ObjectiveTo investigate the clinical efficacy of oral/ gastric tube/ jejunal tube administration or retention enema of Qingjie Huagong Formula （清解化攻方， QHF） mirabilite abdominal bag external application combined with conventional western medicine in patients with acute pancreatitis （AP）. MethodsA prospective， randomized， double-blind， placebo-controlled trial was conducted. A total of 128 AP patients were enrolled and randomly assigned to a control group and a treatment group， with 64 cases in each group. The control group received placebo and conventional western medicine， while the treatment group additionally received oral/ gastric tube/ jejunal tube administration or retention enema of QHF， and mirabilite abdominal bag external application. Both groups received treatment from admission to discharge as one complete course， with the maximum treatment duration not exceeding 14 days.The primary outcome was the severity grading of AP. Secondary outcomes were clinical efficacy， laboratory indicators including white blood cell count （WBC）， C-reactive protein （CRP）， procalcitonin （PCT）， blood urea nitrogen （BUN）， lactate （Lac）， and D-dimer， gastrointestinal function recovery indicators including time to relief of abdominal pain， time to recovery of bowel sounds， and time to resumption of enteral nutrition， total fluid volume administered within 24 h after admission， intra-abdominal pressure， length of hospital stay， hospitalization costs， and incidence of complications. ResultsDuring the treatment period， 3 cases dropped out in the control group and 9 cases in the treatment group， leaving 116 cases for final analysis （55 in the treatment group and 61 in the control group）. After treatment， the markedly effective rate and overall effective rate in the treatment group were 69.09% （38/55） and 92.73% （51/55）， respectively， which was higher than 49.18% （30/61） and 80.33% （49/61） in the control group. The severity of the disease in the treatment group was significantly lower than that in the control group （P＜0.05）. Compared to the control group， the treatment group showed significantly reduced levels of WBC， CRP， PCT， BUN， Lac， and D-dimer； the time to relief of abdominal pain， time to recovery of bowel sounds， and time to resumption of enteral nutrition were significantly shortened； the fluid volume administered within 24 h after admission and intra-abdominal pressure were significantly reduced， as well as the length of hospital stay and hospitalization costs （P＜0.05 or P＜0.01）. The incidences of acute kidney injury， systemic inflammatory response syndrome， and infected pancreatic necrosis in the treatment group were significantly lower than those in the control group （P＜0.05）. ConclusionQHF combined with conventional western medicine can significantly improve the inflammatory status of AP patients， promote gastrointestinal function recovery， reduce intra-abdominal pressure and fluid resuscitation requirements， lower the risk of certain complications， and shorten the length of hospital stay.

ObjectiveTo investigate the clinical efficacy of oral/ gastric tube/ jejunal tube administration or retention enema of Qingjie Huagong Formula （清解化攻方， QHF） mirabilite abdominal bag external application combined with conventional western medicine in patients with acute pancreatitis （AP）. MethodsA prospective， randomized， double-blind， placebo-controlled trial was conducted. A total of 128 AP patients were enrolled and randomly assigned to a control group and a treatment group， with 64 cases in each group. The control group received placebo and conventional western medicine， while the treatment group additionally received oral/ gastric tube/ jejunal tube administration or retention enema of QHF， and mirabilite abdominal bag external application. Both groups received treatment from admission to discharge as one complete course， with the maximum treatment duration not exceeding 14 days.The primary outcome was the severity grading of AP. Secondary outcomes were clinical efficacy， laboratory indicators including white blood cell count （WBC）， C-reactive protein （CRP）， procalcitonin （PCT）， blood urea nitrogen （BUN）， lactate （Lac）， and D-dimer， gastrointestinal function recovery indicators including time to relief of abdominal pain， time to recovery of bowel sounds， and time to resumption of enteral nutrition， total fluid volume administered within 24 h after admission， intra-abdominal pressure， length of hospital stay， hospitalization costs， and incidence of complications. ResultsDuring the treatment period， 3 cases dropped out in the control group and 9 cases in the treatment group， leaving 116 cases for final analysis （55 in the treatment group and 61 in the control group）. After treatment， the markedly effective rate and overall effective rate in the treatment group were 69.09% （38/55） and 92.73% （51/55）， respectively， which was higher than 49.18% （30/61） and 80.33% （49/61） in the control group. The severity of the disease in the treatment group was significantly lower than that in the control group （P＜0.05）. Compared to the control group， the treatment group showed significantly reduced levels of WBC， CRP， PCT， BUN， Lac， and D-dimer； the time to relief of abdominal pain， time to recovery of bowel sounds， and time to resumption of enteral nutrition were significantly shortened； the fluid volume administered within 24 h after admission and intra-abdominal pressure were significantly reduced， as well as the length of hospital stay and hospitalization costs （P＜0.05 or P＜0.01）. The incidences of acute kidney injury， systemic inflammatory response syndrome， and infected pancreatic necrosis in the treatment group were significantly lower than those in the control group （P＜0.05）. ConclusionQHF combined with conventional western medicine can significantly improve the inflammatory status of AP patients， promote gastrointestinal function recovery， reduce intra-abdominal pressure and fluid resuscitation requirements， lower the risk of certain complications， and shorten the length of hospital stay.

