OBJECTIVE To comprehensively analyze the effectiveness， safety and economic value of carfilzomib in the treatment of multiple myeloma （MM）， and provide evidence-based guidance for clinical rational drug use. METHODS A systematic search was performed in PubMed， Embase， the Cochrane Library， Web of Science， CNKI， Wanfang， VIP， and relevant health technology assessment （HTA） websites， from database inception to December 31， 2024. Two researchers independently screened studies based on predefined inclusion and exclusion criteria， extracted data， and assessed study quality. Descriptive statistical analyses were conducted. RESULTS A total of 21 studies were included， comprising 7 systematic reviews/meta-analyses， 5 clinical trials， 5 pharmacoeconomic studies， and 4 HTA reports. Effectiveness analysis indicated that， compared with control groups， carfilzomib significantly improved overall response rate and clinical benefit rate （ P ＜0.05）， prolonged progression-free survival， and enhanced patient’s quality of life （ P ＜0.05）， while its impact on overall survival remains to be further confirmed. Safety analysis showed there was no significant difference in the risk of peripheral neuropathy between carfilzomib and controls， while the risks of cardiotoxicity and hypertension were significantly increased （ P ＜0.05）. Economic analysis suggested that carfilzomib regimens demonstrated certain cost-effectiveness in second-line treatment in the U.S. and some European countries. However， its economic value was influenced by drug price， dosing regimen， and regional differences， and it may lack a cost advantage in some countries or in third-line treatment. CONCLUSIONS Carfilzomib shows definite efficacy and generally acceptable safety in the treatment of MM， but cardiotoxicity and hypertension risks require careful monitoring. Given its high treatment cost， pharmacoeconomic studies in the Chinese population are urgently needed.

The lack of clear definition and classification for “moderate ulcerative colitis (UC)” creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

The lack of clear definition and classification for “moderate ulcerative colitis (UC)” creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

The lack of clear definition and classification for “moderate ulcerative colitis (UC)” creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

Objective To explore the application effect of bedside critical ultrasound in volume management of acute kidney injury(AKI)donors.Methods Clinical data of 56 AKI donors and 106 recipients from the Transplantation Center of People's Hospital of Guangxi Zhuang Autonomous Region from October 1,2020 to May 31,2022 were collected.They were divided into the critical ultrasound group(34 donors,66 recipients)and the traditional central venous pressure(CVP)group(22 donors,40 recipients)according to the volume management methods.The AKI stage and recovery time,renal function indicators(serum creatinine(Scr),cystatin C,estimated glomerular filtration rate),donor Remuzzi score,cold ischemia time,biventricular inotrope usage rate and time,delayed graft function(DGF)incidence and recovery time,and renal function indicators at 6 and 12 months after surgery were compared and analyzed between the two groups.Results There were no statistically significant differences in gender,age,body weight,AKI stage,pre-acquisition renal function indicators,biventricular inotrope usage rate,renal function indicators at 6 and 12 months after surgery,DGF recovery time,donor Remuzzi score and cold ischemia time of the donors and recipients between two groups(all P>0.05).The AKI recovery time,continuous renal replacement therapy rate and biventricular inotrope usage time of donors in the critical ultrasound group were shorter or lower than those in the traditional CVP group(all P<0.05).The incidence of DGF in recipients of the critical ultrasound group was lower than that of the traditional CVP group(P<0.05).Subgroup analysis showed that there was no statistically significant difference in Scr at 6 and 12 months after surgery in recipients of the critical ultrasound group(P>0.05),while the Scr at 12 months after surgery was higher than that at 6 months in recipients of the traditional CVP group(P<0.05).Conclusions AKI kidneys may be used for kidney transplantation after active maintenance.Bedside critical ultrasound has unique advantages in volume management of AKI donors and may improve the function of AKI kidneys to a certain extent.

