OBJECTIVE To form an expert consensus addressing clinical issues regarding the use of parenteral direct thrombin inhibitors （DTIs） in special populations. METHODS Led by the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital（the Affiliated Hospital of UESTC）， a multidisciplinary working group was formed comprising experts from multiple fields， including clinical pharmacy， cardiac surgery， obstetrics， pediatrics and evidence-based medicine. Through literature review and the Delphi method， clinical questions regarding the efficacy and safety of parenteral DTIs used in special populations were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” （PICO） framework；systematic searches were conducted in CJFD， PubMed， Embase and other databases. Relevant evidence from randomized controlled trials，cohort studies and systematic reviews were included and synthesized. Evidence quality was assessed using the Grading of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through three rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven clinical questions were ultimately selected （with a consensus rate exceeding 90%）， resulting in the formulation of seven recommendations on the use of parenteral DTIs in special populations， including children， pregnant women， patients with hepatic or renal impairment， patients with mesenteric venous thrombosis， and individuals with thrombophilia. These recommendations clarify the preferred agents， dosing ranges， monitoring parameters， and safety management strategies for parenteral DTIs in these special populations. 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 special populations.

Objective:To develop an artificial intelligence (AI)-based platelet review strategy to identify abnormal platelet histograms with no significant difference between initial impedance platelet count (PLT-I) and PLT-F results.Methods:This study included 5 119 routine blood analysis in Nanfang Hospital of Southern Medical University and its Ganzhou branch from July 2023 and March 2024. Specimens exhibiting abnormal platelet histograms and an initial platelet count >40×10?/L underwent review using the fluorescent platelet count (PLT-F) channel. Consistency of the results was defined as a difference between impedance platelet count (PLT-I) and PLT-F less than ±20% of the PLT-F results. A deep learning model was developed using platelet and red blood cell histogram data from a training set of 3 807 specimens. The model′s diagnostic performance was evaluated on an independent external validation set ( n=805) using receiver operating characteristic (ROC) curve analysis. Changes in the number of reviewed samples and sample turnaround time were analyzed to assess its clinical utility. Results:The deep learning model based on platelet and red blood cell histograms achieved an area under the ROC curve (AUC) of 0.854 in the training set. At a cutoff value of 0.1, the sensitivity was 0.954 and specificity was 0.358. The model could reduce review by 16.80% (190/1 131). In the validation set, the AUC was 0.805, with a sensitivity of 0.955 and specificity of 0.307, corresponding to a reduction of 17.41% (47/270) in reviewed specimens.Conclusion:The platelet review prediction model developed based on deep learning technology can efficiently identify samples with consistent results before and after review, reducing unnecessary reviews and shortening specimen testing time, thereby improving the efficiency of platelet test.

In August 2024,the European Society of Cardiology Working Group on the management of Peripheral Artery and Aortic disease issued the"Guidelines for the management of peripheral and aortic arterial disease".The guideline stated that peripheral artery and aortic diseases were very common,significantly increasing cardiovascular disease morbidity and mortality in the general population,and their prevention and treatment strategies needed to be strengthened.This article interpreted the content of antithrombotic drug therapy in the guideline from the perspective of drug therapy,which could provide a reference for clinicians and pharmacists to formulate antithrombotic strategies.

In August 2024,the European Society of Cardiology Working Group on the management of Peripheral Artery and Aortic disease issued the"Guidelines for the management of peripheral and aortic arterial disease".The guideline stated that peripheral artery and aortic diseases were very common,significantly increasing cardiovascular disease morbidity and mortality in the general population,and their prevention and treatment strategies needed to be strengthened.This article interpreted the content of antithrombotic drug therapy in the guideline from the perspective of drug therapy,which could provide a reference for clinicians and pharmacists to formulate antithrombotic strategies.

