Objective To investigate the therapeutic effect of Huangkui capsules on targeted drug-related proteinuria in patients with hepatocellular carcinoma (HCC). Methods A retrospective analysis was conducted on clinical data of HCC patients with targeted drug-related proteinuria from June 2023 to December 2024 at Zhongshan Hospital, Fudan University. According to the treatment plan, patients were divided into the conventional treatment group and the Huangkui combination treatment group (Huangkui capsules combined with conventional treatment), and the clinical efficacy between the two groups was compared. The logistic regression analysis was used to identify the main factors affecting treatment efficacy. Results The Huangkui combination treatment group (n＝29) showed a significantly higher overall effective rate (79.3% vs 42.3%, P＝0.005), and an earlier proteinuria improvement (median time: 3 months vs 6 months, P＝0.008) than the conventional treatment group (n＝26) . The multivariate logistic regression analysis showed angiotensin-converting enzyme inhibitor (ACEI) or angiotensin Ⅱ receptor blocker (ARB) using (OR＝0.190, 95%CI 0.045-0.808, P＝0.025), targeted drug adjustment (OR＝0.132, 95%CI 0.030-0.581, P＝0.007), and Huangkui capsules using (OR＝0.168, 95%CI 0.039-0.730, P＝0.017) were protective factors for treatment efficacy of targeted drug-related proteinuria. Conclusions On the basis of conventional treatment, additive treatment with Huangkui capsules can alleviate targeted drug-related proteinuria faster and more effectively in HCC patients.

Employing bibliometric methods and adhering to principles of textual research， this study systematically investigated prescription source， formula name， composition evolution， dose evolution， origin， processing， ancient and modern applications of Xiaofengsan. Xiaofengsan， also known as Renshen Xiaofengsan and Chantui Xiaofengsan， was first recorded in the Taiping Huimin Hejijufang（hereafter referred to as Jufang） of the Southern Song dynasty. The formula composition included Schizonepetae Spica， Glycyrrhizae Radix et Rhizoma， Chuanxiong Rhizoma， Notoptery Rhizoma et Radix， Bombyx Batryticatus， Saposhnikoviae Radix， Poria， Cicadae Periostracum， Pogostemonis Herba， Ginseng Radix et Rhizoma， Magnoliae Officinalis Cortex and Citri Reticulatae Pericarpium， a total of 12 medicinal materials. In terms of the evolution of formula composition， formulas across dynasties largely aligned with those recorded in Jufang， with only minor variations in application. The results of the formula dosage research indicated that one dose of medication in Jufang corresponded to the following modern dosages：Schizonepetae Spica of 82.6 g， Glycyrrhizae Radix et Rhizoma of 82.6 g， Chuanxiong Rhizoma of 82.6 g， Notoptery Rhizoma et Radix of 82.6 g， Bombyx Batryticatus of 82.6 g， Saposhnikoviae Radix of 82.6 g， Poria of 82.6 g， Cicadae Periostracum of 82.6 g， Pogostemonis Herba of 82.6 g， Ginseng Radix et Rhizoma of 82.6 g， Magnoliae Officinalis Cortex of 20.65 g and Citri Reticulatae Pericarpium of 20.65 g， the origins of all the constituent drugs were consistent with the 2020 edition of Pharmacopoeia of the People's Republic of China. The results of the investigation into the decoction method indicated that the aforementioned drugs should be finely ground into powder（pass through the No.5 sieve）， and 8.26 g was taken for each dose， which was taken with the clear liquid obtained by steeping tea leaves in boiling water for several minutes. This mixture was administered three times daily， 30 min after meals. The ancient functional indications of this formula mainly involved dispelling wind-heat， eliminating pathogenic factors and regulating the middle Jiao. It primarily treated all wind-heat syndromes manifesting as skin diseases， predominantly affecting the upper body， especially the head and face. The diseases involved in modern applications were mostly dermatological diseases， including urticaria， eczema， atopic dermatitis and others. In this paper， by combing the relevant ancient literature， the key information of Xiaofengsan was textual researched， in order to provide reference for the modern application and development of this formula.

