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 investigate the influence of CYP2C19 gene polymorphism on platelet function and inflammatory cytokines in elderly patients with ischemic stroke， and to analyze potential factors associated with poor prognosis. METHODS A retrospective study was conducted on elderly patients with ischemic stroke admitted to our hospital from June 2024 to June 2025， wh o underwent CYP2C19 genotype testing and received antiplatelet therapy with clopidogrel. The levels of platelet function indicators and inflammatory cytokines before and after treatment were compared among patients with different metabolic phenotypes. Based on the prognosis at 6 months post-treatment， patients were divided into poor prognosis group and good prognosis group. Univariate analysis was performed on general data， metabolic phenotype， the levels of platelet function indicators and inflammatory cytokines. Variables with P ＜0.05 and the levels of inflammatory cytokines before treatment were included in a multivariate Logistic regression analysis to identify independent risk factors for poor prognosis. Multiple linear regression was used to further analyze the relationship between metabolic phenotypes and inflammatory cytokines. RESULTS A total of 448 elderly patients with ischemic stroke were included； among them， 162 cases were normal metabolic phenotype， 218 were intermediate metabolic phenotype， and 68 were poor metabolic phenotype. No rapid or ultrarapid metabolic phenotypes were observed. After treatment， platelet aggregation rate， the levels of P-selectin and platelet activated complex-1 （PAC-1）， high-sensitivity C-reactive Protein （hs-CRP）， interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α （TNF-α） in the normal metabolic phenotype group， intermediate metabolic phenotype group， and poor metabolic phenotype group （except for platelet aggregation rate， and the levels of P-selectin and PAC-1 in the poor metabolic phenotype group） were significantly lower than those before treatment in the same group. Moreover， the above indicators in the normal metabolic phenotype group were significantly lower than those in the intermediate and poor metabolic phenotype groups at the corresponding time， and the levels of platelet function indicators in the intermediate metabolic phenotype group were significantly lower than those in the poor metabol ic phenotype group at the corresponding time （ P ＜0.05）. Univariate and multivariate Logistic regression analyses showed that combined with hypertension， combined with diabetes mellitus， and intermediate or poor metabolic genotypes were independent risk factors for poor prognosis in elderly patients with ischemic stroke （ P ＜0.05）. Multiple linear regression analysis showed that serum levels of hs-CRP， IL-1β， IL-6 and TNF-α before treatment were significantly higher in patients with intermediate and poor metabolic genotypes compared to those with normal metabolic genotype （ P ＜0.05）， with a greater magnitude of increase in inflammatory cytokines observed in the patients with poor metabolic genotype. CONCLUSIONS The elderly ischemic stroke patients with CYP2C19 intermediate and poor metabolic genotypes have poor inhibition effect on platelet and higher levels of inflammatory cytokines than normal metabolic genotype； CYP2C19 gene polymorphism， and in combination with hypertension and diabetes， can be used as independent predictors of poor prognosis.

Objective To explore the influence of the medical and health management model based on artificial intelligence (AI) on type 2 diabetes mellitus (T2DM) combined with masked hypertension (MH). Methods A total of 342 patients with T2DM admitted to the hospital from May 2021 to August 2024 were selected as research subjects, and the incidence rate of MH was counted. All patients were classified into the reference group (routine management) and the study group (AI+medical health management) according to the random number table method, with 171 cases in each group. The self-management, glycolipid metabolism and ambulatory blood pressure were compared between both groups before and after intervention. Results Among the 342 patients with T2DM, MH occurred in 34 cases, with an incidence rate of 9.94% (34/342). The self-management ability in the two groups was improved after 6 months and 12 months of intervention, and the self-management ability was higher in the study group (P<0.05). After 6 months and 12 months of intervention, the glucolipid metabolism indexes in both groups were optimized, and the improvements in the study group were greater (P<0.05). The daytime average systolic blood pressure and diastolic blood pressure, 24 h average systolic blood pressure and diastolic blood pressure were decreased in both groups after 6 months and 12 months of intervention, and the study group showed lower indexes (P<0.05). Conclusion T2DM are prone to MH. AI medical and health chronic disease management can enhance patients' self-management ability, help improve glucose and lipid metabolism, lower blood pressure, and help reduce the risk of MH.

