The ethnic medicine for external use is an important dosage form in the external treatment methods of ethnic medicine.China has made significant progress in related research and applications.However,the regulations and guidelines for clinical research on external medicine are limited,and the related technologies and quality standards are not yet well-established in China.This article summarized the specific issues during the implementation of clinical research on ethnic medicine of external use:the research design failing to reflect the value and unique characteristics of these medicine;the big difficulty in the recruitment of participants,leading to delays in progress;inconsistent implementation of interventions;and the quality of research data needing to be improved,etc.Combining the authors'experience in project implementation management,this article proposed solutions to improve research quality and progress,including incorporating experts from various fields including ethnic medicine and research centers;refining participant recruitment strategies;analyzing factors affecting progress and optimizing the implementation process;and strengthening overall management and establishing a competitive enrollment mechanism.The article also shared a case study of the Tibetan medicine Qingpeng Ointment for the treatment of acute gouty arthritis,aiming to provide a reference for the clinical research on ethnic medicine of external use.

Objective:To investigate the effect of mild moxibustion on transient receptor potential vanilloid type 1(TRPV1)channel expression in primary dysmenorrhea(PD)rats and explore its mechanism in alleviating central pain sensitization.Methods:Thirty-two female non-pregnant Wistar rats were randomized into a blank group,a model group,a mild moxibustion group,and a capsazepine group,with 8 rats in each group.Except for the blank group,the other three groups used estradiol benzoate,ice-water bath,and oxytocin to establish the rat PD model of cold-dampness stagnation pattern.The interventions began on day 1 of modeling,once a day,and lasted 10 d.The mild moxibustion group received mild moxibustion at Shenque(CV8)and Guanyuan(CV4),20 min/time;in the capsazepine group,capsazepine was injected at a dose of 2 mg/(kg·bw).The abdominal pain threshold was measured 10-30 min after oxytocin injection on day 11;enzyme-linked immunosorbent assay was used to detect serum prostaglandin F2α(PGF2α)level;the expression of TRPV1,cluster of differentiation 11B(CD11B),and proto-oncogene c-Fos in the spinal dorsal horn and hypothalamus was detected by immunofluorescence and Western blotting.Results:Compared to the blank group,the model group showed a decreased pain threshold(P<0.05)and an increased serum PGF2α level with elevated TRPV1,CD11B,and c-Fos protein expression in the spinal dorsal horn and hypothalamus(P<0.05).Compared to the model group,both the mild moxibustion group and capsazepine group showed significantly increased pain thresholds(P<0.05),along with decreased serum PGF2α levels and reduced protein expression levels of TRPV1,CD11B,and c-Fos in the spinal dorsal horn and hypothalamus(P<0.05).Rat pain threshold in the capsazepine group was higher than that in the mild moxibustion group(P<0.05).Serum PGF2α level,the expression levels of CD11B and c-Fos proteins in the spinal dorsal horn,as well as TRPV1,CD11B,and c-Fos proteins in the hypothalamus of the capsazepine group were lower than those in the mild moxibustion group(P<0.05).Conclusion:Mild moxibustion at Shenque(CV8)and Guanyuan(CV4)may alleviate the central pain sensitization in PD rats by down-regulating TRPV1 channel expression in the spinal dorsal horn and hypothalamus,thus playing an analgesic effect.

Objective To investigate the effects of indirect moxibustion on the expressions of DNA methyltransferases(DNMT)and methylation of the brain-derived neurotrophic factor(BDNF)promoter region in uterine tissues of rats with primary dysmenorrhea(PD);To explore the mechanism of epigenetic regulation of indirect moxibustion on PD model rats.Methods A total of 32 female SD rats were randomly divided into blank group,model group,indirect moxibustion group and Western medicine group,with 8 rats in each group.The PD model with cold dampness stagnation syndrome was established using ice-water baths combined with estradiol benzoate and oxytocin.Starting from the first day of modeling,the indirect moxibustion group received salt-partitioned moxibustion at"Shenque"and ginger-partitioned moxibustion at"Guanyuan"for 20 min,while the Western medicine group was gavaged ibuprofen solution.Both interventions were given once a day for 10 days.On day 11,writhing responses were observed and scored after oxytocin injection,Western blot and RT-qPCR were used to detect protein and mRNA expression of BDNF,DNMT3A and DNMT3B in uterine tissue,immunohistochemical staining was used to detect the positive expressions of DNMT3A and DNMT3B in uterine tissue.The DNA methylation of BDNF promoter region in uterine tissue was detected by sulfite sequencing.Results Compared with the blank group,the writhing latency was shortened and the writhing score increased in the model group(P<0.01);the protein and mRNA expressions of BDNF,DNMT3A and DNMT3B in uterine tissue increased(P<0.01),the positive expressions of DNMT3A and DNMT3B increased(P<0.01),and the DNA methylation rate in BDNF promoter region decreased(P<0.01).Compared with the model group,the writhing latency was lengthened and the writhing score decreased in the indirect moxibustion group and Western medicine group(P<0.05,P<0.01);the protein and mRNA expressions of BDNF,DNMT3A and DNMT3B in uterine tissue decreased(P<0.05,P<0.01),the positive expressions of DNMT3A and DNMT3B decreased(P<0.01),and the DNA methylation rate in BDNF promoter region increased(P<0.01).Conclusion Indirect moxibustion at"Shenque"and"Guanyuan"may inhibit the transcription of BDNF by increasing the DNA methylation level of BDNF promoter region,and reduce the expression of BDNF,so as to relieve the pain of PD rats.

