The surgical management of empyema (excluding those caused by mycobacterium tuberculosis and non-tuberculous mycobacteria) is rapidly evolving towards minimally invasive, precise, and stepwise approaches. The traditional three-stage classification (exudative, fibrinopurulent, and organizing) has limitations in guiding dynamic clinical decision-making. For the first time, this consensus explicitly identifies two critical junctures in the pathological progression of empyema: "early transformation" (stage Ⅰ to Ⅱ) and "late transformation" (stage Ⅱ to Ⅲ), and thereby constructs a corresponding "identification-early warning-intervention" stepwise therapeutic framework. The consensus emphasizes that proactive debridement via video-assisted thoracoscopic surgery should be performed during the early transformation phase to halt disease progression. Conversely, during the late transformation phase, therapeutic goals should be rationally adjusted to prioritize adequate drainage, avoiding futile pleural decortication. Moreover, the consensus underscores the pivotal role of precise perioperative etiological diagnosis (e.g. metagenomic nest-generation sequencing) and standardized anti-infective therapy. Integrating practical experiences from multiple thoracic surgery centers in China and relevant evidence-based literature, this consensus formulates recommendations on the precise definitions of staging, surgical indications for each phase, key technical points, perioperative management, and training systems. It aims to promote the standardized and individualized surgical management of empyema, ultimately optimizing patient prognosis.

Objective:To investigate the clinical manifestation, therapy, and prognosis of Susac syndrome and enhance the understanding of this disease.Methods:A case summary was made.The clinical data of two siblings with Susac syndrome treated at Children′s Medical Center, Peking University First Hospital in January 2024 were summarized.Reported cases of pediatric Susac syndrome were reviewed.Results:The onset of the disease in the two siblings was at the age of 3.00 and 6.75 years, with recurrent headaches, tinnitus, hearing loss and encephalopathy symptoms.Cranial magnetic resonance imaging showed multiple cerebral microbleeding and microinfarction lesions, " snowball like" in the corpus callosum and diffuse white matter edema in the brain.Audiometry revealed sensorineural hearing loss.In one case, ophthalmic fluorescein angiography revealed ischemic changes due to branch retinal artery occlusions.No pathogenic variants were detected in gene testing.This child was diagnosed with Susac syndrome, and the symptoms were improved after treatment with Corticosteroids and Rituximab.No relapse was observed during the 9-month follow-up.A total of 20 pediatric cases of Susac syndrome were retrieved, including 18 reported previously and 2 cases from this study.There were 2 boys and 18 girls, with the age of onset ranging from 2.5 to 17.0 years.The common initial symptoms included headache (19 cases), vertigo and tinnitus or hearing loss (9 cases), and vision impairment or visual field defect (4 cases). The symptoms were improved after immunotherapy.Conclusions:With a low incidence, Susac syndrome is rare in children and difficult to diagnose.There may be a genetic predisposition in such disease.Early diagnosis and immunotherapy can low the relapse and improve the prognosis.

Objective:To synthesize evidence regarding discharge preparation services for patients with severe acute pancreatitis (SAP) .Methods:Systematic search of relevant domestic and international websites and databases for diverse evidence concerning discharge preparation in SAP patients were conducted. Literature quality of the included studies was evaluated, and related evidence was extracted and graded.Results:Based on the researchers' evaluation and synthesis, 25 pieces of evidence related to discharge preparation services for patients with SAP were identified and summarized. These were categorized into five key areas: comprehensive assessment, care planning, multidimensional interventions, post-discharge follow-up, and ongoing evaluation. Among them, the evidence with stronger recommendation levels included multidisciplinary team assessment within 24 hours of admission, the assignment of dedicated personnel to coordinate, monitoring the discharge plan and continuous evaluation of the effectiveness of discharge preparation services.Conclusions:This study summarizes the best evidence available regarding discharge preparation services for SAP patients. It may provide an evidence-based foundation for nursing staff to standardize clinical practice and to further develop discharge preparation programs.

