Objective To explore the prognosis-related genes of lung adenocarcinoma(LUAD)and establish a prognostic prediction model for LUAD.Methods The differentially expressed genes of LUAD tissues and adjacent normal tissues in the GSE43458,GSE7670,and GSE140797 datasets were screened.The protein-protein interaction(PPI)network analysis,gene ontology(GO)function,Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathway enrichment analyses,least absolute shrinkage and selection operator for prognosis coefficient screening,disease-specific survival analysis,Cox regression analysis,and gene correlation analysis were performed.Independent prognostic genes of LUAD were screened from the differential genes,and a prognostic prediction model of LUAD was established.The expression of independent prognostic genes was analyzed,and the predictive model was evaluated by receiver operating characteristic(ROC)curve.The GSE68465 data set was used as an external validation set to verify the predictive model.Results There were 197 up-regulated differential genes and 77 down-regulated differential genes in LUAD and adjacent normal tissues common to the three datasets.Through stepwise screening,two genes,IL7R and SLC2A1,were identified as independent prognostic factors for LUAD.IL7R was an independent protective factor,while the SLC2A1 was an independent risk factor.A prediction model for curve was built with IL7R and SLC2A1.The prediction model for LUAD constructed with IL7R and SLC2A1 is as follows:Risk score=(-0.694)×expression level of IL7R+0.763×expression level of SLC2A1.Conclusion This study screened out IL7R as an independent prognostic protective factor for LUDA,and SLC2A1 as an independent prognostic risk factor for LUAD.The LUDA prediction model constructed based on these two genes has good predictive ability and generalization ability,which can provide references for the research and clinical individualized treatment of LUAD.

Pregnancy with chronic kidney disease (CKD), particularly in stages 4-5, carries high risks of adverse outcomes including maternal renal failure, preeclampsia/eclampsia, fetal growth restriction, and preterm birth. This report described a 26-year-old woman with congenital solitary kidney, polycystic ovaries, and uterine septum due to PAX2 gene variant, complicated by CKD stage 4. Through multidisciplinary team precision management and individualized treatment strategies, including timely initiation of dialysis, the patient successfully maintained pregnancy until 34 +1 weeks and delivered a female infant via cesarean section. This case summarizes key management experiences for end-stage renal disease in pregnancy, highlighting early risk assessment, precise nutritional management, hemodialysis protocol optimization, and the crucial role of multidisciplinary collaboration, providing valuable references for managing CKD-complicated pregnancies.

Objective:To investigate the effect of blood lipids and statins use on the outcome of acute ischemic stroke (AIS) patients with cerebral microbleeds (CMBs).Methods:Consecutive AIS patients with CMBs hospitalized at the First People's Hospital of Taicang, Jiangsu Province from July 2023 to June 2024 were included retrospectively. At 3 months after onset, the modified Rankin Scale was used for outcome assessment. 0-2 was defined as good outcome and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to identify independent influencing factors for poor outcome. Results:A total of 110 AIS patients with CMBs were enrolled, including 72 males (65.5%), aged 68.04±3.12 years. Thirty patients (27.3%) had poor outcome. Univariate analysis showed that age, baseline National Institutes of Health Stroke Scale (NIHSS) score, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and the proportion of patients with hypertension and diabetes in poor outcome group were significantly higher than those in good outcome group, while baseline high-density lipoprotein cholesterol and the proportion of patients using statins before onset were significantly lower than those in good outcome group ( P<0.05). Multivariate logistic regression analysis showed that age (odds ratio [ OR] 1.309, 95% confidence interval [ CI] 1.007-1.702; P=0.044), the baseline NIHSS score ( OR 1.541, 95% CI 1.143-2.078; P=0.005) and high triglycerides ( OR 5.150, 95% CI 2.150-8.717; P=0.023) were the independent risk factors for poor outcome, while high high-density lipoprotein cholesterol ( OR 0.001, 95% CI 0.001-0.034; P<0.001) and statins use ( OR 0.231, 95% CI 0.046-0.558; P=0.019) were the independent protective factors for good outcome. Conclusions:Blood lipid and statins use are independent influencing factors for the outcome of AIS patients with CMBs. The use of statins before onset is associated with a lower risk of poor outcome in AIS patients with CMBs.

