OBJECTIVE To analyze the influencing factors for achieving target plasma drug concentration （trough） （abbreviated as “PDC”） of vancomycin in patients from high-altitude regions and establish a predictive model for PDC using single- center data， providing references for rational clinical drug use. METHODS Inpatients with vancomycin （1 g， q12 h） administered intravenously in our hospital from January 2021 to June 2024 were retrospectively included. Demographic data， liver and kidney function and hematological indexes were collected. Spearman correlation analysis was used to evaluate the correlation between vancomycin PDC and each detection index. Univariate analysis was used to evaluate the differences of each index in patients with different PDC， and the effects of different gender， body mass index， age and underlying diseases （hypertension/diabetes） on vancomycin PDC. Based on the results of correlation analysis and univariate analysis， multiple linear stepwise regression analysis was used to obtain the independent predictors of vancomycin PDC and construct the prediction model. RESULTS A total of 141 patients were included， with an overall attainment rate of 46.81% for the target PDC of vancomycin. Correlation analysis showed that the vancomycin PDC was positively correlated with age， blood urea nitrogen， uric acid （UA）， serum creatinine （CRE） and β2- microglobulin （β2-MG）， and negatively correlated with height， weight， creatinine clearance rate （CCR）， glomerular filtration rate （GFR）， alanine transaminase （ALT）， hemoglobin （HGB）， white blood cell count and neutrophils （P＜0.05）. There were significant differences in age， CRE and other 14 indexes among different PDC groups （P＜0.05 or P＜0.01）. Age and underlying diseases had significant effects on vancomycin PDC （P＜0.05 or P＜0.01）. CCR， direct bilirubin （DBil）， β2-MG， UA， HGB and height （standardized coefficients were －0.371， 0.367， 0.169， 0.232， －0.140， －0.132； P＜0.05） were independent predictors of vancomycin PDC. The F value of the regression equation was 34.858 （P＜0.05）， the R2 was 0.610， and the adjusted R2 was 0.592. CONCLUSIONS The vancomycin PDC of patients in high-altitude regions is affected by multiple factors such as renal function， liver function and hematological indexes. CCR， HGB and height could be used to predict vancomycin PDC negatively， while DBil， β2-MG and UA could be used to predict vancomycin PDC positively. The variables of the established prediction model could explain 59.2% of the variation of vancomycin PDC.

OBJECTIVE Establish a quantitative analysis method for salidroside （Sal） in mouse serum， bronchoalveolar lavage fluid （BALF）， and lung tissue， and compare the distribution differences of Sal and its liposomes. METHODS Using high-performance liquid chromatography（HPLC）， Welch Xtimate C18 was used as the chromatographic column， with methanol-formic acid aqueous solution （formic acid volume fraction： 0.1% for serum and BALF detection， 0.2% for lung tissue detection） as the mobile phase， flow rate of 1.0 mL/min， detection wavelength of 275 nm， column temperature of 30 ℃， and injection volume of 10 μL. Serum， BALF， and lung tissue homogenate samples were precipitated with methanol for protein analysis. Twelve mice were randomly divided into Sal group and Sal liposome group， and the concentrations of Sal in serum， BALF， and lung tissue were detected after intragastric administration corresponding liquid medicine at a dose of 300 mg/kg （calculated as Sal） for 0.5 h. RESULTS The linear ranges of Sal in serum， BALF， and lung tissue were 1.56-200.00 μg/mL， 1.56-100.00 μg/mL， and 6.24-400.00 μg/g， respectively （all r＝0.999 9）， with intra-day RSD of 1.35%-3.87%， 1.10%-2.75%， and 1.90%-3.86%， respectively； the inter-day RSD of 3.38%-5.11%， 2.22%- 4.36%， and 2.41%-4.73%， respectively. The relative accuracies were 97.95%-101.61%， 98.29%-101.82%， and 97.41%- 106.94%， respectively. The stability RSDs were all less than 6%. Compared with the Sal group， the Sal liposome group significantly increased the concentration of Sal in BALF of mice （P＜0.05）， and significantly decreased the concentration of Sal in serum and lung tissue （P＜0.05）. CONCLUSIONS The HPLC method established in this study is suitable for quantitative analysis of Sal in mouse serum， BALF， and lung tissue. Sal liposomes have a tendency to distribute towards the alveolar cavity during early administration.

