Objective To investigate the therapeutic effect of Huangkui capsules on targeted drug-related proteinuria in patients with hepatocellular carcinoma (HCC). Methods A retrospective analysis was conducted on clinical data of HCC patients with targeted drug-related proteinuria from June 2023 to December 2024 at Zhongshan Hospital, Fudan University. According to the treatment plan, patients were divided into the conventional treatment group and the Huangkui combination treatment group (Huangkui capsules combined with conventional treatment), and the clinical efficacy between the two groups was compared. The logistic regression analysis was used to identify the main factors affecting treatment efficacy. Results The Huangkui combination treatment group (n＝29) showed a significantly higher overall effective rate (79.3% vs 42.3%, P＝0.005), and an earlier proteinuria improvement (median time: 3 months vs 6 months, P＝0.008) than the conventional treatment group (n＝26) . The multivariate logistic regression analysis showed angiotensin-converting enzyme inhibitor (ACEI) or angiotensin Ⅱ receptor blocker (ARB) using (OR＝0.190, 95%CI 0.045-0.808, P＝0.025), targeted drug adjustment (OR＝0.132, 95%CI 0.030-0.581, P＝0.007), and Huangkui capsules using (OR＝0.168, 95%CI 0.039-0.730, P＝0.017) were protective factors for treatment efficacy of targeted drug-related proteinuria. Conclusions On the basis of conventional treatment, additive treatment with Huangkui capsules can alleviate targeted drug-related proteinuria faster and more effectively in HCC patients.

Objective To construct a dynamic prediction model for JC polyomavirus (JCV) reactivation after kidney transplantation. Methods A retrospective analysis was conducted on the clinical data of 128 recipients who met the inclusion criteria and received kidney transplantation in Nanfang Hospital, Southern Medical University, from June 2021 to December 2024. Dynamic Cox regression and dynamic restricted mean survival time (RMST) regression based on the landmark method were adopted to establish the dynamic prediction models, and Monte Carlo cross-validation was used to evaluate model performance. Results The dynamic models could predict the incidence and onset time of JCV reactivation within the subsequent 3 months according to covariates at each landmark time point from the 1st to the 6th month after transplantation. Remuzzi score, body mass index and warm ischemia time were independent risk factors for JCV reactivation, while a history of urinary BK polyomavirus reactivation served as a protective factor. The median values of the area under the curve, C-index and Brier score of the dynamic Cox model were 0.873, 0.851 and 0.065 respectively, and the C-index of the dynamic RMST model was 0.829, all of which were superior to those of the static model. Conclusions The landmark-based dynamic models exhibit excellent predictive performance, which may integrate baseline data and post-transplant follow-up information to realize dynamic assessment of the risk and time window of JCV reactivation, thereby providing evidence for optimizing post-operative monitoring and individualized intervention strategies.

The recombinant human thyroid-stimulating hormone (rhTSH) can be used for differentiated thyroid cancer (DTC) preparation before ¹³¹I therapy, and follow-up. Since its approval by the American Food and Drug Administration (FDA) in 1998, rhTSH has been clinically used in European countries, the United States, and other countries for nearly 30 years. In April 2024, China’s first independently developed rhTSH agent was approved. Based on clinical experience and evidence from domestic and international studies, an expert consensus on the application of rhTSH has been developed following thorough consultations among experts. The consensus offers evidence-based recommendations to guide the appropriate use of rhTSH in clinical practice.

ObjectiveTo interpret the main contents of the Expert Consensus on Clinical Application of Yifei Zhike Capsules （hereinafter referred to as the Consensus）， analyze its evidence basis， and explore future research directions， thus providing a reference for rational drug use in clinical practice. MethodsThe core contents of the Consensus are summarized. Focusing on clinical issues， this paper summarizes the recommendations and consensus suggestions in the Consensus and explains them from aspects such as indications， key advantages， usage and dosage， combined medication， contraindications， precautions， and safety. ResultsThe Consensus clearly states that Yifei Zhike capsules can be used for acute or chronic bronchitis， pulmonary tuberculosis and other respiratory system diseases. It for the first time proposes that the applicable TCM syndrome of Yifei Zhike capsules is Qi-Yin deficiency together with combined phlegm and stasis. For different diseases， the Consensus provides specific usage instructions， dosage， and treatment course recommendations， supplementing the contents not covered in the drug instructions. In terms of combined medication， the Consensus emphasizes the principle of using this drug in combination with standardized chemotherapy regimens or conventional Western medicines and the applicability for the treatment of pulmonary tuberculosis and moderate to severe acute or chronic bronchitis. In terms of safety， the Consensus proposes methods for identifying common adverse reactions， drug contraindications， and precautions based on a review of the existing data and preliminarily builds a risk management framework. However， the evidence on which the Consensus is based are mostly early studies， with small sample sizes， which result in the low evidence grades （mainly C and D） of some recommendations. ConclusionThe Consensus provides specific guidance for the clinical use of Yifei Zhike capsules. However， due to the limited quality of the existing research evidence， more high-quality clinical studies are needed in the future to further verify its efficacy， safety， and explore its broader application prospects.

