This article provides a systematic interpretation and review of the Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design. Developed based on the Grading of Recommendations Assessment, Development and Evaluation methodology, the guideline address five core themes: ICU layout, room design, infection control, infrastructure, and staff spaces, and put forward 17 evidence-based recommendations, including 5 good practice statements. This article briefly introduces the guideline development methods and evidence characteristics, and focuses on summarizing key recommendations, including high-visibility layouts, single-bed ward settings, natural lighting and noise reduction strategies, integrated infection prevention and control design, remote monitoring, and flexible capacity expansion capabilities. Furthermore, it delves into the applicability and localized implementation pathways within China's healthcare environment, analyzing limitations in terms of evidence quality, specialty applicability, and cost-effectiveness. Furthermore, by integrating the Chinese Guidelines for the Construction and Development of Critical Care Medicine (2025 Edition) and current domestic practices, the article proposes tiered and phased implementation recommendations. This article aims to provide domestic healthcare institutions with a scientific reference that balances international cutting-edge concepts with China's real-world conditions for the construction and renovation of ICUs, thereby promoting the development of intensive care environments centered on patient safety, healthcare worker well-being, and infection control.

Bruton's tyrosine kinase inhibitors (BTKi) are a class of novel small-molecule targeted antitumor drugs used to treat B-cell malignancies. However, safety issues associated with BTKi may lead to treatment interruption, compromising their efficacy. To promote the standardized management of safety in BTKi treatment, Evidence-Based Pharmacy Professional Committee of the Chinese Pharmaceutical Association, Hospital Pharmacy Professional Committee of the Chinese Pharmaceutical Association, Division of Therapeutic Drug Monitoring of Chinese Pharmacological Society, Expert Committee on Lymphoma of Chinese Society of Clinical Oncology, Expert Committee on Leukemia of Chinese Society of Clinical Oncology, Integrated Cancer Cardiology Branch of China Anti-Cancer Association, Hematology Branch of the Chinese Medical Association, and Hospital Pharmacy Professional Committee of the Cross-Straits Medicine Exchange Association formulated the Evidence-based Expert Consensus on the Clinical Management of Safety of Bruton′s Tyrosine Kinase Inhibitors (2024), which was published in the Chinese Journal of Cancer Research in June 2024. It covered 9 clinical issues in the following 3 domains: (1) the management of common adverse reactions of BTKi such as bleeding, cardiovascular events, hematological toxicity, infections, rashes, diarrhea, and arthralgia; (2) the management of drug-drug interactions; (3) management guidance for special populations. This consensus provides evidence-based recommendations for the safety management of BTKi medication in clinical practice. This article provides an interpretation and evidence summary of the consensus in Chinese, aiming to facilitate its implementation in China, enhance the safety management of BTKi treatment, and improve patient outcomes.

