Driven by the growing practical need to accelerate drug development and the continuous innovation of trial design in recent years， the number of protocol amendments during clinical trials have gradually increased， and the changed contents have become more flexible and complex， which significantly heightens the difficulty of ethical review on amendments. Against this backdrop， it is of great importance to fully leverage the role and responsibilities of ethics committees， effectively control clinical trial risks， and ensure subject safety. This paper analyzed development trends of protocol amendments in recent years， sorted out requirements for protocol amendments in Chinese regulations and guiding principles， and examined difficulties of amendment ethical review in practical work. Based on these， targeted strategies and recommendations were proposed， namely， strengthening the integration with scientific review， enhancing the formal review， adjusting the scope of review according to approval notifications， and adopting appropriate review methods， with a view to providing insights and references for the management of the amendment ethical review in drug clinical trials.

The relevant laws and regulations regarding the utilization of the deceased as medical research subjects are not yet fully developed in China nowadays. Taking the deceased as research subjects as a starting point， this paper discussed the definition of the deceased and the scope of their interest protection from multiple perspectives. It posited that the scope of interest protection for the deceased encompassed two components： spiritual personality interests and material personality interests represented by the remains. The spiritual personality interests of the deceased included identification information such as name， portrait， reputation， honor， privacy， and personal information， as well as medical and health information. The personal information of the deceased was not directly affected by the individual’s life and death status and remained relatively independent. In terms of ethical review， the research team approached from two perspectives： the remains and the personal information of the deceased. Based on the standard of whether the research subjects involve a human body， research with the remains of the deceased as the medical research subjects was classified as non-clinical research. According to the standard of whether a human body is clinically operated， research with the personal information of the deceased （including medical and health information） as the medical research subjects was recognized as clinical research without human research operation. This approach provided evidence for the application of existing laws and regulations in ethical review and record management. The ethical review of investigator-initiated clinical research conducted in medical and health institutions， as well as the regulatory conditions for exemption from ethical review， were examined. The forms， content， and acquisition of informed consent were summarized， and the risk-benefit characteristics of the research activity were evaluated， with a view to providing a basis for the smooth and compliant implementation of research activities involving the deceased as medical research subjects.

OBJECTIVES: To explore the value of serum cystatin C (CysC) levels in evaluating renal prognosis in IgA nephropathy (IgAN) patients. METHODS: We retrospectively collected the clinical data of IgAN patients diagnosed by renal biopsy at Guangdong Provincial People's Hospital from January, 2014 to December, 2018. Based on baseline serum CysC levels, the patients were divided into high serum CysC (>1.03 mg/L) group and normal serum CysC (≤1.03 mg/L) group. The composite endpoint for poor renal prognosis was defined as ≥50% decline in estimated glomerular filtration rate (eGFR) and/or progression to end-stage renal disease (ESRD). Lasso regression, multivariate Cox regression and Kaplan-Meier survival analysis were used to identify the risk factors and compare renal survival rates between the two groups. Smooth curves fitting and threshold effect analysis were used to explore the relationship between serum CysC levels and the outcomes. A nomogram model was constructed and its predictive performance was evaluated using concordance index, calibration curve, receiver operating characteristic (ROC) curve and the area under curve (AUC). RESULTS: A total of 356 IgAN patients were enrolled, who were followed up for 4.65±0.93 years. The composite endpoint occurred in 74 patients. High serum CysC was identified as an independent risk factor for poor renal prognosis in IgAN (HR=2.142, 95% CI 1.222 to 3.755), and the patients with high serum CysC levels had a lower renal survival rate (Log-rank χ²=47.970, P<0.001). In patients with serum CysC below 2.12 mg/L, a higher CysC level was associated with an increased risk of poor renal prognosis (β=3.487, 95% CI: 2.561-4.413, P<0.001), while above this level, the increase of the risk was not significant (β=0.676, 95% CI: -0.642-1.995, P=0.315). The nomogram model based on serum CysC and 3 other independent risk factors demonstrated good internal validity with a concordance index of 0.873 (95% CI: 0.839-0.907) and an AUC of 0.909 (95% CI: 0.873-0.945). CONCLUSIONS Serum CysC levels are associated with renal prognosis in IgAN patients, and high serum CysC an independent risk factor for poor renal prognosis.
Humans ; Glomerulonephritis, IGA/diagnosis* ; Cystatin C/blood* ; Prognosis ; Risk Factors ; Retrospective Studies ; Glomerular Filtration Rate ; Kidney Failure, Chronic ; Male ; Female ; Adult ; Nomograms ; Middle Aged