Objective:To evaluate the application efficiency of the artificial prenatal sonography quality assurance system（PSAIS）in the quality control of fetal image quality during the first trimester（11-14 weeks），and to assist the quality control of fetal ultrasound examinations in the first trimester in Liaoning Province using this system.Methods:One hundred fetuses（2 757 ultrasound images）from early pregnancy ultrasound screenings at the Shengjing Hospital Affiliated to China Medical University in November 2022 were retrospectively randomly selected as the test set. The performance of PSAIS were evaluated by 3 obstetric ultrasound experts. First，the experts' sectional classification was used as the gold standard，the accuracy of PSAIS in classifying standard sections was assessed；the consistency between PSAIS and expert ratings was evaluated using the intraclass correlation coefficient（ICC）. The difference of time between PSAIS and expert quality control was analyzed. Finally，PSAIS was used to evaluate the quality of early pregnancy fetal ultrasound examinations at various levels of hospitals in Liaoning province，involving a total of 35 hospitals. Ten early pregnancy fetal ultrasound screening cases were randomly selected from each hospital. The specific evaluation content included the number of stored ultrasound images per examination，the completion rate of standard sections，image quality scores for each examination and individual images，excellence rates and pass rates. The assessment results were statistically described and analyzed.Results:The accuracy rate of PSAIS classification reached to 88.25%（706/800）；the ICC between PSAIS and expert ratings was 0.978. PSAIS analysis showed that the time for each early pregnancy fetal ultrasound examination was less than the average time required by experts（3.0 s vs. 63.5 s， P<0.05）.Quality control checks revealed statistically significant differences among hospitals at various levels in terms of the number of stored images，completeness of sections，scoring，excellence rate，and pass rate（all P<0.05）. Among them，tertiary hospitals performed better than secondary hospitals，private hospitals outperformed public ones，and specialized hospitals excelled over general hospitals. In the evaluation of section standardization，the fetal median sagittal plane had the highest completion rate［99.43%（348/350）］，while the umbilical cord abdominal wall entry transverse plane scan had the lowest completion rate［31.14%（109/350）］. Conclusions:PSAIS can reliably assess the quality of early pregnancy fetal ultrasound examinations，significantly enhancing the efficiency of quality control. There are noticeable differences among hospitals at various levels in Liaoning Province regarding the image quality of early pregnancy fetal ultrasounds，and there are also some common issues in standardizing sections. The quality of obstetric ultrasound images still needs further improvement.

Objective:To develop an artificial intelligence (AI)-based platelet review strategy to identify abnormal platelet histograms with no significant difference between initial impedance platelet count (PLT-I) and PLT-F results.Methods:This study included 5 119 routine blood analysis in Nanfang Hospital of Southern Medical University and its Ganzhou branch from July 2023 and March 2024. Specimens exhibiting abnormal platelet histograms and an initial platelet count >40×10?/L underwent review using the fluorescent platelet count (PLT-F) channel. Consistency of the results was defined as a difference between impedance platelet count (PLT-I) and PLT-F less than ±20% of the PLT-F results. A deep learning model was developed using platelet and red blood cell histogram data from a training set of 3 807 specimens. The model′s diagnostic performance was evaluated on an independent external validation set ( n=805) using receiver operating characteristic (ROC) curve analysis. Changes in the number of reviewed samples and sample turnaround time were analyzed to assess its clinical utility. Results:The deep learning model based on platelet and red blood cell histograms achieved an area under the ROC curve (AUC) of 0.854 in the training set. At a cutoff value of 0.1, the sensitivity was 0.954 and specificity was 0.358. The model could reduce review by 16.80% (190/1 131). In the validation set, the AUC was 0.805, with a sensitivity of 0.955 and specificity of 0.307, corresponding to a reduction of 17.41% (47/270) in reviewed specimens.Conclusion:The platelet review prediction model developed based on deep learning technology can efficiently identify samples with consistent results before and after review, reducing unnecessary reviews and shortening specimen testing time, thereby improving the efficiency of platelet test.

Objective:To evaluate the application efficiency of the artificial prenatal sonography quality assurance system（PSAIS）in the quality control of fetal image quality during the first trimester（11-14 weeks），and to assist the quality control of fetal ultrasound examinations in the first trimester in Liaoning Province using this system.Methods:One hundred fetuses（2 757 ultrasound images）from early pregnancy ultrasound screenings at the Shengjing Hospital Affiliated to China Medical University in November 2022 were retrospectively randomly selected as the test set. The performance of PSAIS were evaluated by 3 obstetric ultrasound experts. First，the experts' sectional classification was used as the gold standard，the accuracy of PSAIS in classifying standard sections was assessed；the consistency between PSAIS and expert ratings was evaluated using the intraclass correlation coefficient（ICC）. The difference of time between PSAIS and expert quality control was analyzed. Finally，PSAIS was used to evaluate the quality of early pregnancy fetal ultrasound examinations at various levels of hospitals in Liaoning province，involving a total of 35 hospitals. Ten early pregnancy fetal ultrasound screening cases were randomly selected from each hospital. The specific evaluation content included the number of stored ultrasound images per examination，the completion rate of standard sections，image quality scores for each examination and individual images，excellence rates and pass rates. The assessment results were statistically described and analyzed.Results:The accuracy rate of PSAIS classification reached to 88.25%（706/800）；the ICC between PSAIS and expert ratings was 0.978. PSAIS analysis showed that the time for each early pregnancy fetal ultrasound examination was less than the average time required by experts（3.0 s vs. 63.5 s， P<0.05）.Quality control checks revealed statistically significant differences among hospitals at various levels in terms of the number of stored images，completeness of sections，scoring，excellence rate，and pass rate（all P<0.05）. Among them，tertiary hospitals performed better than secondary hospitals，private hospitals outperformed public ones，and specialized hospitals excelled over general hospitals. In the evaluation of section standardization，the fetal median sagittal plane had the highest completion rate［99.43%（348/350）］，while the umbilical cord abdominal wall entry transverse plane scan had the lowest completion rate［31.14%（109/350）］. Conclusions:PSAIS can reliably assess the quality of early pregnancy fetal ultrasound examinations，significantly enhancing the efficiency of quality control. There are noticeable differences among hospitals at various levels in Liaoning Province regarding the image quality of early pregnancy fetal ultrasounds，and there are also some common issues in standardizing sections. The quality of obstetric ultrasound images still needs further improvement.