Objective To analyze the risk factors for gastrointestinal bleeding in patients with cerebral infarction during hospitalization.Methods This retrospective study included patients with cerebral infarction admitted to the Department of Neurology at West Coast New District People's Hospital of Qingdao from January 2022 to December 2024.Baseline characteristics,including age,gender,admission systolic and diastolic blood pressure,and National Institutes of Health stroke scale(NIHSS)score at admission,medical history(hypertension,diabetes mellitus,coronary artery disease,atrial fibrillation,history of cerebral infarction,dyslipidemia,and gastrointestinal disease[gastritis or gastric ulcer]),infarction location(anterior circulation,posterior circulation,or multiple infarcts),trial of Org 10172 in acute stroke treatment(TOAST)classification,laboratory parameters at admission(hemoglobin,platelet count,prothrombin time[PT],and activated partial thromboplastin time)and the treatment status(antiplatelet therapy,anticoagulation,intravenous thrombolysis,lipid-lowering therapy,and prophylactic proton pump inhibitor use)were collected for all patients.Patients were divided into bleeding group and non-bleeding group based on the occurrence of gastrointestinal bleeding during hospitalization as diagnosed according to the Expert Consensus on Emergency Diagnosis and Treatment Procedures for Acute Upper Gastrointestinal Bleeding(2020 Edition).The length of hospital stay and in-hospital all-cause mortality were compared between the two groups.Variables with statistically significant differences in univariate analysis were further examined using multivariate Logistic regression to evaluate the risk factors for gastrointestinal bleeding in patients with cerebral infarction.Results A total of 344 patients with cerebral infarction were enrolled in this study,including 201 males and 143 females,aged 32-91 years,with an average age of(68±12)years.Among them,22 cases(6.4％)were experienced gastrointestinal bleeding,while 322 cases(93.6％)did not.(1)Patients in the bleeding group has higher age([74±12]years vs.[67±12]years),NIHSS score at admission(8[4,20]vs.2[2,4]),PT at admission([13.1±1.5]s vs.[12.4±1.1]s),history of coronary heart disease(50.0％[11/22]vs.20.8％[67/322]),history of atrial fibrillation(50.0％[11/22]vs.15.5％[50/322]),history of gastrointestinal disease(27.3％[6/22]vs.14.3％[46/322]),intravenous thrombolysis(22.7％[5/22]vs.2.2％[7/322])than those in the non-bleeding group(all P＜0.05).The hemoglobin count at admission([118±21]g/L vs.[135±16]g/L),and the use of antiplatelet therapy(59.1％[13/22]vs.79.5％[256/322])were lower in the bleeding group(all P＜0.05).The in-hospital all-cause mortality rate(40.9％[9/22]vs.1.6％[5/322])and the length of hospital stay([11.24±2.90]d vs.[6.96±1.42]d)were significantly higher in the bleeding group(all P＜0.05).Significant differences were also observed in the infarct sites distribution and TOAST types between the two groups(both P＜0.01).No other variables in the univariate analysis demonstrated a statistically significant difference(all P＞0.05).(2)Multivariate Logistic regression analysis showed that a high NIHSS score at admission(OR,1.183,95％CI 1.112-1.259,P＜0.01),cardiogenic embolic subtype(OR,2.858,95％CI 1.302-7.917,P=0.043),antiplatelet therapy(OR,2.142,95％CI 1.238-3.705,P=0.006),and intravenous thrombolysis(OR,7.242,95％ CI 1.802-29.110,P=0.005)were the risk factors of gastrointestinal bleeding in patients with cerebral infarction.Conclusion High NIHSS score at admission,cardiogenic embolic subtype,antiplatelet therapy and intravenous thrombolysis are significant risk factors for gastrointestinal bleeding in patients with cerebral infarction during hospitalization.

Objective:To investigate the preventive and therapeutic effects and mechanisms of Dachaihu decoction(DCD)on dextran sodium sulfate(DSS)-induced ulcerative colitis(UC)and liver injury in mice,as well as the association between DCD benefits and gut microbiota modulation.Methods:Mice were treated with DCD(20.10 and 10.05 g/kg)for 2 weeks,with free access to drinking water containing 3%DSS in the second week to induce UC.Histopathological examination,RT-qPCR and 16S rRNA sequencing were used to investigate the effect of DCD on UC mice.Results:DCD pretreatment significantly alleviated weight loss,bloody diarrhea with mucus,histopathological abnormalities of the colon,and colon shortening in mice with DSS-induced UC.In addition,DCD pretreat-ment significantly upregulated the levels of Occludin,ZO-1,and MUC-2 in the colon and protected the intestinal barrier of mice.DCD pretreatment also alleviated inflammatory cell infiltration in the colon and the liver and significantly reduced the expression levels of the proinflammatory factors such as IL-1β,IL-6,TNF-α,iNOS,COX-2,and NLRP3,thereby exerting a protective effect against UC and liver injury.It should be noted that DCD corrected gut micro-biota imbalance in UC mice by enriching probiotic bacteria such as Lactobacillus and Bifidobacterium and reducing harmful bacteria such as Norank_f_Desulfovibrionaceae and Escherichia-Shigella.Conclusion:DCD can alleviate DSS-induced UC and exert a liver-protecting effect by protecting intestinal barrier,inhibiting inflam-mation,and regulating gut microbiota.