Chinese patent medicines for external use represent a distinct category of clinical drugs with unique therapeutic characteristics.At present,the research foundation of some topical Chinese patent medicines for external use is weak,and the accuracy and standardization of clinical application need to be improved.The research on clinical positioning of Chinese patent medicines for external use is of great significance for standardizing clinical medication,exploring the differentiated value of drugs and similar products,enhancing the safety of drug use,improving the efficiency of medical resource use,and promoting the secondary development and cultivation of drugs after listing.On the basis of summarizing the research status of clinical positioning of Chinese patent medicines for external use,this article put forward the significance,necessity and challenges of carrying out this research.Combined with the authors'practical experience,the authors put forward five experiences to carry out the post marketing clinical positioning research of Chinese patent medicines for external use,including distinguishing the theory of external treatment of Chinese materia medica,paying attention to the unmet needs in the modern medical system,not separating from the actual efficacy and dosage form characteristics of Chinese patent medicines for external use,clarifying the mechanism of"same treatment for different diseases",and verifying the clinical positioning hypothesis,which can provide references for relevant research.

OBJECTIVE To systematically evaluate the efficacy and safety of tislelizumab in the treatment of advanced non- small cell lung cancer （NSCLC）. METHODS Computerized searches were conducted in PubMed， Embase， the Cochrane Library， CNKI， Wanfang and other Chinese and English databases to collect randomized controlled trials （RCTs） on tislelizumab for advanced NSCLC. The search period was from the establishment of the databases to December 2024. After strictly screening the literature， extracting data and conducting quality evaluations in accordance with the inclusion and exclusion criteria， a meta-analysis was performed using RevMan 5.3 and Stata 16.0 software. RESULTS A total of 18 RCTs involving 2 337 patients were included， with 1 283 in the experimental group and 1 054 in the control group. The meta-analysis results showed that the objective response rate [RR＝1.61， 95%CI （1.48， 1.75）， P＜0.000 01]， disease control rate [RR＝1.21， 95%CI （1.13， 1.29）， P＜0.000 01]， progression free survival [HR＝0.55， 95%CI （0.45， 0.66）， P＜0.000 01]， and overall survival [HR＝0.78， 95%CI（0.62， 0.97）， P＝0.03] were significantly better in the experimental group than in the control group. There was no statistically significant difference in the incidence of adverse reactions between the two groups [RR＝1.00， 95%CI （0.73， 1.37）， P＝1.00]； among the common adverse reactions， only the incidence of liver function impairment was significantly higher in the experimental group than in the control group [RR＝1.30， 95%CI （1.10， 1.54）， P＜0.01]. CONCLUSIONS Tislelizumab in combination with chemotherapy or targeted drugs significantly improves the efficacy in patients with advanced NSCLC without increasing the risk of adverse reactions overall. However， liver function should be closely monitored during treatment.

To review the clinical characteristics, short-term outcomes, and risk factors of patients with infective endocarditis(IE) who underwent surgical treatment at a single center, and to summarize treatment experience.

