OBJECTIVE To evaluate the effect of clinical pharmacists participating in the treatment of chronic heart failure （CHF） based on the clinical pharmacy pathway （CPP）. METHODS Totally 226 CHF patients recruited from August 24th， 2024 to March 14th， 2025， were divided into an observation group and a control group based on the random number table method， with 113 cases in each group. All patients were treated with conventional therapy. The observation group was additionally given CPP management （including pharmaceutical care during hospitalization， the formulation of individualized discharge medication regimens， and pharmaceutical follow-up after discharge）. The cardiac function parameters at admission， at discharge， at 3 and 6 months after discharge， drug use at 6 months after discharge， economic indicators， as well as the readmission rate and mortality rate at 6 months after discharge were compared between the two groups. Morisky Medication Adherence Scale-8 Items （MMAS-8）， Somatic Self-rating Scale （SSS） and Patient Health Questionnaire-9 （PHQ-9） scores were compared at admission， at discharge and at 3 and 6 months after discharge. RESULTS Six months after discharge， 24 patients dropped out. Eventually， 104 patients in the observation group and 98 patients in the control group completed the study. Compared with at admission， New York Heart Association （NYHA） cardiac functional classification， left ventricular ejection fraction （LVEF） and N -terminal pro-B-type natriuretic peptide （NT-proBNP） of both groups of patients at discharge as well as at 3 and 6 months after discharge were significantly improved； moreover， the improvements at 3 and 6 months after discharge were significantly better than those at discharge. Meanwhile， the above indexes （except for NYHA cardiac functional classification at discharge， NT-proBNP and NYHA cardiac functional classification at 3 months after discharge） of the observation group at discharge， at 3 and 6 months after discharge were significantly better than the control group （ P ＜0.05）. The utilization rates of angiotensin converting enzyme inhibitor （ACEI）/angiotensin Ⅱ receptor blocker （ARB）/angiotensin receptor neprilysin inhibitor （ARNI）， the proportion of β-blockers reaching the target dose， the utilization rate of sodium-glucose linked transporter 2 inhibitor （SGLT2i）， and the proportion of SGLT2i reaching the target dose in the observation group were significantly higher than the control group （ P ＜0.05）， and the proportion of drugs and readmission rate were significantly lower than the control group （ P ＜0.05）. Compared with at admission， MMAS-8 scores of the patients in the observation group at discharge， at 3 and 6 months after discharge were significantly increased， while SSS and PHQ-9 scores were significantly lowered （ P ＜0.05）. And all the above scores gradually decreas ed with the extension of discharge time （ P ＜0.05）. CONCLUSIONS Clinical pharmacists can utilize CPP to significantly improve patients’ cardiac function， medication adherence， somatic symptoms and depression. Additionally， they can significantly improve the utilization rates of ACEI/ARB/ARNI and SGLT2i， as well as the proportion of target doses of β-blockers and SGLT2i， while simultaneously reducing readmission rates.

Colorectal cancer(CRC) is a common malignant tumor worldwide. Due to the treatment intolerance and side effects, CRC rank the top among various cancers regarding the incidence and mortality rates. Therefore, exploring new therapies is of great significance for the treatment of CRC. Aerobic glycolysis(AEG) plays an important role in the microenvironment formation, proliferation, metastasis, and recurrence of CRC and other tumor cells. It has been confirmed that intervening in the AEG pathway can effectively curb CRC. The active ingredients and compound prescriptions of traditional Chinese medicine(TCM) can effectively inhibit the proliferation, metastasis, and drug resistance and regulate the apoptosis of tumor cells by modulating AEG-associated transport proteins [eg, glucose transporters(GLUT)], key enzymes [hexokinase(HK) and phosphofructokinase(PFK)], key genes [hypoxia-inducible factor 1(HIF-1) and oncogene(c-Myc)], and signaling pathways(MET/PI3K/Akt/mTOR). Accordingly, they can treat CRC, reduce the recurrence, and improve the prognosis of CRC. Although AEG plays a key role in the development and progression of CRC, the specific mechanisms are not yet fully understood. Therefore, this article delves into the intrinsic connection of the targets and mechanisms of the AEG pathway with CRC from the perspective of tumor cell glycolysis and explores how active ingredients(oxymatrine, kaempferol, and dioscin) and compound prescriptions(Quxie Capsules, Jiedu Sangen Decoction, and Xianlian Jiedu Prescription) of TCM treat CRC by intervening in the AEG pathway. Additionally, this article explores the shortcomings in the current research, aiming to provide reliable targets and a theoretical basis for treating CRC with TCM.