Introduction: Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with a predilection for metastasis to the liver, lungs, and lymph nodes. Bone involvement is less common and typically occurs alongside widespread disease. Isolated skeletal progression without visceral involvement is unusual and not well characterized. Case: A 60-year-old female underwent left adrenalectomy in 2019 for an incidentally detected adrenal mass, which was reported as a benign adrenal cortical adenoma (Ki67 <3%). In 2022, she presented with persistent low back pain. Imaging demonstrated fluorodeoxyglucoseavid lesions involving the T12 vertebra and right ilium, without evidence of local recurrence or visceral metastases. Histopathological evaluation of a bone biopsy initially suggested a neuroendocrine neoplasm based on synaptophysin positivity. Following multiple expert reviews and integration of clinical, radiological, and immunohistochemical findings, a consensus diagnosis of metastatic ACC was established. She received palliative radiotherapy to symptomatic skeletal sites and subsequently completed six cycles of etoposide, doxorubicin, and cisplatin chemotherapy in 2023, achieving disease stabilization. Surveillance imaging in May 2025 demonstrated progression confined to the axial and appendicular skeleton, with no involvement of the adrenal bed or visceral organs. Mitotane therapy was initiated in December 2025. Ongoing management focuses on systemic disease control, symptom palliation, and multidisciplinary supportive care. Conclusion This case illustrates an uncommon pattern of ACC progression characterized by bone-dominant metastases in the absence of visceral disease. It also highlights the importance of reconsidering the initial histopathological diagnosis when clinical behavior is discordant. Vigilance for atypical metastatic patterns is warranted, even years after resection of an adrenal lesion initially classified as benign.
Adrenocortical Carcinoma

Introduction: Thyroid hormone resistance syndrome (THR) is a disorder characterized by reduced responsiveness of target tissues to thyroid hormones with non-suppressed thyroidstimulating hormone (TSH) despite elevated free thyroxine 4 (FT4). Diagnosing and managing THR in athyreotic patients, however, is challenging; indeed, TSH levels post thyroidectomy for Differentiated Thyroid Carcinoma in patients with THR have been reported to reach levels as high as 112.59 mIU/L despite high-dose thyroxine-suppressive therapy. This case highlights the complexities in diagnosing Resistance to Thyroid Hormone (RTH) post-thyroidectomy. Case: A 63-year-old female with end-stage renal failure (ESRF) on hemodialysis and prior parathyroidectomy for tertiary hyperparathyroidism underwent total thyroidectomy in 1997 for presumed benign goiter. Following surgery, she demonstrated persistently elevated TSH, ranging from 93.2 to 670.4 mIU/L (0.55–4.78 mIU/L), with normal to mildly elevated FT4 levels, ranging from 17 to 35 pmol/L (11.5–22.7 pmol/L), while on thyroxine replacement doses as low as 0.86 ug/kg. Discordant thyroid function tests (TFTs) were consistent across different assay platforms. Polyethylene glycol precipitation excluded macro-TSH interference. Intermittent levothyroxine increments suppressed TSH but led to thyrotoxic symptoms, including weight loss, heat intolerance, insomnia, and fragility fracture. Uncontrasted pituitary magnetic resonance imaging (risk of nephrogenic systemic fibrosis with gadolinium in ESRF) showed a small pituitary gland without adenoma, excluding TSH-oma. T3 suppression test was relatively contraindicated due to her advanced age and co-morbidities. There was no family history of thyroid disorder; the patient’s only child had a normal TFT, and her parents/siblings could not be tested. A working diagnosis of RTHβ was made. She declined genetic testing for RTH. She is currently on levothyroxine 50 mcg OD (1.07 ug/kg) with FT4 16.1 pmol/L and TSH 562 mIU/L with no symptoms/signs of hypo or hyperthyroidism. Conclusion This case highlights the diagnostic challenges in managing possible RTHβ post-total thyroidectomy. Treatment should be guided by clinical status and target of mid-to-normal FT4 rather than TSH to avoid iatrogenic thyrotoxicosis.
Thyroidectomy ; Thyroid Hormones

Cancer stands as a significant global public health challenge,and cancer screening serves as a pivotal strategy for reducing its mortality.Presently,only a limited number of cancer types have appropriate screening methods available.Traditional single-cancer screen-ing approaches are fraught with limitations,including invasiveness,low accuracy,and poor patient compliance.Multi-cancer early detection(MCED)leveraging liquid biopsy technology enables non-invasive and efficient early detection of multiple cancers by analyzing biomarkers such as cell-free DNA,cell-free RNA,proteins,and metabolites in blood and other bodily fluids.This innovative approach substantially broadens the spectrum of detectable cancers and enhances population coverage,showcasing immense potential for improving existing can-cer screening strategies.This expert consensus comprehensively reviews the progress of liquid biopsy-based MCED,biomarker selection and detection technologies,the criteria for cancer type selection,research design and clinical utility evaluation,as well as implementation path-ways.The overarching goal of this consensus is to offer scientific guidance for further research and the widespread adoption of MCED,thereby facilitating the continuous optimization of cancer screening strategies.