Objective:To analyze the factors associated with the occurrence of peritoneal dialysis-associated peritonitis (PDAP) in patients with diabetic nephropathy and to establish a risk model.Methods:The clinical data of 90 patients with diabetic nephropathy who underwent peritoneal dialysis using Einkorn dextrin dialysate at Yiwu Central Hospital from January 2021 to December 2023 were analyzed retrospectively. Patients were classified into the PDAP group and the non-PDAP group based on the occurrence of PDAP as recorded in the medical records system. The clinical data and laboratory indicators of the two patient groups were collected and compared. Collinearity analysis was performed on the significantly different variables, and those without collinearity issues were included in a logistic regression model to identify factors associated with infection. The statistically significant variables from the regression analysis were used as predictors to construct a nomogram risk prediction model for the occurrence of infections in patients, and the model was subsequently validated.Results:Among the 90 patients, 21 (23.33%) developed PDAP and were included in the PDAP group, while the remaining 69 patients (76.67%) did not develop PDAP and were included in the non-PDAP group. The differences in baseline systemic inflammatory response index (SIRI), serum albumin (ALB), blood potassium levels, hemoglobin (Hb) levels, and dialysis duration between the two groups were statistically significant [(1.53 ± 0.45) vs. (1.31 ± 0.32), (28.67 ± 3.64) g/L vs. (34.61 ± 4.13) g/L, (3.13 ± 0.47) mmol/L vs. (3.97 ± 0.51) mmol/L, (90.83 ± 10.15) g/L vs. (107.27 ± 10.66) g/L, 43.00 (38.50, 48.00) months vs. 34.00 (32.00, 38.00) months, t/ Z = 3.17, 5.92, 6.72, 6.25, 7.03, all P < 0.05]. None of the indicators exhibited collinearity issues (variance inflation factor ≤ 10, tolerance ≥ 0.1), allowing for their inclusion in the logistic regression model. According to the logistic regression analysis, baseline SIRI ( OR = 5.816, 95% CI: 1.404-24.097) and dialysis duration ( OR = 1.412, 95% CI: 1.214-1.643) were identified as independent risk factors for the occurrence of PDAP in patients with diabetic nephropathy. In contrast, ALB ( OR = 0.653, 95% CI: 0.533-0.801), blood potassium levels ( OR = 0.025, 95% CI: 0.005-0.132), and Hb levels ( OR = 0.867, 95% CI: 0.811-0.926) were protective factors against the occurrence of PDAP. A prediction model incorporating these five predictors was established using logistic regression, and corresponding nomograms were plotted along with a decision curve and calibration curve. The net benefit rate of the prediction model within the threshold range was high, indicating that the accuracy of the model was good. Conclusions:Baseline SIRI, ALB, blood potassium levels, Hb levels, and dialysis duration in patients with diabetic nephropathy are all related risk factors for the occurrence of PDAP after peritoneal dialysis treatment. The nomogram model constructed based on these indicators can aid in the clinical screening of high-risk populations and provide a theoretical basis for the implementation of preventive and therapeutic measures.

Objective:To analyze the factors associated with the occurrence of peritoneal dialysis-associated peritonitis (PDAP) in patients with diabetic nephropathy and to establish a risk model.Methods:The clinical data of 90 patients with diabetic nephropathy who underwent peritoneal dialysis using Einkorn dextrin dialysate at Yiwu Central Hospital from January 2021 to December 2023 were analyzed retrospectively. Patients were classified into the PDAP group and the non-PDAP group based on the occurrence of PDAP as recorded in the medical records system. The clinical data and laboratory indicators of the two patient groups were collected and compared. Collinearity analysis was performed on the significantly different variables, and those without collinearity issues were included in a logistic regression model to identify factors associated with infection. The statistically significant variables from the regression analysis were used as predictors to construct a nomogram risk prediction model for the occurrence of infections in patients, and the model was subsequently validated.Results:Among the 90 patients, 21 (23.33%) developed PDAP and were included in the PDAP group, while the remaining 69 patients (76.67%) did not develop PDAP and were included in the non-PDAP group. The differences in baseline systemic inflammatory response index (SIRI), serum albumin (ALB), blood potassium levels, hemoglobin (Hb) levels, and dialysis duration between the two groups were statistically significant [(1.53 ± 0.45) vs. (1.31 ± 0.32), (28.67 ± 3.64) g/L vs. (34.61 ± 4.13) g/L, (3.13 ± 0.47) mmol/L vs. (3.97 ± 0.51) mmol/L, (90.83 ± 10.15) g/L vs. (107.27 ± 10.66) g/L, 43.00 (38.50, 48.00) months vs. 34.00 (32.00, 38.00) months, t/ Z = 3.17, 5.92, 6.72, 6.25, 7.03, all P < 0.05]. None of the indicators exhibited collinearity issues (variance inflation factor ≤ 10, tolerance ≥ 0.1), allowing for their inclusion in the logistic regression model. According to the logistic regression analysis, baseline SIRI ( OR = 5.816, 95% CI: 1.404-24.097) and dialysis duration ( OR = 1.412, 95% CI: 1.214-1.643) were identified as independent risk factors for the occurrence of PDAP in patients with diabetic nephropathy. In contrast, ALB ( OR = 0.653, 95% CI: 0.533-0.801), blood potassium levels ( OR = 0.025, 95% CI: 0.005-0.132), and Hb levels ( OR = 0.867, 95% CI: 0.811-0.926) were protective factors against the occurrence of PDAP. A prediction model incorporating these five predictors was established using logistic regression, and corresponding nomograms were plotted along with a decision curve and calibration curve. The net benefit rate of the prediction model within the threshold range was high, indicating that the accuracy of the model was good. Conclusions:Baseline SIRI, ALB, blood potassium levels, Hb levels, and dialysis duration in patients with diabetic nephropathy are all related risk factors for the occurrence of PDAP after peritoneal dialysis treatment. The nomogram model constructed based on these indicators can aid in the clinical screening of high-risk populations and provide a theoretical basis for the implementation of preventive and therapeutic measures.