Objective To explore the effects of family delivery room service combined with staged psychological intervention on labor progress and comfort in primiparas undergoing painless delivery.Methods A total of 200 primiparas with a gestational age of above 36 weeks who were admitted to Cangzhou People's Hospital between January 2020 and January 2024 were enrolled in this study.Their mean age was(28.94±4.38)years(range,20-38 years),and mean body weight was(69.31±6.83)kg(range,60-80 kg).They were divided into control group(100 cases,routine nursing)and observation group(100 cases,family delivery room service combined with staged psychological intervention).The progress of labor(the first,second and third stages of labor)was compared between the two groups.The comfort(general comfort questionnaire[GCQ]),pain(visual analogue scale[VAS]),psychological health(childbirth attitude questionnaire[CAQ],pregnancy-related anxiety questionnaire[PAQ],Edinburgh postnatal depression scale[EPDS])and nursing satisfaction were evaluated.Results The first and second stages of labor in the observation group were shorter than those in the control group([7.14±1.05]h vs[8.18±1.12]h,[1.05±0.14]h vs[1.22±0.16]h,P<0.05),but there was no significant difference in the third stage of labor between the two groups(P>0.05).After intervention,GCQ scores in the observation group were higher than those in control group,while VAS,CAQ,PAQ and EPDS scores in the observation group were lower than those in control group(P<0.05).The nursing satisfaction rate in the observation group was higher than that in the control group(86.00%vs 75.00%,P<0.05).Conclusion Family delivery room service combined with staged psychological intervention can alleviate negative emotions and pain during delivery,accelerate labor progress and improve comfort level in primiparas undergoing painless delivery.

BACKGROUND: Durvalumab after chemoradiotherapy (CRT) failed to bring survival benefits to patients with epidermal growth factor receptor ( EGFR ) mutations in PACIFIC study (evaluating durvalumab in patients with stage III, unresectable NSCLC who did not have disease progression after concurrent chemoradiotherapy). We aimed to explore whether locally advanced inoperable patients with EGFR mutations benefit from tyrosine kinase inhibitors (TKIs) and the optimal treatment regimen. METHODS: We searched the PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases from inception to December 31, 2022 and performed a meta-analysis based on a Bayesian framework, with progression-free survival (PFS) and overall survival (OS) as the primary endpoints. RESULTS: A total of 1156 patients were identified in 16 studies that included 6 treatment measures, including CRT, CRT followed by durvalumab (CRT-Durva), TKI monotherapy, radiotherapy combined with TKI (RT-TKI), CRT combined with TKI (CRT-TKI), and TKI combined with durvalumab (TKI-Durva). The PFS of patients treated with TKI-containing regimens was significantly longer than that of patients treated with TKI-free regimens (hazard ratio [HR] = 0.37, 95% confidence interval [CI], 0.20-0.66). The PFS of TKI monotherapy was significantly longer than that of CRT (HR = 0.66, 95% CI, 0.50-0.87) but shorter than RT-TKI (HR = 1.78, 95% CI, 1.17-2.67). Furthermore, the PFS of RT-TKI or CRT-TKI were both significantly longer than that of CRT or CRT-Durva. RT-TKI ranked first in the Bayesian ranking, with the longest OS (60.8 months, 95% CI = 37.2-84.3 months) and the longest PFS (21.5 months, 95% CI, 15.4-27.5 months) in integrated analysis. CONCLUSIONS: For unresectable stage III EGFR mutant NSCLC, RT and TKI are both essential. Based on the current evidence, RT-TKI brings a superior survival advantage, while CRT-TKI needs further estimation. Large randomized clinical trials are urgently needed to explore the appropriate application sequences of TKI, radiotherapy, and chemotherapy. REGISTRATION PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; No. CRD42022298490.
Humans ; Carcinoma, Non-Small-Cell Lung/therapy* ; ErbB Receptors/genetics* ; Lung Neoplasms/drug therapy* ; Mutation/genetics* ; Protein Kinase Inhibitors/therapeutic use* ; Chemoradiotherapy ; Antibodies, Monoclonal/therapeutic use*

