Background: This research was to develop a special method for enriching Circulating tumor cells (CTCs) of Hepatocellular carcinoma (HCC) by Glypican-3 immunoliposomes (GPC3-IML), and to analyze the correlation between the CTCs count and tumor malignancy, as well as to investigate the mutation characteristics of CTC-derived NGS.Results: In this study characterization of physical parameters was performed with the preparation of GPC3-IML. CTCs in peripheral blood of HCC patients were further separated and identified. Immunofluorescence was used to identify CTCs for further counting. By this means, the correlation between CTCs count and clinicopathological features was analyzed, and the genetic mutation characteristics of NGS derived from CTCs were investigated and compared with that of tissue NGS. Results showed that compared with EpCAM and vimentin, GPC-3 had a stronger CTCs separation ability. There was a correlation between "positive" count of CTCs (≥ 5 PV-CTC per 7.5 ml blood) and BCLC stage (P = 0.055). The result of CTC-NGS was consistent with that of tissue-NGS in 60% cases, revealing thatKMT2Cwas a common highly-frequent mutated gene.Conclusion: The combination of immunomagnetic separation of CTCs and anti-tumor marker identification technology can be regarded as a new technology of CTCs detection in peripheral blood of patients with HCC.Trial registrationEHBHKY2020-k-024. Registered 17 August 2020—Retrospectively registered

Thrombi in the axial calf veins have quite different anatomical and physiological characteristics from that in the muscular calf veins, but their treatment was usually addressed in the same manner. We performed a meta-analysis of randomized and cohort studies to compare clinical outcomes among patients with isolated axial vs muscular calf deep vein thrombosis (DVT). Recurrent venous thromboembolism (VTE) was selected as the primary outcome. Resolution, proximal propagation of calf DVT, pulmonary embolism (PE), major bleeds, and clinically relevant non-major bleeds were separately analyzed as secondary outcomes. Data were pooled and compared with risk ratio (RR) and 95% confidence interval (CI). Thirteen studies, consisting of 4889 patients, met the inclusion criteria and were included for analysis. A greater rate of recurrent VTE (FE model: RR, 1.23; 95% CI, 1.00-1.53; I² = 29%), resolution (FE model: RR, 1.32; 95% CI, 1.01-1.72; I² = 31%), proximal propagation (FE model: RR, 1.63; 95% CI, 1.10-2.41; I² = 40%), and PE (FE model: RR, 2.79; 95% CI, 1.31-5.95; I² = 0%) in the axial group compared with the muscular group. There was no difference in the pooled estimates for major bleeds (FE model: RR, 1.09; 95% CI, 0.61-1.95; I² = 0%), and clinically relevant non-major bleeds (FE model: RR, 1.80; 95% CI, 0.93-3.48) in the axial and muscular arms. Patients with calf DVT limited to muscular veins might have a lower rate of recurrent VTE, resolution, proximal propagation, and PE vs those with axial calf vein involvement and exhibited similar safety outcomes.

Deep vein thrombosis (DVT) ranks among the top five most prevalent vascular diseases globally and encompasses proximal deep vein thrombosis (PDVT) and isolated distal deep vein thrombosis (IDDVT). IDDVT affects approximately 50% to 65% of patients with DVT. However, due to a lack of prospective studies and conflicting perspectives on its potential to lead to pulmonary embolism (PE), the management of IDDVT remains contentious. Therefore, this meta-analysis was conducted to compare the clinical outcomes of PDVT and IDDVT. We searched studies including proximal and isolated distal thrombotic outcomes in the electronic databases PubMed, EMBASE, Cochrane, and Web of Science. The literature was then screened based on title, abstract, and full text to exclude those that did not meet the criteria. A total of 21 cohort and randomized controlled studies were included. Compared with IDDVT, PDVT was associated with higher rates in recurrent vein thromboembolism (VTE) (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.35-1.93; P < .001), PE (OR, 1.52; 95% CI, 1.16-1.99; P = .002), major bleeding (OR, 1.95; 95% CI, 1.23-3.09; P = .005), and all-cause mortality (OR, 2.02; 95% CI, 1.19-3.44; P = .009). However, no significant differences were found in the rates of any bleeding (OR, 1.57; 95% CI, 0.96-2.58; P = .070) and nonmajor bleeding (OR, 1.03; 95% CI, 0.69-1.54; P = .88). Compared with patients with PDVT, patients with IDDVT may have lower rates of recurrent VTE, PE, major bleeding events, and all-cause mortality, demonstrating safer clinical outcomes.

