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.

OBJECTIVE To form an expert consensus addressing clinical issues regarding the use of parenteral direct thrombin inhibitors （DTIs） in special populations. METHODS Led by the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital（the Affiliated Hospital of UESTC）， a multidisciplinary working group was formed comprising experts from multiple fields， including clinical pharmacy， cardiac surgery， obstetrics， pediatrics and evidence-based medicine. Through literature review and the Delphi method， clinical questions regarding the efficacy and safety of parenteral DTIs used in special populations were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” （PICO） framework；systematic searches were conducted in CJFD， PubMed， Embase and other databases. Relevant evidence from randomized controlled trials，cohort studies and systematic reviews were included and synthesized. Evidence quality was assessed using the Grading of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through three rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven clinical questions were ultimately selected （with a consensus rate exceeding 90%）， resulting in the formulation of seven recommendations on the use of parenteral DTIs in special populations， including children， pregnant women， patients with hepatic or renal impairment， patients with mesenteric venous thrombosis， and individuals with thrombophilia. These recommendations clarify the preferred agents， dosing ranges， monitoring parameters， and safety management strategies for parenteral DTIs in these special populations. 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 special populations.

Objective To systematically evaluate the efficacy and safety of traditional Chinese medicine (TCM) compound in treating pulmonary nodules, providing evidence-based medical evidence for TCM intervention in pulmonary nodules. Methods Computer search of PubMed, CNKI, Wanfang, VIP, and SinoMed was conducted to select randomized controlled trials (RCTs) of TCM compound intervention in pulmonary nodules, with the retrieval time from the inception to November 29, 2023. The Cochrane bias risk assessment tool was used to evaluate the quality of the included studies, and Review Manager 5.4 was used for Meta-analysis. Results A total of 18 RCTs were included, covering 8 provinces across the country, with a total sample size of 1301 patients. The TCM compounds used in the included studies all incorporated the method of dissolving phlegm and dissipating nodules. There was a high risk of bias uncertainty in the included studies. Meta-analysis results suggested that TCM compound could significantly reduce the diameter of pulmonary nodules [MD=−1.41, 95%CI (−1.70, −1.13), P<0.001], decrease the number of nodules [MD=−0.37, 95%CI (−0.73, −0.01), P=0.05], alleviate clinical symptoms [MD=−4.84, 95%CI (−6.04, −3.64), P<0.001], and improve lung function [forced expiratory volume in one second (FEV1), MD=0.55, 95%CI (0.09, 1.01), P=0.02; FEV1/forced vital capacity, MD=6.12, 95%CI (4.47, 7.78), P<0.001]. However, there was no statistically significant difference in the probability of malignancy between the experimental group and the control group [MD=−0.01, 95%CI (−0.01, 0.00), P=0.09]. Conclusion TCM compound can significantly reduce the diameter of pulmonary nodules, decrease the number of nodules, alleviate clinical symptoms, and improve lung function, but future multicenter, large-sample, high-quality RCTs are still needed to further explore and verify this conclusion.

Objective:To construct a nursing quality evaluation indicator system for pulse indicator continuous cardiac output (PiCCO) monitoring and provide a basis for evaluating the nursing quality of PiCCO monitoring.Methods:Using Donabedian′s "structure-process-result" three-dimensional quality evaluation model as the theoretical framework, the nursing quality evaluation indicator system for PiCCO was established through literature search, Delphi expert correspondence, and hierarchical analysis during the period May to August 2023.Results:Of the 22 experts, 6 were male and 16 were female, aged (46.59 ± 4.34) years. The return rates of the questionnaires of the 2 rounds of expert correspondence were both 100%, the coefficients of expert authority were both 0.945, and the Kendall coordination coefficients were 0.045-0.186 ( χ2 values were 2.00-221.46, all P<0.05) and 0.045-0.132 ( χ2 values were 2.00-82.16, all P<0.05), respectively. The finalized nursing quality evaluation indicator system for PiCCO included 3 primary indicators, 7 secondary indicators, and 36 tertiary indicators. Conclusions:The nursing quality evaluation indicator system for PiCCO is practical and scientific, which can provide reference for PiCCO monitoring nursing quality evaluation.