Objective To investigate the effect of fraxetin(FXT)on the malignant biological behavior of ovarian cancer cells by regulating Toll-like receptor 4(TLR4)/signal transducer and activator of transcription 3(STAT3)pathway.Methods Ovarian cancer cell lines SKOV3 and SW626 and ovarian epithelial cell line IOSE80 were treated with different concentrations of FXT(0,10,20,40,60,80 and 100 μmol/L),and the cytotoxicity of FXT was detected by methylthiazolyl diphenyl-tetrazolium bromide(MTT)assay.SKOV3 and SW626 cells were randomly divided into control group,FXT low,medium,high dose(40,60,80 μmol/L)group and FXT(80 μmol/L)+colivelin(STAT3 agonist,0.5 μmol/L)group.Colony formation assay and Transwell assay were used to detect cell proliferation,invasion and migration.The expressions of epithelial-mesenchymal transition and TLR4/STAT3 pathway related proteins were measured by Western blot.Results Compared with IOSE80 cells,SKOV3 and SW626 cell survival gradually decreased with increasing FXT concentration,and the differences were statistically significant(F=134.283,146.831,P<0.001).Compared with the control group,the relative colony lineage rates of SKOV3 and SW626 cells in the FXT low-,medium-and high-dose groups,invasion rate and mobility were reduced(t=4.433～45.909),E-cadherin were increased(t=5.879～17.345),and the expression of N-cadherin,zinc finger transcription factors(snail),vimentin,TLR4,phosphorylated(p)-STAT3/STAT3,cell cycle protein D1(Cyclin D1)and MYC oncogenes(Cancer-myc,C-myc)expression were sequentially reduced(t=7.348～50.117),and the differences were statistically significant(all P<0.01),respectively.Compared with the high-dose FXT group,the relative colony formation rate,cell invasion rate and migration rate of SKOV3 and SW626 cells in the FXT+colivelin group increased(t=9.224～20.703),while the expression of E-cadherin protein decreased(t=3.104,5.041),the expression of N-cadherin,snail,vimentin,TLR4,p-STAT3/STAT3,Cyclin D1,and C-myc increased(t=8.403～42.175),and the differences were statistically significant(all P<0.05),respectively.Conclusion FXT may exert antitumor effects by antagonizing the activation of TLR4/STAT3 signaling pathway and inhibiting ovarian cancer cell proliferation,migration,invasion and epithelial mesenchymal transition.

Objective:To summarize the early clinical outcomes of aortic valve replacement(AVR) using the Perceval sutureless aortic valve.Methods:This retrospective study included 50 patients who underwent AVR with the Perceval sutureless prostheses at Beijing Anzhen Hospital between June 2023 and January 2025. Surgical parameters, early clinical outcomes, valve function, and hemodynamic performance were evaluated to summarize clinical effectiveness.Results:The mean age of patients was(63.5±9.1) years, predominantly female(36/50). Severe aortic stenosis was present in 43 cases(86.0%). A preoperative aortic annulus dimension of 20.0(19.0, 21.0) mm measured in both anteroposterior and transverse diameters. Preoperative peak transvalvular gradient was(92.7±31.0)mmHg(1 mmHg=0.133 kPa), with a mean gradient of (58.0±21.2) mmHg. All procedures were successfully completed using the Perceval sutureless prostheses. Isolated AVR was performed in 20 patients(40.0%), with cardiopulmonary bypass and aortic cross-clamp times of 75.0(50.5, 99.5) min and 50.5(29.5, 71.5) min, respectively. Postoperative transesophageal echocardiography revealed an immediate reduction in the peak transvalvular gradient to 11.0(8.0, 18.0) mmHg, significantly lower compared to preoperative measurements( P<0.001). Two cases of paravalvular leakage and one case requiring permanent pacemaker implantation were reported postoperatively. All patients completed the 3-month follow-up, with one death during the follow-up period; the remaining patients exhibited normal prosthetic valve function without major adverse cardiovascular events. Significant postoperative reductions were observed in left ventricular end-diastolic diameter(45.8 mm vs. 43.2 mm, P=0.003) and left atrial diameter(53.9 mm vs. 44.6 mm, P<0.001) compared with baseline. Conclusion:AVR using the Perceval sutureless prostheses demonstrated safe and effective early clinical outcomes with excellent hemodynamic performance and low incidence of postoperative paravalvular leakage and permanent pacemaker implantation. The sutureless technique represents a viable alternative strategy, particularly advantageous for patients with small aortic annuli or complex surgical conditions, warranting broader clinical adoption.

Objective:To explore the feasibility and safety of the combined liver and kidney procurement technique with preservation of the donor diaphragm.Methods:A retrospective study was conducted on the clinical data of 135 donors with pulmonary infection who underwent combined liver and kidney procurement and their corresponding 370 recipients in the Department of Transplantation, Guangxi Zhuang Autonomous Region People's Hospital from January 2021 to August 2023. According to whether the donor diaphragm was resected during procurement, the donors were divided into diaphragm preservation group (67 cases) and diaphragm resection group (68 cases). The t-test and chi-square test were used to compare the baseline characteristics of the donors, donor procurement time, surgical injury to organs, donor-derived infection (DDI), delayed graft function (DGF), primary non-function (PNF), and perioperative death between the two groups.Results:There were no statistically significant differences in age, sex, body mass index, number of organs procured, number of organs transplanted, number of organs discarded, or positive rate of sputum cultures for different strains between the two groups (all P>0.05). The donor procurement time was (46.70±12.61) min in the diaphragm preservation group and (45.79±12.78) min in the diaphragm resection group, with no statistically significant difference ( P=0.679). No surgical injuries to other abdominal organs (such as intestines or, in the diaphragm resection group, the lungs) occurred during procurement. After transplantation, the incidence of delayed graft function in kidney recipients was 7.32% (9/123) in the diaphragm preservation group and 11.67% (14/120) in the diaphragm resection group, with no statistically significant difference between the two groups ( P=0.279). The incidence of DDI was 0 in the diaphragm preservation group and 7.07% (13/184) in the diaphragm resection group, showing a statistically significant difference ( P<0.001). No cases of primary non-function or perioperative death occurred in either group. Conclusion:Compared with the conventional method, the combined liver and kidney procurement technique that preserves the donor diaphragm does not significantly increase operative time, organ injury, delayed graft function, primary non-function, or perioperative mortality. It significantly reduces the incidence of donor-derived infections and is worthy of clinical promotion and application.

To summarize and analyze the clinical data of one case of kidney transplantation in an HIV-positive child with end-stage renal disease (ESRD) in the Department of Transplantation, the People's Hospital of Guangxi Zhuang Autonomous Region, and to explore the safety and efficacy of kidney transplantation in HIV-positive children with ESRD. This pediatric recipient was found to be HIV-positive at birth and underwent kidney transplantation due to ESRD, with good postoperative recovery. During the 2.5-year follow-up, no rejection or rebound in HIV RNA levels was observed. The function of the transplanted kidney was good, and the quality of life was comparable to that of healthy individuals. It suggests that kidney transplantation in HIV-positive children with ESRD is safe and effective under adequate preoperative preparation and close postoperative follow-up.

Tuberculosis remains a significant global public health threat.Early diagnosis and effective treatment are crucial to combat this disease.Yet,traditional diagnostic methods for tuberculosis face limitations due to their low sensitivity,extended detection periods,and dependence on sputum samples.Molecular diagnostic techniques,while offering higher sensitivity,still primarily rely on sputum samples,thereby impeding significant advancements in tuberculosis diagnosis.In clinical settings,there exists a pressing demand for diagnostic approaches that are not solely reliant on sputum samples.In recent years,extracellular vesicles(EVs),as emerging biomarkers,have demonstrated substantial potential in various diseases,including tumors and infectious diseases.A multitude of studies indicate that EVs also exhibit potential in the field of tuberculosis.This review provides an in-depth analysis of the biological characteristics of EVs and their role in the pathogenesis of tuberculosis.It systematically summarizes the progress and significance of EV-based biomarkers in tuberculosis diagnosis,treatment monitoring,and disease mechanism exploration,while addressing the challenges and future prospects in this field.The aim is to offer valuable insights and up-to-date research findings to researchers and clinicians engaged in tuberculosis-related studies.