The recombinant human thyroid-stimulating hormone (rhTSH) can be used for differentiated thyroid cancer (DTC) preparation before ¹³¹I therapy, and follow-up. Since its approval by the American Food and Drug Administration (FDA) in 1998, rhTSH has been clinically used in European countries, the United States, and other countries for nearly 30 years. In April 2024, China’s first independently developed rhTSH agent was approved. Based on clinical experience and evidence from domestic and international studies, an expert consensus on the application of rhTSH has been developed following thorough consultations among experts. The consensus offers evidence-based recommendations to guide the appropriate use of rhTSH in clinical practice.

Objective To understand the instrument distribution and capacities of inter-laboratory comparisons among occupational medical examination (OME) institutions in Guangdong Province. Methods A total of 291 OME institutions in Guangdong Province that were within the validity period of filing in June 2024 and 101 OME institutions that participated in inter-laboratory comparisons in 2023 were selected as the study subjects. Their filing categories, instrument distribution and external quality assessment in laboratories were collected and analyzed. Results The location of 291 OME institutions distributed in 21 prefectural-level cities in the province, mainly in the Pearl River Delta (PRD) region, accounting for 68.4% of the total. The public hospitals, private medical institutions, the center for disease control and prevention and occupational disease prevention and treatment institutions (hereinafter referred to as "occupational prevention institutions") accounted for 61.2%, 28.5% and 10.3%, respectively. The filing rates for physical factors, chemical factors, and dust categories among OME institutions were 91.1%, 86.9%, and 86.6%, respectively. The average number of institutional instruments, from high to low, was 53.8, 38.8 and 38.2 per unit in occupational prevention institutions, private medical institutions and public hospitals, respectively. The passing rates of inter-laboratory comparisons among OME institutions of external quality assessment in laboratories among OME institutes in Guangdong Province, from high to low were occupational prevention institutions, public hospitals and private medical institutions (96.2% vs 86.8% vs 73.0%, P<0.05). Conclusion The regional distribution of OME institutes in Guangdong Province is unbalanced, mainly concentrated in the PRD region. Low overall level of OME capacity is found in public hospitals and private medical institutions. Leading by the occupational prevention institutions, public hospitals and private medical institutions should strengthen the development and investment in OME hardware, in order to improve the OME level.

Objective To analyze challenges in translating exercise management evidence for patients with metabolism-associated fatty liver disease(MAFLD),develop actionable strategies,and evaluate the application of best evidence.Methods Utilizing the evidence translation model,the best evidence was implemented for MAFLD patients in 4 phases:evidence acquisition,baseline practice review,intervention,and outcome evaluation.We compared the knowledge of exercise management evidence,implementation rates of review indicators,completion of exercise programs,BMI,liver stiffness measurement,controlled attenuation parameters,and patient satisfaction among medical staff at a tertiary hospital in Fujian Province during baseline(March-May 2023),mid-practice(June-August 2023),and late-practice(September-November 2023)phases.Results A total of 88 patients were included at baseline review,95 during mid-practice,and 107 in late-practice.Significant improvements were observed in the implementation rates of 21 review indicators,nurses'knowledge,completion rate,BMI,and controlled attenuation parameters compared to the data at baseline(P＜0.05).Conclusion The application of best evidence in exercise management for MAFLD patients enhances nurses'knowledge,standardizes nursing practices,and reduces patients'BMI and controlled attenuation parameters.

