Objective:To investigate the clinical characteristics of patients with hepatitis B virus（HBV）-related primary hepatocellular carcinoma（HCC）who were treated in a multidisciplinary team（MDT）for liver cancer，so as to provide a basis for clinical optimization of the diagnosis and treatment of patients with chronic hepatitis B（CHB）.Methods:A retrospective analysis was performed for 482 HBV-related HCC patients who were treated with HCC-MDT every Thursday afternoon in The First Affiliated Hospital of the Army Medical University from January 2022 to May 2024，aged 18-87（55.54±10.84）years，86.93%（419/482）males and 13.07%（63/482）females. According to the different underlying liver diseases at the time of initial medical treatment and the different prognostic outcomes at the later follow-up，the differences in clinical characteristics between groups under different conditions were compared and analyzed，and the influencing factors of HCC prognosis were understood by Logistic regression analysis. Results:At the time of MDT presentation，the differences in HBeAg status（ χ2=6.311 ，P=0.043），γ-glutamyl traspeptidase（GGT）（ Z=6.277， P=0.043），alkaline phosphatase（ALP）（ Z=7.236 ，P=0.027），and model for end-stage liver disease（MELD）scores（ Z=6.111， P=0.047）among patients with different underlying liver diseases were statistically significant. At follow-up，6.75%（11/163）of HBV-related HCC patients who presented to MDT had a family history of HCC，and their cumulative mortality rate was as high as 60.8%（205/337）at least for 1 year. Mulitivariate Logistic regression analysis showed that different underlying liver disease at the time of initial medical treatment，HBV DNA replication level，MELD score and choice of anti-cancer treatment regimen were the influencing factors for the prognosis of HCC（all P<0.05）. The worse the degree of cirrhosis at the initial presentation，the higher the level of HBV DNA replication，and the higher the MELD score，the worse the prognosis for HCC. Conclusion:Advancing the diagnosis and treatment of CHB，maximizing the inhibition of HBV DNA replication，reducing the MELD score，and optimizing the anti-cancer treatment regimen can reduce the mortality rate of HBV-related HCC.

Objective:To investigate the clinical characteristics of patients with hepatitis B virus（HBV）-related primary hepatocellular carcinoma（HCC）who were treated in a multidisciplinary team（MDT）for liver cancer，so as to provide a basis for clinical optimization of the diagnosis and treatment of patients with chronic hepatitis B（CHB）.Methods:A retrospective analysis was performed for 482 HBV-related HCC patients who were treated with HCC-MDT every Thursday afternoon in The First Affiliated Hospital of the Army Medical University from January 2022 to May 2024，aged 18-87（55.54±10.84）years，86.93%（419/482）males and 13.07%（63/482）females. According to the different underlying liver diseases at the time of initial medical treatment and the different prognostic outcomes at the later follow-up，the differences in clinical characteristics between groups under different conditions were compared and analyzed，and the influencing factors of HCC prognosis were understood by Logistic regression analysis. Results:At the time of MDT presentation，the differences in HBeAg status（ χ2=6.311 ，P=0.043），γ-glutamyl traspeptidase（GGT）（ Z=6.277， P=0.043），alkaline phosphatase（ALP）（ Z=7.236 ，P=0.027），and model for end-stage liver disease（MELD）scores（ Z=6.111， P=0.047）among patients with different underlying liver diseases were statistically significant. At follow-up，6.75%（11/163）of HBV-related HCC patients who presented to MDT had a family history of HCC，and their cumulative mortality rate was as high as 60.8%（205/337）at least for 1 year. Mulitivariate Logistic regression analysis showed that different underlying liver disease at the time of initial medical treatment，HBV DNA replication level，MELD score and choice of anti-cancer treatment regimen were the influencing factors for the prognosis of HCC（all P<0.05）. The worse the degree of cirrhosis at the initial presentation，the higher the level of HBV DNA replication，and the higher the MELD score，the worse the prognosis for HCC. Conclusion:Advancing the diagnosis and treatment of CHB，maximizing the inhibition of HBV DNA replication，reducing the MELD score，and optimizing the anti-cancer treatment regimen can reduce the mortality rate of HBV-related HCC.