The ethnic medicine for external use is an important dosage form in the external treatment methods of ethnic medicine.China has made significant progress in related research and applications.However,the regulations and guidelines for clinical research on external medicine are limited,and the related technologies and quality standards are not yet well-established in China.This article summarized the specific issues during the implementation of clinical research on ethnic medicine of external use:the research design failing to reflect the value and unique characteristics of these medicine;the big difficulty in the recruitment of participants,leading to delays in progress;inconsistent implementation of interventions;and the quality of research data needing to be improved,etc.Combining the authors'experience in project implementation management,this article proposed solutions to improve research quality and progress,including incorporating experts from various fields including ethnic medicine and research centers;refining participant recruitment strategies;analyzing factors affecting progress and optimizing the implementation process;and strengthening overall management and establishing a competitive enrollment mechanism.The article also shared a case study of the Tibetan medicine Qingpeng Ointment for the treatment of acute gouty arthritis,aiming to provide a reference for the clinical research on ethnic medicine of external use.

Objective:To investigate the effect of mild moxibustion on transient receptor potential vanilloid type 1(TRPV1)channel expression in primary dysmenorrhea(PD)rats and explore its mechanism in alleviating central pain sensitization.Methods:Thirty-two female non-pregnant Wistar rats were randomized into a blank group,a model group,a mild moxibustion group,and a capsazepine group,with 8 rats in each group.Except for the blank group,the other three groups used estradiol benzoate,ice-water bath,and oxytocin to establish the rat PD model of cold-dampness stagnation pattern.The interventions began on day 1 of modeling,once a day,and lasted 10 d.The mild moxibustion group received mild moxibustion at Shenque(CV8)and Guanyuan(CV4),20 min/time;in the capsazepine group,capsazepine was injected at a dose of 2 mg/(kg·bw).The abdominal pain threshold was measured 10-30 min after oxytocin injection on day 11;enzyme-linked immunosorbent assay was used to detect serum prostaglandin F2α(PGF2α)level;the expression of TRPV1,cluster of differentiation 11B(CD11B),and proto-oncogene c-Fos in the spinal dorsal horn and hypothalamus was detected by immunofluorescence and Western blotting.Results:Compared to the blank group,the model group showed a decreased pain threshold(P<0.05)and an increased serum PGF2α level with elevated TRPV1,CD11B,and c-Fos protein expression in the spinal dorsal horn and hypothalamus(P<0.05).Compared to the model group,both the mild moxibustion group and capsazepine group showed significantly increased pain thresholds(P<0.05),along with decreased serum PGF2α levels and reduced protein expression levels of TRPV1,CD11B,and c-Fos in the spinal dorsal horn and hypothalamus(P<0.05).Rat pain threshold in the capsazepine group was higher than that in the mild moxibustion group(P<0.05).Serum PGF2α level,the expression levels of CD11B and c-Fos proteins in the spinal dorsal horn,as well as TRPV1,CD11B,and c-Fos proteins in the hypothalamus of the capsazepine group were lower than those in the mild moxibustion group(P<0.05).Conclusion:Mild moxibustion at Shenque(CV8)and Guanyuan(CV4)may alleviate the central pain sensitization in PD rats by down-regulating TRPV1 channel expression in the spinal dorsal horn and hypothalamus,thus playing an analgesic effect.