[Objective] To compare the clinical efficacy of super pulse thulium laser enucleation of the prostate (SPThuLEP) with "open tunnel" and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH), in order to provide reference for the treatment options of BPH. [Methods] The clinical data of 112 BPH patients treated in our hospital during Jan.2023 and Jul.2023 were retrospectively analyzed, including 65 treated with SPThuLEP with "open tunnel" and 57 with HoLEP.The operation time, postoperative hemoglobin decrease, postoperative bladder irrigation, catheter indwelling time, hospitalization time and complications were compared between the two groups.The changes of maximum urine flow rate (Qmax), international prostate symptom score (IPSS), quality of life score (QoL), postvoid residual (PVR) and prostate-specific antigen (PSA) were compared between the two groups before operation and one month after operation. [Results] All operations were successful without conversion to open or transurethral plasmakinetic resection.The postoperative decrease of hemoglobin in SPThuLEP group was lower than that in HoLEP group [(13.12±6.72) g/L vs. (21.02±6.51) g/L], with statistical difference (P<0.05). There were no significant differences in the operation time [(63.35±15.73) min vs.(61.02±17.55) min], postoperative bladder irrigation time [(1.07±0.45) d vs. (1.06±0.36) d], catheter indwelling time [(2.98±0.56) d vs. (3.01±0.63) d] and hospitalization time [(3.63±0.61) d vs.(3.79±0.76) d] between the two groups (P>0.05). No blood transfusion, secondary bleeding or unplanned hospitalization occurred, and there were no serious complications such as transurethral electroresection syndrome (TURS), urethral stricture and urinary incontinence.One month after operation, the Qmax, IPSS, QoL, PVR and PSA of the two groups were significantly improved compared with those before operation (P<0.05), but with no statistical difference between the two groups (P>0.05). [Conclusion] SPThuLEP with "open tunnel" has comparable efficacy as HoLEP in the treatment of BPH.With advantages of small amount of bleeding and high safety, this minimally invasive technique can be widely popularized in clinical practice.

Objective To establish a gas chromatography-mass spectrometry (GC-MS) method for the simultaneous determination of four carbonate compounds (CCs), including ethyl methyl carbonate (EMC), diethyl carbonate (DEC), vinylene carbonate (VC), and ethylene carbonate (EC) in workplace air. Methods Vapor-phase EMC, DEC, VC, and EC in workplace air were collected using activated carbon tubes. After desorption with dichloromethane, the samples were analyzed by GC-MS. Qualitative identification was performed based on retention times and characteristic ions, while quantitative analysis was conducted using peak areas of selected characteristic ions. Results The quantitative determination ranges for the four CCs were from 0.57×10⁻³ to 200.00 mg/L, with correlation coefficients ≥0.999 45. The detection limit ranged from 0.17 to 1.60 μg/L, and the lower limit of quantification ranged from 0.57 to 5.33 μg/L. The minimum detection concentration and minimum quantitation concentration were 0.11-1.07 and 0.38-3.55 μg/m³, respectively. Mean spiked recoveries ranged from 85.70% to 111.65%. The intra- and inter-batch relative standard deviations were 0.11%-2.04% and 1.27%-5.18%, respectively. Mean desorption efficiencies of the method ranged from 74.70% to 118.20%. EMC, DEC, and EC samples were stable for up to five days at 4 °C, while VC samples were stable for up to three days at 4 °C. Conclusion The GC-MS method is suitable for the simultaneous determination of the four CCs including EMC, DEC, VC, and EC in workplace air.

