With the continuous deepening of the concept of precision diagnosis and treatment for lung cancer, how to achieve higher efficiency and accuracy in the screening, diagnosis, and treatment pathways in clinical practice has become an important issue that urgently needs to be overcome. The current clinical difficulty lies in the fact that despite continuous advancements in imaging and molecular diagnostic technologies, there are still limitations in manual efficiency and subjective experience when it comes to massive data analysis and multi-scale feature extraction. Artificial intelligence (AI), especially algorithm systems based on deep learning, is an innovative technology capable of deeply empowering medical big data. This method utilizes algorithms such as convolutional neural networks, combined with radiomics, pathomics, and multi-modal data fusion analysis, demonstrating immense potential in early precise detection and benign-malignant differentiation of pulmonary nodules, digital pathological subtype recognition and non-invasive prediction of driver genes, precise 3D surgical planning and automatic delineation of radiotherapy target volumes, as well as dynamic risk warning during follow-up. This innovative technology provides a brand-new solution for realizing intelligent and individualized lung cancer diagnosis and treatment models. This consensus, based on the latest evidence from evidence-based medicine and combined with the development trends in the AI field and real-world clinical needs, was ultimately formed by gathering the consensus opinions of multidisciplinary experts in radiology, pathology, thoracic surgery, and other fields. The main content covers the application specifications of AI in the three core scenarios of lung cancer screening, diagnosis, and treatment, the technical standards for data collection and algorithm validation, as well as the ethical and regulatory challenges faced at the current stage. It aims to clarify the applicable boundaries of AI as a clinical auxiliary decision support tool, providing scientific guidance and standardized exploration directions for peers currently engaged in or planning to carry out AI-assisted clinical diagnosis, treatment, and translation of lung cancer.

The expert consensus on the clinical treatment of herpes zoster with fire needling was developed, and the commonly used fire needling treatment scheme verified by clinical research was selected to form a standardized diagnosis and treatment scheme for acute herpes zoster and postherpetic neuralgia (PHN), so as to answer the core problems in clinical application. The consensus focuses on patients with herpes zoster, and forms recommendations for 9 key clinical issues, covering simple fire needling and TCM comprehensive therapy based on fire needling, including fire needling combined with cupping, fire needling combined with Chinese herb, fire needling combined with cupping and Chinese herb, fire needling combined with filiform needling, fire needling combined with moxibustion, and provides specific recommendations and operational guidelines for various therapies.
Humans ; Herpes Zoster/therapy* ; Acupuncture Therapy/instrumentation* ; Consensus ; Clinical Protocols

Objective To analyze the medical malpractice technical appraisals accepted by a health administration department,and to provide suggestions for the work improvement of the health administration department and its affiliated medical institutions.Methods A total of 57 cases of technical appraisals for medical malpractice accepted from 2015 to 2023 were analyzed retrospectively.Yi fa hui's reasons for the failure of medical institutions were taken as the main classification basis of the medical fault.Results There were 51 cases of the first appraisal and 6 cases of the second appraisal.Among them,38 cases were completed,and the completion rate was 66.67%,involving 15 departments;17 cases were deemed medical accidents.The most frequent category was Grade 1 medical malpractice with minor liability borne by the healthcare provider,involving 8 types of faults.Conclusion The majority of appraisals accepted by a health administration department is the first appraisal,and the completion rate of appraisal needs to be improved.It is suggested that the health administration department should do well in the explanation and communication in the process of medical malpractice technical appraisal,and medical institutions should strengthen their supervision responsibility for clinical work.

