OBJECTIVE To form an expert consensus addressing clinical issues regarding the use of parenteral direct thrombin inhibitors （DTIs） in special populations. METHODS Led by the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital（the Affiliated Hospital of UESTC）， a multidisciplinary working group was formed comprising experts from multiple fields， including clinical pharmacy， cardiac surgery， obstetrics， pediatrics and evidence-based medicine. Through literature review and the Delphi method， clinical questions regarding the efficacy and safety of parenteral DTIs used in special populations were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” （PICO） framework；systematic searches were conducted in CJFD， PubMed， Embase and other databases. Relevant evidence from randomized controlled trials，cohort studies and systematic reviews were included and synthesized. Evidence quality was assessed using the Grading of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through three rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven clinical questions were ultimately selected （with a consensus rate exceeding 90%）， resulting in the formulation of seven recommendations on the use of parenteral DTIs in special populations， including children， pregnant women， patients with hepatic or renal impairment， patients with mesenteric venous thrombosis， and individuals with thrombophilia. These recommendations clarify the preferred agents， dosing ranges， monitoring parameters， and safety management strategies for parenteral DTIs in these special populations. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in special populations.

ObjectiveTo systematically explore the current practical status, core predicaments, and optimization paths of effective contract fulfillment by family doctors in Shanghai from the perspective of informatization, and to provide empirical support and policy references for the high-quality development of contracted services. MethodsA mixed research approach was adopted. The connotation of effective contract fulfillment, the current status of informatization support, and the priority of demand were comprehensively analyzed through policy document review, in-depth interviews with key informants, and a questionnaire survey covering 45 community health service centers across all 16 districts of Shanghai. ResultsThe family doctor contract service in Shanghai has formed a dual-core framework of “accurate contracting” and “substantive service delivery”, yet challenges persist in system interoperability, health data integration, and the limited diversity of service outreach tools. The comprehensive utilization rate of the information integration terminal in the 45 surveyed community health service centers was merely 50.74%. Three prioritized demands were identified: horizontal connectivity between the Hospital Information System (HIS) and the public health system for contract status updates, integration of “medical-prevention-management” information, and automated generation of health assessments. Based on these findings, this study proposed a closed-loop fulfillment pathway of “tag generation-task management-service delivery-data return”. ConclusionTo facilitate the high-quality development of contracted services, it is recommended to transform the concept of contracted services and promote the integration of medical care and disease prevention through information system construction from a holistic perspective. Concurrently, municipal top-level design and district-level platform development should be reinforced to refine data governance and application. Furthermore, substantial efforts should be devoted to cultivating interdisciplinary talents bridging clinical practice and information technology, thus strengthening the convergence of clinical and information operations.

ObjectiveTo investigate the metabolic mechanisms of Limosilactobacillus reuteri （L. reuteri） in alleviating chemotherapy-induced intestinal mucosal injury （CIMI）. MethodsC57BL/6 mice were randomly divided into the Control group， Model group， and L. reuteri treatment group （n=8 per group）. Mice in the L. reuteri group were intragastrically administered L. reuteri （1 × 10⁹ CFU/mL） for 10 consecutive days. From day 5， mice in the Model and L. reuteri groups were intraperitoneally injected with 5-FU （65 mg/kg） for 6 consecutive days to establish a CIMI model. Body weight changes， colon length， and related indicators were recorded. Intestinal histopathological injury was assessed by HE staining with measurement of villus height and crypt depth. The expression levels of zonula occludens-1 （ZO-1）， Occludin， Claudin-4， Muc1， and Muc2 in ileal tissues were determined by RT-qPCR and immunohistochemistry to evaluate intestinal barrier function. In addition， untargeted metabolomics was performed on cecal contents from each group to analyze metabolic profiles and enrichment of differential metabolic pathways. ResultsL. reuteri intervention significantly alleviated body weight loss （P<0.001） and colon shortening （P<0.05） in CIMI mice， effectively reducing ileal tissue pathological damage， and upregulating the expression of ZO-1， Occludin， Claudin4， Muc1， and Muc2 （P<0.05）. Untargeted metabolomics analysis showed that L. reuteri treatment reversed the abnormal metabolic profile in the cecal contents of CIMI mice， bringing it closer to normal. Various differential metabolites， such as acylcarnitines and polyunsaturated fatty acids， might play an important role in L. reuteri-mediated alleviation of CIMI. These differential metabolites were primarily enriched in key pathways such as linoleic acid metabolism， tryptophan metabolism， and unsaturated fatty acid biosynthesis. ConclusionThis study reveals that L. reuteri improves intestinal barrier function and alleviates CIMI by regulating the intestinal metabolic profile， particularly lipid and amino acid metabolism. It provides a novel potential strategy for the prevention and treatment of CIMI.