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 assess the scientific rigor， clarity and feasibility of the recommendations of the Guidelines for Evidence-based Use of Biological Agents for the Clinical Treatment of Osteoporosis （hereinafter referred to as the Guideline） through external review， in order to further revise and improve the Guideline recommendations. METHODS This study employed a cross-sectional survey research design， a convenience sampling method was adopted to select frontline medical workers in the field of osteoporosis （including clinical doctors， clinical pharmacists， and nurses） as well as patients or their family members. External review was conducted through a combination of closed-ended and open-ended electronic questionnaires to get feedback from them on the appreciation，clarity and feasibility of the 32 preliminary recommendations in the Guideline. RESULTS A total of 90 external review subjects from 15 hospitals were collected， including 45 clinical doctors， 15 clinical pharmacists， 15 nurses and 15 patients or their family members. The overall appreciation degree of recommendations was 99.38%， the overall clarity degree of recommendations was 98.92%， and the overall feasibility degree of recommendations was 99.65%. At the same time， 111 subjective suggestions were collected， which provided an important reference for the further improvement of the Guideline recommendations. Based on the above feedback， the Guideline steering committee and core expert group revised the wording of 12 draft recommendations without deletion， and finally determined 32 recommendations. CONCLUSIONS The external review provides an important basis for the final formation of the Guideline， further improves the scientific rigor， clarity and feasibility of the recommendations， and ensures the standardization， practicality and implementability of the Guideline.

Objective To investigate the influencing factors and Traditional Chinese Medical(TCM)syndrome classification of skin pruritus in patients with maintenance hemodialysis(MHD).Methods A total of 174 hemodialysis patients who underwent regular dialysis in Zhejiang Chinese Medical University Affiliated Jiaxing TCM Hospital from July to September 2024 were selected as study subjects.According to the presence or absence of uremic pruritus(UP),they were divided into pruritus group(n=66)and non-pruritus group(n=108).Both groups of patients were classified into TCM syndromes,and the factors affecting skin pruritus in MHD patients were analyzed by Logistic regression analysis and an evaluation model was established.The evaluation efficiency of the model was evaluated by receiver operating characteristic curve.The relationship between TCM syndromes and pruritus degree was analyzed.Results Both groups of patients were mainly characterized by spleen and kidney Qi deficiency,and the difference was statistically significant(P＜0.05).Logistic regression analysis showed that β2 microglobulin(β2-MG),blood phosphorus,hyper-sensitive C-reactive protein and parathyroid hormone(PTH)were all risk factors for skin pruritus in MHD patients.The area under the curve of skin pruritus in MHD patients was 0.962(95％CI:0.930-0.995).The underlying syndrome of UP patients was mainly spleen and kidney Qi deficiency,and marked syndrome was mainly blood deficiency and wind-dryness.Conclusion β2-MG,blood phosphorus,hyper-sensitive C-reactive protein and PTH are closely related to the occurrence of skin pruritus in MHD patients.The TCM syndrome of UP patients is mainly characterized by spleen and kidney Qi deficiency,and syndrome of blood deficiency and wind-dryness is mainly characterized by UP patients,and there is a certain correlation between TCM syndrome classification and the degree of skin pruritus.

In the implementation process,the current medical service price item standard faces the facts,including disconnection between item establishment and clinical improvement innovation,disconnection from the masses'demand and disconnection from price management needs.The compilation of the guidelines for the establishment of medical service price items marks that the unified standardization of national medical service price items has entered the"fast lane".It reviews the policy requirements to promote the standardization and unification of the current medical service price items by compiling up item guidelines in batches,analyze the framework structure of the medical service price item guidelines,and studies the main changes of the medical service price item guidelines:integrating stock,compatible improvement,and supporting innovation.The policy suggestions to accelerate the implementation and application of the medical service price item guide include:according to the item guidelines,determine the mapping relationship between old and new items,standardize and integrate the current price items,and stop the original items;carry out cost investigation and calculation,weighted average according to the service volume,shift the price of old items,and approve the price of new items;guide public hospitals to implement item guidelines,track price implementation,monitor service number,and strengthen charge supervision.