Osteoarthritis （OA） and stroke are common clinical diseases that reduce patients' quality of life and place a burden on families and society. Ruyi Zhenbaowan， a classic prescription in Tibetan medicine， have the functions of clearing heat， awakening the brain and opening orifices， relaxing tendons and promoting meridian circulation， and eliminating yellow water. Clinically， they are used to treat osteoarthritis， post-stroke sequelae， neuropathic pain， and other related conditions. Modern pharmacological studies have demonstrated their anti-inflammatory， analgesic， and nerve-repairing effects. However， current research remains insufficient regarding the appropriate indications， timing， and efficacy of this medicine in treating relevant diseases. To enhance clinicians' understanding of this medicine and promote its standardized and rational clinical use， a panel of national experts， including clinical specialists， Tibetan medicine practitioners， pharmacologists， and methodologists， formulated this consensus based on clinical experience and evidence-based practice. The Cochrane systematic review framework， the Grading of Recommendations Assessment， Development and Evaluation （GRADE） system， and the nominal group method were employed to generate seven graded recommendations and 19 consensus-based suggestions. These recommendations clearly define the key points in the clinical application of Ruyi Zhenbaowan， including therapeutic indications， dosage and administration， treatment duration， and medication safety. The consensus specifically addresses the clinical efficacy， appropriate timing of administration， dosage strategies， treatment cycles， and combination medication strategies for treating osteoarthritis and stroke and provides an overview of safety considerations. The aim is to provide standardized guidance for hospitals and healthcare institutions nationwide to ensure the rational application of Ruyi Zhenbaowan in the treatment of osteoarthritis and stroke， reduce medication-related risks， and further leverage its clinical advantages. This consensus has been approved and issued by the China Association of Chinese Medicine， with the standard number GS/CACM 369-2024.

Liver diseases have become a major challenge threating the global health, posing a heavy burden on both social and personal well-being. In recent years, the development of the gut-liver axis theory has provided new research perspectives and intervention strategies for the prevention and treatment of liver diseases. Natural products, recognized as biological molecules with diverse sources, rich activities, and minimal side effects, demonstrate great potential in regulating intestinal flora and improving liver health. Studies have shown that natural products such as saponins, polyphenols, polysaccharides, and alkaloids can regulate the composition and metabolites of intestinal flora, thereby intervening in liver diseases. In this paper, we systematically review the role of natural products in the regulation of the intestinal flora-gut-liver axis and summarize recent research progress in the prevention and treatment of liver diseases. Furthermore, we outline the challenges and limitations currently facing the study in this field. Finally, this paper makes an outlook on the clinical application of natural products in treating liver diseases and discusses future research directions, aiming to give new insights into the mechanisms by which natural products regulate the intestinal flora-gut-liver axis and the applications of these products in the prevention and treatment of liver diseases.
Humans ; Gastrointestinal Microbiome/drug effects* ; Liver Diseases/prevention & control* ; Biological Products/pharmacology* ; Polyphenols/pharmacology* ; Saponins/pharmacology* ; Intestines/microbiology* ; Alkaloids/pharmacology* ; Polysaccharides/pharmacology* ; Liver

Breast cancer remains one of the frequently diagnosed malignant tumors among Chinese women,with hereditary cases accounting for 5%-10%of all diagnoses,where BRCA1/2 gene mutations serve as the primary genetic predisposition factors.Although targeted therapies like poly(ADP-ribose)polymerase(PARP)inhibitors have significantly improved prognoses for patients with BRCA-mutated breast cancer in recent years,critical clinical challenges persist,including the standardization of genetic testing protocols,optimization of precision treatment approaches,and refinement of long-term management strategies.In response to these challenges,our expert panel has conducted a comprehensive update to the 2018 Edition of this consensus by integrating the latest global evidence-based medical research with China's unique clinical practice characteristics.This 2025 Edition provides systematic evaluations and recommendations on five key aspects:indications for BRCA1/2 gene testing,testing methodologies,result interpretation,treatment strategies,and risk management.The main updates include:① Increasing the relationship between BRCA1/2 gene mutations and programmed death ligand-1(PD-L1)expression,as well as related content on BRCAness types;② Standardizing the application of genetic testing,such as increasing the significance,timing,and sample selection of clinical testing,and optimizing the BRCA testing population;③ Updating treatment strategies,such as non-drug treatment of BRCA1/2 gene mutation,treatment of triple negative breast cancer(TNBC)patients with BRCA1/2 gene mutation,treatment decisions of hormone receptor(HR)+/human epidermal growth factor receptor 2(HER2)-breast cancer patients with BRCA1/2 gene mutation,clinical use of PARP inhibitors and adverse reaction management;④ Addion of relevant content on long-term risk management,such as covering follow-up management,indications for preventive surgery,quality control and requirements for new genetic testing,updating genetic testing processes,report content and interpretation.This consensus aimed to establish standardized diagnostic and therapeutic frameworks for clinicians,advance precision medicine in BRCA-mutated breast cancer,and ultimately improve patient survival outcomes.As new evidence emerges,continuous updates will be implemented to incorporate the latest research findings.This consensus has been registered on the Practice guideline REgistration for transPAREncy(PREPARE)platform(registration number:PREPARE-2025CN1085).

