The theory of "fire and primordial qi incompatibility" was proposed by LI Gao in Clarifying Doubts about Damage from Internal and External Causes, which has important guiding significance for explaining the pathogenesis, prognosis and treatment of immune-related adverse events (irAEs). "Fire" refers to yin fire, a type of deficient fire transformed from the deficiency of the spleen and stomach, reflecting the pathological state of coexisting deficiency and heat patterns in patients with tumor after immune checkpoint inhibitor (ICI) therapy. "Primordial qi" is the most fundamental essence of human life activities and serves as the source of all bodily qi. Based on the theory of "fire and primordial qi incompatibility" and Western medicine research, we found that excessive use of ICIs can damage the spleen and stomach, leading to excessive yin fire. When yin fire becomes excessive, it consumes and injures the primordial qi; when the primordial qi is depleted, it leads to more excessive yin fire and further deficiency of the spleen and stomach, forming a syndrome in which deficiency and excess coexist. Starting from the theory of "fire and primordial qi incompatibility, "combined with our team′s clinical practice and modern pharmacological research, this study explores the application characteristics of sweet-natured herbs for irAEs during ICIs therapy and interval periods, and summarizes the treatment principles, aiming to provide new perspectives and approaches for the prevention and treatment of tumor-related irAEs with traditional Chinese medicine.

Objective To investigate the effects of icariin on high glucose-induced autophagy and apoptosis of podocytes,and the regulating effects on mammalian target of rapamycin(mTOR)/serine-threonine kinase(Akt)/cyclic adenosine monophosphate response element binding protein(CREB)pathway.Methods The mouse podocytes MPC5 were taken and divided into five groups:normal control group(5.5 mmol·L-1 glucose),high glucose group(30 mmol·L-1 glucose),icariin group(30 mmol·L-1glucose+5 μmol·L-1icariin),GDC-0349 group(30 mmol·L-1glucose+50 μmol·L-1 GDC-0349),icariin+GDC-0349 group(30 mmol·L-1 glucose+5 μmol·L-1 icariin+50 μmol·L-1 GDC-0349).Cultured for 48 hours,the tetramethylazozolium salt method was used to detect the viability of MPC5 cells;acridine orange staining was used to observe the autophagy of MPC5 cells;apoptosis of MPC5 cells was detected by flow cytometry;Western blotting was used to detect the expression of autophagy[microtubule associated protein one light chain 3(LC3)II,LC3Ⅰ,autophagy-related protein(Beclin-1)],apoptosis[Bcl-2 related X protein(Bax),B cell lymphoma-2(Bcl-2)]and mTOR/Akt/CREB pathway-related proteins of MPC5 cells.Results Compared with the normal control group,the cell viability,expression levels of Bcl-2,phosphorylated mTOR(p-mTOR)/mTOR,phosphorylated Akt(p-Akt)/Akt,phosphorylated CREB(p-CREB)/CREB protein of MPC5 cells in the high glucose group were significantly decreased(P＜0.05),the autophagy ability was enhanced,the autophagosome showed orange fluorescence,and the apoptosis rate,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bax protein expression levels were significantly increased(P＜0.05).Compared with the high glucose group,the cell viability,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bcl-2,p-mTOR/mTOR,p-Akt/Akt,p-CREB/CREB protein expression levels of MPC5 cells in icariin group were significantly increased,the autophagy ability was further enhanced,the number of autophagosomes was increased,the autophagosomes showed brick red fluorescence(P＜0.05),the apoptosis rate and Bax protein expression level were significantly decreased(P＜0.05),and the cell viability,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bcl-2,p-mTOR/mTOR,p-Akt/Akt and p-CREB/CREB proteins expression levels of MPC5 cells in GDC-0349 group were significantly decreased,the autophagy ability was weakened,the number of autophagosomes was reduced,the autophagosomes showed orange fluorescence(P＜0.05),and the apoptosis rate and Bax protein expression level were significantly increased(P＜0.05);icariin+GDC-0349 could reverse the effect of icariin on high glucose induced MPC5 cells(P＜0.05).Conclusion Icariin promotes elevated glucose-induced podocyte autophagy and inhibits apoptosis by activating the mTOR/Akt/CREB pathway.

Objective To investigate the relationship between insomnia,gastrointestinal symptoms,and glycosylated hemoglobin(HbA1c)levels in individuals diagnosed with type 2 diabetes mellitus(T2DM),as well as the related influencing factors.Methods A total of 910 T2DM patients treated in our multicenter from January 2022 to December 2022 were enrolled in this study.General information(gender,age,smoking and drinking history,exercise,course of disease,treatment and complications),HbA1c,Athens Insomnia Scale(AIS)scores and Gastrointestinal Symptoms Rating Scale(GSRS)scores of patients were collected.The differences of sleep and gastrointestinal symptoms between groups were analyzed,and the correlation between the differences and HbA1c was analyzed.Furthermore,the risk factors for non-standard HbA1c were analyzed.Results The AIS score and GSRS score in the HbA1c control group were less than those in the non-standard group(P＜0.01).Insomnia was reported by 37.0％of T2DM patients,and the HbA1c level in the insomnia group was significantly higher than that in the non-insomnia group(10.00％±2.38％vs.8.26％±1.73％,P＜0.01).Gastrointestinal symptoms were present in 57.5％of T2DM patients,and the HbA1c levels in the group with gastrointestinal symptoms were significantly higher than those in the group without gastrointestinal symptoms(9.26％±2.23％vs.8.43％±1.98％,P＜0.01).Furthermore,26.3％of T2DM patients experienced both insomnia and gastrointestinal symptoms.Remarkably,the HbA1c levels in the group with both insomnia and gastrointestinal symptoms were significantly higher than those in the group without either condition(10.18％±2.44％vs.8.45％±1.86％,P＜0.01).Correlation analysis demonstrated a significant association between sleep quality,gastrointestinal function,and HbA1c levels(P＜0.01).The logistic regression analysis result revealed that age,GSRS score,AIS score,and the presence of insomnia combined with gastrointestinal symptoms were independent risk factors for predicting HbA1c≥6.5％(P＜0.01).Having both insomnia and gastrointestinal symptoms concurrently was the strongest risk factor for substandard HbA1c control,and the risk of blood sugar control may increase about 5 times when both appear together.Conclusion Insomnia and gastrointestinal symptoms are common comorbidities in T2DM patients,showing a cross-interfering relationship,and they appear together with poor blood sugar control,interact causally,and amplify each other.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Enhanced recovery after surgery (ERAS) is a concept based on evidence-based medicine, with the reduction of patients' physiological and psychological stress as the core, multiple optimized perioperative paths as specific measures, and the ultimate goal of rapid rehabilitation. In the field of abdominal surgery, perioperative analgesia is a key factor affecting the rapid recovery of patients after surgery and an important link in accelerating the rehabilitation of ERAS program. With the development of modern medical technology and clinical research, breakthroughs have been made in the development of new analgesic drugs, and analgesic techniques and programs have been improved day by day. Preventive, multimodal and individualized analgesic regiments are currently recommended. We reviewed the current application status of analgesics and pain management techniques in the field of abdominal surgery. Combined with the pain management experience of our center, the research progress and existing problems in preventive, multi-modal and individualized analgesia are discussed.

Objective:To study the diagnostic value of artificial intelligence B-ultrasound image computer-aided diagnosis system (hereinafter referred to as intelligent ultrasound system) in adult goiter.Methods:In June 2022 and March 2023, two phases of thyroid disease survey were carried out in 4 cities in Anhui Province. One village was selected in each city, and 250 adults were selected as survey subjects in each village. Adult bilateral thyroid area was scanned by both intelligent ultrasound system and conventional ultrasound scanning equipment, and the effectiveness of intelligent ultrasound system in the diagnosis of goiter was analyzed based on the results of conventional ultrasound examination. Receiver operating characteristic (ROC) curve was drawn, and Kappa test was used to analyze the consistency between intelligent ultrasound system and conventional ultrasound examination in the diagnosis of goiter. At the same time, Spearman correlation analysis and Bland-Altman method were used to evaluate the consistency of the two methods in measuring thyroid volume.Results:After screening and removing outliers and missing values, a total of 910 adults were included, including 253 males (27.80%) and 657 females (72.20%). The age was (45.92 ± 10.20) years old, ranging from 18 to 60 years old. The sensitivity, specificity, and accuracy of the intelligent ultrasound system for diagnosing adult goiter were 80.00%, 99.67%, and 99.56%, respectively. The area under the ROC curve (AUC) was 0.996, which was consistent with the results of conventional ultrasound examination for diagnosing goiter ( κ = 0.67, P < 0.001). After controlling for variables such as gender, thyroid function, and thyroid nodules, the intelligent ultrasound system showed good consistency with conventional ultrasound examination in the diagnosis of goiter in females, adults with thyroid dysfunction, and adults without thyroid nodules ( κ = 0.66, 0.80, 0.80, P < 0.001). The consistency in the diagnosis of goiter in adults with thyroid nodules was moderate ( κ = 0.56, P < 0.001). Spearman correlation analysis showed a highly positive correlation between the measurement results of adult thyroid volume by intelligent ultrasound system and conventional ultrasound examination ( r = 0.88, P < 0.001). The Bland-Altman method results showed that only 4.62% (42/910) of points in adults were outside the 95% consistency limit, indicating good consistency between intelligent ultrasound system and conventional ultrasound examination in measuring thyroid volume (< 5%). The proportion of points outside the 95% consistency limit in males, adults with thyroid dysfunction, and adults with thyroid nodules was 6.72% (17/253), 5.83% (12/206), and 6.45% (12/186), respectively. Conclusions:The intelligent ultrasound system has certain diagnostic value for adult goiter and has good consistency with conventional ultrasound examination for thyroid volume measurement. However, the accuracy of diagnosis for males and adults with thyroid nodules still needs to be improved.

Hepatocellular carcinoma is a significant disease that seriously threatens the life and health of our people, and chronic hepatitis B virus infection is the most important cause of hepatocellular carcinoma in China. Radical surgery is an essential treatment for hepatocellular carcinoma patients who are expected to achieve long-term survival. However, the high recurrence and metastasis rate after surgery significantly affects the long-term prognosis. Postoperative recurrence of hepatocellular carcinoma is characterized by a bimodal pattern, with early recurrence leading to higher mortality and poorer survival prognosis. Postoperative adjuvant therapy can help to reduce the recurrence rate and improve the overall efficacy, but there is no standardized postoperative adjuvant therapy regimen at home and abroad. Studies have shown that antiviral therapy, interventional therapy, targeted therapy, immunotherapy, radiation therapy, and traditional Chinese medicine may have a specific effect on reducing the recurrence of hepatocellular carcinoma after surgery and prolonging overall survival. Key issues such as how to accurately assess and screen the population with a high risk of postoperative recurrence of hepatocellular carcinoma, select the best postoperative adjuvant treatment modality and timing and determine the duration of postoperative adjuvant treatment still need to be confirmed by high-quality fundamental research breakthroughs and multicenter clinical randomized controlled studies. In this article, the authors will discuss the characteristics of postoperative recurrence of hepatocellular carcinoma, the selection of adjuvant treatment strategies, and the problems faced based on the latest research progress and in light of the reality of hepatocellular carcinoma occurrence in China.

Objective To investigate whether VHD prefabricated foot orthoses can reduce the incidence of lower limb overuse injury (LLOI) in naval recruits. Methods Totally 400 recruits who underwent enlistment training were enrolled and randomly assigned to the intervention group (n=200) and control group (n=200). During the enlistment training,the recruits in the intervention group wore VHD prefabricated foot orthoses,while those in the control group did not wear foot orthoses. Questionnaire survey was conducted 1 week later,and the foot orthoses of those recruits with adverse events were remoulded. The health data of recruits were collected again by questionnaire survey and physical examination 12 weeks later.The primary outcome was the incidence of LLOI. The secondary outcomes included the type of LLOI,the lost training time due to LLOI,the comfort score of the foot orthoses,and the adverse events. Results There were no significant differences in the baseline characteristics between the 2 groups (P>0.05). A total of 76 cases of LLOI was recorded,including 24 cases (12％) in the intervention group and 52 cases (26％) in the control group. Plantar fasciitis was the most common type of LLOI. The lost training time of the intervention group and the control group were 51 d (2.12 d for each one) and 123 d (2.37 d for each one),respectively. The comfort scores of the foot orthoses at 1 week and 12 weeks were 3.76±1.87 and 2.03±1.74,respectively. The incidences of adverse events in 1 week and 3 months were 18％ (36/200) and 5％ (10/200),respectively. The most common adverse event was arch pain. Conclusion VHD prefabricated foot orthoses can reduce the incidence of LLOI and lost training time due to LLOI in recruits,with good wearing comfort and less adverse events.

Lenvatinib mesylate is an oral receptor tyrosine kinase inhibitor against targets of vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor α, stem cell growth factor receptor, and rearranged during transfection, et al. Lenvatinib has been approved by the National Medical Products Administration of China on September 4,2018, for the first-line treatment of patients with unresectable hepatocellular carcinoma who have not received systematic treatment before. Up to February 2023, Lenvatinib has been listed in China for more than 4 years, accumulating a series of post-marketing clinical research evidences. Based on the clinical practice before and after the launch of lenvatinib and referring to the clinical experience of other anti-angiogenesis inhibitors, domestic multidisciplinary experts and scholars adopt the Delphi method to formulate the Chinese Expert Guidance on Overall Application of Lenvatinib in Hepatocellular Carcinoma after repeated discussions and revisions, in order to provide reference for reasonable and effective clinical application of lenvatinib for clinicians.

At the end of February 2023, the new Notice on the Issuance of Ethical Review Measures for Life Science and Medical Research Involving Humans was issued by the National Health Commission, the Ministry of Education, the Ministry of Science and Technology, and the State Administration of Traditional Chinese Medicine. It adheres to the basic principles and institutional framework of the Ethical Review Measures for Biomedical Research Involving Humans , and combines with the actual situation of domestic ethical work to optimize and improve the details and procedures of the review. Based on the Ethical Review Measures for Biomedical Research Involving Humans, the Ethical Review Measures for Life Science and Medical Research Involving Humans have expanded the scope of application of ethical review. Different experts in the field have discussed in detail the changes in the scope of review, and proposed review procedures that may need to be corresponding adjustments based on the changes for the readers’ reference.