Objective:To systematically evaluate the predictive value of the reverse shock index multiplied by the Glasgow coma scale score (rSIG) for mortality of trauma patients.Methods:A comprehensive literature search was conducted to identify studies on the predictive value of rSIG for mortality of trauma patients in the following databases from inception to April 2025, including CNKI, Wanfang Data, SinoMed, PubMed, Cochrane Library, Web of Science, and Embase. Two investigators independently screened the literature, extracted data, and assessed study quality according to predefined inclusion and exclusion criteria. The Quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool was used to evaluate the risk of bias in the included studies. Meta analysis was performed using Stata 17.0 software with a bivariate mixed-effects model. The following metrics were used to assess the predictive value of rSIG for mortality in trauma patients, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC) curve (AUC). The influence of various factors on the predictive performance of rSIG was examined, including injury type, study design, region, sample size, cut-off value, rSIG measurement time, and outcome measures. Additionally, sensitivity analysis, Fagan′s nomogram, and Deeks′ funnel plot were employed to assess the robustness of the findings, clinical applicability, and publication bias.Results:A total of 15 studies involving 710 612 trauma patients were included, 26 105 of whom were deceased. Meta analysis results showed that rSIG had a pooled sensitivity of 0.78(95% CI 0.71, 0.84), a pooled specificity of 0.78(95% CI 0.68, 0.86), a pooled PLR of 3.60(95% CI 2.46, 5.27), a pooled NLR of 0.28(95% CI 0.22, 0.36), a pooled DOR of 12.70(95% CI 8.10, 19.91), and an AUC of 0.85(95% CI 0.81, 0.87) for predicting mortality of trauma patients. Subgroup analysis identified injury type as one of the major sources of heterogeneity, and the predictive specificity of rSIG was significantly higher in patients with multiple trauma (0.82) than in those with isolated traumatic brain injury (0.65) ( P<0.05). Sensitivity analysis indicated that the findings were robust and stable. Fagan′s nomogram showed that when the pre-test probability was 7%, the post-test probability of death increased to 21% in patients with low rSIG and decreased to 2% in those with high rSIG. Deeks′ funnel plots suggested no significant publication bias among the included studies ( P>0.05). Conclusion:Low rSIG has good predictive performance for mortality of trauma patients and can serve as an effective tool for early and rapid prognosis assessment with superior predictive performance in patients with multiple trauma compared to those with traumatic brain injury.

Objective:To investigate the efficacy and safety of bendamustine combined with anti-CD20 monoclonal antibody in the first-line treatment of older patients with indolent B-cell non-Hodgkin lymphoma (B-iNHL) .Methods:The clinical data of 159 patients with B-iNHL enrolled in 16 hospitals from Jiangsu Cooperative Lymphoma Group from December 1, 2019, to April 20, 2024, were analyzed for regimen efficacy and safety. Bendamustine plus rituximab (BR) and bendamustine plus obinutuzumab (BG) were administered to 139 (87.4% ) and 20 (12.6% ) patients, respectively.Results:Among the 159 patients, 101 (63.5% ) were male and 58 (36.5% ) were female, with a median age of 69 years (range: 60–84). Efficacy could be assessed in 138 (86.8% ) patients. The efficacy assessment demonstrated that the overall response rate was 92.0% with complete and partial remissions in 75 (54.3% ) and 52 (37.7% ) cases, respectively. With a median follow-up of 24 months (range: 4–64), the progression-free survival rate was (87.5 ± 3.0) % and the overall survival rate was (83.2 ± 3.3) %. Of the 27 patients who died, 6 (22.2% ) died due to disease progression. The mean applied dose of bendamustine per cycle was 73.0 (50.8–89.7) mg/m 2 per day, administered on days 1 and 2. Adverse events of grade 3 or higher were reported in 53 (33.3% ) patients, with infection (30 cases,18.9% ) and neutropenia (24 cases, 15.1% ) demonstrating the highest incidence. Conclusion:Bendamustine combined with anti-CD20 monoclonal antibody demonstrated good efficacy and is well-tolerated in the first-line treatment of elderly patients with B-iNHL.