Objective To comprehensively evaluate the quality difference of Huaihua powder obtained by the hospital's electromagnetic furnace decoction method and automatic decoction machine decoction method.Methods Five methods(induction cooker decoction(once decoction,twice decoction),normal pressure decoction(once decoction,twice decoction),and pressure decoction)were used to prepare the decoction.The HPLC method used a Shiseido CAPCELL PAK-C18(250 mm×4.6 mm,5 μm)column,with a UV detection wavelength of 254 nm,mobile phase of acetonitrile 0.1%phosphoric acid water,column temperature of 30℃,flow rate of 1.0 mL/min,and detection of index components including rutin,naringin,quercitrin,neohesperidin,quercetin,and menthone.The extraction rate of the index components was calculated and the cream yield of each decoction was detected.The evaluation of quality differences is based on the comprehensive score of cream yield(40%)and indicator components(60%).Results The HPLC fingerprint similarity of Huaihua powder prepared by 5 decoction methods was greater than 99%.There was no significant difference(P>0.05)in the yield of ointment and the content of indicator components between the induction cooker one decoction and the induction cooker twice decoction methods.The yield of ointment and the extraction rate of indicator components were significantly higher in twice normal pressure decoction using a decoction machine than once normal pressure decoction using a decoction machine(P<0.05).The index component score of machine under pressure decoction once was the highest,but the comprehensive score of twice normal pressure decoction was the highest,with a combined score of 92.13 and 89.58,respectively,far higher than the 36.01,18.79,and 15.60 of the other three decoction methods.Classify the decoction into three categories through cluster analysis.Orthogonal partial least squares-discriminant analysis was used to screen for rutin,naringin and neohesperidin as differential biomarkers.Conclusion The quality of Huaihua powder decocted by a decoction machine is significantly better than that by an induction cooker,and the twice decocted at normal pressure by the decoction machine are significantly better than those decocted at normal pressure once.Decoction under pressure once may be a better choice.

Objectives:Comparative analysis of the beagles acute-phase electrocardiographic,hemodynamic,left ventricular flow field status,and energy consumption characteristics of pacing at different sites of conduction system may help to elucidate the scientific mechanism of left bundle branch pacing(LBBP)as a option of physiological pacing therapy.Methods:Eight healthy adult beagles were used in this study.Initially,an active fixation lead was implanted in the right atrial appendage,followed by implantation of another active fixation lead at the right ventricular apex,distal His bundle,and left bundle septal branch,respectively.After connecting a dual-chamber pacemaker,electrocardiographic and acute phase hemodynamic parameters under sinus rhythm,right ventricular apex pacing(RVAP),distal His bundle pacing(DHBP),and LBBP states were collected and analyzed.Three complete cardiac cycles of standard apical three-chamber color Doppler dynamic images were acquired under vector flow mapping(VFM)mode.Offline analysis was performed on obtained parameters including isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,atrial contraction period,and left ventricular intracavitary energy consumption.These parameters were compared under pacing at different sites and the linear correlations of major parameters were analyzed.Results:The QRS duration of baseline intrinsic sinus rhythm,RVAP,DHBP and LBBP were(45.0±4.0)ms,(98.4±6.2)ms,(50.0±4.5)ms and(62.0±4.7)ms,respectively.The LBBP-QRS duration was significantly wider than intrinsic sinus rhythm and DHBP,but significantly narrower than RVAP(all P<0.01).Compared with baseline AOO mode(the pacing rate was performed at 10 beats/min above the intrinsic heart rate),the change of acute phase maximum left ventricular pressure rise rate(LVdP/dtmax)in RVAP,DHBP and LBBP was([-7.89±5.67]% ),([0.74±2.05]% )and([-0.14±3.59]% ),respectively.There was no significant difference in LVdP/dtmax changes between DHBP and LBBP(P=0.667),but both pacing modalities were significantly better than RVAP(all P<0.01).The average energy consumption of the left ventricle under RVAP was significantly higher than that of intrinsic sinus rhythm,DHBP,and LBBP in isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,and atrial contraction period(all P<0.01).However,there was no statistically significant difference in energy consumption among intrinsic sinus rhythm,DHBP,and LBBP during the above five phases(all P>0.05).DHBP and LBBP did not show a significant increase in the number of left ventricular vortices,vortex area,and circulation intensity compared to intrinsic sinus rhythm,and LBBP did not show a significant increase in vortex area and circulation intensity compared to DHBP.Conclusions:Although LBBP canines significantly prolonged the paced QRS duration,it showed no significant differences in acute phase left ventricular hemodynamics,left ventricular flow field status,and energy consumption compared to intrinsic sinus rhythm and DHBP.Performance of LBBP was superior to RVAP.This study may contribute to revealing the theoretical basis of LBBP as a feasible physiological pacing therapy.