OBJECTIVE: To explore the effectiveness of arthroscopic All-inside single needle vertical suture technique in treatment of complete radial tear of the meniscus. METHODS: Between January 2019 and January 2022, 18 patients (18 knees) with complete radial tear of the meniscus were treated by using arthroscopic All-inside single needle vertical suture technique. Among them, there were 12 males and 6 females with an average age of 37.1 years (range, 16-50 years). The causes of radial meniscus tears included the sports injuries in 11 cases, sprains/falls in 4 cases, and traffic accident injuries in 3 cases. The interval between injury and operation was 3-25 days (mean, 11.7 days). All patients had knee joint pain. Knee joint tenderness and McMurray sign were both positive. MRI showed the 15 cases of lateral meniscus tear and 3 cases of medial meniscus tear; 15 cases of anterior cruciate ligament injury, 1 case of posterior cruciate ligament injury, and 15 cases of tibial plateau bone contusion. Six patients underwent isolated meniscus repair and 12 patients with cruciate ligament rupture underwent meniscus repair and simultaneous cruciate ligament reconstruction. The operation time and incidence of postoperative complications were recorded. At last follow-up, the meniscus healing was evaluated according to Barrett's criteria and knee joint MRI, respectively. Lysholm score and International Knee Documentation Committee (IKDC) score were used to evaluate the functional recovery of the knee joint. RESULTS: The operation time was 19-28 minutes (mean, 23.3 minutes) in 6 patients with isolated meniscus repair and 38-52 minutes (mean, 45.8 minutes) in 12 patients with meniscus repair and simultaneous cruciate ligament reconstruction. All incisions healed by first intention. After operation, 1 patient developed the deep vein thrombosis of lower limb, the other patients had no complication. All patients were followed up 12-18 months (mean, 15.2 months). At last follow-up, 16 cases of meniscus reached clinical healing according to Barrett's criteria, with a healing rate of 88.9%. MRI re-examination of the knee joint showed that 5 cases had complete healing of the meniscus, 11 cases had partial healing, and 2 cases did not heal. The total healing rate (complete healing and partial healing) was 88.9%. After operation, the Lysholm score and IKDC score of 18 patients increased compared to preoperative scores, and further improved with time. The differences between different time points were significant ( P<0.05). Six patients with isolated meniscus repair had the same changes in the above scores, and the differences between the different time points were significant ( P<0.05). CONCLUSION The arthroscopic All-inside single needle vertical suture technique can achieve good short-term effectiveness in the treatment of complete radial tears of the meniscus.
Humans ; Male ; Adult ; Female ; Arthroscopy/methods* ; Tibial Meniscus Injuries/surgery* ; Middle Aged ; Adolescent ; Young Adult ; Suture Techniques ; Treatment Outcome ; Magnetic Resonance Imaging ; Anterior Cruciate Ligament Injuries/surgery* ; Menisci, Tibial/surgery* ; Knee Joint/surgery*

The compilation instructions for the Expert Consensus on Clinical Application of Yifei Zhike Capsules systematically expound the development background， methodological framework， and core achievements of this consensus. In view of the problems existing in the clinical application of Yifei Zhike Capsules， such as insufficient efficacy evidence and lack of standardized syndrome differentiation， the Institute of Basic Research in Clinical Medicine， China Academy of Chinese Medical Sciences took the lead and collaborated with 21 tertiary grade-A hospitals and research institutions across China to form a multidisciplinary expert group （comprising 30 experts in clinical medicine， pharmacy， and methodology）. The compilation work was carried out in strict accordance with the World Health Organization （WHO） guidelines， the GB/T 1.1-2020 standard， and the writing specifications for the explanatory notes of expert consensus on clinical application of Chinese patent medicines. Through systematic literature retrieval （including 32 studies， with 24 clinical studies）， Grading of Recommendations Assessment， Development and Evaluations （GRADE）-based evidence grading， and multiple rounds of discussions using the nominal group method （25 experts voted to determine 17 clinical questions）， 5 evidence-based recommendations and 11 expert consensus suggestions were formed. It is clarified that this medicine （Yifei Zhike Capsules） is applicable to the treatment of expectoration/hemoptysis in acute and chronic bronchitis and the adjuvant treatment of pulmonary tuberculosis. It is recommended that it can be used alone or in combination with anti-tuberculosis drugs. The safety evaluation shows that this medicine mainly induces the following adverse reactions： mild gastrointestinal reactions （such as nausea and abdominal pain） and rashes. The contraindicated populations include pregnant women and women during menstruation. The compilation process of the consensus underwent three rounds of expert letter reviews， two rounds of peer reviews， and quality control assessments to ensure methodological rigor and clinical applicability. In addition， through policy alignment， academic promotion， and a dynamic revision mechanism， the standardization of clinical application was promoted， providing a demonstration for the evidence-based transformation of characteristic therapies of Miao medicine.