Objective To investigate the expression changes of serum circRNA membrane bound O-acyltransferase 2(circRNA MBOAT2)and circRNA recombinant actinin 4(circRNA ACTN4)in patients with cholangiocarcinoma and their relationship with prognosis.Methods 96 patients with cholangiocarcinoma treated at the First Hospital of Handan City from January 2020 to January 2022 in Department of Hepatobiliary Surgery were regarded as as the cholangiocarcinoma group.Additionally,85 patients with intraductal stones and 90 healthy volunteers were collected as the stone group and control group,respectively.Quantitative real-time reverse transcription PCR(qRT-PCR)was applied to detect the expression levels of circRNA MBOAT2 and circRNA ACTN4.χ2 test was applied to analyze the relationship between circRNA MBOAT2 and circRNA ACTN4 and clinical pathological features.Pearson was applied to analyze the correlation between circRNA MBOAT2 and circRNA ACTN4 in patients with cholangiocarcinoma.ROC was applied to analyze the diagnostic value of circRNA MBOAT2 and circRNA ACTN4 in the occurrence of cholangiocarcinoma.COX was applied to analyze the influencing factors of poor prognosis in patients with cholangiocarcinoma.Kaplan-Meier method was applied for survival analysis.Results circRNA MBOAT2(1.24±0.38)and circRNA ACTN4(1.27±0.42)in cholangiocarcinoma group were higher than those in stone group(1.02±0.31,1.05±0.34)and control group(0.83±0.24,0.78±0.21),and the stone group was higher than that in control group,with statistically significance(t=5.016～14.025,all P<0.05).There was a positive correlation between circRNA MBOAT2 and circRNA ACTN4 in patients with cholangiocarcinoma group(r=0.428,P<0.05).Combined diagnosis of MBOAT2 and ACTN4 was better than single diagnosis of cholangiocarcinoma(Z=4.063,4.004,all P<0.05);circRNA MBOAT2 and circRNA ACTN4 were correlated with clinical staging and lymph node status(t=5.091～5.984,all P<0.05).Positive lymph node status and elevated levels of circRNA MBOAT2 and circRNA ACTN4 were independent risk factors for mortality(HR=1.527,1.582,1.727,all P<0.05).The cumulative survival rate of patients with high expression of circRNA MBOAT2(23.40%vs 46.94%)and circRNA ACTN4(24.00%vs 47.83%)was lower than that of patients with low expression(χ2=5.809,5.946,all P<0.05).Conclusion The serum levels of circRNA MBOAT2 and circRNA ACTN4 increase with the progression of the disease,and the combination of the two has certain value in diagnosing the occurrence of cholangiocarcinoma.

BACKGROUND:At present,the clinical application of gastrointestinal stents is relatively common.Conventional self-expanding metal and plastic stents have the problems of easy displacement,difficulty to remove,and postoperative restenosis.With the advantages of biodegradability and low postoperative restenosis rate,biodegradable drug-eluting stents have become the hot spot in the research of gastrointestinal stents.OBJECTIVE:To summarize the research progress of biodegradable drug-eluting gastrointestinal stents and to provide a forecast of biodegradable drug-eluting gastrointestinal stents.METHODS:Relevant articles were retrieved on CNKI,WanFang,PubMed,and Web of Science databases from January 1994 to March 2024.The Chinese and English search terms were"biodegradable,drug-eluting stent,esophageal stent,biliary stent,pancreatic duct stent,intestinal stent,gastrointestinal stent."Finally,64 articles were included for review and analysis.RESULTS AND CONCLUSION:(1)Biodegradable drug-eluting gastrointestinal stent is a medical device that uses biodegradable material as the main body of the stent,carries and locally elutes drugs for different therapeutic purposes,and plays the dual roles of physical support and drug therapy.By adjusting the properties of stent materials,improving manufacturing processes and auxiliary means,the degradation rate of stents can be accelerated or slowed down to meet clinical needs.Drug elution technology uses drug coatings,nanoparticles,and polymer drug-loaded films,as drug-loading platforms to accurately release drugs,increase local drug concentrations in lesions,and reduce drug loss and systemic absorption of toxic drugs.(2)The main structure of biodegradable drug-eluting gastrointestinal stent is one or more functional drugs combined with biodegradable polymers,metals or nanofiber materials.The available functional drugs are divided into anti-inflammatory and antiproliferative,antitumor,lithotripsy,and enzyme inhibitors.(3)Maintaining the stability of the mechanical properties of gastrointestinal stent and precise controlled drug release are the problems that need to be solved at this stage of biodegradable drug-eluting gastrointestinal stent.The development of new biodegradable materials and the continuous innovation of drug-carrying and drug-releasing methods,manufacturing processes and auxiliary means are the future research directions.