Objective: To present the plotting of trend analysis charts and the application of multi-rule trend analysis method for monitoring the quality of whole blood, washed red blood cells, and leukocyte-depleted suspended red blood cells. Methods: Samples of whole blood, washed red blood cells, and leukocyte-depleted suspended red blood cells were collected in accordance with relevant protocols and requirements. The results of blood quality testing were compiled. The trend line charts were plotted for the deviation rates of volume, hemoglobin (Hb) content, supernatant protein content, and leukocyte residual count. In addition, the trend line chart were plotted for hematocrit and post-storage hemolysis rate. Results: The trend analysis rules for the deviation rate of volume from the standard were: 1 categorized as out-of-control, (3 of 4) as warning, R as warning, 8 as alert, and 12 as alert. For Hb content deviation rate, the rules were: <0% categorized as out-of-control; <20% but ≥0% (for whole blood) or <10% but ≥0% (for washed red blood cells and leukocyte-depleted suspended red blood cells) as a warning. For supernatant protein content deviation rate, the rules were: ≥0.0% as out-of-control, and >-10% but <0.0% as a warning. For hematocrit, the rules were: 1 as out-of-control and (3 of 4) as warning. For leukocyte residual count deviation rate, the rules were: >0.0% as out-of-control, and >-10% but ≤0.0% as a warning. For post-storage hemolysis rate, the rule was: ≥0.8% out-of-control. Conclusion: The application of multi-rule trend analysis facilitates the timely identification of trend abnormalities and factors causing deviations in the collection and preparation processes of whole blood, washed red blood cells, and leukocyte-depleted suspended red blood cells, thereby providing reliable numerical evidence for their correction and adjustment.

ObjectiveTo develop an assessment tool for apraxia of speech (AOS) of Chinese Putonghua speakers and test its reliability and validity. MethodsThe Chinese Apraxia of Speech Assessment and Diagnostic Tool (CAADT) was developed based on the Apraxia of Speech Rating Scale 3.5, combined with the linguistic characteristics of Chinese and clinical experience. The tool consistsed of eleven items across three sections: articulation, prosody and alternating motion rates. Six experts evaluated the content validity. From November, 2024 to May, 2025, 51 patients with post-stroke AOS (experimental group) and ten patients with post-stroke aphasia without AOS (control group) were recruited from Anhui Wannan Rehabilitation Hospital (the Fifth People's Hospital of Wuhu), and tested with CAADT. Reliability was assessed using Cronbach's α coefficient, Kendall's coefficient of concordance W and Pearson correlation coefficient. Validity was evaluated using the content validity index (CVI) and Spearman correlation coefficient. Discriminative effect was analyzed using the receiver operating characteristic (ROC) curve. ResultsThe Cronbach's α coefficients for the articulation and prosody sections and the total scale were all > 0.9, while it was 0.454 for the alternating motion rates. Inter-rater reliability was good (W ≥ 0.598, P < 0.001). Test-retest reliability showed high positive correlations for the three sections and the total score between the two assessments (r ≥ 0.84, P < 0.001). The scale-level CVI was 0.95, and the item-level CVI ≥ 0.83. The Spearman correlation coefficients among the sections ranged from 0.30 to 0.70. ROC analysis revealed an area under the curve of 0.953, with a cut-off value of 11, yielding a sensitivity of 0.92 and a specificity of 0.90. ConclusionCAADT demonstrates good reliability, validity and discriminative effect, which can be used for clinical assessment and auxiliary diagnosis of Chinese Putonghua speaking patients with post-stroke AOS.

