OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

OBJECTIVE To conduct a clinical rapid evaluation of the marketed proprotein convertase subtilisin/kexin type 9 （PCSK9） inhibitors in China， including evolocumab， tafolecimab， recaticimab， ebronucimab， ongericimab and inclisiran. METHODS Based on the Rapid Guide for Drug Evaluation and Selection in Chinese Medical Institutions （second edition）， drug instructions， clinical diagnosis and treatment guidelines， and literature for six drugs were retrieved from CNKI， Wanfang Data， VIP， PubMed， Embase， Cochrane Library and related official websites. The clinical rapid evaluation was conducted from five aspects： pharmaceutical characteristics， effectiveness， safety， economy， and other attributes. RESULTS The pharmaceutical characteristics， effectiveness， safety， economy， other attributes， and total score of evolocumab scored 24， 27， 15.7， 10， 5.3， and 82 points， respectively. Tafolecimab scored 23.5， 23， 11.5， 9.97， 4.6， and 72.57 points， respectively. Recaticimab scored 20.5， 22， 15.5， 6.37， 3.5， and 67.87 points. Ebronucimab scored 20， 23， 11， 6.48， 3.5， and 63.98 points. Ongericimab scored 20.5， 23， 8.5， 4.83， 3.5， and 60.33 points. Inclisiran scored 25.5， 24， 13， 6.48， 5， and 73.98 points. CONCLUSIONS Evolocumab is the optimal choice for treating hypercholesterolemia and is recommended as the first-line option. Tafolecimab is the second-line option， and recaticimab is suitable for patients who are sensitive to drug adverse reactions. Inclisiran is suitable for patients with poor compliance. Ebronucimab and ongericimab are weakly recommended due to their later market introduction. Clinicians should make individualized drug selections based on factors such as patient risk level and compliance requirements.

Objective:To examine the impact of returned migration experience on the prevalence of non-sui-cidal self-injury(NSSI)and its associations with childhood emotional maltreatment(EM),social support and sleep quality.Methods:A total of 3 901 middle school students in Guizhou Province were investigated with the Adoles-cent NSSI behavior Questionnaire,Childhood Trauma Questionnaire-short Form(CTQ-SF),Adolescent Social Sup-port Scale,and Pittsburgh Sleep Quality Index(PSQI).Results:The prevalence of NSSI among middle school students in Guizhou province was 22.8％,with the rate of 27.3％among returned migrant middle school students.Social support and sleep quality partially mediate the relationship between childhood EM and NSSI in mid-dle school students,with effect sizes of 0.06.The EM scores of returned migrant middle school students(β=-0.62)and non-returned migrant middle school students(β=-0.50)were negatively correlated with social sup-port scores in childhood.The sleep quality scores of returned migrant students(β=0.22)and non-returned migrant students(β=0.14)were positively correlated with NSSI scores.Conclusion:The prevalence of NSSI in returned migrant students is higher.Social support and sleep quality play an important role in the relationship between child-hood EM and NSSI in middle school students.The relationship between childhood EM and social support,sleep quality and NSSI in returned migrant middle school students is stronger than that in non-returned migrant middle school students.

OBJECTIVE To evaluate the safety of fondaparinux in pregnancy and provide reference for its rational clinical application. METHODS A search was conducted in databases including CNKI， Wanfang， PubMed， Embase， and Elsevier （the search time was from the construction of the database to December 17， 2024） to collect case report literature on fondaparinux use during pregnancy. Patient demographic information， fondaparinux use during pregnancy， concomitant medications， clinical manifestations， and treatment details were extracted for descriptive statistical analysis. RESULTS A total of 17 case reports regarding the use of fondaparinux during pregnancy were collected， involving 42 patients from 11 countries and 47 pregnancy records. Among these， 20 cases involved the use of fondaparinux for the prevention of pregnancy-related venous thromboembolism （VTE）， while 27 cases were fondaparinux treatment due to related conditions. A total of 29 occurrences of the patients were treated with fondaparinux due to a （family） history of VTE. Nine occurrences of complicated pregnancies were reported， and 35 patients had records of comorbidities or relevant medical histories. The adverse events that occurred during pregnancy with the use of fondaparinux include postpartum hemorrhage （7 cases） and excessive anticoagulation caused by inappropriate dosage （1 case）. Among the 7 cases of postpartum hemorrhage， 3 cases had a blood loss of no less than 1 000 mL （including 2 cases with uterine atony）， 3 cases had a drug discontinuation time of ≤12 h. CONCLUSIONS Based on the existing literature， the safety of fondaparinux during pregnancy is generally manageable， with the main adverse event being postpartum hemorrhage. The dosage， interval between discontinuation，comorbidities/medical history， and concomitant medications of fondaparinux may be the main causes of its adverse events.