Objective:To investigate the efficacy of phloroglucinol combined with ballon dilation in promoting cervical ripening and shortening labor duration in full-term primiparas and its effects on maternal and neonatal outcomes.Methods:A randomized controlled study was conducted on 60 full-term primiparas who delivered at the First People's Hospital of Longnan from January 2022 to December 2023. The subjects were randomly divided into a control group and an observation group ( n = 30/group) using the random number table method. The control group underwent ballon dilation for cervical ripening, while the observation group received intravenous injection of 80 mg phloroglucinol in addition to ballon dilation. Cervical ripening effect, labor duration, delivery mode, and the incidence of adverse pregnancy outcomes were observed in both groups. Results:The score of cervical ripening in the observation group was significantly higher than that in the control group [(8.31 ± 0.93) vs. (7.83 ± 0.85), t = 2.09, P = 0.041]. The duration of the first stage of labor, the duration of the second stage of labor, and the total duration of labor were (482.7 ± 18.2) minutes, (38.3 ± 10.7) minutes, and (526.6 ± 21.2) minutes, respectively. All these durations were significantly shorter than those in the control group [(521.3 ± 16.4) minutes, (45.7 ± 8.3) minutes, (573.4 ± 18.5) minutes, t = 2.62, 4.32, 12.80, all P<0.05]. The amount of postpartum bleeding in the observation group was significantly lower than that in the control group [(322.5 ± 21.2) mL vs. (341.9 ± 32.5) mL, t = -3.87, P<0.001]. There were no statistically significant differences in the Apgar scores and neonatal behavioral neurological assessment scores between the two groups (both P>0.05). Conclusions:The use of phloroglucinol combined with ballon dilation can effectively promote cervical ripening in full-term primiparas, shorten labor duration, improve induction success rates, and reduce postpartum hemorrhage. Therefore, this combined treatment significantly enhances maternal and neonatal outcomes while demonstrating high safety.

Objective:To study the relationship between serum levels of angiopoietin-2 (Ang-2), insulin-like growth factor 1 (IGF-1), immune factors, and prognosis in patients with uterine fibroids.Methods:A case-control study was conducted involving 93 patients with uterine fibroids who underwent laparoscopic myomectomy at The First People's Hospital of Longnan City between June 2021 and June 2023. These patients constituted the study group. Additionally, 104 healthy women undergoing routine health check-ups during the same period were selected as the control group. Based on the prognosis of the patients in the study group, they were further divided into two subgroups: a good prognosis group ( n = 42) and a poor prognosis group ( n = 46). The correlations among serum levels of Ang-2, IGF-1, immune factors, and prognosis were analyzed in the study group compared to the control group, as well as between the good prognosis and poor prognosis groups. Results:Four cases from the control group and five cases from the study group were excluded from the analysis. In the study group, serum levels of Ang-2 and IGF-1 were found to be (303.18 ± 42.39) mg/L and (1377.11 ± 84.78) mg/L, respectively. Both levels were significantly higher than those in the control group [(231.25 ± 34.18) mg/L, (438.09 ± 52.15) mg/L, t = 12.87, 19.63, both P < 0.001]. Additionally, CD 8+ levels in the study group were higher than those in the control group ( t = -15.79, P < 0.001). Conversely, CD 3+, CD 4+, and CD 4+/CD 8+ levels were lower in the study group compared to the control group ( t = 7.92, 8.41, 5.21, all P < 0.001). In the