Objective:To explore the correlation between clinical and CT imaging features and epidermal growth factor receptor (EGFR) gene mutation in patients with non-small cell lung cancer (NSCLC) and screening of mutation prediction indicators.Methods:A retrospective case-control study was conducted. The clinical data of 178 NSCLC patients who were confirmed by pathology and underwent pre-treatment chest-enhanced CT scan and EGFR gene mutation testing in General Hospital of Ningxia Medical University from January 2015 to December 2019 were retrospectively analyzed. Patients were classified into EGFR mutation-positive and mutation-negative groups based on genetic testing results, and the clinical and CT imaging features were compared between the two groups; the multivariate logistic regression model was used to identify the independent influencing factors for EGFR gene mutation in NSCLC patients.Results:Among 178 NSCLC patients, 115 cases (64.6%) were EGFR gene mutation-positive and 63 cases (35.4%) were mutation-negative. Among the 115 EGFR gene mutation-positive patients, there were 61 cases (53.0%) of exon 19 deletion (19del) mutation, 45 cases (39.1%) of exon 21 L858R mutation, 8 cases (7.0%) of exon 20 mutation, and 1 case (0.9%) of exon 18 mutation. The proportions of female patients [60.0% (69/115) vs. 30.2% (19/63)] and patients with out smoking history [74.8% (86/115) vs. 36.5% (23/63)] in EGFR gene mutation-positive group were higher than those in the mutation-negative group, and the differences were statistically significant (both P < 0.001), while the proportions of patients with different pathological types and clinical stages in the two groups showed no statistically significant differences (both P > 0.05). The median maximum diameter of tumor [ M ( Q1, Q3)] detected by CT in the EGFR gene mutation-positive group was 3.70 (2.90, 4.70) cm, while in the mutation-negative group it was 5.30 (3.40, 6.80) cm, and the difference was statistically significant ( Z = -3.66, P < 0.001). The proportions of patients with air bronchogram [27.8% (32/115) vs. 7.9% (5/63)] and without emphysema [83.5% (96/115) vs. 55.6% (35/63)] in the EGFR gene mutation-positive group were higher than those in the mutation-negative group, and the differences were statistically significant (both P < 0.01). The results of multivariate logistic regression analysis showed that no smoking history (yes vs. no, OR = 0.218, 95% CI: 0.073-0.647), short maximum diameter of tumor detected by CT ( OR = 0.814, 95% CI: 0.676-0.981), air bronchogram (yes vs. no, OR = 5.354, 95% CI: 1.782-16.090), and no emphysema (yes vs. no, OR = 0.289, 95% CI: 0.128-0.653) were independent risk factors for EGFR gene mutation in NSCLC patients (all P < 0.05). Conclusions:Clinical and CT imaging features may relate to EGFR gene mutation status in NSCLC patients, and no smoking history, short maximum diameter of tumor detected by CT, air bronchogram and no emphysema may predict EGFR gene mutation.

Objective:To investigate the clinical characteristics, prevalent serum groups, and drug sensitivity test results of epidemic cerebrospinal meningitis in children in Shanghai area.Methods:The study was a retrospective case-control study. The children hospitalized for epidemic cerebrospinal meningitis in Children′s Hospital of Fudan University from January 2003 to December 2023 were enrolled. Clinical data were collected, including demographic characteristics, clinical manifestations, pathogen detection results, strain typing, and drug sensitivity test results.Results:A total of 77 children with confirmed epidemic cerebrospinal meningitis were hospitalized, including 50 males (64.94%) and 27 females (35.06%). The age was 24(8, 60) months, with 16 cases (20.78%) aged 0 to five months, nine cases (11.69%) aged six to 11 months, 21 cases (27.27%) aged 12 to 35 months, 16 cases (20.78%) aged three to five years, 13 cases (16.89%) aged six to 11 years, and two cases (2.60%) aged 12 years. The highest number of cases was in spring, with 36 cases (46.75%), followed by winter with 25 cases (32.47%). Thirty-three cases (42.86%) had vaccinated with meningococcal vaccine. The clinical symptoms included fever in all 77 cases (100.00%), skin petechiae and ecchymosis in 58 cases (75.32%), vomiting in 56 cases (72.73%), respiratory symptoms in 12 cases (15.58%), convulsions in 17 cases (22.08%), conscious disturbance in 24 cases (31.17%), shock in 38 cases (49.35%), circulatory failure in 13 cases (16.88%), and respiratory failure in seven cases (9.09%). Among the 77 children, fifty-seven cases (74.03%) were common type and 20 cases (25.97%) were fulminant type, with seven deaths (9.09%). Neisseria meningitidis (Nm) was detected in 55 cases (71.43%), with the positive rates of skin petechiae smear and cerebrospinal fluid smear of 23.26%(10/43) and 19.44%(14/72), respectively. The positive rates of cerebrospinal fluid culture and blood culture were 36.51%(23/63) and 31.51% (23/73), respectively. The positive rate of polymerase chain reaction detection was 79.17%(38/48). The serogroups were determined in the 38 Nm strains, including 18 cases (47.37%) of group B, 14 cases (36.84%) of group C, five cases (13.16%) of group A, and one case (2.63%) of group Y. Among the 29 Nm strains tested for antimicrobial susceptibility, one strain (3.45%) was resistant to penicillin, two strains (6.90%) were resistant to cefotaxime, 21 strains (72.41%) were resistant to ciprofloxacin, and 25 strains (86.21%) were resistant to sulfamethoxazole/trimethoprim. All strains were sensitive to ceftriaxone, azithromycin, meropenem, rifampicin, chloramphenicol, and minocycline. Conclusions:Epidemic cerebrospinal meningitis presents a low prevalence trend in children in Shanghai area. Infants and toddlers remain the major susceptible individuals. Nm has reduced sensitivity to penicillin, but remains sensitive to ceftriaxone. Ceftriaxone is recommended as the first-line choice for antibiotic therapy. The prevalent serogroups are Group B, Group C, Group A and Group Y in sequence. Immunization plan adjustment should be suggested. Vaccination covering the current epidemic serum population as early as possible should be recommended.

