Objective: To evaluate the methodological quality and reporting quality of clinical practice guidelines or expert consensus on blood transfusion and blood use (BTBU) in China (hereinafter referred to as "guidelines/consensus"), providing reference for the development and updating of future BTBU guidelines/consensus. Methods: A systematic search was conducted in Chinese databases such as China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Data-base, relevant guideline release platforms, and professional association websites. BTBU-related guidelines/consensus published between January 2006 and December 2025 were included. According to the inclusion and exclusion criteria, after completing literature screening and data extraction, three evaluators independently assessed the quality of the included literature using the Scientificity, Transparency, and Applicability of Guidelines Rating Tool (STAR), the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ), and the International Practice Guideline Reporting Standards (RIGHT). Results: A total of 29 documents were included, including 5 guidelines, 22 consensus statements, and 2 protocols. The results of the STAR assessment showed that the total score was (21.7±8.8)%. The domain score ratios for registration, research protocol, funding, working group, conflict of interest, clinical question, evidence, consensus method, recommendation, accessibility and other domains were (2.2±12.1)%, 0, (36.7±25.1)%, (18.3±7.6)%, (19.2±15.3)%, (16.6±23.1)%, (15.1±6.3)%, (9.6±21.2)%, (54.3±18.4)%, (31.7±10.4)% and (10.3±31.0)%, respectively. For the AGREE Ⅱ assessment, the methodological quality of 26 articles was rated Grade B and 3 articles Grade C. The results of the RIGHT assessment indicated that the overall reporting rate of all guidelines/consensuses was (65.3±4.0)%. Conclusion: The methodological and reporting quality of current expert guidelines/consensus on BTBU in China still need improvement, and guidelines and consensus should be strictly formulated and standardized according to the standards of STAR, AGREE II and RIGHT.

Objective:To study the results of detection of pulmonary nodules among military flying personnel and analyze the contributors to pulmonary nodules so as to provide data for early prevention and interventions.Methods:The physical examination data of 1 465 military flying personnel was retrospectively analyzed who had received the annual health checkup and undergone chest CT examinations at Lintong Rehabilitation and Recuperation Center. They were grouped by age (<40 years and ≥40 years), flying hour (<1 000 h and ≥1 000 h) and type of personnel [pilots and air support (technical) personnel]. The detection rates of pulmonary nodules among flying personnel were compared across groups, and a multivariate Logistic regression analysis was conducted to analyze the contributing factors to pulmonary nodules.Results:Among the 1 465 military flying personnel, 212 cases (14.47%) with pulmonary nodules were detected. A total of 230 pulmonary nodules were detected, including 35 pulmonary nodules (15.22%) in the left upper lung, 42 pulmonary nodules (18.26%) in the left lower lung, 52 pulmonary nodules (22.61%) in the right upper lung, 47 pulmonary nodules (20.43%) in the right middle lung, and 54 pulmonary nodules (23.48%) in the right lower lung. The detection rate of pulmonary nodules among military flying personnel in the ≥1 000 h group was higher than in the <1 000 h group, and the difference was statistically significant ( χ2=4.14, P=0.042). More pulmonary nodules were detected among military flying personnel who smoked than among those who did not, and the difference was statistically significant ( χ2=9.34, P=0.002). Age, types of personnel, body mass index, and complications with other lung diseases made no significant difference in the detection rate of pulmonary nodules (all P>0.05). Multivariate Logistic regression analysis showed that smoking was a risk factor for pulmonary nodules ( OR=1.692, 95% CI: 1.217-2.351). Conclusions:Among military flying personnel, pulmonary nodules are more likely to occur in the right lung. Smoking is an independent risk factor for pulmonary nodules, suggesting that routine chest CT screening should be carried out during the annual physical examinations of military flying personnel in order to exercise early interventions.

Objective To determine the effects of cardiac resynchronization therapy at different pacing sites on electrocardiogram(ECG),left ventricular(LV)function and adverse events in elderly patients with heart failure(HF).Methods A total of 214 elderly HF patients admitted to our department between July 2021 and July 2024 were retrospectively recruited.According to different pacing sites in cardiac resynchronization therapy,they were divided into His bundle group(102 cases)and left bundle branch group(112 cases).Their grades of New York Heart Association(NYHA)cardiac function,duration of QRS complex,pacing parameters(pacing threshold,pacing perception,pacing resistance),cardiac function indicators,LV function,LV systolic synchrony[standard deviation of time to peak longitudinal strain,to peak radial strain and to peak circumferential strain(Tls-SD,Trs-SD and Tcs-SD)],and incidence of adverse events were compared between the two groups before and at 6 months after cardiac pacemaker implantation.Results In 6 months after surgery the left bundle branch group had significantly lower N-terminal pro-B-type natriuretic peptide level,smaller LV end-diastolic diameter and LV end-systolic diameter,decreased Tls-SD,Trs-SD and Tcs-SD,and shorter duration of QRS complex,but higher LV ejection fraction,cardiac index and cardiac output when compared with the His bundle group(P＜0.01).The incidence of adverse events was obviously lower in the left bundle branch group than the His bundle group(6.25％vs 15.69％,P＜0.05).Conclusion Left bundle branch pacing shows significant improvement for cardiac function in elderly HF patients,and can effectively maintain ECG stability and improve LV function.It is a safe and effective cardiac resynchronization therapy.