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore the clinical effect of surgery combined with photodynamic therapy on ear keloid.Methods:The clinical data of patients with ear keloid admitted to the Department of Dermatology and Venereology, the First People’s Hospital of Jinzhong were analyzed retrospectively. According to the treatment methods, they were divided into surgery combined with isotope therapy group (isotope group) and surgery combined with photodynamic therapy group (photodynamic group). Patients in both groups underwent surgical excision of keloid core first. In the isotope group, stitches were removed on the 7th day after the operation. After stitches were removed, 90Sr- 90Y applicator was applied to the skin close to the incision for 5 min each time, once every other day, with a dose of 6 Gy each time and a total dose of 18 Gy for three times, and the second course was conducted after an interval of 3 months. In the photodynamic group, photodynamic therapy was performed on the third day after the operation. The prepared 5-aminolevulinic acid solution with a concentration of 20% was applied to the incision of ear keloid surgery, and then it was sealed in the dark for 3 hours. After that, it was irradiated with a photodynamic laser therapeutic instrument with a wavelength of 635 nm, with an irradiation distance of 10 cm, an energy density of 80-100 J/cm 2, an irradiation time of 30 min. The treatment was performed 3 times with an interval of 7-10 days. Before the operation and one year after treatment, two dermatologists who participated in the treatment used Vancouver scar scale (VSS) to score scars, with a total score of 0-10 points. The higher the score, the more serious the scar. The patients scored the scar by the patient scar assessment scale (PSAS), with a total score of 6-60 points. The higher the score, the more serious the scar. One year after the end of treatment, the therapeutic effect (including cured, effective and ineffective) was evaluated, and the total effective rate [(cured cases+ effective cases)/total cases ×100%] and the recurrence rate (recurrent cases/total cases ×100%) were analysed. The treatment process and complications of the two groups were recorded. SPSS 22.0 software was used to analyze the data. The measurement data in accordance with normal distribution were expressed as Mean±SD. Comparisons between the groups were performed using t-test, and comparisons within the groups were performed using paired t-test. The counting data was expressed by the number of cases and percentage. Chi-square test was used for the comparison between groups. P<0.05 indicated that the difference was statistically significant. Results:Thirty-one patients (6 males and 25 females) were included in the isotope group. The age was (35.0±1.1) years. The course of disease was (2.0±1.1) years. The volume of keloid was (1.8±0.1)cm 3. Thirty cases were included in photodynamic group, 6 males and 24 females. The age was (34.0±4.8) years, the course of disease was (2.0±0.5) years, and the volume of keloid was (1.7±0.3) cm 3. There was no significant difference in general data between the two groups ( P>0.05). The ear keloids of 61 patients were all removed and the incision healed well. The VSS score in isotope group was (2.72±0.06) points one year after treatment, which was significantly lower than that before treatment [(8.36±0.12) points] ( t=2.75, P<0.001). The VSS score in photodynamic group was (2.81±0.04) points one year after treatment, which was also significantly lower than that before treatment [(8.21±0.34) points] ( t=2.77, P<0.001). There was no significant difference in VSS scores between the two groups before treatment and one year after treatment ( P>0.05). PSAS score in isotope group was (8.80±0.02) points one year after treatment, which was significantly lower than that before treatment [(44.51±0.15) points] ( t=2.83, P<0.001). The PSAS score in photodynamic group was (8.80±0.06) points one year after treatment, which was also significantly lower than that before treatment [(44.60±0.27) points] ( t=2.90, P<0.001). There was no significant difference in PSAS scores between the two groups before treatment and one year after treatment ( P>0.05). One year after treatment, 22 cases were cured, 7 cases were markedly effective and 