The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

OBJECTIVE: To explore the corrective strategies and effectiveness of osteotomy surgery for severe lower limb deformities in hypophosphatemic rickets. METHODS: A retrospective analysis was conducted on 29 patients with severe lower limb deformities of hypophosphatemic rickets who underwent surgical treatment between February 2012 and August 2024. There were 9 males and 20 females. The age ranged from 13 to 53 years, with an average of 24.6 years. All patients were deformities of both lower limbs, presenting as 24 cases of O-shaped legs, 2 cases of wind-blown deformities, and 3 cases of X-shaped legs. Based on the full-length films of both lower limbs in the standing position before operation, the osteotomy planes of the femur, tibia, and fibula were designed. Among them, if both the same-sided thigh and leg were deformed, staged surgeries of both lower limbs were selected. If only the thigh or leg were deformed, simultaneous surgeries of both lower limbs were selected. The femur deformity was corrected immediately after osteotomy at the deformed plane; the osteotomy fragment was temporarily controlled with an external fixator, which was removed after perform internal fixation with a steel plate. After fibular osteotomy, the Ilizarov frame or Taylor frame was installed on the tibia and fibula. The threaded rods were removed and then tibial osteotomy was performed on the deformed plane. Patients using the Taylor frame did not undergo deformity correction during operation. The external fixators were adjusted starting 7 days after operation to correct the varus, valgus, and rotational deformities of the lower limb. Patients using the Ilizarov frame corrected the rotational deformity of the tibia during operation. The external fixator was adjusted starting 7 days after operation to correct the varus and valgus deformities of the lower limb. During the treatment period, the patient could walk with partial weight-bearing on the operated limb with crutches. The external fixator was removed after the bone healed. Before operation and at last follow-up, the medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), anatomic lateral distal femoral angle (aLDFA), posterior distal femoral angle (PDFA), and mechanical axis deviation (MAD), lower limb rotation, limb length discrepancy (LLD) were measured. The self-made scoring criteria were adopted to evaluate the degree of lower limb deformity of the patients. RESULTS: All operations were successfully completed, and no complications such as nerve or vascular injury occurred. The adjustment time of the external fixator of the lower limb after operation was 28-46 days, with an average of 37.4 days. The wearing time of the external fixator ranged from 134 to 398 days, with an average of 181.5 days. Mild pin tract infections occurred in 2 limbs. The osteofascial compartment syndrome occurred in 1 limb after operation. No complications related to orthopedic adjustment of the external fixator occurred in other patients. All patients were followed up 6-56 months, with an average of 28.2 months. At last follow-up, full-length films of both lower limbs in the standing position showed that the coronal mechanical axes of the lower limbs of all patients returned to the normal. At last follow-up, MPTA, LDTA, PPTA, aLDFA, PDFA, MAD, lower limb rotation, LLD, and the score of lower limb deformity significantly improved when compared with those before operation ( P<0.05). There was no significant difference in ADTA between pre- and post-operation ( P>0.05). The degree of lower limb deformity were rated as moderate in 2 cases and poor in 27 cases before operation and as excellent in 7 cases, good in 18 cases, and moderate in 4 cases at last follow-up, with an excellent and good rate of 86.2%. CONCLUSION For severe lower limb deformities in hypophosphatemic rickets, immediate correction of deformities with femoral osteotomy and internal plate fixation, as well as gradually correction of deformities with tibiofibular osteotomy and circular external fixation (Ilizarov frame or Taylor frame), have satisfactory therapeutic effects.
Humans ; Male ; Osteotomy/instrumentation* ; Female ; Adult ; Retrospective Studies ; Tibia/abnormalities* ; Adolescent ; Femur/abnormalities* ; Middle Aged ; Fibula/surgery* ; Rickets, Hypophosphatemic/complications* ; Young Adult ; Treatment Outcome ; External Fixators ; Bone Plates ; Lower Extremity Deformities, Congenital/etiology*

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

Objective:To study the effect of anti-melanoma differentiation-related gene 5(MDA5) antibody positive dermatomyositis on the heart of patients.Methods:A total of 71 patients with dermatomyositis diagnosed in Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 1, 2014 to December 31, 2019 were enrolled as the sample group, including anti-MDA5 (+) group( n=28); anti-MDA5(-) groups( n=43). Electrocardiogram and echocardiography were performed in the sample group and the control group. The electrocardiogram, echocardiography and other relevant clinical data of the anti-MDA5 (+) group, anti-MDA5 (-) group and the healthy control group were retrospectively analyzed. The logistic regression analysis model was used to analyze the related factors influencing cardiac involvement in anti-MDA5 (+) patients. Results:In the anti-MDA5 (+) group, more than half of the patients showed elevated levels of lactate dehydrogenase (21/28, 75%) and α-hydroxybutyrate dehydrogenase (16/28, 57%), and 11%(3/28) showed elevated levels of creatine kinase isoenzyme and myoglobin. Compared with the anti-MDA5 (-) group, the white blood cell count in the blood routine of the anti-MDA5 (+) group [5.2 (4.0, 6.5) ×10 9/L vs. 7.8 (5.6, 10.6)×10 9/L, Z=-3.447, P=0.001], creatine kinase [62.5 (29.3, 108.3) U/L vs. 481.0 (179.0, 2 738.0) U/L, Z=-5.895, P<0.001], lactate dehydrogenase [313.0 (239.0, 362.0) U/L vs. 448.0 (291.0, 542.0) U/L, Z=-3.236, P<0.001], creatine kinase isoenzyme [1.9 (1.1, 3.9)ng/ml vs. 17.7 (4.0, 67.2) ng/ml, Z=-4.724, P<0.001], myoglobin [28.2 (20.0, 43.0) ng/ml vs. 307.4 (48.1, 612.2) ng/ml, Z=-4.800, P<0.001]. Electrocardiogram analysis showed that QRS axis [33.5±265.9 vs. 46.9±22.4, t=-2.900, P=0.004], SV1 amplitude [0.7 (0.4, 0.9) vs. 0.9 (0.7, 1.0), Z=-2.148, P=0.023] in anti-MDA5 antibody (+) group in anti-MDA5 antibody (+) group were lower than anti-MDA5 antibody (-) group. QRS duration [84.0 (78.0, 96.5) vs.92.0 (87.8, 100.5), Z=-2.900, P=0.004], QRS axis [33.5±265.9 vs. 46.9±20.4, Z=-2.32, P=0.023] in the anti-MDA5 antibody (+) group were lower than those in healthy control group. Echocardiographic analysis showed that the E peak of anti-MDA5 (+) group [63.0 (52.5, 69.5)] was significantly lower than that of anti-MDA5 (-) group [85.0 (68.0, 108.0), Z=-4.926, P<0.001)]and healthy control group [67.0 (62.8, 80.3), Z=-2.897, P=0.004]. The peak A of anti-MDA5 (+) group [65.5 (56.5, 80.0)] was significantly lower than that of anti-MDA5 (-) group [76.0 (65.0, 90.0), Z=-2.631, P=0.011], but higher than that of healthy control group [55.0(51.0, 66.5), Z=-4.550, P<0.001]. There was no significant difference in echocardiographic findi-ngs among the other groups. All patients with anti-MDA5 (+) dermatomyositis had interstitial lung disease (28/28, 100%). Patients with MDA5 antibody (+++) are more likely to have cardiac involvement than patients with MDA5 antibody (++). Conclusion:The results of relevant examinations in anti-MDA5-DM patients suggest that there is damage to myocardial cells and cardiac function.

Kaempferol(KAE),as a natural flavonoid compound,possesses multiple biological activities including po-tent anti-inflammatory,antioxidant,and immunomodulatory effects,as well as anti-cancer properties.It has demonstrated good therapeutic effects in the intervention and treatment of various ocular diseases such as fungal keratitis,corneal trans-plantation rejection,age-related macular degeneration,and diabetic retinopathy.Furthermore,the development of novel ocular drug delivery systems-such as KAE-loaded bovine serum albumin porous membranes,KAE eye drops based on poly-vinylpyrrolidone nanocomplexes,gelatin nanoparticles encapsulating KAE,and platelet-derived extracellular vesicles loaded with KAE-has improved the bioavailability of KAE,laying a foundation for expanding its applications.However,there is a lack of systematic and comprehensive reviews on the application of KAE in ophthalmic diseases.Therefore,this article summarizes the research progress,efficacy mechanisms,and novel delivery methods of KAE in ophthalmic diseases,ai-ming to provide new diagnostic and therapeutic strategies for the treatment of related ocular conditions.

Objective To explore the application of artificial intelligence (AI) in the standardized training of thoracic surgery residents, specifically in enhancing clinical skills and anatomical understanding through AI-assisted lung nodule identification and lung segment anatomy teaching. Methods Thoracic surgery residents undergoing standardized training at Peking Union Medical College Hospital from September 2023 to September 2024 were selected. They were randomly assigned to a trial group and a control group using a random number table. The trial group used AI-assisted three-dimensional reconstruction technology for lung nodule identification, while the control group used conventional chest CT images. After basic teaching and self-practice, the ability to identify lung nodules on the same patient CT images was evaluated, and feedback was collected through questionnaires. Results A total of 72 residents participated in the study, including 30 (41.7%) males and 42 (58.3%) females, with an average age of (24.0±3.0) years. The trial group showed significantly better overall diagnostic accuracy for lung nodules (91.9% vs. 73.3%) and lung segment identification (100.0% vs. 83.70%) compared to the control group, and the reading time was significantly shorter [ (118.5±10.5) s vs. (332.1±20.2) s, P<0.01]. Questionnaire results indicated that 94.4% of the residents had a positive attitude toward AI technology, and 91.7% believed that it improved diagnostic accuracy. Conclusion AI-assisted teaching significantly improves thoracic surgery residents’ ability to read images and clinical thinking, providing a new direction for the reform of standardized training.

The retina is a crucial site for mediating the conversion of external light signals into neural electrical signals.Connexin (Cx), as the basic structural and functional protein molecule of gap junction channels, plays an important role in maintaining the functional homeostasis of the retina.Cx36 has physiological functions in aspects such as retinal information transmission and biochemical factor regulation, and is involved in the formation of myopia.The " local retina-sclera remodeling" theory holds that abnormal visual information acts on the retina, causing sclera remodeling through retinal pigment epithelium-choroid signal transduction, and ultimately leading to myopia.Exploring the role and mechanism of retinal Cx36 in visual development and myopia formation is of great guiding significance for myopia prevention and control.This article reviews the research progress in the physiological functions of Cx36 in the retina and its role in myopia development in recent years.

The retina is a crucial site for mediating the conversion of external light signals into neural electrical signals.Connexin (Cx), as the basic structural and functional protein molecule of gap junction channels, plays an important role in maintaining the functional homeostasis of the retina.Cx36 has physiological functions in aspects such as retinal information transmission and biochemical factor regulation, and is involved in the formation of myopia.The " local retina-sclera remodeling" theory holds that abnormal visual information acts on the retina, causing sclera remodeling through retinal pigment epithelium-choroid signal transduction, and ultimately leading to myopia.Exploring the role and mechanism of retinal Cx36 in visual development and myopia formation is of great guiding significance for myopia prevention and control.This article reviews the research progress in the physiological functions of Cx36 in the retina and its role in myopia development in recent years.

Kaempferol(KAE),as a natural flavonoid compound,possesses multiple biological activities including po-tent anti-inflammatory,antioxidant,and immunomodulatory effects,as well as anti-cancer properties.It has demonstrated good therapeutic effects in the intervention and treatment of various ocular diseases such as fungal keratitis,corneal trans-plantation rejection,age-related macular degeneration,and diabetic retinopathy.Furthermore,the development of novel ocular drug delivery systems-such as KAE-loaded bovine serum albumin porous membranes,KAE eye drops based on poly-vinylpyrrolidone nanocomplexes,gelatin nanoparticles encapsulating KAE,and platelet-derived extracellular vesicles loaded with KAE-has improved the bioavailability of KAE,laying a foundation for expanding its applications.However,there is a lack of systematic and comprehensive reviews on the application of KAE in ophthalmic diseases.Therefore,this article summarizes the research progress,efficacy mechanisms,and novel delivery methods of KAE in ophthalmic diseases,ai-ming to provide new diagnostic and therapeutic strategies for the treatment of related ocular conditions.

Objective:To compare the clinical effects of pedicle screw internal fixation under different approaches for the treatment of asymptomatic thoracolumbar fractures.Methods:Retrospective analysis was conducted to collect data from 83 patients with asymptomatic thoracolumbar fractures treated with pedicle screw internal fixation at Handan Central Hospital from January 2023 to December 2023. Based on different surgical approaches, 40 patients who underwent regular percutaneous approach surgery were included in the conventional approach group, and 43 patients who underwent modified Wiltse approach surgery were included in the modified approach group. The perioperative indexes and postoperative complications of the two groups were statistically analyzed. The visual analogue score (VAS) was compared before operation, 1 month after operation and 3 months after operation. The anterior vertebral height, Cobb angle and fracture healing factors were compared before operation and 3 months after operation.Results:The surgical time, incision length and intraoperative fluoroscopy frequency of the modified approach group were all lower than those of the conventional approach group: (65.75 ± 7.16) min vs. (74.28 ± 6.85) min, (6.75 ± 0.42) cm vs. (9.58 ± 0.50) cm and (9.22 ± 1.24) times vs. (21.03 ± 2.45) times, with statistically significant differences ( P<0.05). The total incidence of postoperative complications in the modified approach group was 9.30% (4/43), while the total incidence of postoperative complications in the conventional approach group was 15.00% (6/40), with no statistically significant difference ( P>0.05). The VAS of the modified approach group was lower than that of the conventional approach group at 1 and 3 months after surgery: (3.05 ± 0.82) points vs. (3.86 ± 0.85) points and (1.62 ± 0.32) points vs. (2.24 ± 0.54) points, with statistically significant differences ( P<0.05). Three months after surgery, the height of the anterior vertebral edge, serum type Ⅰ procollagen N-terminal propeptide and platelet-derived growth factor in the modified approach group were significantly higher than those in the conventional approach group: (72.96 ± 9.27)% vs. (67.58 ± 9.02)%, (174.36 ± 16.75) μg/L vs. (146.24 ± 15.86) μg/L, (250.28 ± 14.62) U/L vs. (241.20 ± 12.75) U/L, the Cobb angle was lower than that of the conventional approach group: (10.15 ± 1.32)° vs. (12.20 ± 1.86)°, with statistically significant differences ( P<0.05). Conclusions:The modified Wiltse approach and percutaneous approach pedicle screw internal fixation are safe and effective in treating asymptomatic thoracolumbar fractures; but compared to the latter, the former has a shorter surgical time, fewer intraoperative fluoroscopy sessions, and less postoperative pain. It has better effects in improving the height of the anterior edge of the injured vertebra, Cobb angle recovery, and fracture healing factors.