The prevention and treatment of chronic obstructive pulmonary disease （COPD） pose a major global challenge， with difficulties in effectively integrating holistic regulation and precise micro-intervention. The traditional Chinese medicine （TCM） theory of state-target pattern differentiation and treatment advocates the combination of state regulation and target intervention， offering a new paradigm for integrated TCM and Western medicine. This article systematically reviews the theoretical connotations of this theory and constructs a dynamic correspondence framework linking TCM pattern states， signaling pathways， and targeted interventions across different stages of COPD. At the acute exacerbation stage， the phlegm-heat obstructing the lung state is characterized by hyperactivation of the nuclear factor （NF）-κB/NOD-like receptor protein 3 （NLRP3） inflammation pathway， and formulas for clearing heat and resolving phlegm suppress the cytokine storm through multi-component synergy. At the stable stage， the lung-spleen Qi deficiency state is characterized by functional decompensation of the nuclear factor erythroid 2-related factor 2 （Nrf2）/Kelch-like ECH-associated protein 1 （Keap1） antioxidative stress pathway， and therapies for tonifying the lung and spleen repair the essence of Qi deficiency through antioxidative defense and energy metabolism. At the severe/very severe stable stage， the lung-kidney deficiency state is pathologically based on dysregulation of the transforming growth factor （TGF）-β/Wnt repair network and depletion of stem/progenitor cells， and therapies for tonifying the kidney and reinforcing Qi absorption achieve simultaneous regulation of deficiency and stasis by inhibiting aberrant fibrosis and guiding ordered regeneration. These three pathways are not isolated but exhibit dynamic shifts in dominance and cross-talk， constituting the molecular network basis of deficiency causing excess and intermingled deficiency and excess. Furthermore， this article points out the current shortcomings in quantitative evidence， objective syndrome standardization， and coverage of syndrome states， and proposes future directions including building multi-omics databases， conducting biomarker-stratified randomized controlled trials， and developing disease-pattern combined animal models， aiming to provide a theoretical perspective that integrates holism and micro-targeting for precision prevention and treatment of COPD.

The prevention and treatment of chronic obstructive pulmonary disease （COPD） pose a major global challenge， with difficulties in effectively integrating holistic regulation and precise micro-intervention. The traditional Chinese medicine （TCM） theory of state-target pattern differentiation and treatment advocates the combination of state regulation and target intervention， offering a new paradigm for integrated TCM and Western medicine. This article systematically reviews the theoretical connotations of this theory and constructs a dynamic correspondence framework linking TCM pattern states， signaling pathways， and targeted interventions across different stages of COPD. At the acute exacerbation stage， the phlegm-heat obstructing the lung state is characterized by hyperactivation of the nuclear factor （NF）-κB/NOD-like receptor protein 3 （NLRP3） inflammation pathway， and formulas for clearing heat and resolving phlegm suppress the cytokine storm through multi-component synergy. At the stable stage， the lung-spleen Qi deficiency state is characterized by functional decompensation of the nuclear factor erythroid 2-related factor 2 （Nrf2）/Kelch-like ECH-associated protein 1 （Keap1） antioxidative stress pathway， and therapies for tonifying the lung and spleen repair the essence of Qi deficiency through antioxidative defense and energy metabolism. At the severe/very severe stable stage， the lung-kidney deficiency state is pathologically based on dysregulation of the transforming growth factor （TGF）-β/Wnt repair network and depletion of stem/progenitor cells， and therapies for tonifying the kidney and reinforcing Qi absorption achieve simultaneous regulation of deficiency and stasis by inhibiting aberrant fibrosis and guiding ordered regeneration. These three pathways are not isolated but exhibit dynamic shifts in dominance and cross-talk， constituting the molecular network basis of deficiency causing excess and intermingled deficiency and excess. Furthermore， this article points out the current shortcomings in quantitative evidence， objective syndrome standardization， and coverage of syndrome states， and proposes future directions including building multi-omics databases， conducting biomarker-stratified randomized controlled trials， and developing disease-pattern combined animal models， aiming to provide a theoretical perspective that integrates holism and micro-targeting for precision prevention and treatment of COPD.

