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.

Early-onset colorectal cancer (EOCRC) shows a different epidemiological trend compared to later-onset colorectal cancer, with its incidence rising in most regions and countries worldwide. However, the reasons behind this trend remain unclear. The etiology of EOCRC is complex and could involve both genetic and environmental factors. Apart from Lynch syndrome and Familial Adenomatous Polyposis, sporadic EOCRC exhibits a broad spectrum of pathogenic germline mutations, genetic polymorphisms, methylation changes, and chromosomal instability. Early-life exposures and environmental risk factors, including lifestyle and dietary risk factors, have been found to be associated with EOCRC risk. Meanwhile, specific chronic diseases, such as inflammatory bowel disease, diabetes, and metabolic syndrome, have been associated with EOCRC. Interactions between genetic and environmental risk factors in EOCRC have also been explored. Here we present findings from a narrative review of epidemiological studies on the assessment of early-life exposures, of EOCRC-specific environmental factors, and their interactions with susceptible loci. We also present results from EOCRC-specific genome-wide association studies that could be used to perform Mendelian randomization analyses to ascertain potential causal links between environmental factors and EOCRC.
Humans ; Colorectal Neoplasms/etiology* ; Risk Factors ; Genome-Wide Association Study ; Genetic Predisposition to Disease/genetics*

Objective To investigate the prevalence of Echinococcus infections in small rodents around human residential areas in Yushu City, Qinghai Province in 2023, so as to provide insights into precision echinococcosis control. Methods One or two quadrats, each measuring 50 m × 50 m, were randomly assigned in Shanglaxiu Township and Longbao Township, Yushu City, Qinghai Province on June 2023, respectively, and 300 plate-type mouse traps, each measuring 12.0 cm × 6.5 cm, were assigned in each quadrat. Small rodents were captured during the period between 10 : 00 and 18 : 00 each day for 4 days. Then, all captured small rodents were identified and dissected, and liver specimens with suspected Echinococcus infections were subjected to pathological examinations. The Echinococcus cytochrome c oxidase 1 (cox1) gene was amplified using PCR assay, and the sequence of the amplified product was aligned to that was recorded in the GenBank to characterize the parasite species. In addition, a phylogenetic tree of Echinococcus was generated based on the cox1 gene sequence using the neighbor-joining method. Results A total of 236 small rodents were captured in Shanglaxiu and Longbao townships, Yushu City, including 65 Qinghai voles and 51 plateau pikas in Shanglaxiu Township, and 62 Qinghai voles and 58 plateau pikas in Longbao Township, and there was no significant difference in the constituent ratio of small rodents between the two townships (χ² = 0.294, P > 0.05). Seven plateau pikas and 12 Qinghai voles were suspected to be infected with Echinococcus by dissection, and pathological examinations showed unclear structure of hepatic lobules and disordered hepatocyte arrangement in livers of small rodents suspected of Echinococcus infections. PCR assay identified E. shiquicus DNA in 7 Qinghai voles, which were all captured from Shanglaxiu Township. Phylogenetic analysis showed that the cox1 gene sequence of Echinococcus in small rodents was highly homologous to the E. shiquicus cox1 gene sequence reported previously. Conclusion Plateau pika and Qinghai vole were predominant small rodents around human residential areas in Yushu City, Qinghai Province in 2023, and E. shiquicus infection was detected in Qinghai voles.

Objective To investigate the clinical efficacy of liver-soothing and spleen-reinforcing acupuncture in treating functional constipation.Methods Sixty patients with functional constipation were randomly allocated to treatment and control groups, 30 cases each. The treatment group received liver-soothing and spleen-reinforcing acupuncture and the control group, oral administration of prucalopride succinate tablets. The number of complete spontaneous bowel movements (CSBM), the number of spontaneous bowel movements (SBM), constipation symptoms (defecation time, defecatory difficulty and fecal characters) scores and The Patient Assessment of Constipation Quality of Life (PAC-QOL) score were recorded in the two groups before and after two and four weeks of treatment. The clinical therapeutic effects were compared.Results After two weeks of treatment, there were statistically significant pre-/post-treatment differences in CSBM and SBM in the treatment group (P<0.05) and significant post-treatment differences in CSBM and SBM between the two groups (P<0.05). After four weeks of treatment, there were statistically significant pre-/post-treatment differences in CSBM and SBM in the two groups (P<0.05) and no significant post-treatment differences in CSBM and SBM between the two groups (P>0.05). After two and four weeks of treatment, there were statistically significant pre-/post-treatment differences in constipation symptoms scores in thetwo groups (P<0.05). After two weeks of treatment, the defecation time and defecatory difficulty scores were significantly lower in the treatment group than in the control group; there were statistically significant differences between the two groups (P<0.05). After two and four weeks of treatment, the fecal character score was significantly higher in the control than in the treatment group; there was a statistically significant difference between the two groups (P<0.05). There were statistically significant pre-/post-treatment differences in the PAC-QOL scores in the two groups (P<0.05) and no significant post-treatment differences in the PAC-QOL scores between the two groups (P>0.05). The total efficacy rate was 80.0% in the treatment group and 73.3% in the control group; there was no statistically significant difference between the two groups (P>0.05).Conclusions Liver-soothing and spleen-reinforcing acupuncture has a marked therapeutic effect on functional constipation. It produces a quick effect with high safety.