Objective:To investigate the efficacy of botulinum toxin type A (BTX-A) injections in treating motor tics in adult patients with tic disorders.Methods:A retrospective analysis was conducted on the baseline and clinical data of 25 adult tic disorder patients who received BTX-A treatment at the Movement Disorders Clinic of the Department of Neurology, Peking Union Medical College Hospital, from January 2019 to July 2023. Before the treatment, the Yale Global Tic Severity Scale (YGTSS) was used to assess the severity of motor and vocal tics. The injection sites and dosage of BTX-A were determined based on the distribution and severity of tic symptoms. Post-treatment improvement was evaluated via telephone follow-up.Results:Among the 25 patients, 18 were male and 7 were female, with an age of 27.0 (23.5, 31.0) years and a disease duration of 10.0 (5.5, 18.5) years. The pre-treatment YGTSS score was 41.3±12.3. After treatment, the time to onset of effect was 2.0 (1.0, 5.0) days, the peak efficacy was achieved at (15.5±9.4) days, and the duration of efficacy was 4.0 (2.5, 6.0) months. Post-treatment YGTSS score decreased to 14.7±11.3, with an improvement rate of 63.7%±24.9%. Significant efficacy was observed in 68.0% (17/25) of patients, 28% (7/25) showed moderate improvement, and 4% (1/25) had no response. Anxiety symptoms were alleviated in 91% (21/24) of patients, and premonitory urges were reduced in 90% (18/20) of patients. Retreatment in 13 patients with symptom recurrence remained effective. Adverse effects included facial stiffness in 4 patients, scalp tightness in 1, and mild neck muscle weakness in 5, all of which resolved spontaneously within 3-14 days; 16 patients reported no adverse effects.Conclusion:BTX-A is safe and effective in controlling motor tics in adult patients with tic disorders.

With the rising incidence of breast cancer among women, neoadjuvant chemotherapy (NAC) is becoming increasingly crucial as a preoperative treatment modality, enabling tumor downstaging and volume reduction. However, its efficacy varies significantly among patients, underscoring the importance of predicting pathological complete response (pCR) following NAC. Early research relied on statistical methods to integrate clinical data for predicting treatment outcomes. With the advent of artificial intelligence (AI), traditional machine learning approaches were subsequently employed for efficacy prediction. Deep learning emerged to dominate this field, and demonstrated the capability to automatically extract imaging features and integrate multimodal data for pCR prediction. This review comprehensively examined the applications and limitations of these three methodologies in predicting breast cancer pCR. Future efforts must prioritize the development of superior predictive models to achieve precise predictions, integrate them into clinical workflows, enhance patient care, and ultimately improve therapeutic outcomes and quality of life.
Humans ; Breast Neoplasms/pathology* ; Neoadjuvant Therapy ; Artificial Intelligence ; Female ; Machine Learning ; Deep Learning ; Chemotherapy, Adjuvant ; Treatment Outcome

OBJECTIVE: To observe the clinical efficacy of Xujiang Xie's bloodletting therapy combined with Qingyan Lige decoction on acute pharyngitis with lung-stomach heat accumulation. METHODS: A total of 88 patients with acute pharyngitis of lung-stomach heat accumulation were randomly divided into an observation group (44 cases, 4 cases dropped out) and a control group (44 cases, 4 cases dropped out). The control group was treated with oral Qingyan Lige decoction, 150 mL each time, twice a day for 6 continuous days. On the basis of the treatment in the control group, Xujiang Xie's bloodletting therapy was applied at bilateral Shaoshang (LU11), Shangyang (LI1), and Erjian (EX-HN6) in the observation group, 0.1-0.5 mL of bloodletting per site, once every other day for 3 times in total. The TCM symptom and sign score, complete blood count (white blood cell [WBC] count, neutrophilic granulocyte percentage [NE%]), inflammation indexes (serum levels of C-reactive protein[CRP], interleukin[IL]-1β, IL-6, tumor necrosis factor [TNF]-α) and immune indexes (？？, ？？, ？？) of the two groups were observed before treatment and after 6 days of treatment, and the clinical efficacy was evaluated. RESULTS: After 6 days of treatment, the sore throat scores, redness and swelling scores of pharyngeal mucosa and uvula, pharyngeal dry and burning scores, hyperemia scores of posterior pharyngeal lymphoid follicles, chill and fever scores, total scores of TCM symptom and sign, WBC count, NE%, CRP, IL-1β, IL-6, TNF-α and ？？ in both groups were decreased compared with those before treatment (P<0.05), the above indexes in the observation group were lower than those in the control group (P<0.01, P<0.05, P<0.001). After 6 days of treatment, the levels of ？？ and ？？ in both groups were increased compared with those before treatment (P<0.05), and the above indexes in the observation group were higher than those in the control group (P<0.001). The total effective rate of the observation group was 95.0% (38/40), which was higher than 90.0% (36/40) in the control group (P<0.001). CONCLUSION Xujiang Xie's bloodletting therapy combined with Qingyan Lige decoction could improve the symptoms in patients with acute pharyngitis of lung-stomach heat accumulation, inhibit inflammatory response and improve immune function.
Humans ; Drugs, Chinese Herbal/administration & dosage* ; Male ; Female ; Pharyngitis/drug therapy* ; Adult ; Middle Aged ; Bloodletting ; Young Adult ; Lung/drug effects* ; Combined Modality Therapy ; Interleukin-6 ; Adolescent ; Tumor Necrosis Factor-alpha ; Acute Disease/therapy* ; Treatment Outcome