Humans ; Colorectal Neoplasms/genetics* ; Drugs, Chinese Herbal/therapeutic use* ; Glycolysis/drug effects* ; Animals ; Medicine, Chinese Traditional ; Signal Transduction/drug effects*

Surgical methods for varicocele remain controversial. This study intends to evaluate the efficacy and safety of different surgical approaches for treating varicocele through a network meta-analysis (NMA). PubMed, Embase, Cochrane, and Web of Science databases were thoroughly searched. In total, 13 randomized controlled trials (RCTs) and 24 cohort studies were included, covering 9 different surgical methods. Pairwise meta-analysis and NMA were performed by means of random-effects models, and interventions were ranked based on the surface under the cumulative ranking curve (SUCRA). According to the SUCRA, microsurgical subinguinal varicocelectomy (MSV; 91.6%), microsurgical retroperitoneal varicocelectomy (MRV; 78.2%), and microsurgical inguinal varicocelectomy (MIV; 76.7%) demonstrated the highest effectiveness in reducing postoperative recurrence rates. In this study, sclerotherapy embolization (SE; 87.2%), MSV (77.9%), and MIV (67.7%) showed the best results in lowering the risk of hydrocele occurrence. MIV (82.9%), MSV (75.9%), and coil embolization (CE; 58.7%) were notably effective in increasing sperm motility. Moreover, CE (76.7%), subinguinal approach varicocelectomy (SV; 69.2%), and SE (55.7%) were the most effective in increasing sperm count. SE (82.5%), transabdominal laparoscopic varicocelectomy (TLV; 76.5%), and MRV (52.7%) were superior in shortening the length of hospital stay. The incidence rates of adverse events for MRV (0), SE (3.3%), and MIV (4.1%) were notably low. Cluster analyses indicated that MSV was the most effective in the treatment of varicocele. Based on the existing evidence, MSV may represent the optimal choice for varicocele surgery. However, selecting clinical surgical strategies requires consideration of various factors, including patient needs, surgeon experience, and the learning curve.
Humans ; Male ; Embolization, Therapeutic/methods* ; Microsurgery/methods* ; Randomized Controlled Trials as Topic ; Sclerotherapy/methods* ; Treatment Outcome ; Urologic Surgical Procedures, Male/methods* ; Varicocele/surgery*

Although clinical evidence suggests that nonalcoholic fatty liver disease is an established major risk factor for heart failure, it remains unexplored whether sleep disorder-caused hepatic damage contributes to the development of cardiovascular disease (CVD). Here, our findings revealed that sleep fragmentation (SF) displayed notable hepatic detrimental phenotypes, including steatosis and oxidative damage, along with significant abnormalities in cardiac structure and function. All these pathological changes persisted even after sleep recovery for 2 consecutive weeks or more, displaying memory properties. Mechanistically, persistent higher expression of nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) in the liver was the key initiator of SF-accelerated damage phenotypes. SF epigenetically controlled the acetylation of histone H3 lysine 27 (H3K27ac) enrichment at the Nox4 promoter and markedly increased Nox4 expression in liver even after sleep recovery. Moreover, fine coordination of the circadian clock and hepatic damage was strictly controlled by BMAL1-dependent Sirtuin 1 (Sirt1) transcription after circadian misalignment. Accordingly, genetic manipulation of liver-specific Nox4 or Sirt1, along with pharmacological intervention targeting NOX4 (GLX351322) or SIRT1 (Resveratrol), could effectively erase the epigenetic modification of Nox4 by reducing the H3K27ac level and ameliorate the progression of liver pathology, thereby counteracting SF-evoked sustained CVD. Collectively, our findings may pave the way for strategies to mitigate myocardial injury from persistent hepatic detrimental memory in diabetic patients.