OBJECTIVE:Neuromuscular exercise is a new comprehensive rehabilitation therapy in recent years,but its effect on knee osteoarthritis is still controversial.The purpose of this paper is to systematically evaluate the efficacy of neuromuscular exercise on knee osteoarthritis pain and function. METHODS:The randomized controlled trials addressing neuromuscular exercise in the treatment of knee osteoarthritis pain and function were retrieved from PubMed,Cochrane Library,Embase,EBSCO,CNKI,Web of Science,China Biomedical Database(CBM),VIP,and WanFang Database.The retrieval time ranged from database inception to October 2023.The neuromuscular training group(experimental group)was given neuromuscular training or neuromuscular training as the main intervention;the control group was a blank group or given conventional rehabilitation.Outcome indicators included the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,walking time,knee stability,and the maximum number of knee flexion in 30 seconds.The risk of bias was evaluated by the Cochrane Collaboration tool and the Physiotherapy Evidence Database.Meta-analysis was performed using RevMan 5.4 software. RESULTS:A total of 11 randomized controlled trials were included,and 628 samples were extracted.The results of Meta-analysis showed that the experimental group was superior to the control group in terms of WOMAC pain score[standardized mean difference(SMD)=0.38,95%confidence interval(CI):0.08-0.69,P=0.01],knee stability(SMD=0.57,95%CI:0.23-0.92,P=0.001),the maximum number of knee joint flexion in 30 seconds(SMD=0.35,95%CI:0.05-0.65,P=0.02),and WOMAC physical function score(SMD=-0.79,95%CI:-1.30 to-0.28,P=0.002).In both groups,walking speed was increased and walking ability was improved in patients with knee osteoarthritis,but there was no significant difference(walking time:SMD=-0.22,95%CI:-0.48-0.03,P=0.09). CONCLUSION:Neuromuscular exercise can effectively improve knee joint pain,enhance the stability of the knee joint,and promote functional recovery in patients with knee osteoarthritis.However,more high-quality randomized controlled trials are still needed to further confirm the research.

Objective To investigate the intervention mechanism of Bushen Zhupai Decoction on polycystic ovary syndrome rats with insulin resistance based on IL-6/PI3K/AKT signaling pathway Methods A rat model of polycystic ovary syndrome with insulin resistance was established by feeding high-fat diet combined with oral administration of letrozole,and the blank group was fed with ordinary diet.The modeled rats were randomly divided into model group,metformin group and Bushen Zhupai Decoction low-,medium-and high-dosage groups.The corresponding intervention were given for 28 days.Fasting blood glucose(FBG)content was detected,and insulin resistance index(HOMA-IR)was calculated.ELISA was used to detect serum fasting insulin(FINS),testosterone(T),estradiol(E2),luteinizing hormone(LH)and follicle stimulating hormone(FSH)contents.HE staining was used to observe the morphology of ovarian tissue.Immunohistochemistry was used to detected the expressions of interleukin(IL)-6,p-PI3K,p-AKT and GLUT4 in ovarian tissue.Western blot was used to detect the protein expressions of IL-6,PI3K,p-PI3K,AKT,p-AKT and GLUT4 in ovarian tissue,while RT-PCR was used to detect the mRNA expressions of IL-6,PI3K,AKT and GLUT4.Results Compared with the blank group,the body mass,FBG,FINS and serum T and LH contents of the model group rats significantly increased(P<0.01),while the serum E2 and FSH contents significantly decreased(P<0.01);ovarian tissue showed polycystic changes,with reduced layers and loose arrangement of granulosa cells,the expression of IL-6 protein and mRNA in ovarian tissue significantly increased(P<0.01),the expressions of p-PI3K,p-AKT and GLUT4 proteins significantly decreased(P<0.01),and the expressions of PI3K,AKT and GLUT4 mRNA significantly decreased(P<0.01).Compared with the model group,the body mass of rats in each administration group decreased,and the contents of FBG,FINS and serum T and LH decreased(P<0.01,P<0.05),while the contents of E2 and FSH increased;polycystic changes in ovarian tissue were reduced,mature follicles increased,and granulosa cells were tightly arranged,the expression of IL-6 protein and mRNA in ovarian tissue decreased,the expressions of p-PI3K,p-AKT,GLUT4 protein and PI3K,AKT,GLUT4 mRNA increased.Bushen Zhupai Decoction high-dosage group showed statistical significance(P<0.01).Conclusion Bushen Zhupai Decoction can improve reproductive and metabolic disorders in polycystic ovary syndrome with insulin resistance rats,and its mechanism may be related to inhibiting IL-6 expression,activating the PI3K/AKT signaling pathway,and alleviating insulin resistance.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To investigate the association between serum IgG concentration and renal prognosis in patients with IgA nephropathy (IgAN).Methods:It was a multi-center retrospective cohort study, patients with biopsy proven primary IgAN who were recorded in the Chinese IgA Nephropathy Information Registration System between April 1996 and September 2018 were included. Exclusion criteria were: (1) age <18 years; (2) <8 glomeruli in biopsy specimens; (3) estimated glomerular filtration rate (eGFR) <15 ml·min -1·(1.73 m 2) -1 at biopsy; (4) missing baseline serum IgG values; (5) incomplete follow-up data; (6) follow-up duration <12 months. Enrolled patients were divided into 3 groups according to the baseline tertiles of serum IgG: ≤9.50 g/L (G1 group), 9.51-11.99 g/L (G2 group), and ≥12.00 g/L (G3 group). Clinical, and pathological parameters were compared across groups. The endpoint events were defined as doubled serum creatinine level from baseline, or end-stage renal disease (ESRD). Results:A total of 1 976 IgAN patients were included in this study, 631 were in G1 group, 664 in G2 group, and 681 in G3 group. The comparison of baseline clinical data showed that there were statistically significant differences among the three groups in terms of gender, age, microscopic hematuria, edema, body mass index, systolic blood pressure, diastolic blood pressure, hemoglobin, serum creatinine, eGFR, 24-hour urine protein quantity, blood uric acid, blood albumin, serum IgA, serum IgM, the proportion of using immunosuppressants, and the proportion of using glucocorticoids (all P<0.05). In terms of pathology, the higher the serum IgG concentration, the relatively less severe the overall renal pathological damage. The results of univariate Cox regression analysis showed that gender, systolic blood pressure, diastolic blood pressure, hemoglobin, serum creatinine, eGFR, 24-hour urine protein quantity, total protein, serum albumin, globulin, serum IgG, Oxford renal pathological classification, glomerular sclerosis ratio, and glomerular IgM deposition were all associated with the occurrence of renal endpoint events (all P<0.05). Based on clinical practice and previous studies, after adjusting for gender, age, systolic blood pressure, diastolic blood pressure, eGFR, 24-hour urine protein quantity, body mass index, Oxford renal pathological classification, glomerular sclerosis ratio, and the use of renin-angiotensin-aldosterone system inhibitors, glucocorticoids, and immunosuppressants, multivariate Cox regression analysis showed that as a continuous variable, the baseline serum IgG level ( HR=0.91, 95% CI 0.87-0.96) was independently associated with the risk of renal endpoint events in IgAN patients; as a categorical variable, with serum IgG ≤ 9.50 g/L as the reference, serum IgG 9.51-11.99 g/L and serum IgG ≥ 12.00 g/L were independent factors for the occurrence of renal endpoint events in IgAN patients ( HR=0.69, 95% CI 0.49-0.96, P=0.027; HR=0.50, 95% CI 0.34-0.74, P<0.001). During a median follow-up of 33(21, 53) months started from the date of renal biopsy and continued until December 31, 2019, the median follow-up duration was 33 (21, 53) months, and a total of 232 patients (11.74%) reached the composite endpoint. Kaplan-Meier survival analysis showed that the higher the serum IgG concentration in patients with IgAN, the higher their cumulative renal survival rate (Log-rank test, χ2=47.176, P<0.001). Conclusion:The higher level of serum IgG at diagnosis is associated with better clinicopathologic features and renal outcomes, and may portend better renal survival in IgAN patients.