Objective:To investigate the relationship between dynamic alterations in serum albumin (ALB) concentrations and clinical outcomes in hospitalized surgical patients, thus providing a basis for optimizing clinical management strategies.Methods:This study utilized data from a prospective observational cohort study on nutritional status among 7 122 elderly hospitalized patients across 34 tertiary hospitals in 18 Chinese cities. A total of 1 714 surgical patients hospitalized for 7-30 days with complete data were included. Standardized protocols were used to collect demographic data, clinical outcomes, and a range of laboratory results, including nutritional and hematological parameters. Heterogeneous effects of ALB on clinical outcomes were explored. Receiver operating characteristic (ROC) curves were used to determine cutoff values for infection-related complications. Correlation analyses and multiple linear regression models were used to identify independent predictors of the absolute change in ALB (?ALB).Results:Among the surgical patients, 69.7% (1 195/1 714) experienced a decline in ALB levels during their hospital stay, which was significantly associated with the occurrence of both infection- and non-infection-related complications. Simultaneously, a marked decrease in ALB was also significantly correlated with changes in nutritional and inflammatory status during hospitalization, worsening of gastrointestinal symptoms at discharge, and functional activity abnormalities (all P<0.05). ?ALB exhibited a close association with outcome variables such as infection-related complications. Based on the incidence of infection-related complications, a cutoff value for ALB was calculated, dividing patients into a high-risk group ( n=179) and a low-risk group ( n=1 535), and a statistically significant difference in the incidence of infection-related complications was found between these two groups ( P<0.05). Correlation analysis and multiple linear regression modeling revealed that female gender, a higher baseline ALB level, a poorer baseline inflammatory status, an exacerbation of inflammatory status, larger alterations in platelet-to-lymphocyte ratio, and the presence of infection-related complications were predictive factors for a decline in ALB levels among surgical patients during their hospital stay. Conclusions:?ALB serves as a critical indicator of the inflammatory-nutritional interplay, with its magnitude of decline effectively predicting clinical outcomes and nutritional status changes and guiding multidisciplinary interventions in surgical patients.

Objective:To evaluate the safety and efficacy of accelerator-based boron neutron capture therapy (AB-BNCT) in the treatment of recurrent and refractory malignant tumors.Methods:The data of 14 patients admitted to Xiamen Humanity Hospital from September 2022 to April 2023 were prospectively collected, including 7 patients with primary brain malignancies and 7 patients with locally recurrent inoperable head and neck malignancies. All patients received intravenous infusion of boron drug (NBB-001, p-dihydroxyborylphe nylalanine, a patented freeze-dried formulation) at a total nominal dosage of 500 mg/kg (11 patients) or 750 mg/kg (3 patients), and were irradiated with neutrons (operating with NeuPex system). Adverse events after treatment were recorded and assessed. The primary efficacy endpoint was the 90 d objective response rate (ORR), while the secondary endpoints included progression-free survival (PFS) and complete response rate (CRR). Data were compiled and analyzed by SAS 9.4 software. The rate and 95% CI were calculated using Clopper-Pearson method. Results:The median dose delivered to 80% of the target volume (D 80%) was 16.80 GyE (range: 8.93-23.79 GyE). The most common adverse reactions were hyperamylasemia, alopecia, and hyperprolactinemia. Five patients experienced 8 cases of grade 3 or above adverse events, including 1 case of grade 4 acute kidney injury and 7 cases of grade 3 adverse events. All adverse events were recovered after observation or treatment. At 90 d after treatment, the ORR of all patients was 9/14 (64%, 95% CI: 35%-87%), disease control rate (DCR) was 10/14 (71%, 95% CI: 42%-92%), CRR was 2/14 (14%, 95% CI: 2%-42%); and the best overall response during the entire course included an ORR of 10/14 (71% ,95% CI: 42%-92%), DCR of 13/14 (93%, 95% CI: 66%-100%), and CRR of 3/14 (21% ,95% CI: 5%-51%). The 1-year survival rate for head and neck malignancies was 71.4%, and the 2-year survival rate was 42.8%. The 1-year survival rate for recurrent brain malignancies was 42.8%. Conclusion:AB-BNCT demonstrates favorable safety and promising efficacy in treating primary brain malignancies and recurrent/refractory head and neck malignancies, representing a potential therapeutic option.