Objective To longitudinally analyze the changes in perioperative nutritional indicators in elderly patients with spontaneous intracerebral hemorrhage(ICH)and their correlation with the score of modified Rankin scale(mRS)score.Methods A total of 295 elderly ICH patients ad-mitted to the neurosurgery intensive care unit of North China University of Science and Technolo-gy Affiliated Hospital from June 2022 to November 2024 were consecutively enrolled in this study.The levels of relevant nutritional indicators were measured before(T1),and in 1(T2),3(T3),5(T4)and 7 d(T5)after surgery.According to the mRS score in 90 d after onset of the disease,they were divided into a good prognosis group(mRS score≤ 2,114 cases)and a poor prognosis group(mRS score≥3,181 cases).The general data and levels of nutritional indicators at above time points were compared between the two groups.Binary logistic regression analysis was applied to study the relationship between the perioperative nutritional indicator levels and the prognosis in elderly patients with spontaneous ICH.Results The poor prognosis group had significantly higher SBP,larger proportions of stroke history,hemorrhage in the brainstem and midline dis-placement,and increased NIHSS score than the good prognosis group(P＜0.05,P＜0.01).Obvi-ously lower BMI(56.48±9.54 kg vs 66.62±8.12 kg),decreased serum levels of albumin[40.24(39.10,41.16)g/L vs 43.30(40.65,45.50)g/L],prealbumin[203.00(164.00,261.00)mg/L vs 229.00(180.00,282.00)mg/L]and TC[4.68(4.11,5.39)mmol/L vs 4.91(4.47,5.66)mmol/L],reduced lymphocyte count[1.58(0.95,2.03)× 109/L vs 1.77(1.99,1.91)× 109/L],and reduced GCS[7.00(5.00,10.00)vs 9.00(7.00,13.00)]and Barthel[55.00(43.00,64.00)vs 61.00(52.00,69.00)]scores at admission were observed in the poor prognosis group than the good prognosis group(all P＜0.01).At all different time points,the poor prognosis group also got notably higher Controlling Nutritional Status(CONUT)scores(reaching the highest levels at 3 d after opera-tion),and lower Prognostic Nutritional Index(PNI)score and Geriatric Nutritional Risk Index(GNRI)score(both declining the lowest levels at same time)when compared with the poor prog-nosis group(all P＜0.01).Binary logistic regression analysis showed that COUNT scores,PNI scores and GNRI scores before(T1)and at 1(T2),3(T3),5(T4)and 7 d(T5)after operation were independent risk factors for 90-day poor prognosis in elderly patients with spontaneous ICH.Conclusion The fluctuations of 3 nutritional indicators at different time points in the periopera-tive period are closely associated with the 90-day prognosis of elderly ICH patients.Monitoring the changes in the nutritional indicators can quickly and conveniently predict the prognosis of the pa-tients,which has high clinical application value.