As an exclusive Miao medicine of Honwing Pharma （Guizhou） Co. Ltd.， Yifei Zhike capsules are both a prescription drug and an over-the-counter （OTC） drug. Its main ingredients include Ranunculus ternatus and Panax notoginseng. With the effects of nourishing Yin and moistening the lungs， as well as relieving cough and reducing phlegm， Yifei Zhike capsules are often used in the treatment of acute and chronic bronchitis， pulmonary tuberculosis， and other diseases. However， there is insufficient understanding of their efficacy， suitable syndromes， and safety in clinical practice， with a lack of relevant expert consensus on clinical application. To standardize their clinical application， 30 experts from the fields of respiratory medicine， pharmacy， and evidence-based medicine were invited to develop an Expert Consensus on the Clinical Application of Yifei Zhike Capsules （Consensus for short） through evidence-based medicine methods. The Consensus clarified the syndrome characteristics， disease stages， dosages， treatment courses， combined medication， and other norms in the treatment of acute/chronic bronchitis and pulmonary tuberculosis and could be applicable to clinical physicians and pharmacists in medical and health institutions at all levels. In disease diagnosis， it provided diagnostic criteria for traditional Chinese medicine and Western medicine and clarified that the suitable traditional Chinese medicine syndrome was the syndrome of Qi-Yin deficiency with intermingled phlegm-blood stasis. Clinical studies have confirmed that Yifei Zhike capsules combined with standard anti-tuberculosis therapy can effectively improve the symptoms of pulmonary tuberculosis patients， increase the sputum smear conversion rate， and promote the absorption of lesions. When treating acute cough caused by respiratory tract infections， Yifei Zhike capsules can increase the markedly effective rate and the seven-day disappearance rate of cough symptoms. Meanwhile， recommendations for specific usage， dosages， and treatment courses were given for different diseases， and it was pointed out that long-term medication required key monitoring of adverse reactions. In safety， the adverse reactions of Yifei Zhike capsules involved multiple aspects such as the digestive system and allergic reactions， and pregnant women and women during menstruation were prohibited from using it. In addition， modern research has shown that Yifei Zhike capsules have an adjuvant therapeutic effect on tuberculous pleurisy and may be effective for inflammatory and benign pulmonary nodules. However， further research should be conducted on the toxicological safety of long-term medication. The formulation of the Consensus provides a scientific basis for the rational clinical application of Yifei Zhike capsules， which helps to improve clinical efficacy and reduce medication risks.

ObjectiveWe reviewed the existing experimental studies about renal injury-inducing Chinese medicine and systematically analyzed the toxicity mechanisms， toxic components， toxicity attenuation measures， and modern evaluation methods of renal injury-inducing Chinese medicine. The results are expected to provide new ideas for the modern research on kidney injury-inducing Chinese medicine， offer new breakthrough points for the toxicity attenuation of Chinese medicine by compatibility and processing， and give insights into the future research of Chinese medicine toxicology on the basis of ensuring the safety and scientific application of Chinese medicine. MethodsThe animal， cell， and clinical studies of kidney injury-inducing Chinese medicine were retrieved from CNKI， Wanfang Data， VIP， PubMed， and Web of Science. The names and toxic components of renal injury-inducing Chinese medicine， renal injury sites， toxicity mechanisms， toxicity attenuation measures， and related evaluation methods were summarized. ResultsThe toxicity mechanisms of kidney injury-inducing Chinese medicine mainly involved oxidative stress， endoplasmic reticulum stress， inflammatory cell infiltration， and organic anion transporters. Processing and compatibility were the main toxicity attenuation measures. The evaluation methods encompassed animal experiments， cell models， network pharmacology， metabolomics， toxicology genomics， and fluorescent probe technology. ConclusionAt present， the toxicological verification of kidney injury-inducing Chinese medicine starts from toxic components and combines various experimental methods， which is more comprehensive and systematic than the previous studies based on only animal experiments. According to the classical theories of traditional Chinese medicine， the toxicity of kidney injury-inducing Chinese medicine is mainly attenuated by decocting in water， steaming， and frying. With the progress of science and technology， new processing methods for toxicity attenuation are emerging， and structural transformation， fermentation， and microwave methods are the key research directions of toxicity attenuation of Chinese medicine in recent years.