Background: Recurrent pregnancy loss undermines the physical and mental health of women. Recent randomized controlled trials have reported some effects of traditional Chinese medicine (TCM); however, whether various TCM methods have different effectiveness remains unclear. Objective: To comprehensively evaluate the efficacy and adverse events of TCM for patients with RPL and to explore whether various TCM methods have different effectiveness. Methods: Ten databases were searched up to May 27, 2024. The risk of bias was assessed using the RoB2 tool. The certainty of the evidence was evaluated using the grading of Recommendations, Assessment, Development, and Evaluation tool. Pairwise and network analyses were conducted using Stata 18.0. Results: A total of 47 randomized controlled trials enrolling 6678 women with RPL were included. Pairwise analysis showed that use of TCM had a significantly lower miscarriage rate (RR 0.50 [95% CI 0.45, 0.55]), lower preterm birth rate (RR 0.81 [95% CI 0.67, 0.98), and lower adverse event rate (RR 0.46 [95% CI 0.37, 0.58]). Moreover, use of TCM was associated with a higher alive-fetus rate (RR 1.21 [95% CI 1.15, 1.26]), live-birth rate (RR 1.20 [95% CI 1.15, 1.25]), and full-term rate (RR 1.37 [95% CI 1.23, 1.53]) compared with nonuse of TCM. Network analysis demonstrated that Bushenshugan combined with conventional Western medicine was ranked the best for the reduction of miscarriage rate. Discussion: Use of TCM is more likely to improve pregnancy outcomes and reduce adverse events compared with nonuse of TCM in patients with RPL. Different TCM methods have differences in reducing the miscarriage rate. The Bushenshugan method might be a potential optimal TCM therapy, but more high-quality evidence is needed to further validate and evaluate the efficacy and safety.

OBJECTIVE To construct a closed-loop management model for externally dispensed intravenous prescriptions， and to provide reference for standardized management of externally dispensed intravenous prescriptions. METHODS Based on the Expert Consensus on Closed-loop Management of Externally Dispensed Intravenous Prescriptions in Guangxi Zhuang Autonomous Region previously formulated by our hospital， risk points during the entire process were systematically identified through multidisciplinary team brainstorming and a fishbone diagram. A series of strategies were subsequently formulated and implemented， including qualifying designated external dispensing pharmacies and the drug catalogs， operating and maintaining the hospital information system and the Pharmacy Intravenous Admixture Service （PIVAS） intelligent management platform， and strengthening differentiated training for staff in the whole workflow. A whole-process closed-loop management system was constructed with PIVAS as the co re hub and the daytime chemotherapy center as the safety terminal. RESULTS A total of 3 cooperating pharmacies and an initial drug list comprising 35 product specifications were selected. A closed‑loop management process encompassing hospital outpatient prescribing， patient drug purchase in designated pharmacies， PIVAS drug dispensing， and medication use in daytime chemotherapy center was successfully established. This system enabled the mandatory grouping and association of externally dispensed intravenous prescriptions with in-hospital diluents， full-process verification based on drug traceability codes， intelligent monitoring of infusion parameters， and whole-process data traceability. CONCLUSIONS The constructed model effectively resolves the coordination and safety oversight during the use of externally dispensed intravenous drugs from out-of-hospital circulation to in-hospital use， and has preliminarily enabled procedural standardization， whole-process information traceability， and proactive control of medication risks.

Dupilumab is a fully human monoclonal antibody that exerts its effects by targeting and binding to the interleukin (IL)-4 receptor alpha subunit, thereby blocking IL-4/13 signaling and downregulating Type 2 inflammation. It has been approved in China for the treatment of moderate-to-severe atopic dermatitis (AD) in patients aged 6 months and older, as well as prurigo nodularis (PN) and bullous pemphigoid in adults. Given its approval age and safety profile, the application of Dupilumab in children has unique advantages, and it has been widely used in the treatment of various Type 2 inflammation-associated and other pediatric dermatologic conditions.Early and proactive management of type 2 inflammatory dermatoses may have preventive and therapeutic implications for modulating the atopic march and type 2 inflammatory comorbidities. This article reviews and summarizes the recent applications of dupilumab in pediatric dermatological diseases.

Objective:To evaluate the clinical effects of a combined pelvic floor rehabilitation magneto-electric therapy approach in women with postpartum pelvic floor dysfunction(PFD).Method:Sixty patients with PFD were randomly divided into three groups:an electrical stimulation group,a magnetic stimulation group,and a combined group,with 20 patients in each group.The evaluation indexes were pelvic floor surface electromyography(sEMG)Glazer assessment,four-dimensional ultrasound of the pel-vic floor,MOS rating,PFDI-20,and PISQ-12 scores.All indexes were evaluated at baseline and after 6 weeks of treatment.Result:After 6 weeks of treatment,the pelvic floor sEMG Glazer assessment,MOS ratings,PISQ-12,PFDI-20 scores,and pelvic floor four-dimensional ultrasound indexes of the patients in all three groups were im-proved compared with those of the pre-treatment period(P＜0.05).Compared with the electrical stimulation group,the combined group showed superior improvement for pelvic floor sEMG Glazer assessment(except for rapid contraction maxima),PFDI-20 scores,and pelvic floor four-dimensional ultrasound(except for area of levator hiatus)(P＜0.05).Compared to the magnetic stimulation group,the combined group showed superior improvement in pelvic floor sEMG Glazer assessment,MOS ratings,PISQ-12 scores,PFDI-20 scores,blad-der neck mobility,and area of levator hiatus(P＜0.05).None of the differences were statistically significant in the electrical stimulation group compared to the magnetic stimulation group(P＞0.05).Conclusion:Magneto-electricity therapy can significantly improve the pelvic floor structure and function of pa-tients with postpartum pelvic floor dysfunction and improve the quality of life,making it worthy of clinical promotion.

Dupilumab is a fully human monoclonal antibody that exerts its effects by targeting and binding to the interleukin (IL)-4 receptor alpha subunit, thereby blocking IL-4/13 signaling and downregulating Type 2 inflammation. It has been approved in China for the treatment of moderate-to-severe atopic dermatitis (AD) in patients aged 6 months and older, as well as prurigo nodularis (PN) and bullous pemphigoid in adults. Given its approval age and safety profile, the application of Dupilumab in children has unique advantages, and it has been widely used in the treatment of various Type 2 inflammation-associated and other pediatric dermatologic conditions.Early and proactive management of type 2 inflammatory dermatoses may have preventive and therapeutic implications for modulating the atopic march and type 2 inflammatory comorbidities. This article reviews and summarizes the recent applications of dupilumab in pediatric dermatological diseases.

Objective To analyze the medication rules and clinical experience of Qin Zujie in treating virtual labor based on data mining.Methods Outpatient medical records of Qin Zujie,diagnosed with deficiency syndrome at Ethnic Medicine Characteristic Diagnosis and Treatment Center,Guangxi International Zhuang Medical Hospital from January to December 2024 were selected.A standardized database was established and processed,yielding 148 clinical prescriptions containing 171 herbal ingredients.Frequency analysis,association rule analysis,and cluster analysis were employed to examine medication rules and clinical experience.Results The 20 Chinese herbal ingredients used more than 30 times each,with the first three being Zhigancao,Baizhu,Danggui.These herbs are primarily warm in nature,neutral in temperature,and slightly cold in effect,characterized by sweet,pungent,and bitter flavors.They mainly affect the spleen meridian and function to tonify deficiency,with Qi-tonifying herbs being the most common.Through association rule analysis,the most frequently combined pairs were Baizhu-Dangshen.Cluster analysis identified three core prescription clusters.Conclusion Qin Zujie's academic thought of treating virtual labor is to supplement deficiency as the main,detoxification as the auxiliary,and treat both the symptoms and the causes.