The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To investigate the efficacy of a predictive model for differentiating benign and malignant renal tumors based on CT radiomic features and clinical features.Methods:A retrospective study was conducted on 1 395 patients with renal tumors admitted to the First Affiliated Hospital of Zhengzhou University from December 2011 to December 2021, including 842 males and 553 females. The median age was 55 (44, 59) years, and the median tumor diameter was 3.6 (2.7, 4.6) cm. All patients underwent contrast-enhanced CT scaning before surgery, and radiomic features were extracted from non-contrast, arterial, and venous phase images. Prediction models for distinguishing benign and malignant renal tumors were constructed using five machine learning algorithms (logistic regression, support vector machine, neural network, random forest, and extreme gradient boosting), and these models were then ensembled to construct a stacking classifier. All patients underwent partial nephrectomy, and they were divided into a training group (941 cases, December 2011 to June 2020) and a validation group (454 cases, July 2020 to December 2021) based on the date of surgery. A clinical-radiomic model was developed by combining the result of stacking classifier, clinical features and CT report results, and its predictive performance was evaluated in the validation group.Results:The radiomic signature based on the combined features and five machine learning algorithms(AUC 0.835-0.844) showed higher accuracy in predicting benign and malignant renal tumors compared to single phases (AUC 0.744-0.831). After integrating the five machine learning algorithms, the AUC of the three-phase combined radiomic model in the validation group improved to 0.847(95% CI 0.802-0.892). The clinical-radiomic model, incorporating radiomic features, clinical features, and CT report results, achieved a significantly higher AUC in the validation group compared to radiologists [0.919(95% CI 0.889-0.950)vs. 0.835(95% CI 0.786-0.883), P<0.01]. Conclusions:The predictive model integrating CT radiomics features, clinical characteristics, and CT report results demonstrates excellent discriminative ability in distinguishing benign and malignant renal tumors.

Objective To discuss the causes of abnormal arterial pressure waveforms occurring during coronary angiography(CAG)and percutaneous coronary intervention(PCI).Methods A total of 760 patients,who received CAG and PCI at Nanjing Municipal First Hospital of China from September 2023 to March 2024,were enrolled in this study.The abnormal arterial pressure waveforms were collected,and their morphological features and causes were analyzed.Results A total of 848 abnormal waveforms were recorded,and based on the morphology these abnormal waveforms were classified into 8 types.Three most commonly-seen abnormal waveforms were nested waveform(22.76％,n=193),atypical waveform(21.11％,n=179)and attenuated waveform(15.57％,n=132).The causes of the abnormal waveforms could be classified into 5 categories.The top three reasons were technical operation factors(n=445,52.49％),vascular factors(n=214,25.23％),and individual factors of the patient(n=101,11.91％).In the specific abnormal reasons,the ostial lesions and spasm of the coronary arteries accounted for the largest proportion(n=183,21.57％).Conclusion Accurate identification of abnormal waveforms is essential for the prevention of complications in performing CAG and PCI procedure.The technical operation factors are the main causes for the occurrence of abnormal waveform.