Objective To observe the clinical efficacy of Bu Shen Tiao Qi(supplementing the kidney and regulating qi) needling in treating perimenopausal syndrome.Method Fifty patients were randomized into two groups, 25 cases each. The treatment group was intervened by Bu Shen Tiao Qineedling combined with electroacupuncture, while the control group was by shallow needling plus sham electroacupuncture. Kupperman Index (KI) wasobserved respectively before treatment, after 2-week and 4-week treatment, and in the 4-week follow-up study. The differences of scores and improvements of the 13 symptoms listed in KI were calculated.Result The total effective rate was 92.0% in the treatment group versus 44.0% in the control group; in the treatment group, the KI scores after 2-week treatment and in the 4-week follow-up study were significantly different from that before treatment (P<0.05), and a more significant difference was found after 4-week treatment (P<0.01); the between-group differences were statistically significant in comparing KI (P<0.05).Conclusion Bu Shen Tiao Qineedling can produce a satisfactory efficacy in treating perimenopausal syndrome.

Objective To investigate the reduce of experimental autoirnmune encephalomyelitis(EAE) susceptivity after lipopolysaccharide (LPS) exposure in neonatal rats and its relation with inhibition of macrophage immune function.Methods Litter male neonatal rats were divided into blank control group (n=1 1),phosphate buffer (PBS) group (n=12) and LPS group (n=12);rats in the LPS group were performed intraperitoneal injection of 50 μL LPS on postpartum day 3 and 5.Rats in the PBS group and LPS group were established EAE models by immune induce of spinal cord homogenate of guinea pig with complete Freund's adjuvant at 12 weeks old,while rats in the blank control group were given immune induce of complete Freund's adjuvant.Since the day of induce,the behavioral scale scores of all the rats were assessed.On the 20th d,all rats were sacrificed and paraffin sections were cut and stained with HE to detect inflammatory cell infiltration.The number of infiltrating macrophages and the expressions of CD86,CD80,MHC-Ⅱ were determined by flow cytometry.The transcriptional levels of C-C chemokine receptor type 2 (CCR2),interleukin (IL)-1β and tumor necrosis factor (TNF)-α in macrophages were determined by real-time fluorogenic quantitative PCR.Results As compared with the PBS group,LPS group had significantly lower EAE incidence (11/12 vs.5/12) and higher EAE latency ([10.50±0.71] d vs.[12.17± 1.17] d),and statistically decreased cumulative clinic scores and peak clinic scores (20.00±9.13 vs.5.58±7.12;2.58±1.08 vs.1.03±0.83,P＜0.05).The inflammation in the spinal cord of the PBS group was severer than that in the LPS group (2.83±0.75 vs.1.17±1.17,P＜0.05).The number of infiltrating macrophages of the PBS group was significantly larger than that in the LPS group ([202.70 ±81.89] × 103 cells vs.[92.58 ±42.65] × 103 cells,P＜0.05).The expressions of CD80 and MHC-Ⅱ,and mRNA levels of CCR2,IL-1β and TNF-α in the PBS group were significantly higher than those in the LPS group (P＜0.05).Conclusion Neonatal LPS exposure reduces the severity of EAE,which may relate to impaired macrophage immune function.

Objective:To share the experience of clinical cooperation of physicians and clinical pharmacists in the treatment of one case of rodenticide poisoning. Methods: One case of rodenticide poisoning was early diagnosed by physicians according to the con-sciousness disorder and coagulation dysfunction. Clinical pharmacists participated in the drug treatment actively through providing vita-min K1 at the dose of 30 mg·d-1 as the treatment dose and monitoring the effectiveness. Toxicology analysis was recommended, and 718 ng·ml-1 bromadiolone was found out in the blood samples. According to the long half-life of bromadiolone, the initial duration of treatment was set at 2-3 months, while follow-up plan and final duration of treatment were defined based on coagulation parameters and poison concentration monitoring results. Results:The patient recovered rapidly after hospitalization due to the cooperation of physicians and clinical pharmacists through quickly correcting diagnosis of physicians and actively participating in medication of clinical pharma-cists. After the 3-month treatment, the coagulation parameters of the patient were normal and the patient was discharged with follow-up. Conclusion:The collaboration of physicians and clinical pharmacists leads to the optimal regimen with early, full dose and long course of vitamin K1 therapy.