Objective:To explore the impact of age on the genetic variant spectrum and prognosis of patients with previously untreated Diffuse large B-cell lymphoma (DLBCL).Methods:A retrospective analysis was conducted on the clinical data and follow-up information of 254 previously untreated DLBCL patients from 14 hospitals in the Jiangsu Cooperative Lymphoma Group (JCLG) enrolled from July 2018 and July 2023. Following extraction of DNA from tumor tissue samples, next-generation sequencing (NGS) technique was employed to analyze the genetic variant spectrum of the DLBCL patients, with an evaluation of the relationship between age and genetic variants as well as prognosis. This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Nantong University (Ethics No.: 2023-K048-01).Results:The median age of the 254 DLBCL patients was 62 years old, with 55% of patients aged 60 years or above. Clinical evaluation showed that younger (< 60 years) patients had higher complete response (CR) (70% vs. 59%), and objective response rate (ORR) (88% vs. 79%) than older patients, though the difference between the two groups was not statistically. Survival analysis indicated that both the five-year overall survival (OS) (82.7% vs. 71.7%, P=0.006) and progression-free survival (PFS) (70.6% vs. 50.2%, P<0.05) rates were significantly higher in younger patients. NGS showed that 99.6% of the patients harbored genetic variants, with PIM1, KMT2D, TP53, MYD88, and CD79B being the most common genes. Age significantly affected the variant frequency of certain genes, with MYC variants serving an adverse prognostic factor for OS in younger patients ( P=0.001), while TP53 ( P=0.024) and BCL2 ( P=0.002) variants significantly impacted OS in older patients. Prognostic analysis identified age ≥ 60 years ( HR=3.439, 95% CI=1.318~9.874), presence of B symptoms ( HR = 2.871, 95% CI=1.133~7.307), and elevated lactate dehydrogenase ( HR=3.528, 95% CI=1.231~10.66) as independent adverse prognostic factors. Conclusion:Age, genetic variants, and clinical factors may significantly affect the prognosis of the DLBCL patients. Younger patients have better survival compared to older patients. Variants of the MYC, BCL2, and TP53 genes are closely associated with poor prognosis.

Polyetheretherketone (PEEK) and its composite materials have garnered widespread attention in the field of dental implantology due to their good biocompatibility, mechanical properties, and corrosion resistance. The low elastic modulus of PEEK, comparable to that of human jawbone, helps to reduce the stress shielding effect around the implant, thereby enhancing the rate of bone integration. This article reviews the latest research progress of PEEK and its composite materials in the field of dental implantation, including the synthesis of materials, surface modification techniques, and applications in implant-abutment-crown complexes and full-arch denture bridges.

Objective To analyze the prescription patterns of Professor Chen Bin in treating chronic superficial gastritis(CSG)with data mining methods.Methods Prescription data from effective medical records of outpatients with CSG treated by Professor Chen Bin at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October of 2022 to April of 2023 were collected.R language,SPSS,and IBM SPSS Modeler were used to perform frequency statistics,association rule analysis,and systematic cluster analysis on the prescription data,and then the medication and prescription patterns of Professor Chen Bin in treating CSG were explored.Results A total of 64 outpatient prescriptions formulated by Professor Chen Bin were included,involving 95 Chinese herbal medicines.The top 10 frequently-used herbs were Glycyrrhizae Radix et Rhizoma Praeparata cum Melle(Zhigancao),Bupleuri Radix(Chaihu),Pinelliae Rhizoma Praeparatum(Fabanxia),Jujubae Fructus(Dazao),Zingiberis Rhizoma(Ganjiang),Codonopsis Radix(Dangshen),Scutellariae Radix(Huangqin),Paederiae Herba(Jishiteng),Citri Reticulatae Pericarpium(Chenpi),and Taraxaci Herba(Pugongying).Most of the herbs were warm,cold,and mild in nature,and were sweet in flavor.And the herbs mainly had the meridian tropism of spleen,stomach,and liver meridians,and had the primary therapeutic effects of strengthening the spleen and replenishing qi,regulating qi,and resolving dampness.Based on the results of association rule analysis,a total of 21 core herb combinations were screened out,and cluster analysis yielded 4 clustered prescriptions.Combining the results of high-frequency herb statistics and cluster analysis and based on the traditional Chinese medicine theory,the core herbs for treating CSG was identified as Zhigancao,Chaihu,Fabanxia,Dazao,Ganjiang,Dangshen,Huangqin,Jishiteng,Chenpi,and Pugongying.Conclusion In treating CSG,Professor Chen Bin adheres to the treatment principle of replenishing qi and regulating the pivot,and the therapeutic methods of regulating qi movement,strengthening the spleen and harmonizing the stomach are applied with Xiaochaihu Decoction as the fundamental prescriptions.His view of treatment by focusing on the spleen and stomach,emphasizing the combination of herbs with cold and warm properties and based on syndrome differentiation will provide a reference for the clinical application of traditional Chinese medicine in treating CSG.