Trastuzumab deruxtecan (T-DXd) is a new generation of antibody-drug conjugate targeting human epidermal growth factor receptor 2. It has strong antitumor effects and has been recommended by many authoritative guidelines at home and abroad. Drug-induced interstitial lung disease (DILD) is one of the common adverse reactions and causes of death of T-DXd and is an important factor limiting its clinical application. The pathogenesis of DILD induced by T-DXd is still unclear, and the mainstream view holds that it may be related to the non-target-dependent uptake of the drug. Glucocorticoids are an important treatment method for DILD, and other alternative drugs still lack clinical effectiveness evidence. The research progress on the pathogenesis of T-DXd induced DILD was summarized in this review, aiming to provide new ideas for the prevention and treatment of DILD.

Malnutrition is a significant risk factor for the progression of chronic kidney disease (CKD), and monitoring the nutritional status of CKD patients is crucial for delaying disease progression and improving patient prognosis. Currently, there is a scarcity of studies on malnutrition in CKD, and a unified standard for nutritional assessment in CKD is still lacking. Clinical evaluation must be conducted according to the condition of patients, combined with multiple indicators. Nutritional screening and assessment scales are the common nutritional assessment methods; however, due to limitations in the applicable populations, the applicability of some scales for the CKD population requires further verification. Additionally, anthropometric indicators, body composition analysis, and clinical laboratory indicators can also reflect human nutritional status, each with its respective advantages and limitations. This review summarizes the research status and clinical application characteristics of various nutritional assessment methods in CKD patients, aiming to provide references for the clinical assessment of malnutrition in CKD.

Objective To analyze the characteristics of drug resistance in patients with disseminated pulmonary tuberculosis, and provide references for the clinical development of individualized treatment plans. Methods A retrospective analysis was conducted on 71 hospitalized patients with disseminated pulmonary tuberculosis treated at the Beijing Chest Hospital, Capital Medical University from January 2015 to January 2024. The susceptibility of Mycobacterium tuberculosis from these patients to 16 anti-tuberculosis drugs was detected using the microplate method for mycobacterial drug susceptibility testing. The study analyzed the culture results of Mycobacterium tuberculosis, drug susceptibility test results, initial treatment or re-treatment status, drug resistance, and differences in drug resistance types between initial and re-treated patients. Results Among the 71 patients with disseminated pulmonary tuberculosis, there were 51 males (71.8%), and 58 cases (81.7%) of acute disseminated pulmonary tuberculosis, with an overall drug resistance rate to 16 anti-tuberculosis drugs of 38.0%. There was no statistically significant difference in the total drug resistance rate between re-treated patients and those undergoing initial treatment [52.2%(12/23) vs. 31.3%(15/48), P=0.089]. The top 7 drugs to which patients were resistant were streptomycin (Sm) and isoniazid (INH) with 13 cases each (18.3%), rifapentine (Rft) and isoniazid aminosalicylate (Pa) with 10 cases each (14.1%), rifampicin (RFP), rifabutin (Rfb), and capreomycin (Cm) with 9 cases each (12.7%). The top 6 drugs to which initially treated patients were resistant were Cm with 6 cases (12.5%), Sm with 5 cases (10.4%), Pa with 4 cases (8.3%), INH, clarithromycin (Clr), and p-aminosalicylic acid (PAS) with 3 cases each (6.3%). The top 7 drugs to which re-treated patients were resistant were INH with 10 cases (43.5%), Sm, RFP, and Rft with 8 cases each (34.8%), Rfb with 7 cases (30.4%), Pa and levofloxacin (Lfx) with 6 cases each (26.1%). The overall mono-resistance rate, poly-drug resistance rate, and multidrug-resistant rate to 16 anti-tuberculosis drugs were 9.9%, 7.0%, and 11.3%, respectively; all mono-resistance patients were initially treated; there was no statistically significant difference in the poly-drug resistance rate between re-treated and initially treated patients (13.0% vs. 4.2%, P=0.591), but the multidrug-resistant rate was significantly higher in re-treated patients (30.4% vs. 2.1%, P=0.002). Conclusion Drug resistance in disseminated pulmonary tuberculosis is severe. Clinical physicians can develop personalized anti-tuberculosis treatment plans based on drug susceptibility test results.