Objective:To investigate the clinical characteristics, prevalent serum groups, and drug sensitivity test results of epidemic cerebrospinal meningitis in children in Shanghai area.Methods:The study was a retrospective case-control study. The children hospitalized for epidemic cerebrospinal meningitis in Children′s Hospital of Fudan University from January 2003 to December 2023 were enrolled. Clinical data were collected, including demographic characteristics, clinical manifestations, pathogen detection results, strain typing, and drug sensitivity test results.Results:A total of 77 children with confirmed epidemic cerebrospinal meningitis were hospitalized, including 50 males (64.94%) and 27 females (35.06%). The age was 24(8, 60) months, with 16 cases (20.78%) aged 0 to five months, nine cases (11.69%) aged six to 11 months, 21 cases (27.27%) aged 12 to 35 months, 16 cases (20.78%) aged three to five years, 13 cases (16.89%) aged six to 11 years, and two cases (2.60%) aged 12 years. The highest number of cases was in spring, with 36 cases (46.75%), followed by winter with 25 cases (32.47%). Thirty-three cases (42.86%) had vaccinated with meningococcal vaccine. The clinical symptoms included fever in all 77 cases (100.00%), skin petechiae and ecchymosis in 58 cases (75.32%), vomiting in 56 cases (72.73%), respiratory symptoms in 12 cases (15.58%), convulsions in 17 cases (22.08%), conscious disturbance in 24 cases (31.17%), shock in 38 cases (49.35%), circulatory failure in 13 cases (16.88%), and respiratory failure in seven cases (9.09%). Among the 77 children, fifty-seven cases (74.03%) were common type and 20 cases (25.97%) were fulminant type, with seven deaths (9.09%). Neisseria meningitidis (Nm) was detected in 55 cases (71.43%), with the positive rates of skin petechiae smear and cerebrospinal fluid smear of 23.26%(10/43) and 19.44%(14/72), respectively. The positive rates of cerebrospinal fluid culture and blood culture were 36.51%(23/63) and 31.51% (23/73), respectively. The positive rate of polymerase chain reaction detection was 79.17%(38/48). The serogroups were determined in the 38 Nm strains, including 18 cases (47.37%) of group B, 14 cases (36.84%) of group C, five cases (13.16%) of group A, and one case (2.63%) of group Y. Among the 29 Nm strains tested for antimicrobial susceptibility, one strain (3.45%) was resistant to penicillin, two strains (6.90%) were resistant to cefotaxime, 21 strains (72.41%) were resistant to ciprofloxacin, and 25 strains (86.21%) were resistant to sulfamethoxazole/trimethoprim. All strains were sensitive to ceftriaxone, azithromycin, meropenem, rifampicin, chloramphenicol, and minocycline. Conclusions:Epidemic cerebrospinal meningitis presents a low prevalence trend in children in Shanghai area. Infants and toddlers remain the major susceptible individuals. Nm has reduced sensitivity to penicillin, but remains sensitive to ceftriaxone. Ceftriaxone is recommended as the first-line choice for antibiotic therapy. The prevalent serogroups are Group B, Group C, Group A and Group Y in sequence. Immunization plan adjustment should be suggested. Vaccination covering the current epidemic serum population as early as possible should be recommended.