poor prognosis group, the levels of Ang-2 and IGF-1 were (335.16 ± 42.67) mg/L and (1406.18 ± 83.77) mg/L, respectively, both of which were significantly higher than those in the good prognosis group [(284.63 ± 36.19) mg/L, (434.91 ± 53.28) mg/L, t = 5.96, 64.1, both P < 0.001]. The CD 8+ levels in the poor prognosis group were also higher than those in the good prognosis group ( t = -10.27, P < 0.001), while CD 3+, CD 4+, and CD 4+/CD 8+ levels were lower in the poor prognosis group ( t = 5.31, 7.03, 3.15, all P < 0.001). Correlation analysis revealed that Ang-2 was negatively correlated with CD 3+, CD 4+, and CD 4+/CD 8+ levels ( r = -0.623, -0.578, -0.662). In contrast, Ang-2 was positively correlated with CD 8+ levels, a history of uterine fibroids, the number of fibroids, a history of miscarriage, and the duration of breastfeeding ( r = 0.593, 0.452, 0.446, 0.419, 0.422). IGF-1 levels were also negatively correlated with CD 3+, CD 4+, and CD 4+/CD 8+ levels ( r = -0.720, -0.751, -0.712), while positively correlated with CD 8+, a history of uterine fibroids, the number of fibroids, a history of miscarriage, and the duration of breastfeeding ( r = 0.631, 0.503, 0.444, 0.501, 0.451). Furthermore, multivariate logistic regression analysis indicated that a family history of uterine fibroids, the number of fibroids, a history of miscarriage, and the duration of breastfeeding were all significant risk factors affecting the prognosis of patients with uterine fibroids (all P < 0.05). Conclusions:Patients with uterine fibroids have higher levels of Ang-2, IGF-1 and CD 8+, while the levels of CD 3+, CD 4+, and CD 4+/CD 8+ are lower. Additionally, the expression levels of Ang-2 and IGF-1 are associated with the patients' immune factors and prognosis.

Objective:To construct a scientific, systematic, and clinically applicable evaluation system of quality-sensitive indicators for nursing care of patients with tracheostomy and swallowing disorders following brain injury, providing a basis for evaluating nursing care quality in this patient population.Methods:By reviewing the literature and qualitative studies, a draft evaluation indicator was formed based on nursing issues related to patients with swallowing disorders during their hospital stay, employing the "structure-process-outcome" three-dimensional quality management model as the theoretical foundation. Between July and September 2023, two rounds of Delphi method expert consultations were conducted to add, delete, and modify indicators, and the analytic hierarchy process was used to determine indicator weights.Results:A total of 18 experts participated in two rounds of consultations, with a questionnaire return rate of 18/18. All 18 experts were female, with an average age of (47.61 ± 8.17) years. The expert authority coefficients were 0.895 and 0.910, while the Kendall concordance coefficients were 0.304 and 0.138 (all P<0.001). The average importance values assigned to each level of indicators ranged from 4.28 to 5.00. The final nursing evaluation indicators for patients with tracheostomy and swallowing disorders following brain injury included 4 first-level indicators, 21 second-level indicators, and 45 third-level indicators. Conclusions:By combining evidence-based research, current situation surveys, qualitative studies, and the Delphi method, a successful nursing quality evaluation indicator system was established for patients with tracheostomy and swallowing disorders following brain injury. These indicators are scientific, systematic, and clinically operable, playing an important role in improving the quality of nursing care for patients with tracheostomy and swallowing disorders following brain injury.