Objective:To observe the efficacy and safety of combined lienal polypeptide injection therapy in the treatment of Mycoplasma pneumoniae pneumonia（MPP）in children aged 3 to 14 years old in multiple clinical centers.Methods:A randomized，controlled，multi-center clinical study design was adopted.A total of 240 hospitalized children aged 3 to 14 years old with MPP from 7 hospitals from September 1，2023 to January 31，2024 were included.According to the severity of pneumonia，they were divided into the mild MPP group with 80 cases and the severe MPP/refractory MPP（SMPP/RMPP）group with 160 cases，and then randomly divided into the control group and the experimental group at a ratio of 1 ∶1，using the random number table method.After screening，subjects entered a treatment period of 5 to 7 days.The control group was treated with azithromycin，while the experimental group was treated with azithromycin plus lienal polypeptide injection .The recovery of lung CT，length of hospital stay，duration of fever，cough score，whether mild cases developed into severe or refractory cases，duration of hormone use，use of intravenous immunoglobulin（IVIG），bronchoscopy treatment，and immune function were observed between the two groups to evaluate the efficacy of lienal polypeptide injection.Adverse events after medication，vital signs，blood routine，urine routine，liver function，myocardial enzymes，renal function，and electrocardiogram were observed to evaluate the safety. Results:A total of 231 subjects have completed the trial in the 7 hospitals，including 118 cases in the experimental group and 113 cases in the control group.Main observation index：the rate of lung CT aggravation in the experimental group was lower than that in the control group（2.6% vs 15.3%， P<0.01），and the difference was statistically significant.Secondary indexes：there were no statistically significant differences in the length of hospital stay，duration of fever，cough score，duration of hormone use，whether IVIG treatment was used，the number of bronchoscopy treatment cases，and immunoglobulin between the two groups（all P>0.05）.However，the rate of cases of plastic bronchitis（PB）found under bronchoscopy in the experimental group was lower than that in the control group（0 vs 18.8%， P=0.03），and the difference was statistically significant.Among the mild MPP（72 cases），there were no statistically significant differences in the length of hospital stay，duration of fever，cough score，duration of hormone use，whether IVIG treatment was used，the number of bronchoscopy treatment cases，and the improvement rate of lung CT between the two groups（all P>0.05）.However，compared with the control group，the rate of cases developing into SMPP/RMPP in the experimental group was less（24.3% vs 48.6%， P=0.03），and the difference in IgG before and after treatment was small［0.53（-0.04，1.18）g/L vs 1.33（0.48，2.25）g/L， P=0.01］.Among the SMPP/RMPP cases（159 cases），the rate of cases of PB found under bronchoscopy in the experimental group was less than that in the control group（0 vs 20%， P=0.04），and the rate of cases with aggravated lung CT in the experimental group was less than that in the control group（1.3% vs 19.5%， P<0.01），and the improvement rate of lung CT in the experimental group was higher than that in the control group（88.8% vs 75.3%， P=0.03），with statistically significant differences.There were no statistically significant differences in the length of hospital stay，duration of fever，cough score，duration of hormone use，whether IVIG treatment was used，the number of bronchoscopy treatment cases，and immunoglobulin between the two groups（all P>0.05）.Two cases in the experimental group developed rashes，which improved after the drug was discontinued.There were no serious adverse reactions such as abnormal vital signs like dyspnea and cyanosis due to the use of lienal polypeptide injection.There were no obvious changes in blood routine，liver function，myocardial enzymes，renal function，electrocardiogram，and urine routine values before and after medication compared with the baseline. Conclusion:The combined use of lienal polypeptide injection in the treatment of MPP in children can reduce the probability of the transformation from mild cases to SMPP/RMPP，reduce the rate of aggravation of the image findings，promote the absorption of lung inflammation，reduce the rate of PB found under bronchoscopy，and has good safety.