Background. Acute generalized exanthematous pustulosis (AGEP) is a rare and serious adverse reaction of terbinafine. Understanding AGEP and terbinafine is primarily based on case reports. The purpose is to explore the clinical characteristics of terbinafine‐induced AGEP, and to provide reference for clinical diagnosis and treatment. Methods. Case reports and original studies of terbinafine‐induced AGEP were retrieved by searching Chinese and English databases from January, 1991, to May 31, 2022. Results. The median age of the 32 patients (17 males and 15 females) was 55 years (range: 6–84). The median time to onset of AGEP is 8 days (range: 1–77) and is usually accompanied by fever (>38°C) and elevated neutrophil levels (>8000/mm³). Four patients (12.5%) had oral mucosal involvement, and 10 patients (31.3%) developed postpustular desquamation. The lesions were mainly distributed in the trunk (43.8%), the whole body (34.4%), and the extremities (53.1%). Skin biopsy revealed subcorneal pustules (65.6%), intraepidermal cavernous pustules (43.8%), necrotic keratinocytes (15.6%), spongy hyperplasia (25.0%), neutrophil exocytosis (34.4%), and papillary dermal edema (40.6%). AGEP resolved completely in all patients at a median time of 12 days (range: 2–90) after discontinuation of terbinafine and symptomatic therapy. Conclusion. Clinicians should be aware that terbinafine‐induced AGEP is a rare cutaneous adverse reaction. AGEP usually occurs within 2 weeks after administration and has a good prognosis after discontinuation.

Objective: Atraumatic splenic rupture (ASR), though rare, is an adverse event linked to direct oral anticoagulants (DOACs). Given their widespread use and potentially fatal consequences if undiagnosed, heightened clinical awareness of DOAC-associated ASR is crucial. Our aim was to analyze the occurrence and clinical characteristics of ASR induced by DOACs. Methods: We conducted a retrospective analysis of all reported DOAC-associated ASR cases through 15 April 2025, without language restrictions. Results: A total of 27 patients (11 males and 16 females) were included with a median age of 64 years. Among them, apixaban (n = 17) was the most common DOAC, followed by rivaroxaban (n = 8) and dabigatran (n = 2), with atrial fibrillation (81.5%, n = 22) being the primary indication. The comorbidities observed among patients with DOAC-associated ASR risk included hypertension (25.9%), coronary heart disease (18.5%), malignancy (18.5%), and infections (18.5%). Among 27 patients, 11 (40.7%) received concomitant medications that may potentiate DOAC effects, with 5 patients taking four interacting drugs simultaneously. Only 4 of the 11 patients had documented anticoagulant dosages, half of which were full-dose regimens. Management included immediate DOAC cessation (100.0%), transfusion (77.8%), splenic artery embolization (44.4%), and splenectomy (70.4%) – with 31.6% of splenectomies representing salvage procedures following failed embolization. All patients were successfully discharged with no mortality. Conclusion: ASR is a potentially life-threatening but preventable DOAC complication. Early recognition—particularly in elderly patients with comorbidities and polypharmacy—and urgent imaging for abdominal pain are crucial for improving clinical outcomes.

Large language models (LLMs) are increasingly applied in clinical decision support, but their reliability in guiding anticoagulation management for nonvalvular atrial fibrillation (NVAF) remains unclear. To systematically evaluate the performance of 9 widely used LLMs in guiding anticoagulation therapy decisions for NVAF. A multidisciplinary team constructed 100 virtual NVAF patient cases with comprehensive demographic, clinical, laboratory, and medication information. Nine LLMs (DeepSeek-V3, DeepSeek-R1, Qwen3, Qwen3 Deep Think, ChatGPT-4o, ChatGPT-4o Deep Research, Gemini 2.5, Gemini 2.5 Deep Research, and Claude Sonnet 4) were prompted to provide individualized Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65–74 years, Sex category (CHA₂DS₂-VASc) and Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) scores, anticoagulation contraindications, anticoagulation decisions, regimens, and monitoring recommendations. Outputs were independently evaluated against the multidisciplinary team consensus using accuracy rates and Likert-scale scores, with statistical comparisons performed across models. Across 900 responses, performance varied substantially across 6 clinical tasks. ChatGPT-4o Deep Research achieved the highest accuracy in CHA₂DS₂-VASc scoring (100%) and medication monitoring (mean score, 4.98), ranking first overall. Claude Sonnet 4 demonstrated the best performance in anticoagulation regimen selection (89% accuracy), ranking second, while DeepSeek-V3 showed the lowest overall performance. Across all models, HAS-BLED scoring accuracy was consistently low (8%-51%). Notably, prompt optimization markedly improved HAS-BLED scoring accuracy, reaching 95% with ChatGPT-4o Deep Research and 89% with DeepSeek-R1 (P < .001). There was significant variability among LLMs in their decision support for NVAF anticoagulation. Prompt optimization has the potential to markedly enhance accuracy. At present, LLMs may serve as valuable adjuncts to clinical practice but remain unsuitable for use as stand-alone decision-makers.