Objective To analyze the problems in the operation and management of drug clinical trials and put forward targeted suggestion. Methods An electronic questionnaire survey was conducted among medical staff in about 80 hospitals in the yangtze river delta region. Results 606 valid questionnaires were received. 71% of the respondents expressed their willingness to study and participate in drug clinical trials. There were significant differences in the cognitive demands, willingness and motivation of the respondents with different occupations and educational backgrounds about the drug clinical trial work （P<0.05）. During the operation of drug clinical trials, respondents reported the main factors affecting the quality of clinical trials which including good clinical practice (GCP) awareness and subjective enthusiasm of investigators （response rate 27%）, job stability of supervisors and research coordinators （27%）, compliance of subjects （45%）, quality control of the whole process of the circulation of test drugs, medical devices and biological samples （52%）, and the informatization level of clinical trial institutions （30%）. Conclusion Hospitals, institutions and project teams could take measures to cultivate and stabilize the drug clinical trial talent team, improve the quality management system of drug clinical trials, improve work efficiency, and promote the high-quality development of drug clinical trials in medical institutions.

Despite of the widespread use of hydrogen and methane breath test, the variability in testing protocols, gas measurement techniques, and interpretation criteria continues to challenge the reproducibility and comparability across centers, especially in the Asia-Pacific region. The Asian Neurogastroenterology and Motility Association hence presents the first Asian monograph guiding application and interpretation of breath test. The monograph was formulated according to the framework of indications, preparatory process, performance, and interpretation of results, as well as future direction for research.

Background/Aims: Chronic constipation is prevalent yet under-diagnosed across Asia, compromising quality of life and burdening healthcare systems. Cultural stigma, varied diets, and limited access to standardized diagnostic tools delay timely care. Methods: The Bali Chronic Constipation Roundtable in November 2024, brought together experts from 11 Asian countries. The group reviewed epidemiological data, analyzed multinational questionnaire on clinical practice pattern, and conducted structured discussions to identify key barriers and propose region-specific recommendations. Results: Chronic constipation prevalence varies across Asia, ranging from 1.8% in India to 16.6% in Japan, with women and the elderly disproportionately affected. Under-reporting persists owing to cultural taboos and widespread self treatment with laxatives and traditional medications. Although the Rome IV criteria remains the global standard, they may not fully reflect Asian symptom profiles, and diagnosis is limited by scarce motility laboratories. First line therapies such as dietary-fiber optimization and osmotic laxatives are widely available, but newer pharmacotherapies (prucalopride, linaclotide, lubiprostone, and elobixibat) remain costly and unevenly accessible. Biofeedback for dyssynergic defecation is underutilized due to limited availability. Experts recommend expanded regional research on to refine diagnostic criteria, coupled with enhanced physician education and public awareness. They advocate accessibility to second-line and novel therapies that incorporate culturally attuned regional guidelines, and improved access to gastrointestinal motility testing. Conclusions The Bali Chronic Constipation Roundtable highlighted Asia’s need for region specific diagnostics and management. Addressing diagnostic and treatment gaps will improve outcomes, while ongoing researcher clinician policy collaboration must standardize guidelines, advance research, and ensure equitable care across Asia.

Prostate cancer is the most prevalent malignant tumor among men, ranking first in incidence and second in mortality globally. Novel hormone therapies (NHT) targeting the androgen receptor (AR) pathway have become the standard of care for metastatic prostate cancer. This review offers a comprehensive overview of NHT, including abiraterone, enzalutamide, apalutamide, darolutamide, and rezvilutamide, which have demonstrated efficacy in delaying disease progression and improving patient survival and quality of life. Nevertheless, resistance to NHT remains a critical challenge. The mechanisms underlying resistance are complex, involving AR gene amplification, mutations, splice variants, increased intratumoral androgens, and AR-independent pathways such as the glucocorticoid receptor, neuroendocrine differentiation, DNA repair defects, autophagy, immune evasion, and activation of alternative signaling pathways. This review discusses these resistance mechanisms and examines strategies to counteract them, including sequential treatment with novel AR-targeted drugs, chemotherapy, poly ADP-ribose polymerase inhibitors, radionuclide therapy, bipolar androgen therapy, and approaches targeting specific resistance pathways. Future research should prioritize elucidating the molecular basis of NHT resistance, optimizing existing therapeutic strategies, and developing more effective combination regimens. Additionally, advanced sequencing technologies and resistance research models should be leveraged to identify novel therapeutic targets and improve drug delivery efficiencies. These advancements hold the potential to overcome NHT resistance and significantly enhance the management and prognosis of patients with advanced prostate cancer.