Objective·To investigate the relation between urinary excretion of protein-bound uremic toxins(PBUTs)and upper urinary tract calculus.Methods·Residents aged 18?80 years in the community of Haitou,Danzhou city in Hainan Province were recruited.Basic information and diet for the last 3 d of the subjects were recorded.Their fasting sera and 24-hour urine samples were collected,and they also underwent ultrasound examination of kidneys and ureters.The subjects with upper urinary calculi detected by ultrasound or a clear history of upper urinary calculi were selected as the calculus group,and the others as the non-calculus group.The biochemical indicators related to the formation of calculus in blood and urine were detected,and the levels of PBUTs,including indoxyl sufate(IS),indole-3-acetic acid(IAA),and p-cresol sulfate(PCS)in blood and urine,as well as oxalic acid and citric acid in urine were detected by high-performance liquid chromatography.The related factors of upper urinary tract calculus formation were analyzed by multivariate Logistic regression.The correlations of urine PBUTs with urine uric acid,oxalic acid,and citric acid were analyzed by Spearman correlation test.Results·A total of 117 participants were screened out with 54 people in the calculus group and 63 people in the non-calculus group.There were no significant differences between the two groups in terms of gender,age,serum indicators,and prevalence of complications such as hypertension,diabetes,and hyperuricemia/gout.The 24-hour urine pH,calcium,uric acid,and chlorine in the calculus group were significantly higher than those in the non-calculus group(all P<0.05),while IS was significantly lower than that in the non-calculus group(P<0.05).Multivariate Logistic regression analysis showed that urinary IS(OR=0.929,95%CI 0.875?0.986,P=0.016)was related to the calculus formation independently,in addition to urinary calcium.The Spearman correlation analysis results showed that the levels of IAA(r=0.420,P=0.000)and PCS(r=0.307,P=0.001)in 24-hour urine were positively correlated with oxalic acid,PCS was positively correlated with uric acid(r=0.297,P=0.002),and IS was positively correlated with citric acid(r=0.289,P=0.002).Conclusion·In the population,a decrease in urinary excretion of IS may be an independent risk factor for the formation of upper urinary tract calculus,and PBUTs levels are correlated with levels of uric acid,oxalic acid,and citric acid.

Based on the discussions in the The Inner Canon of Yellow Emperor （《黄帝内经》）， it is proposed that in the course of the disease， "bind" represents the initial stage of pulmonary nodules， while "accumulation" represents the final form. In terms of the pathogenesis， "two colds interacting" represented by "body cold" and "cold fluid retention" are the prerequisites for the formation of pulmonary nodules， while "disorder of qi" represented by "fainting" is the core of the formation. The specific manifestation is the disturbance of pivot of shaoyang （少阳） or shaoyin （少阴）， resulting in a complex of cold and heat， and then phlegm and stasis are suddenly generated and further formed into nodules. Therefore， the treatment principle should be to regulate the cardinal mechanism， dissolve phlegm and blood stasis. Depending on the complex degree of cold and heat， it is suggested to use Chaihu Guizhi Decoction （柴胡桂枝汤）， Chaihu Guizhi Ganjiang Decoction （柴胡桂枝干姜汤）， or Chaihu Xianxiong Decoction （柴胡陷胸汤） for disturbance of shaoyang pivot， while for shaoyin pivot dysfunction， modified Mahuang Fuzi Xixin Decoction （麻黄附子细辛汤） or Shengjiang Powder （升降散） can be used.

In January 2023,the American Heart Association(AHA)released A Scientific Statement:Cancer Therapy Related Hypertension,provided an overview of the mechanisms and clinical management of anticancer therapy related hypertension.Contemporary anticancer drugs are mostly at the expense of cardiovascular toxicities,one of the most common side effects is hypertension,especially vascular endothelial growth factor inhibitors,as well as tyrosine kinase inhibitors and proteasome inhibitors.Cancer therapy related hypertension is often dose limiting,and is usually reversible after interruption or discontinuation of treatment.The exact molecular mechanisms underlying hypertension are unclear,recent discoveries indicate an important role for decreased nitric oxide,increased endothelin-1,endothelial dysfunction,increased sympathetic outflow,and microvascular rarefaction.Based on the International Cardio Oncology Society(IC-OS),this article provides an interpretation of the diagnosis and management of hypertension related to cancer treatment.Insufficient evidence exists supporting an antihypertensive medication strategy specific to patients with anticancer therapy induced hypertension,therefore,antihypertensive management should follow current guidelines for the general population..Multidisciplinary cooperation is needed to optimize management to ensure the optimal therapeutic effect from cancer treatment while minimizing competing cardiovascular toxicities.