OBJECTIVE To evaluate the long-term efficacy of intra-articular injection of hyaluronic acid （HA）， platelet-rich plasma （PRP）， and micro-fragmented adipose tissue （MFAT） in treatment of knee osteoarthritis （KOA）. METHODS Randomized controlled trials （RCTs） of KOA patients receiving intra-articular injection of the three agents were collected from PubMed， Web of Science， Embase， Cochrane Library， CNKI， Wanfang Data， VIP， Chinese Biomedical Literature Service System，and clinical trial registration platforms. The retrieval time limit was from January 2016 to December 2025. After screening the literature， extracting the data，and evaluating the quality of the literature， network meta-analysis was performed using RevMan 5.3 and Stata MP 16.0 software. RESULTS A total of 31 RCTs involving 2 964 patients were included. For pain relief， after 6 months of treatment， the Visual Analogue Scale （VAS） scores in the PRP+HA and PRP groups were significantly lower than those in the saline and HA groups （ P ＜0.05）， PRP+HA and PRP were ranked as the top two by surface under the cumulative ranking curve （SUCRA）. After 12 months of treatment， the VAS scores in the PRP group were significantly lower than those in the HA and saline groups （ P ＜0.05）， PRP and PRP+HA were ranked as the top two by SUCRA. For functional recovery， after 6 months of treatment， the Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） scores in the PRP group were significantly lower than those in the HA or saline groups （ P ＜0.05）. After 12 months of treatment， the WOMAC scores in the MFAT， PRP and PRP+HA groups were significantly lower than those in the HA or saline groups （ P ＜0.05）. After 6 and 12 months of treatment， International Knee Documentation Committee （IKDC） scores in the MFAT and PRP groups were significantly higher than the saline group （ P ＜0.05）， and after 12 months of treatment， the PRP group was significantly higher than the HA group （ P ＜0.05）. MFAT and PRP were ranked as the top two by SUCRA for both the WOMAC and IKDC scores. CONCLUSIONS For pain relief， PRP+HA showed a significant advantage at 6 months after treatment， whereas PRP alone demonstrated a notable superiority at 12 months after treatment. For functional recovery， MFAT exhibited a marked advantage at both 6 and 12 months after treatment.

ObjectiveTo investigate the influencing factors for traditional Chinese medicine （TCM） syndromes of primary liver cancer， and to provide a theoretical basis for the TCM syndrome differentiation and standardized treatment of liver cancer. MethodsTCM syndrome differentiation was performed for 415 patients who were admitted to Shanxi Institute of Traditional Chinese Medicine and were diagnosed with primary liver cancer based on pathological or clinical examinations from January 2019 to December 2023. The chi-square test was used for comparison of categorical data between groups， and the unordered polytomous logistic regression model was used to investigate the influencing factors for TCM syndromes of liver cancer. ResultsThe common initial symptoms of the 415 patients with primary liver cancer included pain in the liver area （31.81%）， abdominal distension （25.30%）， abdominal pain （15.18%）， and weakness （13.98%）， and the main clinical symptoms included poor appetite （70.84%）， fatigue （69.16%）， pain in the liver area （67.47%）， poor sleep （59.04%）， abdominal distension （53.01%）， and constipation （52.53%）. There were significant differences in TCM syndromes between patients with different sexes， courses of the disease， clinical stages， Child-Pugh classes， presence or absence of intrahepatic and extrahepatic metastasis， and presence or absence of transcatheter arterial chemoembolization （TACE） and radiofrequency ablation （all P<0.05）. The logistic regression analysis showed that male sex was a risk factor for damp-heat accumulation （odds ratio ［OR］=2.036， P=0.048） and the syndrome of spleen-kidney Yang deficiency （OR=5.240， P<0.001）； a course of disease of<1 year was a risk factor for damp-heat accumulation （OR=2.837， P=0.004） and syndrome of Qi stagnation and blood stasis （OR=2.317， P=0.021）， but it was a protective factor against syndrome of spleen-kidney Yang deficiency （OR=0.385， P=0.005）； Child-Pugh class A/B was a protective factor against liver-kidney Yin deficiency （OR=0.079， P<0.001）； intrahepatic metastasis was a risk factor for liver-kidney Yin deficiency （OR=5.117， P=0.003） and syndrome of spleen-kidney Yang deficiency （OR=3.303， P=0.010）； TACE was a protective factor against liver-kidney Yin deficiency （OR=0.171， P<0.001） and syndrome of spleen-kidney Yang deficiency （OR=0.138， P<0.001）； radiofrequency ablation was a risk factor for damp-heat accumulation （OR=4.408， P<0.001） and liver-kidney Yin deficiency （OR=32.036， P<0.001）. ConclusionSex， course of disease， Child-Pugh class， intrahepatic metastasis， TACE， and radiofrequency ablation are the main influencing factors for TCM syndromes of liver cancer.