Objective:To investigate the long-term prognosis and related factors in children with multiphasic myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).Methods:A bidirectional cohort study was conducted. This study included 41 children with MOGAD who were treated at the Children′s Medical Center of Peking University First Hospital between January 2013 and December 2024, with a disease duration of ≥5 years. Demographic characteristics, clinical episodes, therapy, and prognostic indicators (including the expanded disability status scale (EDSS) and modified Rankin scale (mRS)) were collected. Children were stratified into relapse and non-relapse groups based on the presence or absence of relapse within 5 years of the last follow-up. χ2 test or Mann-Whitney U test was used to analyze factors associated with relapse. The Log-rank test was used to compare relapse-free rates between children with disease onset 0-<5 years and those with onset at 5-10 years. Results:A total of 41 children were enrolled, including 20 boys and 21 girls. The age at onset was 5.3 (3.8, 8.5) years, the age at last follow-up was 16.1 (13.2, 17.5) years, and the disease duration was 9.4 (8.1, 10.9) years. The annualized relapse rate (ARR) during follow-up was 0.34 (0.19, 0.56) times/year. The duration to first relapse was 0.8 (0.4, 1.5) years. At the last follow-up, the EDSS score was 0.0 (0.0, 0.0) score, and the mRS score was 0 (0, 0) score. A total of 40 children (98%) experienced relapses within the first 5 years after onset, while only 1 child (2%) relapsed at 6.7 years. The relapse rate between 5-10 years was lower than that between 0-<5 years ( HR=0.27, 95% CI 0.16-0.47, P<0.001). A total of 25 children (61.0%) exhibited clustered relapses during the disease course. There were 20 children (49%) in non-relapse groups, who were aged 16.6 (14.8, 17.6) years, disease duration 9.8 (9.3, 10.8) years at the last follow-up. Among those 20 children, 15 children (75%) had discontinued corticosteroids and immunosuppressants. The relapse group had higher clinical event rates and ARR compared to the relapse-free group (both P<0.01), the age at last follow-up was yonger ( P<0.05), while no significant differences were observed in age at onset, disease duration, or timing of immunosuppressant use (all P>0.05). Conclusions:Pediatric multiphasic MOGAD generally has a favorable prognosis, about half of patients remain relapse-free for ≥5 years at last follow-up. Relapses predominantly occur early in the disease course (mostly within 5 years of onset) and often exhibit a clustered pattern.

Objective:To investigate the efficacy of botulinum toxin type A (BTX-A) injections in treating motor tics in adult patients with tic disorders.Methods:A retrospective analysis was conducted on the baseline and clinical data of 25 adult tic disorder patients who received BTX-A treatment at the Movement Disorders Clinic of the Department of Neurology, Peking Union Medical College Hospital, from January 2019 to July 2023. Before the treatment, the Yale Global Tic Severity Scale (YGTSS) was used to assess the severity of motor and vocal tics. The injection sites and dosage of BTX-A were determined based on the distribution and severity of tic symptoms. Post-treatment improvement was evaluated via telephone follow-up.Results:Among the 25 patients, 18 were male and 7 were female, with an age of 27.0 (23.5, 31.0) years and a disease duration of 10.0 (5.5, 18.5) years. The pre-treatment YGTSS score was 41.3±12.3. After treatment, the time to onset of effect was 2.0 (1.0, 5.0) days, the peak efficacy was achieved at (15.5±9.4) days, and the duration of efficacy was 4.0 (2.5, 6.0) months. Post-treatment YGTSS score decreased to 14.7±11.3, with an improvement rate of 63.7%±24.9%. Significant efficacy was observed in 68.0% (17/25) of patients, 28% (7/25) showed moderate improvement, and 4% (1/25) had no response. Anxiety symptoms were alleviated in 91% (21/24) of patients, and premonitory urges were reduced in 90% (18/20) of patients. Retreatment in 13 patients with symptom recurrence remained effective. Adverse effects included facial stiffness in 4 patients, scalp tightness in 1, and mild neck muscle weakness in 5, all of which resolved spontaneously within 3-14 days; 16 patients reported no adverse effects.Conclusion:BTX-A is safe and effective in controlling motor tics in adult patients with tic disorders.

Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA