OBJECTIVE To investigate the effect of pharmaceutical services guided by root cause analysis （RCA） in a problem-oriented manner combined with knowledge-attitude-practice （KAP） theory on reducing the incidence of protocol violations of investigational medicinal products in pediatric clinical trials. METHODS A total of 617 participants from 69 drug clinical trial projects conducted in our hospital from January 2016 to December 2020 were selected as the control group， and 868 participants from 72 drug clinical trial projects from January 2022 to December 2025 as the observation group. RCA was performed on the protocol violations of investigational medicinal product in the control group to identify the types and underlying causes. The control group received routine pharmaceutical services for drug clinical trials， while the observation group was provided with precision pharmaceutical services from the three dimensions of knowledge， attitude and practice on the basis of routine pharmaceutical services， according to the root causes identified by RCA. The occurrence of investigational medicinal products protocol violations was compared between the two groups. RESULTS The total incidence of protocol violations of investigational medicinal products， as well as the incidences of minor and major protocol violations， were all significantly lower in the observation group than in the control group （ P ＜0.001）. The main types of protocol violations in both groups included missed/under-/over-dosing of medications， non-adherence to administration time， failure to adjust dosage as required， and combined medication/vaccination in violation of the protocol. Regarding the responsible subjects of protocol violations， the incidences of protocol violations attributed to participants and their guardians as well as investigators and accidental factors were significantly lower in the observation group than in the control group （ P ＜0.001， P ＜0.001， P ＝0.025）. However， there were no statistically significant differences in the incidences of protocol violations caused by sponsor-related reasons between the two groups （ P ＞0.05）. CONCLUSIONS Pharmaceutical services led by pharmacists， based on problem-oriented RCA and combined with KAP theory， can effectively reduce the protocol violations of investigational medicinal products rate in pediatric clinical trials， thereby safeguarding the safety and rights of study participants.

OBJECTIVE To systematically evaluate the effects of supplementation with different doses of vitamin D on maternal and infant outcomes in vitamin D-deficient pregnant women. METHODS Related literature on the effects of supplementing different doses of vitamin D on maternal and infant outcomes was searched in databases including CNKI， Wanfang Data， VIP， PubMed， Medline， the Cochrane Library， Embase from their inception to June 30， 2025. The risk of bias assessment tool from the Cochrane Handbook 5.1 was used to evaluate the quality of included literature. Meta-analysis of outcome indicators was performed by using RevMan 5.4 software. RESULTS A total of 15 studies were included， involving 4 664 patients [2 129 in the experimental group （daily dose ＞2 000 IU）， 2 058 in control group 1 （daily dose ≤1 000 IU） and 477 in control group 2 （daily dose ＞1 000-≤2 000 IU） ] . Meta-analysis results showed that the incidence of preeclampsia （PE） [OR＝0.71， 95%CI （0.53， 0.96）， P ＝0.03 ] ， gestational diabetes mellitus （GDM） [OR＝0.60， 95%CI （0.43， 0.84）， P ＝0.003 ] ， low birth weight of newborn [OR＝0.72， 95%CI （0.53， 0.97）， P ＝0.03 ] and macrosomia [OR＝0.53， 95%CI （0.29， 0.98）， P ＝0.04 ] in the experimental group were significant lower than control group 1； but there was no significant difference in the incidence of premature delivery [OR＝0.86， 95%CI （0.65， 1.13）， P ＝0.28 ] ， cesarean delivery [OR＝0.92， 95%CI （0.74， 1.15）， P ＝0.48 ] or stillbirth rate [OR＝0.77， 95%CI （0.48， 1.24）， P ＝0.29 ] . The incidence of low birth weight of ne wborn [OR＝0.64， 95%CI （0.41， 0.98）， P ＝0.04 ] in the experimental group was significant lower than control group 2； but there was no significant difference in the incidence of PE [OR＝0.61， 95%CI （0.25， 1.49）， P ＝0.28 ] ， the incidence of GDM [OR＝0.73， 95%CI （0.42， 1.24）， P ＝0.24 ] ， premature delivery rate [OR＝0.90， 95%CI （0.59， 1.39）， P ＝0.63 ] ， cesarean delivery rate [OR＝0.92， 95%CI （0.64， 1.33）， P ＝0.66 ] ， or stillbirth rate [OR＝0.68， 95%CI （0.24， 1.94）， P ＝0.48 ] . CONCLUSIONS Different doses of vitamin D supplementation in early pregnancy have a significant impact on maternal and infant pregnancy outcomes in vitamin D-deficient pregnant women； daily doses ＞2 000 IU have significant advantages in reducing the incidence of PE and GDM and improving the outcome of premature delivery.

arcopenia is a systemic skeletal muscle disorder characterized by a decrease in skeletal muscle mass and progressive decline in function， with multiple signaling pathways involved in its occurrence and development. Among them， the AMP-activated protein kinase （AMPK） signaling pathway， as a key pathway regulating cellular energy homeostasis， plays an important role in the regulation of skeletal muscle metabolism and functional maintenance by improving abnormalities in glucose and lipid metabolism， balancing skeletal muscle protein synthesis and degradation， improving mitochondrial function， promoting autophagy， and inhibiting inflammatory responses and oxidative stress. This article reviews the research progress on how various traditional Chinese medicine （TCM） monomers， including polyphenols， flavonoids， and terpenoids； various traditional Chinese medicine extracts， such as those from Lycium barbarum ， Asini Corii Colla， and Panax quinquefolium ， and TCM compounds， such as Guiqi zhuangjin decoction， Jianpi qiangji granules， and Qigu capsules， intervene in sarcopenia by regulating the AMPK signaling pathway to promote muscle protein synthesis， inhibit protein degradation， improve mitochondrial function， and alleviate inflammation and oxidative stress. Additionally， their molecular mechanisms are explored. The aim is to deeply elucidate the basis of TCM in the prevention and treatment of sarcopenia and to provide theoretical support for the development of related innovative drugs.

Optical brain-computer interface (OBCI) represents an emerging class of neural interaction technologies that use “light” as an information carrier to enable the acquisition, decoding, and modulation of neural signals. Compared with conventional electrical brain-computer interface (BCI), OBCI demonstrates distinct advantages in spatial resolution, cell-type specificity, and the capacity for simultaneous multiparametric monitoring. Driven by rapid advances in functional near-infrared spectroscopy, optical neuroimaging, and optogenetics, optical approaches have progressively extended across the full “read, decode, write” continuum of neural activity, providing a novel technological framework for the development of high-precision closed-loop brain-computer systems. This review systematically summarizes the principal technological strategies and recent advances in OBCI, and further discusses the key challenges encountered during clinical translation, as well as future development direction.

Objective To explore the differences in heartbeat-evoked response (HER) under drug-related cues and neutral cues in individuals with heroin use disorder (HUD), and analyze the correlation between HER potentials and immediate cue-induced craving scores. Methods Fifty HUD participants were recruited from the Chang’an Compulsory Isolation Drug Rehabilitation Center in Shaanxi Province from June to September 2024. Simultaneous acquisition of 64-channel electroencephalography (EEG) and electrocardiogram signals was performed. Twenty alternating segments of drug-related and neutral cue videos were presented, and participants rated their subjective craving after each segment using visual analogue scale (VAS) scores. Scalp EEG data were source analyzed to obtain cortical EEG signals and corresponding HER. Short-time Fourier transform was used to calculate the power spectral density (PSD) of EEG within a time window from 100 ms before the R-peak to 500 ms after it, using the R-peak as the time zero point. Cluster-based permutation testing was used to analyze PSD differences between drug-related and neutral cues in the HUD individuals. Pearson correlation analysis was performed to evaluate the correlation between HER potentials and VAS scores. Results In the 350–420 ms time window, HER potentials in the left posterior parietal, temporal, and posterior cingulate cortices were significantly lower under drug-related cues compared to neutral cues (P＜0.01); in the 140–210 ms time window, HER potentials in the right prefrontal cortex were significantly higher under drug-related cues compared to neutral cues (P＜0.01). Correlation analysis showed that HER potentials in the left temporal and left posterior cingulate cortices were significantly negatively correlated with VAS scores (P＜0.05). Drug-related cues enhanced PSD of γ power (30–100 Hz) in salience network (fronto-insular), parietal and occipital regions (P＜0.05). PSD integrations of low-γ power (40–60 Hz) in parietal region (350–400 ms) and high-γ power (70–100 Hz) in left salience network (fronto-parietal) and occipital regions (300–350 ms) were positively correlated with VAS scores (P＜0.05). Conclusions Drug-related cues may modulate cortical activity related to heartbeat perception in HUD individuals, and such dynamic changes in both time and frequency domains are stably associated with subjective craving.

Objective To compare the clinical efficacy, safety, and patient’ prognosis of catheter-directed thrombolysis (CDT) via anterior tibial vein and popliteal vein approaches in the treatment of acute lower extremity deep vein thrombosis (DVT). Methods A retrospective analysis was conducted on the clinical data of 195 patients diagnosed with acute mixed lower extremity DVT and treated with CDT in the Department of Interventional and Vascular Surgery, Affiliated Hospital of Nantong University from January 2020 to December 2023. Patients were divided into an observation group (anterior tibial vein approach, n＝97) and a control group (popliteal vein approach, n＝98) according to the puncture route. Baseline data, thrombolysis-related indices (urokinase dosage, coagulation function indices), efficacy measures (degree of thrombus dissolution, leg circumference difference, visual analogue scale [VAS] score, venous clinical severity score [VCSS]), recovery parameters (time to ambulation, length of hospital stay), complication rates, and long-term prognosis measures (Villalta score, incidence of post-thrombotic syndrome [PTS]) were compared between the two groups. Results There was no statistically significant difference in urokinase dosage and levels of coagulation function indices between the two groups. Postoperatively, the leg circumference difference at 15 cm below the knee, VAS score, and VCSS score were significantly lower in the observation group than in the control group (P＝0.001). The observation group had higher grade Ⅲ dissolution rates in the popliteal and anterior tibial veins compared to the control group (P＜0.05), while differences of dissolution rates in the iliac and femoral veins were not statistically significant. The observation group had shorter length of hospital stay and earlier ambulation times than the control group (P＝0.001). There were no significant differences in complication rates, Villalta scores, or PTS incidence between the two groups. Conclusions CDT via the anterior tibial vein puncture approach for acute mixed lower extremity DVT is superior to the popliteal vein approach in promoting resolution of lower extremity swelling, alleviating pain, improving venous clinical symptoms, and achieving higher thrombus dissolution rates in the popliteal and anterior tibial veins. It also enables faster recovery and demonstrates good safety.

Objective To investigate the alleviating effect of jujuboside B (JuB) on acute epilepsy in mice and its protective effect on hippocampal neurons. Methods An in vitro epilepsy model was established by stimulating primary hippocampal neurons with cyclothiazide (CTZ). Spontaneous epileptiform discharge was recorded using patch clamp technique. An acute epilepsy model was induced in adult male C57BL/6 mice by intraperitoneal injecting pentylenetetrazol (PTZ) following pretreatment with JuB, and severity of epilepsy was recorded. Mice were euthanized and brain tissues were collected 24 hours after model establishment. The expression levels of mitoptosis related proteins in the hippocampus were detected by Western blotting. Neuronal damage in the hippocampal CA1 and CA3 regions was observed using pathological staining. Results JuB reduced the frequency of CTZ-induced epileptiform discharges (P＜0.001). Pretreatment with 30 mg/kg and 50 mg/kg JuB decreased the maximal behavioral seizure score and prolonged the latency to Racine stage Ⅲ seizures in PTZ-induced epileptic mice (P＜0.001). Compared with the PTZ group, JuB treatment downregulated Bax protein level (P＜0.01) and upregulated Bcl-2 protein level (P＜0.05) in acute epileptic mice. Furthermore, JuB protected neuronal viability in the hippocampal CA1 (P＜0.05) and CA3 (P＜0.01) regions, and ameliorated pathological morphological changes including cellular disarray, unclear boundaries, pyknosis, fragmentation, and dissolution. Conclusions JuB exhibits antiepileptic effects both in vivo and in vitro. It exerts potential antiepileptic effects by inhibiting mitoptosis and attenuating neuronal damage in the hippocampus in an acute epilepsy model.