Objective: To analyze the correlation between ABO blood group compatibility and the risk of early complications after liver transplantation, and to identify risk factors for clinical intervention. Methods: Clinical data of 404 liver transplant recipients and donors were collected. Based on donor-recipient ABO matching, patients were divided into three groups: ABO-Identical (ABO-Id, n=313), ABO-compatible (ABO-c, n=68), ABO-incompatible (ABO-i, n=23). Clinical data, early complications, and associated risk factors were compared. Results: Compared with the ABO-Id, ABO-c and ABO-i recipients were younger, had a higher proportion of primary biliary atresia, and more frequently received living-donor transplantation from relatives (P<0.05). Overall complication rates were: ABO-c 47.1% (32/68), ABO-i 43.5% (10/23), ABO-Id 39.3% (123/313), with no significant intergroup difference (P>0.05). Infection was the most common complication [ABO-c 30.9% (21/68), ABO-i 21.7% (5/23), ABO-Id 17.9% (56/313)]. No significant differences were found in infection, vascular/biliary or acute kidney injury/renal failure among the three groups (P>0.05). However, ABO-c group had significantly higher rates of ascites/abscess (20.6% vs 8.9%, P<0.05) and pleural effusion (14.7% vs 7.0%, P<0.05) than ABO-Id group. There was no significant difference in the incidence of complications and ABO blood group between ABO non-Identical (ABO-c and ABO-i) and Identical groups. Logistic regression analysis showed that the risk of ascites/abscess in ABO non-Identical was higher than that in ABO-Id liver transplantation (P<0.05), and the risk of ascites/abscess after ABO-c liver transplantation was 2.246 times higher than that of ABO-Id liver transplantation. The primary biliary atresia were a risk factor for postoperative ascites/abscess. Conclusion: Enhanced postoperative management is critical for ABO-nonidentical (especially ABO-compatible) recipients, and those with biliary atresia to reduce complication risks.

Objective:To observe any effect of combining repeated transcranial magnetic stimulation (rTMS) with electro-acupuncture in treating post-stroke cognitive impairment (PISC).Methods:Three groups of PISC patients were formed through random selection: an rTMS group, an electro-acupuncture group, and a combined group. In addition to routine medication and conventional rehabilitation training, the rTMS and electro-acupuncture groups received rTMS and electro-acupuncture treatment, while the combined group underwent both for six weeks. Before the treatment, immediately afterward and 3, 6, and 12 months later, everyone′s cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA). The modified Barthel Index (MBI), the 17-item Hamilton Depression Rating Scale (HAMD-17), and the National Institutes of Health Stroke Scale (NIHSS) were also applied. Transcranial Doppler ultrasound (TCD) was employed to measure the mean cerebral blood flow velocity (Vm), pulsatility index (PI), and breath-holding index (BHI) in the subjects′ bilateral middle cerebral arteries (MCAs). The total effectiveness rates and the incidence of adverse reactions were compared among the three groups.Results:The MoCA scores, MBI scores, HAMD-17 scores, NIHSS scores, and Vm of the MCA had improved significantly in all three groups right after the treatment. There was further significant improvement in the average MoCA scores 12 months later. The combined group showed significantly higher MoCA scores than the other two groups at each time point after the treatment. That group also had superior MBI, HAMD-17 and NIHSS scores and a better BHI compared to the other 2 groups, on average. Its total effectiveness rate was significantly higher too. There was no significant difference in the incidence of adverse reactions among the groups.Conclusions:Combining rTMS with electro-acupuncture significantly improves cognition, ADL ability, depression and neurological functioning after a stroke. The combined treatment is worthy of wider clinical application.

