OBJECTIVE To further standardize the technical operations and management processes throughout therapeutic drug monitoring （TDM）， clarify the clinical value of TDM implementation， improve the scientific validity and reliability of monitoring results， and provide a solid reference basis for the formulation and optimization of clinical individualized precision dosing regimens. METHODS The Guidelines for the Management of Therapeutic Drug Monitoring were formulated in accordance with the latest definition of guidelines by the Institute of Medicine of the National Academies and the standard guideline development methodology of the World Health Organization， and in compliance with the requirements of the appraisal of guidelines for research and evaluation. A modified Delphi method was adopted to establish the research question system； evidence-based medicine research methods were applied to systematically search multiple databases to screen the latest and most comprehensive evidence. Evidence was graded and evaluated based on the evidence grading system of the Chinese Evidence-Based Medicine Center， and the grading criteria for recommendation strength from the Oxford Centre for Evidence-Based Medicine were used to determine the recommendation strength. The recommendation opinions were formed through multidisciplinary expert consensus. RESULTS The Guidelines for the Management of Therapeutic Drug Monitoring cover four core modules， including TDM application indications， technical procedures， result interpretation and clinical application， and quality control， involving 18 primary research questions， 34 secondary research questions， and yield 82 recommendations. CONCLUSIONS The guidelines systematically standardize the key technical links and management requirements of the whole TDM process， provide scientific and operable standardized tools， help improve the standardization level of TDM work， promote the translation of monitoring results into clinical decision-making， and provide strong support for precision personalized medicine and ensuring the safety and rationality of medication use.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective:To conduct a bibliometric analysis of scientific publications on aneurysmal subarachnoid hemorrhage (aSAH) worldwide from 2012 to 2022 and to investigate the current research status and hotspots in this field.Methods:The Web of Science Core Collection was used as the data source. According to the set retrieval strategy, the CiteSpace bibliometric tools were used to analyze the published literature and explore the research hotspots and cutting-edge directions.Results:A total of 4 937 articles were included, and the number of publications increased year by year from 2012 to 2022. The United States is a leading country in this field, Harvard University is a leading institution in this field, and Rinkel Gabriel JE is the researcher with the most published articles in this field. The analysis of the keywords provided by the author showed that delayed cerebral ischemia, vasospasm, risk, intracranial aneurysms, endovascular treatment, risk factors, embolization, complications, Pipeline embolization device, coil embolization, hemodynamics, and wall shear stress were the main hotspots and cutting-edge directions of aSAH research.Conclusion:The results of bibliometric analysis help to grasp the current research status of aSAH and determine new directions for future research.

Objective:To investigate the effect of galectin-3 (gal-3) on microglia polarization after subarachnoid hemorrhage (SAH).Methods:C57BL/6 male adult mice were used to induce SAH or sham operation models. Gal-3 siRNA or negative control siRNA was injected into the lateral ventricle 48 h before the model was induced. After 24 h of model preparation, the SAH score, neurological function score, brain water content, and Evans blue exudate were measured. Western blot analysis was used to detect the expressions of M1 phenotypic markers (inducible nitric oxide synthase [iNOS], CD11b, tumor necrosis factor [TNF]-α) and M2 phenotype markers (CD206, YM1/2, arginase-1 [Arg1]).Results:After using Gal-3 siRNA to inhibit Gal-3, the neurological function score significantly increased, while the SAH score, brain water content, and Evans blue exudate significantly decreased ( P<0.001). Western blot analysis showed that the expressions of M1 phenotypic markers (iNOS, CD11b and TNF-α) in microglia were significantly decreased after Gal-3 inhibition, while the expressions of M2 phenotypic markers (CD206, YM1/2 and Arg1) were significantly increased ( P<0.001). Conclusion:Inhibition of Gal-3 expression can alleviate the early brain injury after SAH, and its mechanism may be associated with regulating the polarization of microglia from M1 to M2 phenotype.

Objective:To investigate the efficacy and safety of distal transradial access for cerebral angiography and neurointervention.Methods:The literature about distal transradial access for cerebral angiography and neurointervention were searched in PubMed, EMbase, the Cochrane Library, CNKI, WanFang Data, and VIP database from January 2015 to September 2021. Two reviewers independently screened the literature and extracted data according to the inclusion and exclusion criteria, evaluated the literature quality according to the Newcastle-Ottawa scale. The R 4.0.5 software was used for meta-analysis.Results:A total of 12 articles with 987 patients were enrolled. All the studies were retrospective design and did not compare with the results of proximal transradial access and transfemoral access. A meta-analysis of the operation success rate and complication rate using a fixed effect model showed that the operation success rate of distal transradial access was 96% (95% confidence interval 95%-97%), and the incidence of minor complications was 3% (95% confidence interval 2%-4%). One patient had serious complications.Conclusion:The distal transradial access is a safe and effective alternative approach for cerebral angiography and neurointervention.