Objective:To examine the impact of returned migration experience on the prevalence of non-sui-cidal self-injury(NSSI)and its associations with childhood emotional maltreatment(EM),social support and sleep quality.Methods:A total of 3 901 middle school students in Guizhou Province were investigated with the Adoles-cent NSSI behavior Questionnaire,Childhood Trauma Questionnaire-short Form(CTQ-SF),Adolescent Social Sup-port Scale,and Pittsburgh Sleep Quality Index(PSQI).Results:The prevalence of NSSI among middle school students in Guizhou province was 22.8％,with the rate of 27.3％among returned migrant middle school students.Social support and sleep quality partially mediate the relationship between childhood EM and NSSI in mid-dle school students,with effect sizes of 0.06.The EM scores of returned migrant middle school students(β=-0.62)and non-returned migrant middle school students(β=-0.50)were negatively correlated with social sup-port scores in childhood.The sleep quality scores of returned migrant students(β=0.22)and non-returned migrant students(β=0.14)were positively correlated with NSSI scores.Conclusion:The prevalence of NSSI in returned migrant students is higher.Social support and sleep quality play an important role in the relationship between child-hood EM and NSSI in middle school students.The relationship between childhood EM and social support,sleep quality and NSSI in returned migrant middle school students is stronger than that in non-returned migrant middle school students.

Objective:To systematically assess the effectiveness and safety of acupuncture for spastic hemiplegia after ischemic stroke. Methods:Randomized controlled trials(RCTs)of acupuncture treatment for spastic hemiplegia after ischemic stroke meeting the inclusion criteria in Cochrane Library,Medline,Excerpta Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure(CNKI),SinoMed,Chongqing VIP Database(VIP),and Wanfang Data Knowledge Service Platform(Wanfang)published from each database's inception to February 2023 were retrieved by computer.Two reviewers independently extracted data and evaluated the risk of bias using Cochrane's risk of bias tool.Review Manager 5.4 was used for data analysis.Continuous data were evaluated using mean difference(MD)with a 95%confidence interval(CI),and dichotomous data were analyzed using risk ratio(RR). Results:A total of 24 trials,including 1 970 participants,were included in the study.The meta-analysis of 7 trials showed that compared to the rehabilitation therapy,acupuncture therapy was more effective in improving the simplified Fugl-Meyer assessment score after 1-month treatments[MD=10.52,95%CI(7.81,13.23),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.18,95%CI(11.34,27.02),P<0.001],and the 6-month treatment course resulted in better outcomes than the 1-month course.The meta-analysis of 8 trials showed that acupuncture had a better improvement on the Barthel index score than rehabilitation therapy after 1-month treatments[MD=10.78,95%CI(8.91,12.64),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.94,95%CI(19.02,20.87),P<0.001],and the 6-month course was better than the 1-month course.The meta-analysis of 2 trials showed that the effective rate of the modified Ashworth scale score improvement was more notable in the acupuncture group after 1-month treatments[RR=1.20,95%CI(1.02,1.40),P=0.020].One trial reported no adverse event,and 1 trial reported 3 adverse events without severe influence. Conclusion:Acupuncture might be an effective and safe therapy for spastic hemiplegia after ischemic stroke,but more high-quality,large-sample objectively-evaluated RCTs are needed to validate the conclusion.

The p21 activated kinase 4 (PAK4) is serine/threonine protein kinase that is critical for cancer progression. Guided by X-ray crystallography and structure-based optimization, we report a novel subseries of C-3-substituted 6-ethynyl-1H-indole derivatives that display high potential and specificity towards group II PAKs. Among these inhibitors, compound 55 exhibited excellent inhibitory activity and kinase selectivity, displayed superior anti-migratory and anti-invasive properties against the lung cancer cell line A549 and the melanoma cell line B16. Compound 55 exhibited potent in vivo antitumor metastatic efficacy, with over 80% and 90% inhibition of lung metastasis in A549 or B16-BL6 lung metastasis models, respectively. Further mechanistic studies demonstrated that compound 55 mitigated TGF-β1-induced epithelial-mesenchymal transition (EMT).

Kawasaki disease is an acute febrile systemic vasculitis of unknown etiology that mainly occurs in children under 5 years of age.Coronary artery lesions caused by Kawasaki disease has become one of the common acquired cardiovascular diseases in childhood.The degree of coronary artery lesions determines the prognosis and follow-up management of Kawasaki disease.The use of anticoagulant and antiplatelet drugs is the basis for the treatment of coronary artery disease in Kawasaki disease, while non-pharmacological treatment is another treatment for severe coronary artery lesions and ineffective drug therapy.This paper reviews the research progress of non-pharmacological treatment for coronary artery lesions of Kawasaki disease, providing new ideas for comprehensive and alternative treatment of the disease.