Objective To observe the effect of Huoxin pill （concentrated pill） combined with Baduanjin on the prognosis of patients with acute myocardial infarction complicated by percutaneous coronary intervention （PCI）. Methods 120 patients with acute myocardial infarction complicated with heart failure who received emergency interventional treatment in our hospital from January 2022 to January 2023 were randomly divided into western medicine treatment group and Traditional Chinese Medicine （TCM）comprehensive treatment group. Western medicine treatment: standard western medicine treatment + five prescriptions for cardiac rehabilitation; based on western medicine treatment, Huoxin pill （concentrated pill） combined with Baduanjin therapy was added to the TCM comprehensive treatment group, and the follow-up was 6 months. The observed indexes were exertion angina pectoris scale, Chinese Medicine Syndrome Scale, Chinese medicine syndrome treatment effect evaluation, 6-minute walking test （6MWT）, left ventricular ejection fraction （LVEF）, and brain natriuretic peptide precursor （pro-BNP）. Results Sixty patients were enrolled in the two groups respectively. During the treatment, 2 cases fell off in the western medicine treatment group and 8 cases fell off in the TCM comprehensive treatment group, and a total of 110 cases were enrolled in the group. Compared with the western treatment group, TCM combined therapy significantly improved angina pectoris scale score, TCM Syndrome Scale score, pro-BNP, LVEF and 6MWT （P<0.001）. There were no significant differences in blood routine, liver and kidney function, potassium, blood glucose, blood lipids and cardiac Troponin I （cTnI） between the two groups （P>0.05）. No adverse cardiovascular events occurred during the entire treatment period in both groups. Conclusion Huoxin pill （concentrated pill） combined with Baduanjin was more effective than western therapy in improving LVEF, 6MWT distance, exercise tolerance and cardiac function in patients with acute myocardial infarction complicated with heart failure.

Objectives:To investigate the mid-term outcomes of percutaneous cement discoplasty(PCD)in the treatment of lumbar axial instability,and analyze its technical keypoints and indications.Methods:A retrospective analysis was conducted on 9 patients with axial lumbar instability treated with PCD from January 2018 to December 2019.There were 5 males and 4 females,aged 62-87 years(75.7±8.2 years),with a follow-up period of 0.5-3 years,averaged 2.3±1.0 years.Three cases had three-disc operation at the same time,three had double-space operation and three had single-space operation,involving L2/3 disc in 3 cases,L3/4 disc in 3 cases,L4/5 disc in 4 cases,and L5/S1 disc in 3 cases.Lumbar anteroposterior and lateral ra-diographs in supine and standing positions were performed before operation,at postoperative 1d,3,6,12 months and final follow-up to measure the height of intervertebral space of responsible level,as well as the sagittal area of intervertebral foramen at responsible level.Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the pain and function before surgery,at 1d,3 months,6 months,12 months and final follow-up after operation to assess the clinical efficacy.The amount of bone cement injected in each intervertebral disc,the time of operation and the amount of blood loss were recorded respectively.Results:All the patients successfully completed the operation,no bone cement leakage occurred.The VAS score and ODI after operation were significantly improved compared with those before operation(P＜0.05).The injection volume of bone cement per intervertebral disc was 3.50±0.73mL.The operative time of each disc was 16.33±1.28min,and the blood loss of each disc was 3.83±0.71mL.The height of intervertebral space of responsible level at various time points after operation was different from that before operation(P＜0.05),and there was no difference in any two time points after operation.The sagittal area of intervertebral foramen at each time point after operation was different from that before operation(P＜0.05),and there was difference be-tween postoperative 1d and the final follow-up values(P＜0.05).Conclusions:PCD can increase the height of the intervertebral space after surgery,relieve lumbar pain,and have a lasting effect in the treatment of lum-bar instability,which is safe with satisfactory mid-term effect,and not prone to bone cement leakage,but long-term large-sample follow-up is still needed.