Objective To investigate the effects of rivaroxaban anticoagulant therapy on lower deep venous thrombosis (DVT) after artificial knee arthroplasty. Methods One hundred and forty-four patients who received artificial knee replacement in the Zhujiang Hospital of Southern Medical University from June 2020 to June 2022 were retrospectively analyzed. All the patients received rivaroxaban anticoagulant treatment after surgery. Among them, the patients who started anticoagulant therapy at platelets > 100×10⁹/L were included in the observation group (n=76), and the patients who started anticoagulant at platelets > 300×10⁹/L were included in the control group (n=68). The propensity score matching was used to adjust the balance, and each group included 56 patients. The changes of coagulation markers [D-dimer and plasma viscosity (PV)] before and after operation were compared between the two groups. The survival curve was drawn by Kaplan-Meier method to analyze the occurrence of DVT in the two groups within 30 days after operation. According to the presence or absence of lower limb DVT events after knee arthroplasty, the patients were divided into DVT group (n=36) and non-DVT group (n=76). Logistic regression model was used to analyze the independent correlation between platelet level before anticoagulant therapy and postoperative DVT. Multivariate logistic regression analysis was used to analyze the risk factors of DVT after knee arthroplasty. The nomogram was established by R software and verified 1000 times by Bootstrap method. The area under ROC curve (AUC) and calibration curve were used to evaluate the discrimination and accuracy. Results After matching, the baseline characteristics of the observation group and the control group were balanced (P>0.05). Univariate analysis showed that compared with non-DVT group, BMI and the proportion of bilateral knee arthroplasty, intraoperative blood loss ≥400 ml, general anesthesia, use of bone cement, and triacylglycerol ≥1.7 mmol/L, and the levels of D-dimer and platelet increased, prothrombin time (PT) shortened, and activated partial thromboplastin time (APTT) extended in the DVT group (P<0.05). After adjusting the confounding factors of age, sex, BMI, triglyceride, D-dimer, PT and APTT, the platelet level before anticoagulant therapy was still an independent risk factor for postoperative DVT (OR=3.858, 95%CI 1.849-6.054), and there was a significant difference in platelet trend test from low to high quintile (P_trend<0.001). The results of multivariate logistic regression analysis showed that BMI ≥25 kg/m², bilateral knee arthroplasty, general anesthesia, D-dimer ≥190 μg, platelet ≥300×10⁹/L were risk factors for DVT after knee arthroplasty (OR>1, P<0.05), while not using bone cement and PT ≥12 s were protective factors (OR<1, P<0.05). Before and after the verification of the nomogram, the AUC was 0.851(95%CI 0.773-0.912) and 0.813 (95%CI 0.736-0.894), and the average absolute error of the calibration curve was 0.015. Conclusion The application of rivaroxaban anticoagulation therapy can quickly improve the coagulation function of patients with platelet > 100×10⁹/L after artificial knee replacement surgery and reduce the incidence of DVT.