Objective:To construct a recommended list of high-alert medication (HAM) based on big data from medication error (ME) reports in China, providing reference for preventing and reducing HAM-related risks.Methods:The drugs involved in the serious ME reports of the National Monitoring Network for Clinical Safe Medication (Monitoring Network) were collected (as of December 31, 2023), and the candidate drugs were preliminarily determined referring to the HAM list of China 2023 (Chinese list) and the latest three lists of American Institute for Safe Medication Practices (ISMP). Candidate drugs that were included in both the Chinese list and ISMP lists, as well as those existed in the Chinese list but had never been included in the ISMP lists were included in the current list, and their risk levels followed the original risks in the Chinese list. Candidate drugs that existed in the Chinese list but had been excluded from the ISMP lists, and those existed in the ISMP lists but had not been included in the Chinese list were listed as suspected drugs. For the other candidate drugs, those did not meet the definition of HAM were excluded firstly, and those related to ME that had caused serious harm were listed as suspected drugs, according to the judicial cases on ME of China Judgements Online and PKULAW database. Two methods, including Delphi expert consultation and questionnaire survey, were used to determine whether the above suspected drugs were included in the HAM list and their risk levels.Results:A total of 138 drugs were obtained through the initial screening, 106 of which were directly included in the current list, and 32 of which were listed as drugs requiring further assessment. After 2 rounds of Delphi expert consultation by 18 experts and surveys with 136 valid questionnaires, 32 suspected drugs did not meet the inclusion criteria. Finally, a total of 106 drugs were included in the current list, including 51 A-class drugs in 9 categories, 33 B-class drugs in 9 categories, and 22 C-class drugs in 5 categories.Conclusion:Based on the big data of the ME reports in China, a HAM list is constructed, which is accurate and concise and better fits the actual clinical drug risks in China, helping to improve the drug safety management.

Objective:To explore the risk factors of severe medication errors (ME) of tranexamic acid injection (TXAI), and put forward prevention suggestions.Methods:TXAI-related ME reports in the National Monitoring Network for Clinical Safe Medication (Monitoring Network) and medical literature databases at home and abroad were searched, and case reports of TXAI-related ME were collected; China Judgements Online and PKULAW database were searched, and TXAI-related judicial cases judged to be responsible by the hospital were collected. The retrieval time of all data was up to May 1, 2024. The severity grade, occurrence link and place, and the trigger person of TXAI-related ME reported in the Monitoring Network were retrospectively analyzed. The year of report, country of occurrence, clinical application, error content, and occurrence place of the collected severe ME cases, and the clinical characteristics of patient injury, patient outcome and the ME grading were retrospectively analyzed.Results:From September 22, 2012 to May 1, 2024, the Monitoring Network received a total of 138 TXAI-related ME reports, and there was an increasing trend in the number of reports year by year. Among 138 cases of ME, 79 (57.3%) occurred in the drug dispensing and distribution link; 58 (42.0%) occurred in the prescription/doctor's order prescribing and delivery link and mainly involved easily mixed drugs and drug overdose, of which 1 (1.7%) was a severe ME (grade E); 1 (0.7%) occurred in the drug administration link, and iodohexol was mistakenly injected as TXAI into the patient's joint cavity. A total of 29 severe ME reports related to TXAI were collected. Of them, 24 (82.8%) were due to incorrect administration routes (22 were confused with anesthetics and 2 were confused with injection catheters, all resulting in incorrect intrathecal injections) and 5 (17.2%) were due to prescription errors (3 were overdosed, 1 was used for high-risk thrombosis patient, and 1 was treated with combination use of hemocoagulase for high-risk thrombosis patient); 23 (79.3%) occurred in the operating rooms, and 6 (20.7%) occurred in the wards. The 24 patients involved in incorrect intrathecal injections of TXAI mainly developed severe pain, neurotoxicity (status epilepticus) and/or cardiotoxicity (arrhythmia and ventricular fibrillation), of which 11 (45.8%) died and 2 (8.3%) had sequelae of limb muscle weakness. Among the 5 patients with prescription errors, 4 developed severe thrombotic disease, resulting in 2 deaths and 2 cerebrovascular-related sequelae, and the other one developed palpitation, shortness of breath, nausea and vomiting. Among the 29 severe ME cases, 2 (6.9%) were grade E, 3 (10.3%) were grade F, 4 (13.8%) were grade G, 7 (24.2%) were grade H, and 13 (44.8%) were grade I.Conclusions:TXAI-related ME mainly involved easily mixed drugs and prescription errors. The severe ME main occurred in the operating room and mainly due to incorrect intrathecal injection, leading to fatal neurological and cardiac toxicity in patients.

Objective:To explore the causes of medication errors (ME) associated with deslanoside injection and put forward targeted preventive recommendations.Methods:ME reports related to deslanoside injection in the National Monitoring Network for Clinical Safe Medication (Monitoring Network) as of August 31, 2024 were collected, and sever ME cases of deslanoside injection were also collected though searching medical literature databases at home and abroad, China Judgements Online, and PKULAW database at the same period. The level of severity, occurrence link, error content, occurrence place, trigger personnel and patient outcomes of the MEs were retrospectively analyzed.Results:The Monitoring Network received a total of 41 ME reports of deslanoside injection from September 2012 to August 2024, and the number of reports showed an upward trend year by year. These MEs were classified as grade A in 1 case (2.4%), grade B in 18 cases (43.9%), grade C in 17 cases (41.5%), grade D in 4 cases (9.8%), and grade F in 1 case (2.4%). There were 63.4% (26/41) of MEs occurring in the prescription/doctor′s order prescribing and delivery links, mainly caused by physicians, and the common error contents included solvent errors, medication under contraindications, and having drug-drug interactions. In addition, 26.8% (11/41) of MEs occurred in the drug dispensing and distribution link, and 9.8% (4/41) occurred in the administration and monitoring links. A total of 4 severe MEs of deslanoside injection were collected from the Monitoring Network, medical literature and judicial cases, all of which occurred in the prescription/doctor′s order prescribing and delivery links. Among the 4 severe MEs, 2 ME cases of grade I occurred due to incorrect usage and dosage, resulting in patient death; 1 ME case of grade F was caused by interaction with traditional Chinese medicine, resulting in digitalis poisoning, and another case of grade F was that deslanoside injection was administered to a patient with digitalis poisoning (medication under contraindications).Conclusions:MEs of deslanoside injection often occurs in the prescription/doctor′s order prescribing and delivery links, mainly because of insufficient knowledge of doctors to the drug instructions. It is suggested to strengthen learning and training of medical staff centered around drug instructions, and improve the system interception and process management, so as to improve the medication safety.

Objective:To explore the impact of sleep disturbances on the symptoms and functional impairment outcomes in children with attention deficit hyperactivity disorder (ADHD) and their path analysis.Methods:A cross-sectional study was made.Two hundred and seventy-eight ADHD children aged 6-12 years were selected from the Center for Cognition and Sleep, the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2022 to March 2023.The Swanson, Nolan and Pelham Rating Scale Ⅳ was used to evaluate the core symptoms of ADHD (namely, attention deficit and hyperactivity).The sleep disturbance scale for children was used to assess sleep disturbances [including disorders in initiating and maintaining sleep(DIMS), sleep breathing disorders, sleep-wake transition disorders (SWTD), disorders of arousal, disorders of excessive somnolence (DOES) and nocturnal hyperhidrosis].The Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) was used to assess functional impairment (in family, learning and school, life skills, self-concept, social activities, and risky activities).The descriptive statistical analysis, t test, multivariate linear regression and path analysis were used for statistical analysis. Results:Compared with those without sleep disturbances, ADHD children with sleep disturbances had significantly more serious functional impairment in family [(0.87±0.42) scores vs.(0.63±0.45) scores, P<0.001], learning and school [(0.75±0.37) scores vs.(0.62±0.35) scores, P=0.011], life skills [(1.30±0.37) scores vs.(1.08±0.30) scores, P<0.001], self-concept [(1.20±0.57) scores vs.(0.92±0.49) scores, P<0.001], social activities [(0.88±0.44) scores vs.(0.67±0.42) scores, P<0.001] and risky activities [(0.28±0.24) scores vs.(0.21±0.21) scores, P=0.043].The results of multivariate linear regression analysis showed that after adjusting for gender, age, total intelligence quotient, and core symptoms of ADHD, the regression coefficients of DOES in domains of family ( B=0.02, P=0.042) and life skills ( B=0.03, P<0.001) and the regression coefficient of DIMS in self-concept were still statistically significant ( B=0.02, P=0.013).The path analysis results showed that DOES ( β=0.170, P=0.004), attention deficit ( β=0.223, P<0.001) and hyperactivity ( β=0.385, P<0.001) directly affected WFIRS-P.DOES indirectly affected WFIRS-P through attention deficit ( β=0.270, P<0.001), and SWTD indirectly affected WFIRS-P through hyperactivity ( β=0.199, P=0.004). Conclusions:Severer sleep disturbances are associated with severer functional impairment in children with ADHD, and sleep phenotypes can directly or indirectly affect functional impairment outcomes in different domains in children with ADHD through core symptoms of ADHD.