Objectives:To investigate the mid-term outcomes of percutaneous cement discoplasty(PCD)in the treatment of lumbar axial instability,and analyze its technical keypoints and indications.Methods:A retrospective analysis was conducted on 9 patients with axial lumbar instability treated with PCD from January 2018 to December 2019.There were 5 males and 4 females,aged 62-87 years(75.7±8.2 years),with a follow-up period of 0.5-3 years,averaged 2.3±1.0 years.Three cases had three-disc operation at the same time,three had double-space operation and three had single-space operation,involving L2/3 disc in 3 cases,L3/4 disc in 3 cases,L4/5 disc in 4 cases,and L5/S1 disc in 3 cases.Lumbar anteroposterior and lateral ra-diographs in supine and standing positions were performed before operation,at postoperative 1d,3,6,12 months and final follow-up to measure the height of intervertebral space of responsible level,as well as the sagittal area of intervertebral foramen at responsible level.Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the pain and function before surgery,at 1d,3 months,6 months,12 months and final follow-up after operation to assess the clinical efficacy.The amount of bone cement injected in each intervertebral disc,the time of operation and the amount of blood loss were recorded respectively.Results:All the patients successfully completed the operation,no bone cement leakage occurred.The VAS score and ODI after operation were significantly improved compared with those before operation(P＜0.05).The injection volume of bone cement per intervertebral disc was 3.50±0.73mL.The operative time of each disc was 16.33±1.28min,and the blood loss of each disc was 3.83±0.71mL.The height of intervertebral space of responsible level at various time points after operation was different from that before operation(P＜0.05),and there was no difference in any two time points after operation.The sagittal area of intervertebral foramen at each time point after operation was different from that before operation(P＜0.05),and there was difference be-tween postoperative 1d and the final follow-up values(P＜0.05).Conclusions:PCD can increase the height of the intervertebral space after surgery,relieve lumbar pain,and have a lasting effect in the treatment of lum-bar instability,which is safe with satisfactory mid-term effect,and not prone to bone cement leakage,but long-term large-sample follow-up is still needed.

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is associated with a multitude of adverse outcomes. We aimed to estimate the pooled incidence of NAFLD-related adverse events. Methods: We performed a systematic review and meta-analysis of cohort studies of adults with NAFLD to evaluate the pooled incidence of adverse events. Results: 19,406 articles were screened, 409 full-text articles reviewed, and 79 eligible studies (1,377,466 persons) were included. Mean age was 51.47 years and body mass index 28.90 kg/m2. Baseline comorbidities included metabolic syndrome (41.73%), cardiovascular disease (CVD) (16.83%), cirrhosis (21.97%), and nonalcoholic steatohepatitis (NASH) (58.85%). Incidence rate per 1,000 person-years for mortality included: all-cause (14.6), CVD-related (4.53), non-liver cancer-related (4.53), and liver-related (3.10). Incidence for liver-related events included overall (24.3), fibrosis progression (49.0), cirrhosis (10.9), liver transplant (12.0), and hepatocellular carcinoma (HCC) (3.39). Incidence for non-liver events included metabolic syndrome (25.4), hypertension (25.8), dyslipidemia (26.4), diabetes (19.0), CVD (24.77), renal impairment (30.3), depression/anxiety (29.1), and non-liver cancer (10.5). Biopsy-proven NASH had higher incidence of HCC (P=0.043) compared to non-NASH. Higher rates of CVD and mortality were observed in North America and Europe, hypertension and non-liver cancer in North America, and HCC in Western Pacific/Southeast Asia (P<0.05). No significant differences were observed by sex. Time-period analyses showed decreasing rates of cardiovascular and non-liver cancer mortality and increasing rates of decompensated cirrhosis (P<0.05). Conclusions People with NAFLD have high incidence of liver and non-liver adverse clinical events, varying by NASH, geographic region, and time-period, but not sex.