Objective To determine the rules of acupoint selection for hiccup based on data mining.Methods From the acupuncture and moxibustion sections of 53 medical books included in the 5th edition of Chinese Medical Classics,entries related to acupuncture treatment for hiccups was screened and constructed a"Classical Chinese Medicine Database for Acupuncture Treatment of Hiccups."Data mining techniques,including cluster analysis and association rule analysis,were employed to study the characteristics and patterns of acupoint selection for hiccup treatment in ancient medical texts.Results A total of 126 prescriptions were collected,involving 65 acupoints with a total application frequency of 172 times.The most frequently selected acupoints were Taiyuan(LU9),Shaoshang(LU11),Shiguan(KI18),Wenliu(LI7),Laogong(PC8),and Zusanli(ST36).The primary meridians used were the conception vessel(CV1)and the lung meridian of hand-taiyin.The most commonly stimulated body regions were the upper limbs and the chest/abdomen.Among special acupoint categories,the five-shu points and crossing points were predominantly utilized.Cluster analysis identified two significant clusters:Daling(PC7)-Ximen(PC4)-Yuji(LU10),and Qimen(LR14)-Chengjiang(CV24)-Dadun(LR1)-Guanyuan(CV4)-Juque(CV14).Association rule analysis revealed the strongest acupoint correlation between Danzhong(CV17)and Zhongwan(CV12),followed by the combination of Danzhong-Zhongwan-Zusanli.Conclusion In ancient acupuncture treatment of hiccups,particular emphasis was placed on the flexible combination of Taiyuan-Shaoshang and Danzhong-Zhongwan with other acupoints.This approach fully embodies the meridian syndrome differentiation principle of"where the meridian passes,it can treat"and"where the disease locates,it can treat."The selection follows the acupoint pairing principles of"combining distal and local points"and"coordinating upper and lower regions",while also emphasizing the application of specific acupoint categories.