With the widespread application of chemotherapy, immunotherapy, and targeted therapy, cardiotoxicity associated with anti-tumor treatment has gained increasing attention. Drug-induced cardiac injury can significantly impact patients’ quality of life and may even limit the overall efficacy of anti-tumor therapy. The underlying mechanisms include oxidative stress, inflammatory responses, mitochondrial dysfunction, apoptosis, and immune dysregulation. Owing to multitarget effects, low toxicity, and holistic regulatory properties, Chinese traditional medicines have demonstrated considerable potential in cardioprotection. This review summarizes the principal mechanisms of drug-induced myocardial injury related to anti-tumor therapy and highlights recent advances in the prevention and treatment of cardiotoxicity using Chinese medical formulae, such as compound danshen dripping pills, nuanxinkang, qili qiangxin capsules, and shengmai powder, as well as their bioactive constituents. The cardioprotective effects of these agents are discussed in terms of their antioxidative, anti-inflammatory, immunomodulatory, and mitochondrial-protective actions. Furthermore, it highlights certain traditional medicines that exhibit unique advantages in synergistic cardioprotective and anti-tumor therapy. Future efforts should focus on well-designed, systematic clinical studies to facilitate the translational application of integrated Chinese and Western medicine in cardio-oncology.

Objective To construct machine learning models based on preoperative inflammatory and radiological features for the prediction of glioma grading and isocitrate dehydrogenase (IDH) mutation status, and to analyze application values of these models and identify the optimal predictive models. Methods A retrospective analysis was conducted on the data of pathologically confirmed glioma patients admitted to Tongji Hospital Affiliated to Tongji University from March 2019 to March 2023. LASSO regression was used to screen feature variables, and predictive models were constructed based on logistic regression (LR), random forest (RF), support vector machine (SVM), gradient boosting decision tree (XGBoost) and K-nearest neighbor (KNN) algorithms. The model performance was comprehensively evaluated using metrics including discrimination ability, area under the precision-recall curve (AUC), accuracy, F1 score and Brier score. The DeLong test was adopted to compare the AUC values among different models; Friedman rank-sum test was used to determine the overall performance differences of the models, with the Nemenyi test applied for multiple comparison correction. Results In the task of glioma grading prediction, the LR model achieved the highest comprehensive score (0.726), and no significant difference was observed between the LR model and the other four models; age was positively correlated with glioma grading (P=0.003). In the task of IDH mutation status prediction, the XGBoost model obtained the highest comprehensive score (0.832), which was superior to the LR (0.762, P=0.035) and KNN models (0.754, P=0.025), while no statistical differences were found between the XGBoost model and the RF or SVM models. Conclusions The LR model for glioma grading prediction and XGBoost model for IDH mutation prediction constructed based on a task-oriented strategy achieve a favorable interpretability while ensuring optimized performance, thereby providing reliable decision support for the individualized diagnosis and treatment of glioma.

Large language models (LLM) are increasingly applied in the medical field, yet their clinical implementation faces numerous ethical and regulatory challenges. This paper reviews seven major ethical challenges: patient safety and accuracy, bias and fairness, privacy and data protection, transparency and explainability, accountability and legal liability, patient autonomy and informed consent, and the doctor-patient relationship and trust. At the regulatory level, international research indicates that United States currently lacks specific regulations for medical LLM use, while is exploring the regulation of high-risk LLM. The EU’s AI Act classifies medical AI as high-risk and imposes stringent compliance requirements. China has issued generative AI management measures and advocates industry standards, though its legal framework remains incomplete. Solutions include embedding ethical principles during model development, strengthening human-machine collaboration and manual oversight in clinical settings, establishing clear legal standards for accountability, safeguarding data privacy and security, implementing continuous monitoring and improvement, and deepening international cooperation and multidisciplinary governance.