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

[This corrects the article DOI: 10.1016/j.jpha.2023.08.006.].

Research on IgG4-related disease (IgG4-RD), an autoimmune condition recognized to be a unique disease entity only two decades ago, has processed from describing patients' symptoms and signs to summarizing its critical pathological features, and further to investigating key pathogenic mechanisms. Challenges in gaining a better understanding of the disease, however, stem from its relative rarity-potentially attributed to underrecognition-and the absence of ideal experimental animal models. Recently, with the development of various high-throughput techniques, "omics" studies at different levels (particularly the single-cell omics) have shown promise in providing detailed molecular features of IgG4-RD. While, the application of omics approaches in IgG4-RD is still at an early stage. In this paper, we review the current progress of omics research in IgG4-RD and discuss the value of machine learning methods in analyzing the data with high dimensionality.
Humans ; Immunoglobulin G4-Related Disease/metabolism* ; Immunoglobulin G/metabolism* ; Machine Learning ; Animals ; Proteomics/methods*

Bruton's tyrosine kinase inhibitors (BTKi) are a class of novel small-molecule targeted antitumor drugs used to treat B-cell malignancies. However, safety issues associated with BTKi may lead to treatment interruption, compromising their efficacy. To promote the standardized management of safety in BTKi treatment, Evidence-Based Pharmacy Professional Committee of the Chinese Pharmaceutical Association, Hospital Pharmacy Professional Committee of the Chinese Pharmaceutical Association, Division of Therapeutic Drug Monitoring of Chinese Pharmacological Society, Expert Committee on Lymphoma of Chinese Society of Clinical Oncology, Expert Committee on Leukemia of Chinese Society of Clinical Oncology, Integrated Cancer Cardiology Branch of China Anti-Cancer Association, Hematology Branch of the Chinese Medical Association, and Hospital Pharmacy Professional Committee of the Cross-Straits Medicine Exchange Association formulated the Evidence-based Expert Consensus on the Clinical Management of Safety of Bruton′s Tyrosine Kinase Inhibitors (2024), which was published in the Chinese Journal of Cancer Research in June 2024. It covered 9 clinical issues in the following 3 domains: (1) the management of common adverse reactions of BTKi such as bleeding, cardiovascular events, hematological toxicity, infections, rashes, diarrhea, and arthralgia; (2) the management of drug-drug interactions; (3) management guidance for special populations. This consensus provides evidence-based recommendations for the safety management of BTKi medication in clinical practice. This article provides an interpretation and evidence summary of the consensus in Chinese, aiming to facilitate its implementation in China, enhance the safety management of BTKi treatment, and improve patient outcomes.