Objective:To investigate the effects of naringin on early brain injury in rats with subarachnoid hemorrhage and its possible mechanism of action.Methods:Rats were randomly divided into the sham operation group, the model group, and the naringin group. Each group had 8 rats. The SAH model was established by intravascular perforation, and then rats in the model group and the naringin group were administered 0.9% NaCl or naringin 40 mg/kg by intraperitoneal injection after 0.5 h. SAH score, neurological function score, cerebral edema, and blood-brain barrier permeability were detected. The level of NAD + and nflammatory factors were detected by ELISA. The expression of poly(ADP-ribose) polymerase-1 (PARP-1), apoptosis inducing factor (AIF), and protease-activated receptor (PAR) proteins was detected by Western Blot. The expression of PARP-1 mRNA was detected by quantitative real-time fluorescence PCR (qRT-PCR). Neuronal apoptosis was detected by an immunofluorescence assay. Results:Compared with the model group, naringin treatment improved neurological function ( P<0.01), reduced cerebral edema and Evans blue exudation (all P<0.01), increased the content of NAD + ( P<0.001), reduced IL-1β, IL-6 and TNF-α levels (all P<0.001), and reduced the expression of PARP-1/AIF pathway-related proteins in vivo (all P<0.001). In addition, naringin could inhibit neuronal apoptosis in early brain injury after SAH. Conclusions:Naringin can improve the early brain injury after SAH, which may be achieved by inhibiting the PARP-1/AIF pathway.

Objective:To investigate the effect of rutin on blood-brain barrier in early brain injury after subarachnoid hemorrhage (SAH) in rats.Methods:A rat model of SAH was induced by puncturing the internal carotid artery. The rats were divided into a sham operation group, a model group and a rutin (50 mg/kg) group. Twenty-four hours after modeling, SAH score and neurological deficit score were conducted, and brain water content and Evans blue extravasation rate were detected in each group. Western blot analysis was used to detect the expression of claudin-5, occludin and zonula occluden (ZO)-1. TUNEL staining was used to detect neuronal apoptosis.Results:Compared with the sham operation group, the SAH score increased, the neurological deficit score decreased, and the brain water content and Evans blue extravasation increased in the model group. Rutin could significantly reduce the SAH score, increase neurological deficit score, and reduce brain water content and Evans blue exudation (all P<0.01). Western blot analysis showed that the expression of claudin-5, occludin and ZO-1 protein decreased in the model group, and the expression of claudin-5, occludin and ZO-1 protein increased significantly in the rutin group ( P<0.01). In addition, the number of TUNEL positive cells induced by SAH in the rutin group decreased. Conclusion:Rutin can play a protective role in early brain injury after SAH, and its mechanism may be associated with protecting the integrity of blood-brain barrier.

Objective:To respond to the national requirements on the construction of research integrity, and improve the capacity building of research integrity at hospitals.Methods:Dealing with research integrity problems identified at hospital before 2018, measurements that include " policy and procedures development, standardization of the management of scientific research activities, and optimizing the scientific and technological evaluation system" were adopted to promote the construction of research integrity. Such corrective activities were monitored to summarize experiences and lessons for the continuing improvement of research integrity construction.Results:Both " heteronomy" and " self-discipline" of research integrity have been sublimated simultaneously, at the same time, a tailored research integrity management system with the characteristics of local hospitals has been established.Conclusions:Updating institutional policy and procedures, taking paper management as a priority, as well as research integrity training, these measurements played important roles in promoting the research integrity capacity building at hospitals.

With the accelerating process of aging society, people's life style is changing accordingly, elderly patients due to physical decline in daily activities, often prone to hip fracture, its basic reason is osteoporosis, which belongs to brittle fracture, evaluation of preoperative examination and the systemic function is very important.Perioperative treatment is the key to the success of surgery treatment , a considerable part of the success of surgery depends on the factors of internal diseases.The incidence of cardio cerebral stroke in hip fracture surgery is also increasing , especially in elderly patients, often and there are a variety of medical diseases, the majority of organ function reserve is low, tolerance to anesthesia, surgery and other stress ability is poor, Patients in the perioperative period of traumatic stress, easily lead to stroke secondary cardiovascular disease, in clinical treatment, we should strengthen the prevention measures of perioperative stroke in elderly patients with hip fracture , Salvia miltiorrhiza ligustrazine injection can effectively prevent the occurrence of myocardial ischemia, myocardial infarction, or cerebral infarction by reducing platelet aggregation function and blood viscous degree, expanding coronary artery, cerebrovascular, improving the flow rate of red blood cells and microcirculation.In this paper mainly for Salvia miltiorrhiza ligustrazine in recent years in elderly hip fracture patients perioperative cardio cerebral apoplexy therapy application review to provide some reference value for clinical research .

Objective To explore the clinical effect of conventional surgical treatment of tibial plateau fractures and traditional Chinese medicine intervention. Methods Sixty-eight patients with tibial plateau fractures who had received medical treatment from Hangzhou Cancer Hospital (May 23, 2015 to May 23, 2016) were randomized to the surgical group and the combined group as the subjects of this study. 34 patients in the operation group were treated with surgical treatment. 34 patients in the combined group were treated with traditional Chinese medicine on the basis of operation. The clinical efficacy and knee function scores of the patients with tibial plateau fractures were compared. Results The total effective rate was 91.18% in the combined group, which was significantly higher than that in the operation group (73.53%) (P<0.05). The knee function score of the combined group was (25.36±3.85) The operation group (21.24 ± 3.89) was significantly higher (P<0.05). Conclusion The intervention of traditional Chinese medicine combined with traditional Chinese medicine can significantly improve the function of knee joint in patients with tibial plateau fractures.