This study retrospectively analyzed data from 25 patients with paroxysmal nocturnal hemoglobinuria (PNH) admitted to Peking Union Medical College Hospital and Dongfang Hospital of Beijing University of Chinese Medicine from January 2023 to June 2024. Patients receiving sufficient eculizumab treatment for at least 3 months and who completed hemolytic complex (CH50) level testing pre- and post-treatment for 3 and 6 months were selected. Blood routine, biochemistry, and the 50% CH50-related indicators were monitored pre- and post-treatment. Among these patients, 24 completed 6 months of treatment and CH50 testing. After 3 and 6 months of eculizumab treatment, all patients with PNH showed significant improvement in symptoms, with lactate dehydrogenase (LDH) levels decreasing from a baseline of (1 814.4 ± 924.8) U/L to (248.5 ± 61.0) U/L and (239.3 ± 44.8) U/L. Hemoglobin levels increased from a baseline of (73.9±14.4) g/L to (99.9 ± 21.3) g/L and (99.6 ± 19.8) g/L. The baseline CH50 level was (32.4±14.7) %, which decreased to 2.0% (1.0% –8.0% ) and 1.0% (1.0% –4.0% ) at 3 and 6 months posttreatment, respectively. At baseline, a linear correlation was found between CH50 and LDH levels ( P<0.001), and the trend of CH50 changes was significantly lower than LDH at 3 and 6 months post-treatment with eculizumab, with similar trends. However, no linear correlation was observed between CH50 and LDH levels or other parameters at 3 and 6 months of medication. Our case demonstrates that eculizumab is effective for PNH hemolysis treatment. The serum CH50 level may be a biomarker for complement blockade induced by eculizumab, which can, to some extent, reflect the intravascular hemolysis of PNH and the efficacy of eculizumab.

Objective:To explore the cognitive characteristics, influencing factors, and treatment needs regarding biologic agents among patients with psoriasis.Methods:A cross-sectional study was conducted. Patients with psoriasis attending the Department of Dermatology, Xijing Hospital, Air Force Medical University were selected from October to December 2022, and from June to December 2023. A self-designed electronic questionnaire was used for investigation, covering demographic characteristics, psoriasis history (disease types, disease duration, previous treatments, etc.), biologics knowledge (sources of awareness, core cognitive dimensions), and treatment needs.Results:The valid questionnaire response rate reached 93.2% (439/471). The ages of enrolled patients were 35.95 ± 12.57 years, and the disease duration was 7.90 ± 3.26 years. Psoriasis vulgaris was the predominant type (363 cases, 82.69%). The overall awareness rate of biologics slightly increased from 68.62% (105/153) in 2022 to 72.38% (207/286) in 2023 ( P > 0.05). Primary information sources included new media (WeChat/internet) platforms (168 cases, 53.84%) and peer-to-peer sharing (115 cases, 36.86%), while physician counseling merely accounted for 9.29% (29 cases) ( P < 0.001). Insufficient knowledge of biologics was manifested primarily as poor awareness of comorbidities (47.60%, 209/439) and treatment monitoring protocols (22.32%, 98/439). Core concerns regarding biologic therapy included safety (73.34%, 322/439), economic burden (65.14%, 286/439), and long-term efficacy (63.55%, 279/439) ; 60.13% (264/439) of the patients expected rapid improvement of skin symptoms. As for treatment modalities, 90.20% (396/439) of the patients preferred regimens with extended dosing intervals. Conclusions:The patients with psoriasis demonstrated an imbalance in their cognitive structure regarding biologic agents. Their treatment needs exhibited multidimensional characteristics, emphasizing not only rapid clearance of skin lesions but also greater importance of treatment safety and cost-effectiveness.