Objective: To explore the safety and feasibility of the disconnection of the left renal artery preferentially during robot-assisted inferior vena cava (IVC) thrombectomy for patients with left renal cell carcinoma and tumor emboli. Methods: Clinical data of 7 patients who underwent robot-assisted IVC thrombectomy and radical nephrectomy in the First Affiliated Hospital of Zhengzhou University during Dec.2021 and Oct.2024 were retrospectively analyzed.Thrombectomy was performed first，followed by nephrectomy. The “IVC-first, kidney-last”robotic technique was developed to minimize chances of IVC thrombus. When patients in left lateral decubitus position, the left renal artery was severed from the right side through the inferior vena cava and abdominal aorta. After removal of thrombus from IVC was completed, patients changed to the right lateral position to complete radical left nephrectomy. Results: Imaging examinations revealed that the median diameter of the renal cell carcinomas was 83(46-99) mm; the median length of the inferior vena cava cancerous emboli was 49(2-91) mm.According to the Mayo classification，the cancerous emboli were gradeⅠ in 2 cases，gradeⅡ in 4 cases，and grade Ⅲ in 1 case.All surgeries were successful.The median operation time was 248(201-331) minutes，blood loss 500(200-1000) mL，and 6 cases required intraoperative blood transfusion.The median time for transition into the intensive care unit was 1(1-4) days，and drainage tube removal 6(5-12) days.Serum creatinine increased significantly in 5 cases，4 of which returned to normal after 1 week，but 1 had renal insufficiency (creatinine 166 μmol/L).Chylous fistula occurred in 1 patient，and lower extremity venous thrombosis developed in 3 patients.Pathological examinations indicated 6 cases of renal cell carcinoma and 1 case of MiT family translocation renal cell carcinoma.During the median follow-up of 17(1-35) months，5 cases were tumor-free，while 2 had lung and retroperitoneal metastases.They received targeted therapy of axitinib combined immunotheraphy and lived with tumors. Conclusion: In the left lateral position for left renal cell carcinoma with cancerous emboli，robot-assisted laparoscopic thrombectomy by crossing the inferior vena cava and abdominal aorta and disconnecting the left renal artery first is safe and feasible.

OBJECTIVE To investigate the current status of self-medication behaviors and the demand preferences for pharmaceutical services among residents in Xining， providing a basis for developing pharmaceutical service intervention strategies tailored to regional characteristics. METHODS A self-designed questionnaire， developed based on literature review and revised after expert panel discussion and a pre-survey， was used to conduct anonymous surveys among residents purchasing medicines at 12 retail pharmacies in Xining area from April 2023 to April 2024. Descriptive analysis， Chi-square test， and Spearman correlation analysis were employed to analyze the characteristics and influencing factors of residents’ self-medication behaviors， and pharmaceutical service needs. RESULTS A total of 859 valid questionnaires were collected， with 605 respondents （70.43%） reporting self-medication behaviors. The primary reason for self-medication was mild symptoms （46.94%）. The main conditions treated were gastrointestinal discomfort （38.51%） and cold， fever， headache （35.37%）. Chinese patent medicines were the most commonly used （58.68%）. Drug selection relied mainly on recommendations by pharmacy staff （52.07%）， and retail pharmacies were the primary source of medicines （65.95%）. Dosage and administration were determined primarily by referring to the drug package insert （67.27%）， while a minority relied on personal experience （9.92%）. Notably， 20.33% of respondents never read the package insert before medication， with a higher tendency observed among ethnic minorities， farmers， and individuals with chronic diseases （P＜0.05）. While 65.29% of respondents reported partially understanding the insert content， those aged ≥60 years， ethnic minorities， and individuals with chronic diseases qhsrmyy-28） were more likely to report being completely unable to understand it （P＜0.05）. Self-medication was “often effective” for 52.73% of respondents， whereas 7.77%“ often experienced adverse drug reactions”； farmers were more prone to poor efficacy or adverse reactions （P＜0.05）. A majority （72.89%） of respondents residents believed it necessary to learn about self- medication knowledge， and 47.11% preferred to obtain pharmaceutical services through WeChat public accounts or mobile applications （APP）. CONCLUSIONS Self-medication is common among residents in Xining area. Issues such as neglecting to read package inserts and relying on personal experience are evident. It is essential to develop science popularization programs suitable for the characteristics of the local population and utilize digital platforms like WeChat public accounts and APP to disseminate self- medication knowledge， thereby enhancing residents’ awareness and capacity for rational medication use.