By the end of 2024,the National Healthcare Security Administration has compiled a guide for the establishment of medical service price items covering most disciplines,and basically completed the top-level design of standardization and standardization of national medical service price items.On the basis of sorting out the ideas for the preparation of the for the medical service price item setting guidelines,and combining the practice of docking and implementing the compilation guidelines for the price items setting in typical provinces,it analyzes the impact of the docking and implementation of the item setting guidelines on medical care,medical insurance and patients and the coping strategies:clarifying the boundaries of technical specifications and price items,reforming compatible with technological improvements according to the item guidelines,and supporting major innovations;carrying out price and cost investigation of sample hospitals,scientifically and reasonably approving the integrated item price according to the item guidelines;item guidelines better reflecting the degree of operational risk,technical difficulty,labor value,optimizing the income structure of the hospital;standardizing items with item setting guidelines,promoting transparent and reasonable fees,and making patient payments more clear.

Objective To investigate the influencing factors and Traditional Chinese Medical(TCM)syndrome classification of skin pruritus in patients with maintenance hemodialysis(MHD).Methods A total of 174 hemodialysis patients who underwent regular dialysis in Zhejiang Chinese Medical University Affiliated Jiaxing TCM Hospital from July to September 2024 were selected as study subjects.According to the presence or absence of uremic pruritus(UP),they were divided into pruritus group(n=66)and non-pruritus group(n=108).Both groups of patients were classified into TCM syndromes,and the factors affecting skin pruritus in MHD patients were analyzed by Logistic regression analysis and an evaluation model was established.The evaluation efficiency of the model was evaluated by receiver operating characteristic curve.The relationship between TCM syndromes and pruritus degree was analyzed.Results Both groups of patients were mainly characterized by spleen and kidney Qi deficiency,and the difference was statistically significant(P＜0.05).Logistic regression analysis showed that β2 microglobulin(β2-MG),blood phosphorus,hyper-sensitive C-reactive protein and parathyroid hormone(PTH)were all risk factors for skin pruritus in MHD patients.The area under the curve of skin pruritus in MHD patients was 0.962(95％CI:0.930-0.995).The underlying syndrome of UP patients was mainly spleen and kidney Qi deficiency,and marked syndrome was mainly blood deficiency and wind-dryness.Conclusion β2-MG,blood phosphorus,hyper-sensitive C-reactive protein and PTH are closely related to the occurrence of skin pruritus in MHD patients.The TCM syndrome of UP patients is mainly characterized by spleen and kidney Qi deficiency,and syndrome of blood deficiency and wind-dryness is mainly characterized by UP patients,and there is a certain correlation between TCM syndrome classification and the degree of skin pruritus.

In the implementation process,the current medical service price item standard faces the facts,including disconnection between item establishment and clinical improvement innovation,disconnection from the masses'demand and disconnection from price management needs.The compilation of the guidelines for the establishment of medical service price items marks that the unified standardization of national medical service price items has entered the"fast lane".It reviews the policy requirements to promote the standardization and unification of the current medical service price items by compiling up item guidelines in batches,analyze the framework structure of the medical service price item guidelines,and studies the main changes of the medical service price item guidelines:integrating stock,compatible improvement,and supporting innovation.The policy suggestions to accelerate the implementation and application of the medical service price item guide include:according to the item guidelines,determine the mapping relationship between old and new items,standardize and integrate the current price items,and stop the original items;carry out cost investigation and calculation,weighted average according to the service volume,shift the price of old items,and approve the price of new items;guide public hospitals to implement item guidelines,track price implementation,monitor service number,and strengthen charge supervision.