OBJECTIVE： To study the long-term toxicity of Liqi sanjie extractum in rats after intragastric administration， and to provide reference for safety evaluation before clinical practice. METHODS： A total of 160 rats were randomly divided into control group （normal saline） and Liqi sanjie extractum low-dose， medium-dose and high-dose groups （7.828 0， 15.656 0， 31.312 0 g/kg， calculated by crude drug）， with 40 rats in each group. They were given relevant medicine intragastrically once a day from Monday to Saturday. The experimental period was 120 days， and the recovery period was 30 days after the end of the experiment. General information of rats was observed， and body weight and feed consumption of rats were measured once a week. At the 61st day of administration， the end of administration and the end of recovery period， 10， 20 and 10 rats were collected from each group to observe their hematology， blood biochemistry， organ coefficient and histopathology changes. RESULTS： From 61st day to 120th day of administration， the rats of Liqi sanjie extractum high-dose group had hair loss and erection， and recovered after withdrawal of medicine. During medication， the body weight of mice in Liqi sanjie extractum low-dose and medium-dose groups increased faster than control group， while the body weight of rats in Liqi sanjie extractum high-dose group increased slower than control group. Compared with control group， the feed consumption of Liqi sanjie extractum low-dose group increased， while those of Liqi sanjie extractum medium-dose and high-dose groups decreased； the rats were recovered after drug withdrawal. On the 61st day of administration and after the end of administration， some hematological indexes， blood biochemical indexes and organ coefficients of rats in administration group were significantly different from those of control group （P＜0.05 or P＜0.01）. The hematology， blood biochemistry and organ coefficients of rats were basically recovered after the end of the recovery period. The number of erythrocyte， hematocrit， standard deviation of erythrocyte width， albumin， globulin ratio and potassium K+ levels in Liqi sanjie extractum low-dose group were significantly lower than those in control group （P＜0.05 or P＜0.01）. The absolute value of intermediate cells in blood of rats in Liqi sanjie extractum medium-dose group was significantly higher than that of control group （P＜0.05）， and the mean hemoglobin concentration， K+ and uterine coefficient in blood were significantly lower than those of control group （P＜0.05）. The number of white blood cells， absolute value of lymphocyte， absolute value of intermediate cells， the percentage of intermediate cells， prothrombin time and spleen coefficient in Liqi sanjie extractum high-dose group were significantly higher than those in the control group （P＜0.05 or P＜0.01）. Mean hemoglobin concentration， granulocyte percentage， albumin， alkaline phosphatase and K+ were significantly lower than those in the control group （P＜0.05 or P＜0.01）. No abnormalities in systemic autopsy and histopathology were noticed in rats. CONCLUSIONS： Long-term intragastric administration of Liqi sanjie extractum can cause certain toxic reactions in rats， and low dose of Liqi sanjie extractum causes less and lighter toxic reactions which can be automatically recovered after drug withdrawal. It can provide reference for the determination of clinical safe dose.

OBJECTIVE： To investigate the improvement effects of Liqi sanjie granule on liver-qi stagnation model rats. METHODS： According to the weight， totally 80 rats were randomly divided into blank control group （normal saline）， model control group （normal saline）， Xiaoyao pill control group （positive control a， 750 mg/kg ，calculated by crude drug）， Xiaojin pill control group （positive control b， 200 mg/kg， calculated by pill weight）， Liqi sanjie pill control group （prototype control， 1 957 mg， calculated by crude drug） and Liqi sanjie granule low-dose， medium-dose and high-dose groups （978.5， 1 957， 3 914 mg/kg， calculated by crude drug）， with 10 rats in each group. Each group was given medicine 20 mL/kg intragastrically once a day， for consecutive 21 d. 1 h after per medication， liver-qi stagnation model was established in those groups by binding method except for blank control group. The syrup preference of rats was determined by designing syrup preference test. Rattail suspension test was adopted to determine the hanging immobility time and struggling times of mice. Open-field behavior test was used to determine total behavior score so as to judge the extent of liver-qi stagnation and effect of the drug in rats. RESULTS： Compared with blank control group， hanging immobility time of model control group was significantly prolonged， the syrup preference and the total behavior score of open field test were decreased significantly， with statistical significance （P＜0.05 or P＜0.01）. Compared with model control group， the struggling times of rats were increased significantly in Xiaojin pill control group， Liqi sanjie pill control group and Liqi sanjie granule medium-dose group （P＜0.05 or P＜0.01）； the hanging immobility time of Xiaoyao pill control group， Xiaojin pill control group， Liqi sanjie pill control group， Liqi sanjie granule low-dose and medium-dose groups were shortened significantly； syrup preference and total behavior score of open-field behavior test were increased significantly （P＜0.05 or P＜0.01）. Compared with Liqi sanjie pill control group， the struggling times of rats were decreased significantly and hanging immobility time were prolonged significantly only in Liqi sanjie granule high-dose group （P＜0.05 or P＜0.01）； there was no statistical significance in above indexes of rats in Liqi sanjie granule low-dose and medium-dose groups （P＞0.05）. CONCLUSIONS： Liqi sanjie granule can significantly improve liver-qi stagnation caused by binding method， and the effects of low-dose and medium-dose Liqi sanjie granule are similar to those of Liqi sanjie pill.