Objective To explore the influential factors and predictive value of early femoral head collapse progression following allogeneic fibula grafting (AFG) surgery. Methods Clinical and radiological data of 68 patients (75 hips) with osteonecrosis of the femoral head (ONFH) who underwent AFG between January 2008 and December 2022 at the Orthopedics and Traumatology Department, Affiliated Hospital of Nanjing University of Chinese Medicine were retrospectively analyzed. Seventy-five hips were divided into stable (n=40) and progressive (n=35) groups based on the presence or absence of postoperative collapse progression. Age, gender, etiology, location of the lesion, Association Research Circulation Osseous (ARCO) stage, Japanese Committee of Osteonecrosis Investigation (JIC) classification, China-Japan Friendship Hospital (CJFH) classification, and Hounsfield units (HU) value of anterolateral sclerosis rim (ⅠSHU) were collected. Univariate and multivariate logistic regression analyses were used to identify the factors influencing early collapse progression after AFG. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of the identified factors influencing postoperative early collapse progression. Results Of the 75 hips, 35(46.7%) had postoperative collapse progression. Univariate logistic regression analysis showed that age, ARCO stage, JIC classification, and ⅠSHU were in fluencing factors for early femoral head collapse progression after AFG (P<0.05). Multivariate logistic regression analysis showed that ARCO stage ⅢA and JIC classification C2 were independent risk factors for early femoral head collapse progression after AFG, while ⅠSHU was identified as an independent protective factor (P<0.05). The ROC curve analysis showed that the sensitivities of ARCO stage, JIC classification, ⅠSHU, and the combined predictive model were 0.850, 0.725, 0.800, and 0.775, the specificities were 0.486, 0.657, 0.743, and 0.914, and the area under the ROC curve (AUC) were 0.668, 0.725, 0.811, and 0.896, respectively. Conclusions ⅠSHU is associated with early collapse progression after AFG in patients with ONFH. ARCO stage ⅢA, JIC classification C2, and ⅠSHU are independent factors influencing postoperative early collapse progression and have a certain predictive value.

Pituitary thyroid-stimulating hormone (TSH) adenomas is a rare pituitary disorder, accounting for less than 2% of pituitary adenomas. The clinical manifestations primarily include mild to moderate symptoms of hyperthyroidism, corresponding symptoms caused by other anterior pituitary hormone secretion disorders, and symptoms resulting from the mass effect of pituitary tumors. Pituitary TSH adenomas need to be differentiated from primary hyperthyroidism (Graves' disease) and resistance to thyroid hormone (RTH), as misdiagnosis can lead to tumor growth and aggravation of the condition. Currently, with the help of sensitive laboratory tests, imaging examinations, and targeted functional tests, pituitary TSH adenomas can be diagnosed relatively accurately. The preferred treatment is surgical resection. In cases where surgery is not feasible or unsuccessful, radiotherapy or medical therapy can be considered. Long-acting somatostatin analogs can effectively reduce tumor volume and decrease TSH secretion, thereby normalizing free 3,5,3',5'-tetraiodothyronine (FT₄) and free 3,5,3'-triiodothyronine (FT₃). Early identification and effective treatment are significant for patients with pituitary TSH adenomas. This review summarizes the epidemiology, pathological characteristics, screening objects, clinical manifestations, auxiliary examinations, diagnosis and treatment, follow-up and evaluation of pituitary TSH adenoma, aiming to provide guidance for the clinical diagnosis and treatment of this condition.

Objective To explore the clinical value of red blood cell volume distribution width coefficient of variation (RDW-CV), serum interleukin-11 (IL-11) and interleukin-31 (IL-31) in the diagnosis of interstitial lung disease (ILD). Methods Prospectively selected 46 ILD patients admitted to the Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Chengde Medical University from November 2022 to October 2023 were set as ILD group, 40 patients with community-acquired pneumonia (CAP) as CAP group, and 35 healthy examiners as control group. The ILD group was further divided into idiopathic interstitial pneumonia (IIP) subgroup (n=30) and connective tissue disease-related ILD (CTD-ILD) subgroup (n=16) based on clinical diagnosis. General and clinical data of each group were recorded, and RDW-CV and serum IL-11 and IL-31 levels were detected in each group. The ILD group was tested for alveolar arterial oxygen pressure difference (AaDO₂) and arterial blood oxygen pressure (PaO₂), and calculated the oxygenation index (OI). The correlation between the levels of RDW-CV, IL-11 and IL-31 and the severity of ILD were analyzed to explore the value of the above indicators in the clinical diagnosis of ILD and the differential diagnosis of different types of ILD. Results Compared with control group, there was no statistically significant difference in general information such as age, gender, smoking history, and complications between the ILD and CAP groups (P<0.05); RDW-CV, absolute values of neutrophil count (NEUT), and serum IL-11 and IL-31 levels in ILD group were significantly increased (P>0.05). Compared with CAP group, the levels of RDW-CV and serum IL-11, IL-31 in ILD group were increased, while the level of serum C-reactive protein (CRP) was decreased, with statistically significant differences (P<0.05). Correlation analysis results showed that RDW-CV and serum IL-31 in ILD patients were negatively correlated with OI (P<0.05), and positively correlated with AaDO₂ (P<0.05). The area under the ROC curves (AUC) of RDW-CV and serum IL-11, IL-31 single and combined applications for diagnosing ILD were 0.770, 0.666, 0.646, and 0.854, respectively (P<0.05). The AUC of serum IL-11 for differential diagnosis of CTD-ILD and IIP was 0.727(95%CI 0.580-0.874), with sensitivity of 62.5% and specificity of 73.3% (P<0.05). Conclusions RDW-CV and serum IL-31 have certain value in assessing the severity of ILD. RDW-CV and serum IL-11 and IL-31 have certain value in the diagnosis of ILD. Serum IL-11 has certain value in the differential diagnosis between CTD-ILD and IIP.

Sepsis-induced coagulopathy (SIC), a critical and potentially lethal condition arising from sepsis, results in endothelial damage and significant coagulation dysregulation, making it a major factor contributing to mortality among sepsis patients. Early diagnosis and treatment of SIC are expected to improve the prognosis of sepsis patients. In 2019, the International Society on Thrombosis and Hemostasis (ISTH) issued the first guidelines for the diagnosis and treatment of SIC, but there are no corresponding protocols in China. Therefore, Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association, and Chinese People's Liberation Army Professional Committee of Critical Care Medicine jointly formulated the "Chinese Expert Consensus on the Diagnosis and Treatment of Sepsis-induced Coagulopathy (2024 edition)." This consensus includes 5 parts: pathogenesis, classification, laboratory approaches, diagnosis and treatment, with a total of 14 evidence-based recommendations to guide clinical practice.

Refractory prolactinoma is the most common pituitary neuroendocrine tumor. Dopamine receptor agonists (DA) are the primary choice for drug treatment. Most patients with prolactinomas respond well to DA. However, a minority of prolactinomas patients still show resistance to DA. Although drug-resistant and refractory prolactinomas are rare in clinical practice, their treatment is extremely challenging. Even a combination of drug therapy, multiple surgeries, and radiotherapy may not yield satisfactory outcomes. Therefore, standardizing the diagnosis and treatment process and pathway for refractory prolactionmas and exploring more effective multidisciplinary collaborative treatment strategies are urgent problems to be solved. In the clinical management of refractory prolactinomas, it is often necessary to consider the patient's condition comprehensively, replace other types of DA, or consider surgery, radiotherapy, and immunotherapy, which requires multidisciplinary diagnosis and treatment. This review synthesizes the latest literature at home and abroad to systematically discuss the latest advances in drug therapy, surgery, and radiotherapy treatments for refractory prolactionmas, aiming to provide new ideas for basic research, clinical diagnosis and treatment.

Acromegaly can cause chronic complications in multiple systems such as the cardiovascular, respiratory, digestive, and endocrine systems, increasing the risk of death and significantly shortening the patient's life expectancy. Timely screening and early diagnosis and treatment can significantly improve the prognosis of patients and indirectly reflect the level of diagnosis and treatment of hospitals or teams. Clinical communication and research have revealed that physicians, in the course of clinical practice, are frequently constrained by factors such as time, economic considerations, and patient compliance, which hinder their ability to perform comprehensive screening for acromegaly-related complications. This review draws on expert consensuses and guidelines from both domestic and international sources, integrating them with the specific realities of China, to provide a comprehensive summary of the key aspects of screening and management for acromegaly-related complications. These aspects include the incidence of complications, optimal timing for screening, treatment approaches, long-term monitoring, and strict management protocols. It emphasizes standardization, precision, and personalization in clinical diagnosis and treatment work, aiming to comprehensively improve the diagnosis and treatment level of acromegaly in China, enhance the survival rate of patients, and improve their quality of life.