Objective To investigate the correlation between human leukocyte antigens-A,-B,-DRB1 (HLA-A,-B,-DRB1) high resolution alleles and chronic renal failure (CRF) caused by immunoglobulin-a nephropathy (IgAN).Method The polymerase chain reaction-sequence-based typing (PCR-SBT) method was used to investigate the genotypes of HLA-A,-B and-DRB1 high-resolution alleles in 191 cases of CRF caused by IgAN (experimental group) and 503 healthy blood donors (control group).The alleles frequencies between two groups were compared and the association between CRF caused by IgAN and the polyrnorphism of HLA was analyzed.Result (1) There were 25 alleles at A locus,48 alleles at B locus and 32 alleles at DRB1 locus in experimental group.(2) The genetic frequency of HLAA * 2901 [Pc =0.033,OR =10.738,95％ CI (1.193,96.691)],HLA DRB1 * 1106 [Pc =0.0001,OR =0.969,95％ CI (0.944,0.994)],HLA-DRB1 * 1202[Pc =0.002,OR =1.859,95％ CI (1.259,2.745)],HLA-DRB1 * 1401 [Pc =0.021,OR =0.984,95％ CI (0.967,0.998)],HLA-DRB1 * 1602[Pc=0.015,OR=1.915,95％ CI (1.157,3.17)] in experimental group was higher than in control group (P＜0.05).Conclusion There is susceptibility association of HLA-A * 2901,HLA-DRB1 * 1106,HLA-DRE * 1202,HLA-DRB1 * 1401,HLA-DRB1 * 1602 with CRF caused by IgAN.It is concluded that there is a close genetic and immunological correlation between HLA alleles and the pathogenesis of CRF caused by IgAN.

OBJECTIVE:To systematically review the efficacy and safety of pituitrin combined with phentolamine versus pitui-trin alone in the treatment of bronchiectasis hemoptysis(BH),and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from PubMed,Cochrane Library,EMBase,CJFD,Wanfang and VIP database,the randomized controlled trails(RCT)about pituitrin combined with phentolamine(test group)versus pituitrin alone(control group)in the treatment of BH were collected,and afterdata extract and quality evaluation ,Meta-analysis was performed by using Rev Man 5.2.3 statistics soft-ware. RESULTS:A total of 43 RCTs were included,involving 3 094 patients. Results of Meta-analysis showed the significant effi-cacy [RR=1.50,95%CI(1.38,1.62),P<0.001] and effective rate [RR=1.25,95%CI(1.20,1.30),P<0.001] in test group were sig-nificantly higher than control group,inefficacy [RR=0.29,95%CI(0.23,0.36),P<0.001], hemoptysis stopped or remission time [MD=-2.00,95%CI(-2.43,-1.57),P<0.001],incidence of headache [RR=0.36,95%CI(0.22,0.59),P<0.001],incidence of chest tightness [RR=0.41,95%CI(0.26,0.63),P<0.001],incidence of abdominal pain [RR=0.26,95%CI(0.16,0.43),P<0.001] and incidence of elevated blood pressure [RR=0.28,95%CI(0.14,0.56),P<0.001] in test group were significantly lower than control group,there were significant differences in 2 groups. CONCLUSIONS:Pituitrin combined with phentolamine has better efficacy and safety than pituitrin alone in the treatment of BH. Due to the limit of methodological quality and sample size,it re-mains to be further verified with more rigorously designed and long-term follow-up of large-scale RCT.

Objective To compare the effect of mirror therapy (MT) supplemented by early rehabilitative intervention and acupunture therapy on recovery of hemiplegic limb function versus routine occupational training in post-stroke elderly patients.Methods Totally 120 acute-stroke elderly patients with limb paralysis were randomly divided into two groups:MT group and control group (n=60,each).All 120 patients received routine rehabilitative intervention and acupunture therapy except for 30 minutes mirror therapy daily as add-on therapy to the MT group,all patients were assessed with Chinese Stroke Scale(CSS) and the Barthel index(BI) before and after treatment 1 and 3 months.Results At the end of 1 and 3 months of treatment,CSS in the MT groups was (15.6±8.5)scores,(11.6±7.2)scores,ADL was (75.3±13.9)scores,(80.1±13.0)scores;CSS in the control group was (16.2±5.8)scores,(14.8±6.1)scores,ADL was (68.2±13.5)scores,(70.5±12.9)scores.Before treatment,CSSandADLwas (21.3±7.1)scores,(63.7±12.6)scoresin the MT group; (20.8 ± 7.6) scores,(61.7 ± 11.4) scores in the control group.There were significant differences in CSS and ADL between groups,except CSS after 1 month (t=1.40,2.38,-3.27,-3.47; P=0.166,0.019,0.001,0.001,respectively).After 3 months of treatment,CSS and ADL in the MT group had considerably outperformed those of the control group(t=2.40,-3.47,P＜0.05 or 0.01).Conclusions Mirror therapy is better than routine occupational training in improving the motor function of limbs and activities of daily living(ADL) ability 3 months after stroke,on the basis of early rehabilitative intervention and acupunture therapy.