Objective To analyze the risk factors for gastrointestinal bleeding in patients with cerebral infarction during hospitalization.Methods This retrospective study included patients with cerebral infarction admitted to the Department of Neurology at West Coast New District People's Hospital of Qingdao from January 2022 to December 2024.Baseline characteristics,including age,gender,admission systolic and diastolic blood pressure,and National Institutes of Health stroke scale(NIHSS)score at admission,medical history(hypertension,diabetes mellitus,coronary artery disease,atrial fibrillation,history of cerebral infarction,dyslipidemia,and gastrointestinal disease[gastritis or gastric ulcer]),infarction location(anterior circulation,posterior circulation,or multiple infarcts),trial of Org 10172 in acute stroke treatment(TOAST)classification,laboratory parameters at admission(hemoglobin,platelet count,prothrombin time[PT],and activated partial thromboplastin time)and the treatment status(antiplatelet therapy,anticoagulation,intravenous thrombolysis,lipid-lowering therapy,and prophylactic proton pump inhibitor use)were collected for all patients.Patients were divided into bleeding group and non-bleeding group based on the occurrence of gastrointestinal bleeding during hospitalization as diagnosed according to the Expert Consensus on Emergency Diagnosis and Treatment Procedures for Acute Upper Gastrointestinal Bleeding(2020 Edition).The length of hospital stay and in-hospital all-cause mortality were compared between the two groups.Variables with statistically significant differences in univariate analysis were further examined using multivariate Logistic regression to evaluate the risk factors for gastrointestinal bleeding in patients with cerebral infarction.Results A total of 344 patients with cerebral infarction were enrolled in this study,including 201 males and 143 females,aged 32-91 years,with an average age of(68±12)years.Among them,22 cases(6.4％)were experienced gastrointestinal bleeding,while 322 cases(93.6％)did not.(1)Patients in the bleeding group has higher age([74±12]years vs.[67±12]years),NIHSS score at admission(8[4,20]vs.2[2,4]),PT at admission([13.1±1.5]s vs.[12.4±1.1]s),history of coronary heart disease(50.0％[11/22]vs.20.8％[67/322]),history of atrial fibrillation(50.0％[11/22]vs.15.5％[50/322]),history of gastrointestinal disease(27.3％[6/22]vs.14.3％[46/322]),intravenous thrombolysis(22.7％[5/22]vs.2.2％[7/322])than those in the non-bleeding group(all P＜0.05).The hemoglobin count at admission([118±21]g/L vs.[135±16]g/L),and the use of antiplatelet therapy(59.1％[13/22]vs.79.5％[256/322])were lower in the bleeding group(all P＜0.05).The in-hospital all-cause mortality rate(40.9％[9/22]vs.1.6％[5/322])and the length of hospital stay([11.24±2.90]d vs.[6.96±1.42]d)were significantly higher in the bleeding group(all P＜0.05).Significant differences were also observed in the infarct sites distribution and TOAST types between the two groups(both P＜0.01).No other variables in the univariate analysis demonstrated a statistically significant difference(all P＞0.05).(2)Multivariate Logistic regression analysis showed that a high NIHSS score at admission(OR,1.183,95％CI 1.112-1.259,P＜0.01),cardiogenic embolic subtype(OR,2.858,95％CI 1.302-7.917,P=0.043),antiplatelet therapy(OR,2.142,95％CI 1.238-3.705,P=0.006),and intravenous thrombolysis(OR,7.242,95％ CI 1.802-29.110,P=0.005)were the risk factors of gastrointestinal bleeding in patients with cerebral infarction.Conclusion High NIHSS score at admission,cardiogenic embolic subtype,antiplatelet therapy and intravenous thrombolysis are significant risk factors for gastrointestinal bleeding in patients with cerebral infarction during hospitalization.

A major impedance to neuronal regeneration after peripheral nerve injury(PNI)is the activation of various programmed cell death mechanisms in the dorsal root ganglion.Ferroptosis is a form of pro-grammed cell death distinguished by imbalance in iron and thiol metabolism,leading to lethal lipid peroxidation.However,the molecular mechanisms of ferroptosis in the context of PNI and nerve regeneration remain unclear.Ferroportin(Fpn),the only known mammalian nonheme iron export protein,plays a pivotal part in inhibiting ferroptosis by maintaining intracellular iron homeostasis.Here,we explored in vitro and in vivo the involvement of Fpn in neuronal ferroptosis.We first delineated that reactive oxygen species at the injury site induces neuronal ferroptosis by increasing intracellular iron via accelerated UBA52-driven ubiquitination and degradation of Fpn,and stimulation of lipid peroxidation.Early administration of the potent arterial vasodilator,hydralazine(HYD),decreases the ubiquitination of Fpn after PNI by binding to UBA52,leading to suppression of neuronal cell death and significant ac-celeration of axon regeneration and motor function recovery.HYD targeting of ferroptosis is a promising strategy for clinical management of PNI.