2 cases were ineffective in the isotope group, with a total effective rate of 93.5% (29/31) and a recurrence rate of 6.5% (2/31). In the photodynamic group, 19 cases were cured, 8 cases were markedly effective and 3 cases were ineffective. The total effective rate was 90.0% (27/30) and the recurrence rate was 10.0% (3/30). There were no significant differences in the total effective rate, and the recurrence rate between the two groups ( P>0.05). All patients in the isotope group had itchy skin on the second day of treatment, and 22 cases were accompanied by desquamation. Symptoms disappeared in 25 cases after symptomatic treatment. Six patients developed radiation dermatitis, and the skin healed after symptomatic treatment. However, 2 patients with skin ulceration showed depigmentation at the skin lesions. The patients in the photodynamic group showed mild redness and swelling on the second day after treatment, accompanied by slight itching and desquamation, and the symptoms subsided spontaneously in 1-3 days. Pigmentation appeared in 12 cases at 1 week, and subsided spontaneously 1 week after treatment. No skin ulceration and depigmentation occurred. Conclusion:Surgery combined with photodynamic therapy can improve the appearance of ear keloids, relieve the clinical symptoms of patients and reduce the recurrence rate. Its curative effect is equivalent to isotope therapy, but there are fewer complications and higher safety.

Objective:To explore the clinical effect of surgery combined with photodynamic therapy on ear keloid.Methods:The clinical data of patients with ear keloid admitted to the Department of Dermatology and Venereology, the First People’s Hospital of Jinzhong were analyzed retrospectively. According to the treatment methods, they were divided into surgery combined with isotope therapy group (isotope group) and surgery combined with photodynamic therapy group (photodynamic group). Patients in both groups underwent surgical excision of keloid core first. In the isotope group, stitches were removed on the 7th day after the operation. After stitches were removed, 90Sr- 90Y applicator was applied to the skin close to the incision for 5 min each time, once every other day, with a dose of 6 Gy each time and a total dose of 18 Gy for three times, and the second course was conducted after an interval of 3 months. In the photodynamic group, photodynamic therapy was performed on the third day after the operation. The prepared 5-aminolevulinic acid solution with a concentration of 20% was applied to the incision of ear keloid surgery, and then it was sealed in the dark for 3 hours. After that, it was irradiated with a photodynamic laser therapeutic instrument with a wavelength of 635 nm, with an irradiation distance of 10 cm, an energy density of 80-100 J/cm 2, an irradiation time of 30 min. The treatment was performed 3 times with an interval of 7-10 days. Before the operation and one year after treatment, two dermatologists who participated in the treatment used Vancouver scar scale (VSS) to score scars, with a total score of 0-10 points. The higher the score, the more serious the scar. The patients scored the scar by the patient scar assessment scale (PSAS), with a total score of 6-60 points. The higher the score, the more serious the scar. One year after the end of treatment, the therapeutic effect (including cured, effective and ineffective) was evaluated, and the total effective rate [(cured cases+ effective cases)/total cases ×100%] and the recurrence rate (recurrent cases/total cases ×100%) were analysed. The treatment process and complications of the two groups were recorded. SPSS 22.0 software was used to analyze the data. The measurement data in accordance with normal distribution were expressed as Mean±SD. Comparisons between the groups were performed using t-test, and comparisons within the groups were performed using paired t-test. The counting data was expressed by the number of cases and percentage. Chi-square test was used for the comparison between groups. P<0.05 indicated that the difference was statistically significant. Results:Thirty-one patients (6 males and 25 females) were included in the isotope group. The age was (35.0±1.1) years. The course of disease was (2.0±1.1) years. The volume of keloid was (1.8±0.1)cm 3. Thirty cases were included in photodynamic group, 