Objective:To explore the correlation between clinical and CT imaging features and epidermal growth factor receptor (EGFR) gene mutation in patients with non-small cell lung cancer (NSCLC) and screening of mutation prediction indicators.Methods:A retrospective case-control study was conducted. The clinical data of 178 NSCLC patients who were confirmed by pathology and underwent pre-treatment chest-enhanced CT scan and EGFR gene mutation testing in General Hospital of Ningxia Medical University from January 2015 to December 2019 were retrospectively analyzed. Patients were classified into EGFR mutation-positive and mutation-negative groups based on genetic testing results, and the clinical and CT imaging features were compared between the two groups; the multivariate logistic regression model was used to identify the independent influencing factors for EGFR gene mutation in NSCLC patients.Results:Among 178 NSCLC patients, 115 cases (64.6%) were EGFR gene mutation-positive and 63 cases (35.4%) were mutation-negative. Among the 115 EGFR gene mutation-positive patients, there were 61 cases (53.0%) of exon 19 deletion (19del) mutation, 45 cases (39.1%) of exon 21 L858R mutation, 8 cases (7.0%) of exon 20 mutation, and 1 case (0.9%) of exon 18 mutation. The proportions of female patients [60.0% (69/115) vs. 30.2% (19/63)] and patients with out smoking history [74.8% (86/115) vs. 36.5% (23/63)] in EGFR gene mutation-positive group were higher than those in the mutation-negative group, and the differences were statistically significant (both P < 0.001), while the proportions of patients with different pathological types and clinical stages in the two groups showed no statistically significant differences (both P > 0.05). The median maximum diameter of tumor [ M ( Q1, Q3)] detected by CT in the EGFR gene mutation-positive group was 3.70 (2.90, 4.70) cm, while in the mutation-negative group it was 5.30 (3.40, 6.80) cm, and the difference was statistically significant ( Z = -3.66, P < 0.001). The proportions of patients with air bronchogram [27.8% (32/115) vs. 7.9% (5/63)] and without emphysema [83.5% (96/115) vs. 55.6% (35/63)] in the EGFR gene mutation-positive group were higher than those in the mutation-negative group, and the differences were statistically significant (both P < 0.01). The results of multivariate logistic regression analysis showed that no smoking history (yes vs. no, OR = 0.218, 95% CI: 0.073-0.647), short maximum diameter of tumor detected by CT ( OR = 0.814, 95% CI: 0.676-0.981), air bronchogram (yes vs. no, OR = 5.354, 95% CI: 1.782-16.090), and no emphysema (yes vs. no, OR = 0.289, 95% CI: 0.128-0.653) were independent risk factors for EGFR gene mutation in NSCLC patients (all P < 0.05). Conclusions:Clinical and CT imaging features may relate to EGFR gene mutation status in NSCLC patients, and no smoking history, short maximum diameter of tumor detected by CT, air bronchogram and no emphysema may predict EGFR gene mutation.

Objective:To summarize the clinical characteristics of patients with end-stage heart failure who receive heart transplant under extracorporeal membrane oxygenation (ECMO) support.Methods:The clinical data of 12 pediatric patients who received heart transplant with ECMO support in the Seventh Medical Center of Chinese People′s Liberation Army General Hospital and Guangdong Provincial People′s Hospital, from January 2019 to December 2023 was collected. The data included sex, age, weight, diagnosis, pre-ECMO lactate level, left ventricular ejection fraction (LVEF), vasoactive-inotropic score (VIS), and preoperative ECMO running time. Surgical data included cold ischemia time of the donor heart, cardiopulmonary bypass time, intraoperative use of immunosuppressant, postoperative use of ECMO, duration of postoperative ECMO, rate of successful weaning from ECMO, and survival discharge rate. The paired t-test was performed to compare cardiac function indices before and after left ventricular decompression. Results:The 12 patients ranged in age from 1.1 to 15.8 years, and weighted from 8 to 63 kg. Ten children were diagnosed with dilated cardiomyopathy, one with myocardial underdensification, and one with a novel heterozygous mutation of the SCN5A gene causing overlap syndrome complicated by fatal arrhythmia. Before ECMO, the lactate ranged from 0.6 to>15.0 mmol/L, the LVEF from 6.5% to 43%, and VIS from 3 to 108. Four patients underwent left ventricular decompression supported by preoperative ECMO, and their pulse pressure was significantly increased after decompression ((17.8±2.1) vs. (9.8±1.5) mmHg, 1 mmHg=0.133 kPa, t=11.31, P=0.001), while there was no apparent change in LVEF ((26.8±4.4)% vs. (24.9±4.9)%, t=1.75, P=0.178). A total of 7 children received a second run of ECMO after surgery and 3 of them successfully weaned off ECMO and survived to discharge. In the entire cohort, 10 were successfully weaned from ECMO and 8 survived to discharge. Conclusions:For children with end-stage heart failure supported by ECMO, left ventricular decompression can significantly improve pulse pressure. These patients will eventually require heart transplantation.