Migration is one of the core biological characteristics of migratory birds. The nutrient, energy, and biological flows triggered during this process can facilitate the cross-regional spread of parasites and induce changes in their community structures. This article systematically reviews the interaction between migratory birds and parasites, including the prevalence characteristics of parasites in migratory birds, the vector role of migratory birds in parasite transmission, and the potential impact of parasites on hosts, ecosystems, and humans, in order to provide theoretical support for biodiversity conservation and prevention and control of zoonosis.

Migration is one of the core biological characteristics of migratory birds. The nutrient, energy, and biological flows triggered during this process can facilitate the cross-regional spread of parasites and induce changes in their community structures. This article systematically reviews the interaction between migratory birds and parasites, including the prevalence characteristics of parasites in migratory birds, the vector role of migratory birds in parasite transmission, and the potential impact of parasites on hosts, ecosystems, and humans, in order to provide theoretical support for biodiversity conservation and prevention and control of zoonosis.

The American Heart Association(AHA)/American Stroke Association(ASA)published the"2024 Guidelines for Primary Stroke Prevention"in the Stroke journal on October 21,2024.This document summarized the clinical research and epidemiological data since the publication of the previous version of the guidelines in 2014,providing strategies and recommendations for stroke prevention across the entire lifecycle.The guidelines emphasized the importance of pharmacological treatment,routine screenings,and lifestyle changes,with updated and refined recommendations.This article dissects the newly revised sections of the guidelines,with a special focus on the management of blood pressure,blood glucose,and blood lipids levels,as well as customized advice for particular populations and patient subgroups.Furthermore,it explores health behavior management strategies,including diet and exercise,by intergarting the knowledge from the previous version of the primary stroke prevention guidelines with pertinent domestic and international materials.The ultimate objective is to offer valuable insights and guidance to China in advancing primary stroke prevention efforts and formulating coherent guidelines and consensuses within this critical domain.

Objective:To develop an artificial intelligence (AI)-based platelet review strategy to identify abnormal platelet histograms with no significant difference between initial impedance platelet count (PLT-I) and PLT-F results.Methods:This study included 5 119 routine blood analysis in Nanfang Hospital of Southern Medical University and its Ganzhou branch from July 2023 and March 2024. Specimens exhibiting abnormal platelet histograms and an initial platelet count >40×10?/L underwent review using the fluorescent platelet count (PLT-F) channel. Consistency of the results was defined as a difference between impedance platelet count (PLT-I) and PLT-F less than ±20% of the PLT-F results. A deep learning model was developed using platelet and red blood cell histogram data from a training set of 3 807 specimens. The model′s diagnostic performance was evaluated on an independent external validation set ( n=805) using receiver operating characteristic (ROC) curve analysis. Changes in the number of reviewed samples and sample turnaround time were analyzed to assess its clinical utility. Results:The deep learning model based on platelet and red blood cell histograms achieved an area under the ROC curve (AUC) of 0.854 in the training set. At a cutoff value of 0.1, the sensitivity was 0.954 and specificity was 0.358. The model could reduce review by 16.80% (190/1 131). In the validation set, the AUC was 0.805, with a sensitivity of 0.955 and specificity of 0.307, corresponding to a reduction of 17.41% (47/270) in reviewed specimens.Conclusion:The platelet review prediction model developed based on deep learning technology can efficiently identify samples with consistent results before and after review, reducing unnecessary reviews and shortening specimen testing time, thereby improving the efficiency of platelet test.

Originating in Huangdi Neijing,this theory was pioneered by ZHANG Zhongjing,who established the principles of concurrent heart-lung treatment and integrated therapeutic approaches.It further developed during the Ming-Qing period and has been widely applied in modern clinical practice.This article systematically traces the developmental trajectory of the heart-lung correlation theory in traditional Chinese medicine and analyzes its clinical application in elucidating the pathogenesis and therapeutic strategies for lung cancer complicated by cardiovascular comorbidities.According to this theoretical framework,lung cancer accompanied by cardiovascular comorbidities exhibits a pathomechanism characterized by fundamental deficiency with symptomatic excess.The deficiency manifests as qi-blood depletion or impaired descent of gathering qi,while the excess is reflected in phlegm-stasis coagulation or heat-toxin accumulation.Key pathological features include progressive transformation,meridian disharmony,deteriorating vital substances,and disruption of inter-organ relationships.Treatment adheres to the principles of concurrent heart-lung intervention,integrated cardiopulmonary modulation,and reciprocal organ regulation.Core therapeutic strategies involve eliminating pathogenic factors,promoting circulation,tonifying deficiencies,and harmonizing functions with specific interventions determined through pattern differentiation.For the pattern of phlegm and blood stasis coagulation affecting both the heart and lung,treatment is guided by the principle of simultaneous treatment of phlegm and stasis,coordinated regulation of heart-lung function,and prioritization of qi circulation.Commonly used formulas include Gualou Xiebai Banxia Decoction and Xuefu Zhuyu Decoction.In cases of heat toxin accumulation in the heart and lungs,therapy follows the principle of clearing heart-lung fire and dredging collaterals,often using combinations of insect-derived medicines and vine-derived herbs,such as earthworm and Chinese star jasmine stem.In instances of heart-lung qi-blood deficiency,the therapeutic approach emphasizes simultaneous fortification and qi and blood circulation.Formulas such as modified Renshen Yangrong Decoction or Shengxian Decoction,combined with Taohong Siwu Decoction,are commonly used.These formulas strengthen qi without stagnating blood,promote blood circulation without harming healthy qi,and gradually eliminate pathogens.These three treatment approaches embody the characteristics of integrated heart-lung therapy,emphasizing dynamic regulation and holistic concepts.The focus remains on addressing both manifestation and root causes through flexible herb selection to achieve optimal therapeutic outcomes.

Objective To explore the symptom prevalence in the patients with pulmonary nodules in Lingnan area and to investigate the influencing factors,thus to provide data support for the construction of differentiation and treatment system of symptoms-syndrome elements-syndromes-constitutions for patients with pulmonary nodules,and to promote the establishment of secondary prevention system of lung cancer with the in-depth participation of traditional Chinese medicine(TCM).Methods A cross-sectional study was adopted to investigate patients with pulmonary nodules who admitted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from August 2023 to January 2024.Data collection covered the basic information,clinical characteristics and symptoms of the patients.Likert four-level scale was used for the grading of the severity of the symptoms,multivariate linear regression was adopted to construct three regression models,and then the factors influencing the severity of symptoms of patients with pulmonary nodules were explored.Results(1)A total of 274 patients were enrolled in the analysis,including 160 females and 114 males,with a mean age of(54.44±12.00)years old and the symptom scores averaging(3.97±3.80)point.The included patients with pulmonary nodules were characterized by females outnumbering males,a higher proportion of middle-aged and elderly people,multiple pulmonary nodules being more common.(2)The analysis of the symptoms of the 274 patients showed that symptoms with an incidence over 30%were fatigue(116 cases,42.34%),cough(105 cases,38.32%),expectoration of white sputum(89 cases,32.48%),and irritability and distress(87 cases,31.75%).(3)Multivariate linear regression analysis after variable adjustment suggested that the overall symptomatic severity in the male was milder than that in the female[β=-1.67,95%CI(-2.67,-0.68),P<0.001],and symptom score was positively correlated with age[β=0.07,95%CI(0.03,0.10),P<0.001],history of exposure to secondhand smoke[β=1.27,95%CI(0.26,2.27),P=0.015],history of exposure to other hazardous substances[β=1.96,95%CI(0.39,3.53),P=0.015],and history of allergy[β=2.38,95%CI(1.22,3.54),P<0.001]significantly.Conclusion The overall symptoms of patients with pulmonary nodules in Lingnan area are mild,and the high prevalence of symptoms are fatigue,cough,expectoration of white sputum,and irritability and distress.The symptom severity is correlated with gender,age,history of exposure to secondhand smoke,history of exposure to other hazardous substances,and history of allergy.