6 males and 24 females. The age was (34.0±4.8) years, the course of disease was (2.0±0.5) years, and the volume of keloid was (1.7±0.3) cm 3. There was no significant difference in general data between the two groups ( P>0.05). The ear keloids of 61 patients were all removed and the incision healed well. The VSS score in isotope group was (2.72±0.06) points one year after treatment, which was significantly lower than that before treatment [(8.36±0.12) points] ( t=2.75, P<0.001). The VSS score in photodynamic group was (2.81±0.04) points one year after treatment, which was also significantly lower than that before treatment [(8.21±0.34) points] ( t=2.77, P<0.001). There was no significant difference in VSS scores between the two groups before treatment and one year after treatment ( P>0.05). PSAS score in isotope group was (8.80±0.02) points one year after treatment, which was significantly lower than that before treatment [(44.51±0.15) points] ( t=2.83, P<0.001). The PSAS score in photodynamic group was (8.80±0.06) points one year after treatment, which was also significantly lower than that before treatment [(44.60±0.27) points] ( t=2.90, P<0.001). There was no significant difference in PSAS scores between the two groups before treatment and one year after treatment ( P>0.05). One year after treatment, 22 cases were cured, 7 cases were markedly effective and 2 cases were ineffective in the isotope group, with a total effective rate of 93.5% (29/31) and a recurrence rate of 6.5% (2/31). In the photodynamic group, 19 cases were cured, 8 cases were markedly effective and 3 cases were ineffective. The total effective rate was 90.0% (27/30) and the recurrence rate was 10.0% (3/30). There were no significant differences in the total effective rate, and the recurrence rate between the two groups ( P>0.05). All patients in the isotope group had itchy skin on the second day of treatment, and 22 cases were accompanied by desquamation. Symptoms disappeared in 25 cases after symptomatic treatment. Six patients developed radiation dermatitis, and the skin healed after symptomatic treatment. However, 2 patients with skin ulceration showed depigmentation at the skin lesions. The patients in the photodynamic group showed mild redness and swelling on the second day after treatment, accompanied by slight itching and desquamation, and the symptoms subsided spontaneously in 1-3 days. Pigmentation appeared in 12 cases at 1 week, and subsided spontaneously 1 week after treatment. No skin ulceration and depigmentation occurred. Conclusion:Surgery combined with photodynamic therapy can improve the appearance of ear keloids, relieve the clinical symptoms of patients and reduce the recurrence rate. Its curative effect is equivalent to isotope therapy, but there are fewer complications and higher safety.

Objective:To evaluate the efficacy and safety of of rivaroxaban for different doses in the treatment of isolated distal deep vein thrombosis.Methods:The clinical data of 853 patients of isolated distal deep vein thrombosis attending Nanjing Drum Tower Hospital from Jan 2018 to Dec 2020 was retrospectively analyzed.Results:Thrombotic recurrence rate increased with increasing follow-up in the standard and low dose groups, and it was significantly lower in the standard dose group than in the low dose group (HR=0.44, 95% CI: 0.25-0.78, P=0.005) with most thrombosis occurring within the first year of follow-up. There was no statistical difference between the two groups in terms of major bleeding events (HR=1.70,95%CI 0.56-5.14, P=0.530) and the incidence of clinically relevant non-major bleeding events was significantly higher in the standard dose group than in the low dose group (HR=2.36, 95%CI 1.26-4.44, P=0.020). Subgroup analysis on anticoagulation duration found when anticoagulation duration was longer than 1.5 months, the risk of thrombosis was lower in the standard dose group than the low dose group (1.5-3 months:HR=0.11, 95%CI 0.01-0.87, >3 months: HR=0.19, 95%CI 0.04-0.95), there was an interaction between anticoagulation duration and dose ( P=0.007). Conclusions:Based on the risk of thrombosis recurrence and bleeding events, the standard dose of rivaroxaban (20 mg qd) is recommended for patients with isolated distal deep vein thrombosis, and the anticoagulant duration should be maintained for 1.5 months or more.

Standardization is the universal language of the world, and standardization of traditional Chinese medicine (TCM) is essential for its communication in China and globally. However, the principles and methods of TCM acupuncture standardization have been unclear and inadequate in the early stages. Based on an investigative approach to understanding the current status, identifying problems, and finding solutions, our team has established basic principles of TCM acupuncture that embody Chinese wisdom, evaluated the international strategic environment systematically, proposed the principle of “importance of harmony and exercise of impartiality”, and established basic working principles. A series of methods for TCM acupuncture standard development and evaluation have been constructed, including general standards for the revision of TCM acupuncture standards, the first TCM acupuncture clinical research management specification, a shared full chain technology platform, a data center, and an evaluation research base for TCM acupuncture clinical research. Evaluation criteria for ancient literature and expert experience, a recommendation method for the “three main and three auxiliaries” TCM guideline for prevention were established, and quantifiable assessment methods of TCM standard applicability were proposed. These findings provide methodological guidance for TCM acupuncture standardization.

Objective:To understand preliminarily the current status of medication safety management in pediatric medical institutions in China.Methods:Self-assessment of medication safety situation were conducted in 10 pediatric medical institutions of the Pharmacy Professional Committee of Futang Children′s Medical Development Research Center using the "optimized version of 2011 Medication Safety Self Assessment ? for Hospitals (161 assessment items)" (self-assessment criteria). The self-assessment criteria included 10 key elements, 20 core characteristics, and 161 assessment items. The self-assessment results on medication safety among participating institutions were summarized, and the percentage scores and implementation proportions of the key elements, core characteristics, and assessment items were descriptively analyzed. Results:All 10 participating medical institutions completed the questionnaires within the specified time. The results showed that the overall percentage score of medication safety self-assessment was 74.72%. The element Ⅲ (communication of medication orders and other medicines information, 83.89%) and element Ⅹ (quality process and risk management, 67.84%) were with the highest and lowest percentage scores, respectively. The element Ⅲ (66.67%) and element Ⅸ (patient education, 40.00%) were with the highest and lowest percentage of full implementation, respectively. The element Ⅸ (46.25%) and element Ⅲ (26.67%) were with the highest and lowest percentage of partial implementation, respectively. The element Ⅹ (quality process and risk management, 18.38%) and element Ⅵ (procurement, use, and monitoring maintenance of drug treatment equipment, 6.25%) were with the highest and lowest percentage of non-implementation, respectively. Among the 20 core characteristics, characteristic 10 (guaranteeing the isolation of non-pharmaceutical chemicals from patients and avoiding harm to patients due to misuse, 96.25%) and characteristic 7 (adopting measures such as developing clinical pathways and establishing standardized administration time to ensure patients receive standardized diagnosis and treatment, 57.50%) were with the highest and lowest percentage scores, respectively. The characteristic 20 (following hospital infection control measures during drug storage, formulation, preparation, and administration, 90.00%) and characteristic 17 (establishing a fair and just drug safety culture within the hospital, encouraging and advocating safe behavior, rather than punitive measures for medical personnel related to medication errors, 25.00%) were with the highest and lowest percentage of complete implementation, respectively. The characteristic 7 (55.00%) and characteristic 20 (5.00%) were with the highest and lowest percentage of partial implementation, respectively. The characteristic 17 (22.86%) and characteristic 10 (0) were the highest and lowest percentage of non-implementation, respectively.Conclusions:The 10 pediatric medical institutions participating in the self-assessment have a higher level of management in the communication of medication orders and other drug information, as well as in the storage and distribution of drugs. However, there are shortcomings in the construction of a fair culture, proactive prevention of medication risks, and improvement of information systems.

Objective:To understand preliminarily the current status of medication safety management in pediatric medical institutions in China.Methods:Self-assessment of medication safety situation were conducted in 10 pediatric medical institutions of the Pharmacy Professional Committee of Futang Children′s Medical Development Research Center using the "optimized version of 2011 Medication Safety Self Assessment ? for Hospitals (161 assessment items)" (self-assessment criteria). The self-assessment criteria included 10 key elements, 20 core characteristics, and 161 assessment items. The self-assessment results on medication safety among participating institutions were summarized, and the percentage scores and implementation proportions of the key elements, core characteristics, and assessment items were descriptively analyzed. Results:All 10 participating medical institutions completed the questionnaires within the specified time. The results showed that the overall percentage score of medication safety self-assessment was 74.72%. The element Ⅲ (communication of medication orders and other medicines information, 83.89%) and element Ⅹ (quality process and risk management, 67.84%) were with the highest and lowest percentage scores, respectively. The element Ⅲ (66.67%) and element Ⅸ (patient education, 40.00%) were with the highest and lowest percentage of full implementation, respectively. The element Ⅸ (46.25%) and element Ⅲ (26.67%) were with the highest and lowest percentage of partial implementation, respectively. The element Ⅹ (quality process and risk management, 18.38%) and element Ⅵ (procurement, use, and monitoring maintenance of drug treatment equipment, 6.25%) were with the highest and lowest percentage of non-implementation, respectively. Among the 20 core characteristics, characteristic 10 (guaranteeing the isolation of non-pharmaceutical chemicals from patients and avoiding harm to patients due to misuse, 96.25%) and characteristic 7 (adopting measures such as developing clinical pathways and establishing standardized administration time to ensure patients receive standardized diagnosis and treatment, 57.50%) were with the highest and lowest percentage scores, respectively. The characteristic 20 (following hospital infection control measures during drug storage, formulation, preparation, and administration, 90.00%) and characteristic 17 (establishing a fair and just drug safety culture within the hospital, encouraging and advocating safe behavior, rather than punitive measures for medical personnel related to medication errors, 25.00%) were with the highest and lowest percentage of complete implementation, respectively. The characteristic 7 (55.00%) and characteristic 20 (5.00%) were with the highest and lowest percentage of partial implementation, respectively. The characteristic 17 (22.86%) and characteristic 10 (0) were the highest and lowest percentage of non-implementation, respectively.Conclusions:The 10 pediatric medical institutions participating in the self-assessment have a higher level of management in the communication of medication orders and other drug information, as well as in the storage and distribution of drugs. However, there are shortcomings in the construction of a fair culture, proactive prevention of medication risks, and improvement of information systems.

OBJECTIVE： To screen the active component， target and pathway of couplet medicine of “Bupleuri Radix- Atractylodis macrocephalea Rhizoma”， and to comprehensively explore its potential mechanism. METHODS： Based on the method of network pharmacology， main active componets and potential targets of  couplet medicine of “Bupleuri Radix-A. macrocephalea Rhizoma” were retrieved from TCMSP， DRAR-CPI， Genecards and OMIM database. The active component-potential target network and interaction network of potential targets were established by Cytoscape 3.6.0 software. Five potential core targets were screened， and its affinity with active components were validated with molecule docking method. GO classified enrichment analysis and KEGG pathway enrichment analysis of potential targets were carried out to obtain key pathway so as to construct active component-potential target-key pathway network. RESULTS： Totally 17 active components and 47 active component-potential targets were obtained from couplet medicine of “Bupleuri Radix-A. macrocephalea Rhizoma”. Five core targets were obtained， including AKT1， PRKCA， PRKCE， HRas， and PIK3CA. Five signaling pathways were involved， including MAPK pathway， PI3K/AKT pathway， RAS pathway， Estrogen pathway， BMP pathway. CONCLUSIONS： The couplet medicine of “Bupleuri Radix-A. macrocephalea Rhizoma” not only act on multiple targets through multiple components for mammary hyperplasia， but also play a complex network regulation role through the interaction between potential targets.