A variety of plants are used as Gymnadenia conopsea(L.)R.Br medicine in some areas.According to statistics,there are 7 genera and 16 species of Orchidaceae.There is confusion in medicinal varieties,which seriously affects drug safety and rational utilization of resources.Based on the national standards,this article conducted a textual research from the aspects of ancient herbs,modern monographs,the name of the reference,base,property and taste and efficacy and other aspects.The results showed that,the Gymnadenia conopsea(L.)R.Br medicine is named Erheten nai gar,and the Tibetan medicine is named Wangla,and most of the herbs take"Gymnadenia conopsea(L.)R.Br"as the name.The mainstream varieties of Gymnadenia conopsea(L.)R.Br,a plant of the genus Gymnadenia of Orchidaceae,were born in arid grassland or wetland and meadow,with palmlike roots,green stems and leaves and pink and white flowers.Gymnadenia conopsea(L.)R.Br is different in property and taste and efficacy when used as different ethnic medicines,but it has the commonness of tonifying kidney,producing sperm and strengthening yang and nourishing.The conclusion of textual research could provide references for the resource conservation,rational research and utilization,and artificial cultivation of Gymnadenia conopsea(L.)R.Br resources.

Breast cancer remains one of the frequently diagnosed malignant tumors among Chinese women,with hereditary cases accounting for 5%-10%of all diagnoses,where BRCA1/2 gene mutations serve as the primary genetic predisposition factors.Although targeted therapies like poly(ADP-ribose)polymerase(PARP)inhibitors have significantly improved prognoses for patients with BRCA-mutated breast cancer in recent years,critical clinical challenges persist,including the standardization of genetic testing protocols,optimization of precision treatment approaches,and refinement of long-term management strategies.In response to these challenges,our expert panel has conducted a comprehensive update to the 2018 Edition of this consensus by integrating the latest global evidence-based medical research with China's unique clinical practice characteristics.This 2025 Edition provides systematic evaluations and recommendations on five key aspects:indications for BRCA1/2 gene testing,testing methodologies,result interpretation,treatment strategies,and risk management.The main updates include:① Increasing the relationship between BRCA1/2 gene mutations and programmed death ligand-1(PD-L1)expression,as well as related content on BRCAness types;② Standardizing the application of genetic testing,such as increasing the significance,timing,and sample selection of clinical testing,and optimizing the BRCA testing population;③ Updating treatment strategies,such as non-drug treatment of BRCA1/2 gene mutation,treatment of triple negative breast cancer(TNBC)patients with BRCA1/2 gene mutation,treatment decisions of hormone receptor(HR)+/human epidermal growth factor receptor 2(HER2)-breast cancer patients with BRCA1/2 gene mutation,clinical use of PARP inhibitors and adverse reaction management;④ Addion of relevant content on long-term risk management,such as covering follow-up management,indications for preventive surgery,quality control and requirements for new genetic testing,updating genetic testing processes,report content and interpretation.This consensus aimed to establish standardized diagnostic and therapeutic frameworks for clinicians,advance precision medicine in BRCA-mutated breast cancer,and ultimately improve patient survival outcomes.As new evidence emerges,continuous updates will be implemented to incorporate the latest research findings.This consensus has been registered on the Practice guideline REgistration for transPAREncy(PREPARE)platform(registration number:PREPARE-2025CN1085).