Background: Viral hepatitis causes annual deaths of 1.4 million people. Antiviral therapy rarely cures the disease, and patients are usually required to maintain lifelong medication, leading to cumulative drug toxicity. Schisandrae Fructus (SF) is efficacious in the treatment of viral hepatitis. Objective: The systematic review and meta-analysis aim to examine the efficacy and safety of SF alone or in combination with specific and nonspecific treatments for treating viral hepatitis by analyzing the clinical trials performed up to date. Methods: An extensive literature was searched in 7 databases from inception to May 2023. Final outcomes were divided into the primary outcomes containing the total effective rate and virological responses, as well as the secondary outcomes containing liver biochemical functions and frequencies of adverse events. RevMan 5.3 and GRADE pro 3.6 software were used for meta-analysis and assessment of evidence quality. Subgroup analysis was conducted to explore the source of the heterogeneity. Results: Twenty-nine randomized controlled trials were included in the meta-analysis. SF treatment was comparable with western medicines or other traditional Chinese treatments in terms of primary and secondary outcomes. In combination with specific treatments with antiviral medicines, SF group reduced 18.45 U/L of alanine aminotransferase levels [weighted mean difference: 18.45, 95% confidence interval (CI): (16.12, 20.78), p < 0.000 01] and 8.37 U/L of aspartate aminotransferase levels [weighted mean difference: 8.37, 95% CI: (1.25, 15.48), p = 0.02], and it decreased the levels of hyaluronic acid (HA) [standard mean difference (SMD): 0.92, 95% CI: (0.58, 1.27), p < 0.000 01], laminin (LN) [SMD: 0.64, 95% CI: (0.38, 0.90), p < 0.000 01], and procollagen type III [SMD: 0.48, 95% CI: (0.28, 0.67), p < 0.000 01], while increasing the total effective rate by 24% [risk ratio: 1.24, 95% CI: (1.15, 1.32), p < 0.000 01]. There were no severe adverse events during treatment. Conclusions: SF was a potential adjuvant for antiviral therapy in restoring liver function. However, the poor quality of the included randomized controlled trials limited the recommendations. More long-term, randomized, and double-blind studies should be performed to assess the efficacy and safety of combination therapy.

Background: Viral hepatitis causes annual deaths of 1.4 million people. Antiviral therapy rarely cures the disease, and patients are usually required to maintain lifelong medication, leading to cumulative drug toxicity. Schisandrae Fructus (SF) is efficacious in the treatment of viral hepatitis. Objective: The systematic review and meta-analysis aim to examine the efficacy and safety of SF alone or in combination with specific and nonspecific treatments for treating viral hepatitis by analyzing the clinical trials performed up to date. Methods: An extensive literature was searched in 7 databases from inception to May 2023. Final outcomes were divided into the primary outcomes containing the total effective rate and virological responses, as well as the secondary outcomes containing liver biochemical functions and frequencies of adverse events. RevMan 5.3 and GRADE pro 3.6 software were used for meta-analysis and assessment of evidence quality. Subgroup analysis was conducted to explore the source of the heterogeneity. Results: Twenty-nine randomized controlled trials were included in the meta-analysis. SF treatment was comparable with western medicines or other traditional Chinese treatments in terms of primary and secondary outcomes. In combination with specific treatments with antiviral medicines, SF group reduced 18.45 U/L of alanine aminotransferase levels [weighted mean difference: 18.45, 95% confidence interval (CI): (16.12, 20.78), p < 0.000 01] and 8.37 U/L of aspartate aminotransferase levels [weighted mean difference: 8.37, 95% CI: (1.25, 15.48), p = 0.02], and it decreased the levels of hyaluronic acid (HA) [standard mean difference (SMD): 0.92, 95% CI: (0.58, 1.27), p < 0.000 01], laminin (LN) [SMD: 0.64, 95% CI: (0.38, 0.90), p < 0.000 01], and procollagen type III [SMD: 0.48, 95% CI: (0.28, 0.67), p < 0.000 01], while increasing the total effective rate by 24% [risk ratio: 1.24, 95% CI: (1.15, 1.32), p < 0.000 01]. There were no severe adverse events during treatment. Conclusions: SF was a potential adjuvant for antiviral therapy in restoring liver function. However, the poor quality of the included randomized controlled trials limited the recommendations. More long-term, randomized, and double-blind studies should be performed to assess the efficacy and safety of combination therapy.