Objective To predict the value of admission dehydration state combined with fluid accumulation index for post-operative prognosis in elderly patients with intracerebral hemorrhage(ICH).Methods A retrospective study was conducted on 320 elderly ICH patients receiving surgical treatment in Department of Neurosurgery and then admitted to its Intensive Care Unit of the Affiliated Hospital of North China University of Science and Technology from May 2023 to March 2024.According to the survival status at 30 d after onset,they were divided into a survival group(202 cases)and a death group(118 cases).Clinical data such as basic information,admission vital signs,laboratory indicators,and fluid supplementation were compared between the two groups.ROC curve was plotted.Results The death group exhibited significantly advanced age,more bleeding sites,higher 7-day fluid accumulation index,and larger proportions of ventricular rupture,midline displacement and admission dehydration status,but lower uric acid level than the the survival group(P＜0.05,P＜0.01).Binary logistic regression analysis showed that admission dehydration status and 7-day fluid accumulation index were risk factors for 30-day mortality in elderly ICH patients after surgery(P＜0.01).ROC curve analysis showed that the AUC value of admission dehydration status combined with 7-day fluid accumulation index in predicting 30-day death of elderly ICH patients after surgery was 0.774(95％CI:0.722-0.825),and that of the combination was better than that of each indicator alone(P＜0.05).Conclusion Hospital dehydration status combined with 7-day fluid accumulation index has the best effectiveness in predicting 30-day mortality in elderly ICH patients after surgical treatment.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:To observe the effect of mirror threshold load training on respiration of persons with respiratory muscle fatigue after a cerebral hemorrhage.Methods:Fifty cerebral hemorrhage patients with respiratory muscle fatigue were randomly divided into an observation group and a control group, each of 25. In addition to routine rehabilitation training, the control group was given threshold load training of the respiratory muscles, while the observation group was provided with mirror threshold load training, twice a day in the morning and afternoon, 5 days a week for 4 weeks. Before the experiment and after 1, 2, 3 and 4 weeks of the treatment, everyone′s maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) was recorded. Before and after the 4 weeks forced expiration volume in the first second (FEV1) was measured along with 25% of the forced expiration volume (FEF25), maximum sound time (MPT) and respiration rate (RR).Results:At each time point the MIP and MEP values of both groups were significantly better than those before the treatment. After 4 weeks the average MIP and MEP values of the observation group were significantly better than those of the control group. And after 4 weeks the FEV1, FEF25, MPT and RR values of both groups had also improved significantly, on average. All of the observation group′s averages except MPT were then significantly better than the control group′s averages.Conclusions:Mirror threshold load training of the respiratory muscles can significantly improve the respiration of persons with respiratory muscle fatigue after a cerebral hemorrhage. It is more effective than respiratory muscle threshold load training.

Objective To compare and analyze the predictive value of a variety of novel blood inflammation composite indicators in spontaneous intracerebral hemorrhage(sICH)patients'prognosis.Methods This retrospective study consecutively enrolled 329 sICH patients admitted to the Neurosurgical Intensive Care Unit of North China University of Science and Technology Affiliated Hospital between September 2022 and December 2024.Patients were categorized into favorable(with modified Rankin scale[mRS]score ≤2)or unfavorable(mRS score ≥ 3)prognosis groups based on 90-day post-onset assessments.Baseline and imaging data,included age,gender,smoking history,alcohol consumption history,admission systolic/diastolic blood pressure,medical history(diabetes,coronary heart disease,stroke),24-hour laboratory parameters after admission(albumin,hemoglobin,blood glucose,potassium,platelets,lymphocytes,monocytes,neutrophils,homocysteine,red cell distribution width[RDW]),site of hemorrhage(basil ganglia,lobes,cerebellum,brain stem),hemorrhage volume,the National Institutes of Health stroke scale(NIHSS)score.Systemic complications during hospitalization(pulmonary/urinary tract/bloodstream infections)were recorded.Head CT and CT angiography(CTA)were performed at 24 h after admission to measure hematoma volume.Calculate and analyze the comprised inflammatory indices including systemic immune-inflammation index(SII;platelets × neutrophils/lymphocytes),platelet-to-lymphocyte ratio(PLR),RDW to albumin ratio(RAR;RDW/albumin),hemoglobin to RDW ratio(HRR,hemoglobin/RDW),systemic inflammation response index(SIRI;neutrophils × monocytes/lymphocytes),lymphocyte-neutrophil-albumin ratio(LANR;lymphocytes × albumin/neutrophils),neutrophil-to-albumin ratio(NPAR;neutrophil％/albumin),glucose-to-lymphocyte ratio(GLR;glucose/lymphocytes),and glucose-to-potassium ratio(GPR,glucose/potassium).Variables with P＜0.05 in univariate analysis were included in a collinearity analysis(a tolerance＜0.1 or variance inflation factor[VIF]＞10 indicating collinearity).Significant non-collinear variables with P＜0.05 in univariate analysis were included in multivariate Logistic regression to identify factors influencing prognosis in sICH patients.Receiver operating characteristic(ROC)curves was utilized to compare the predictive power of each indictors through net reclassification improvement(NRI)and integrated discrimination improvement(IDI).With NRI/IDI＞0 indicated superiority of new models over the old ones(higher values denote greater improvement).Delong's test was performed to evaluate the area under the curve(AUC)differences.Results Among the 329 sICH patients enrolled(185 males,144 females;mean age[68±6]years,ranged 36-91),138 were categorized into the favorable prognosis group(mRS score≤ 2)and 191 into the unfavorable prognosis group(mRS score ≥ 3),all patients had received a standardized treatment.Significant differences were observed in alcohol consumption history,diabetes,prior stroke,albumin,hemoglobin,blood glucose,platelets,lymphocytes,monocytes,neutrophils,homocysteine,RDW,hematoma volume,lung infection,and NIHSS score between two groups(all P＜0.05).While no significant differences were observed in the rest baseline/imaging data between the two groups(all P＞0.05).The favorable prognosis group exhibited significantly lower GLR(4.67[3.76,5.92]vs.6.67[4.66,10.32]),SIRI(1.92[1.12,3.24]v.s.4.43[2.25,8.33]),PLR(125.11[105.11,156.20]vs.164.46[122.42,232.63]),RAR(0.28[0.27,0.29]vs.0.32[0.30,0.35]),and NPAR(0.18[0.13,0.21]vs.0.22[0.16,0.33];all P＜0.01);and significantly higher SII(1 632.90[882.18,2 429.78]vs.967.93[702.83,1 290.51]),LANR(9.63[7.75,13.10]vs.5.49[3.25,9.77]),and HRR(11.73[10.97,12.62]vs.10.89[10.00,11.82];all P＜0.01).No significant differences were found in GPR(2.15[1.80,2.65]vs.2.28[1.83,3.31])between the favorable and unfavorable prognosis groups(P=0.094).After excluding factors with multicollinearity(including,lymphocytes,platelets,neutrophils,monocytes,albumin,RDW and hemoglobin),the other factors were included in a multivariate analysis,which identified SIRI(OR,1.312,95％CI1.043-1.650,P=0.020),RAR(OR,1.578,95％CI 1.376-1.810,P＜0.01),and HRR(OR,0.641,95％CI 0.480-0.854,P=0.002)as independent predictors of poor 90-day prognosis for sICH patients.ROC analysis showed that the AUC of RAR,SIRI,and HRR were 0.862,0.739 and 0.683 respectively,with RAR demonstrating superior sensitivity(82.20％vs.SIRI 68.06％vs.HRR 51.83％)and specificity(78.26％vs.SIRI 69.57％vs.HRR 76.81％).IDI confirmed RAR's significantly greater predictive ability versus SIRI(IDI=0.210,P＜0.01)and HRR(IDI=0.263,P＜0.01),and SIRI have superior predictive ability over HRR(IDI=0.053,P=0.040).Delong test showed that RAR had significantly greater predictive power than both SIRI and HRR(both P＜0.01),while the predictive power of SIRI and HRR did not differ significantly(P=0.138).Conclusions The three blood inflammatory indicators(RAR,SIRI,HRR)are effective predictors of poor prognosis in sICH patients at 90 d from onset,and among the three composite inflammatory parameters,RAR is significantly more effective than SIRI and HRR indicators.

With the rapid development of generative artificial intelligence(GAI)technologies,their widespread application in academic research and writing is continuously expanding the boundaries of sci-entific inquiry.However,this trend has also raised a series of ethical and regulatory challenges,inclu-ding issues related to authorship,content authenticity,citation accuracy,and accountability.In light of the growing involvement of AI in generating academic content,establishing an open,controllable,and trustworthy ethical governance framework has become a key task for safeguarding research integrity and maintaining trust within the academic community.This expert consensus outlines ethical requirements across key stages of AI-assisted academic writing-including topic selection,data management,citation practices,and authorship attribution.It aims to clarify the boundaries and ethical obligations surrounding AI use in academic writing,ensuring that technological tools enhance efficiency without compromising in-tegrity.The goal is to provide guidance and institutional support for building a responsible and sustainable research ecosystem.