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

Purpose To assess the impact of in vitro fertilization-embryo transfer(IVF-ET)technology on early embryonic development by using early pregnancy ultrasound parameters.Materials and Methods A retrospective study was conducted on 864 pregnant women who had their early pregnancy ultrasounds at the Haidian District Maternal and Child Health Hospital in Beijing from 2020 to 2022.These women had singleton viable pregnancies with no adverse pregnancy outcomes followed up to 13+6 weeks.They were divided into two groups,based on their method of conception,including IVF-ET group and spontaneously conceived(SC)group.Subgroups were further divided according to the gestational age indicated by ultrasound at 6,7 and 8 weeks.A longitudinal study of early pregnancy ultrasound indicators was conducted in the IVF-ET group and compared with the corresponding parameters in the SC group.The ages of the pregnant women were stratified to compare the differences in ultrasound indicators between the two conception methods at different ages.Univariate linear regression analysis was used to assess the correlation between crown-rump length(CRL)and mean gestational sac diameter(mGSD).Results The CRL and mGSD of pregnant women in both groups increased with gestational age(P＜0.05),while the mGSD-CRL did not show significant changes with the increase in gestational age(F=83.592-840.037,P＞0.05).There were no statistically significant differences in CRL,mGSD and mGSD-CRL at each gestational week during early pregnancy between the SC group and the IVF-ET group(t=0.282-1.713,P＞0.05).When comparing the ultrasound parameters stratified by maternal age,there were no statistically significant differences in ultrasound parameters between the elderly and non-elderly subgroups within both groups(P＞0.05).There were also no statistically significant differences in ultrasound parameters between the elderly subgroup of the IVF-ET group and the SC group,as well as between the non-elderly subgroup of the IVF-ET group and the SC group(P＞0.05).Univariate linear regression analysis showed a positive correlation between CRL and mGSD in the early pregnancy period for both the IVF-ET group and the SC group(t=3.586,9.665,11.170,7.690,11.307,12.263,P＜0.05).Conclusion During early pregnancy,the gestational sac and embryo exhibit regular synchronous growth,and IVF-ET technology and age do not affect their growth patterns.

Radionuclide drug conjugates(RDC)represent the culmination of interdisciplinary integra-tion.By virtue of their precise targeting capability,high diagnostic sensitivity,and remarkable therapeutic effi-cacy in tumor diagnosis and treatment,RDC has emerged as promising theranostic agents with immense applica-tion potential.This article systematically reviews the progress in RDC development in China from 2009 to 2024,encompassing an overview of RDC,its structure and classification,trends in clinical research,advances in clinical trials,and national policy support.The aim is to provide valuable insights for researchers in related fields,thereby facilitating further development and application of RDC-based therapeutics.

Objective:To investigate the diagnostic value of high-resolution magnetic resonance black blood technology imaging (MRBTI) and CT angiography (CTA) in detecting carotid plaque in predicting stroke.Methods:A prospective study was conducted on 135 patients with carotid artery disease diagnosed and treated in Handan Central Hospital from January 2020 to June 2022, all patients underwent cervical MRBTI and CTA examinations. Digital subtraction angiography (DSA) was used as the gold standard to compare the diagnostic value of the two detection methods for carotid plaque properties. Patients were followed up for 2 years and divided into stroke and non-stroke according to the result of follower-up. Imaging indexes of the two groups were compared, and the predictive value of MRBTI combined with CTA for stroke was evaluated by receiver operation characteristic (ROC) curve.Results:The relevant data of 134 patients were included in statistical analysis. For severe carotid stenosis and ulcerative plaques, the accuracy of CTA examination was 85.11% and 84.91% separately, that of MRBTI examination was 91.49% and 92.45%, the combined examination was 95.74% and 96.23%, and the above three examination methods was not statistically significant ( P>0.05). The detection accuracy rates of CTA for mild, moderate carotid artery stenosis and smooth, irregular plaque, were 73.08%, 86.89%, 73.91% and 86.21%, those of MRBTI detection were 92.31%, 91.80%, 86.96% and 93.10%, and those of combined detection were 100.00%, 98.36%, 100.00% and 98.28%, the combined detection was higher than those of CTA and MRBTI alone ( P<0.05); there was no statistically significant difference in the level of tube wall area between the stroke patients and the non-stroke patients ( P>0.05), but the total vascular area and lumen area in stroke patients were significantly higher than those in non-stroke patients: (103.48 ± 22.48) mm 2 vs. (92.51 ± 16.26) mm 2, (46.18 ± 11.03) mm 2 vs. (41.32 ± 10.52) mm 2, and normal wall index was significantly lower: (0.54 ± 0.12) mm 2 vs. (0.61 ± 0.09) mm 2 ( P<0.05); ROC curve analysis showed that MRBTI combined with CTA had the best predictive efficacy for stroke, with area under the curve (AUC) value as high as 0.82, and its sensitivity (79.00%) was significantly higher than that predicted by MRBTI indexes (total vascular area, lumen area and normal wall index) (51.90%, 39.50%, 56.80%) or CTA (30.90%) alone, with statistically significant difference ( P<0.05). Conclusions:The combination of MRBTI and CTA can improve the diagnostic efficiency of carotid artery disease and the prediction efficiency of stroke, and can be used as an auxiliary examination means of DSA to provide a more reliable clinical basis for the assessment of plaque characteristics in patients with carotid artery disease and the prediction of stroke.

Objective:To observe any effect of combining repeated transcranial magnetic stimulation (rTMS) with electro-acupuncture in treating post-stroke cognitive impairment (PISC).Methods:Three groups of PISC patients were formed through random selection: an rTMS group, an electro-acupuncture group, and a combined group. In addition to routine medication and conventional rehabilitation training, the rTMS and electro-acupuncture groups received rTMS and electro-acupuncture treatment, while the combined group underwent both for six weeks. Before the treatment, immediately afterward and 3, 6, and 12 months later, everyone′s cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA). The modified Barthel Index (MBI), the 17-item Hamilton Depression Rating Scale (HAMD-17), and the National Institutes of Health Stroke Scale (NIHSS) were also applied. Transcranial Doppler ultrasound (TCD) was employed to measure the mean cerebral blood flow velocity (Vm), pulsatility index (PI), and breath-holding index (BHI) in the subjects′ bilateral middle cerebral arteries (MCAs). The total effectiveness rates and the incidence of adverse reactions were compared among the three groups.Results:The MoCA scores, MBI scores, HAMD-17 scores, NIHSS scores, and Vm of the MCA had improved significantly in all three groups right after the treatment. There was further significant improvement in the average MoCA scores 12 months later. The combined group showed significantly higher MoCA scores than the other two groups at each time point after the treatment. That group also had superior MBI, HAMD-17 and NIHSS scores and a better BHI compared to the other 2 groups, on average. Its total effectiveness rate was significantly higher too. There was no significant difference in the incidence of adverse reactions among the groups.Conclusions:Combining rTMS with electro-acupuncture significantly improves cognition, ADL ability, depression and neurological functioning after a stroke. The combined treatment is worthy of wider clinical application.