rebiopsy patients (453 and 60 patients, respectively) with PGT in the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2019 to December 2022. The 2∶1 propensity score matching (PSM) method was used to match the age, body mass index (BMI) and infertility duration of women in the two groups, and the laboratory indexes and related indexes of transplant fertility and neonatal outcomes of PGT patients were compared between the two groups. The rebiopsy patients with PGT were divided into PGT for aneuploidy (PGT-A) subgroup, PGT for structural rearrangements (PGT-SR) subgroup and PGT for monogenic (PGT-M) subgroup according to PGT types, and the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo were compared between each two subgroups.Results:After PSM, there were no significant differences in women's age, female body mass index, infertility type, ovulation induction program, PGT type and laboratory-related indexes between the two groups (all P>0.05). At the same time, the implantation rate, the clinical pregnancy rate and the live birth rate of rebiopsy embryos decreased, and the miscarriage rate increased, but the differences were not statistically significant (all P>0.05). The rate of day 3 available embryo in the rebiopsy PGT group [87.50% (434/496)] was significantly increased, and the number of blastocyst [4.00 (2.25,6.75)] was significantly decreased compared with one biopsy PGT group [82.19% (812/980), P=0.020; 5.50 (3.00,8.00), P=0.028]. Then the chromosomal euploidy rate of the rebiopsy embryo [35.9% (28/78)] decreased and the abnormality rate [9.0% (7/78)] increased in the rebiopsy PGT group compared with one biopsy PGT group [49.3% (226/458), P=0.028; 0.9% (4/458), P<0.001], and the differences were statistically significant. The aneuploidy rate and multi-chromosome mosaic rate in the rebiopsy PGT group were higher than those in the one biopsy PGT group, but the difference was not statistically significant (all P>0.05). There were no significant differences in birth weight, gestational age, sex ratio, low birth weight infants, macrosomia, small-for-gestational-age infants, large-for-gestational-age infants, and incidence of birth defects between the two groups (all P>0.05). There was no significant difference in the rebiopsy rate, the success rate of amplification and the rate of transferrable embryo between the subgroups of the PGT group (all P>0.05). Conclusion:For patients who fail the first biopsy, the clinical pregnancy rate, the live birth rate, the neonatal birth weight, and the birth defect incidence rate after the second biopsy of PGT are comparable to those of the patients with the first biopsy of PGT.

Objective: To examine the relationship between interpregnancy interval (IPI) and neurodevelopment among 6-month-old infants, so as to provide insights into the prevention of neurodevelopmental abnormalities among infants. Methods: Puerparas with full-term delivery at Anhui Province Maternity and Child Health Hospital from April 2017 to July 2018 and their babies were recruited. The demographic features, behaviors during pregnancy, IPI and birth outcomes were collected through questionnaires and medical records. The neurodevelopment was evaluated using the Ages and Stages Questionnaire (third edition) among infants at 6 months of age. The association between IPI and neurodevelopment was examined using multivariable logistic regression analysis. Results : Totally 485 maternal-newborn pairs were investigated, and the puerparas had a mean age of ( 29.43±4.40 ) years. There were 330 puerparas ( 68.04% ) with normal pre-pregnancy body mass index, 325 puerparas ( 67.01% ) with eutocia, 233 puerparas (48.04%) with the first delivery, 44 puerparas ( 9.07% ) with IPI of less than one year and 208 puerparas ( 42.89% ) with IPI of one year and greater. There were 246 male babies ( 50.72% ) and 437 babies ( 90.10% ) with normal birth weight. A total of 148 newborns were diagnosed with neurodevelopmental abnormalities, with a detection rate of 30.52%. Of all newborns with neurodevelopmental abnormalities, there were 45 babies with communication abnormalities ( 9.28% ), 87 babies with gross motor abnormalities ( 17.94% ), 73 babies with fine motor abnormalities ( 15.05% ), 68 babies with abnormalities of solving problems ( 14.02% ) and 60 babies with personal-social abnormalities ( 12.37% ). Multivariable logistic regression analysis showed a reduced risk of infant's communication abnormalities ( OR=0.273, 95%CI: 0.090-0.833 ), gross motor abnormalities ( OR=0.340, 95%CI: 0.150-0.770 ), fine motor abnormalities ( OR=0.266, 95%CI: 0.106-0.670 ), personal-social abnormalities ( OR=0.321, 95%CI: 0.121-0.851 ) and neurodevelopmental abnormalities ( OR=0.353, 95%CI: 0.171-0.730 ) among puerparas with IPI of one year and greater as compared to those with IPI of less than one year, and no significant difference was seen in infant's neurodevelopmental abnormalities between puerparas with the first delivery and with IPI of less than one year. Conclusion IPI is associated with neurodevelopmental abnormalities among 6-month-old infants.

Objective:To explore the clinical value of heparin binding protein (HBP) in bronchoalveolar lavage fluid (BALF) for diagnosis and differential diagnosis of bacterial pneumonia.Methods:Eighty eight patients with pulmonary infection from the respiratory department of the Fourth Affiliated Hospital of Anhui Medical University from January 2019 to January 2021 were enrolled in the study, including 48 cases of bacterial pneumonia and 40 cases of non-bacterial pneumonia; meanwhile, 40 non-pulmonary infection patients were also enrolled as the control group. The BALF levels of HBP, procalcitonin (PCT), interleukin-6 (IL-6) were measured, and the clinical values of the above indexes in differential diagnosis of bacterial and non-bacterial pneumonia were analyzed.Results:The BALF levels of HBP and IL-6 in bacterial pneumonia group were significantly higher than those of the non-bacterial pneumonia group and the control group ( P<0.05). ROC curve showed that the areas under the curve (AUC) of HBP and IL-6 were 0.930 and 0.893 for the early diagnosis of bacterial pneumonia; and the sensitivity was 88.5% and 82.7%, the specificity was 92.5% and 92.5%, respectively. Combined detection of HBP and IL-6, the AUC was 0.942 and the sensitivity was 94.2% and the specificity was 95.0%. When they were used to distinguish bacterial pneumonia, the AUC of HBP and IL-6 were 0.890 and 0.777, and the sensitivities were 80.8% and 71.2%, and the specificity were 91.7% and 75.0%, respectively. Combined detection of HBP and IL-6, the AUC was 0.902, and the sensitivity was 96.2% and the specificity was 79.2%. Conclusions:BALF HBP and IL-6 have good clinical value in the early diagnosis and distinguishing bacterial pulmonary infection and the joint value of the two is better.