Urolithiasis represents a prevalent clinical challenge marked by high recurrence rates and morbidity，with existing preventive strategies struggling to effectively curb its epidemic trajectory，thereby posing a significant threat to public health. The etiology of this condition is intricate，involving a complex network of interactions spanning classical supersaturation-crystallization theory，Randall’s plaque theory，and multifactorial elements such as cellular injury，inflammatory responses，metabolic derangements，the gut-kidney axis，immune dysregulation，and genetic predisposition. However，the critical mechanisms initiating stone formation and the early pathophysiological processes remain incompletely elucidated，constituting the core impasse in current preventive strategies. This review systematically synthesizes classical theories and cutting-edge advancements in urolithiasis etiology research，emphasizing the urgent need to integrate emerging technologies，including high-dimensional omics，advanced imaging modalities，and artificial intelligence，to dissect pivotal pathological nodes in early stone formation. Such interdisciplinary efforts are essential to overcome cognitive bottlenecks and ultimately achieve personalized，precision-based prevention strategies.

The core update of the 2025 edition of the European Association of Urology（EAU）Guidelines on Urolithiasis is reflected in the addition of a new section titled "Genetic Factors and Testing"，which systematically defines the clinical application standards for genetic testing in urolithiasis. Given the significant impact of genetic factors on the pathogenesis of urolithiasis，the guidelines recommend genetic testing for specific populations，including urolithiasis patients aged ≤ 25 years，adult patients aged > 25 years with suspected hereditary or metabolic diseases，patients with recurrent stones，bilateral stones，or a family history of urolithiasis. In terms of testing technology，the guidelines suggest using next-generation sequencing（NGS）technology to identify pathogenic genetic variants，while emphasizing that testing should be combined with patients’ metabolic assessment and professional genetic counseling to improve diagnostic accuracy. If hereditary urolithiasis is confirmed，further genetic screening of the patient’s family members is required. The guideline update of this newly added section provides precise guidance on genetic testing for the clinical diagnosis and treatment of urolithiasis，which is conducive to promoting the practice of personalized treatment for urolithiasis and thereby improving the clinical diagnosis and treatment.

Objective:To study the results of detection of pulmonary nodules among military flying personnel and analyze the contributors to pulmonary nodules so as to provide data for early prevention and interventions.Methods:The physical examination data of 1 465 military flying personnel was retrospectively analyzed who had received the annual health checkup and undergone chest CT examinations at Lintong Rehabilitation and Recuperation Center. They were grouped by age (<40 years and ≥40 years), flying hour (<1 000 h and ≥1 000 h) and type of personnel [pilots and air support (technical) personnel]. The detection rates of pulmonary nodules among flying personnel were compared across groups, and a multivariate Logistic regression analysis was conducted to analyze the contributing factors to pulmonary nodules.Results:Among the 1 465 military flying personnel, 212 cases (14.47%) with pulmonary nodules were detected. A total of 230 pulmonary nodules were detected, including 35 pulmonary nodules (15.22%) in the left upper lung, 42 pulmonary nodules (18.26%) in the left lower lung, 52 pulmonary nodules (22.61%) in the right upper lung, 47 pulmonary nodules (20.43%) in the right middle lung, and 54 pulmonary nodules (23.48%) in the right lower lung. The detection rate of pulmonary nodules among military flying personnel in the ≥1 000 h group was higher than in the <1 000 h group, and the difference was statistically significant ( χ2=4.14, P=0.042). More pulmonary nodules were detected among military flying personnel who smoked than among those who did not, and the difference was statistically significant ( χ2=9.34, P=0.002). Age, types of personnel, body mass index, and complications with other lung diseases made no significant difference in the detection rate of pulmonary nodules (all P>0.05). Multivariate Logistic regression analysis showed that smoking was a risk factor for pulmonary nodules ( OR=1.692, 95% CI: 1.217-2.351). Conclusions:Among military flying personnel, pulmonary nodules are more likely to occur in the right lung. Smoking is an independent risk factor for pulmonary nodules, suggesting that routine chest CT screening should be carried out during the annual physical examinations of military flying personnel in order to exercise early interventions.

Objective:To analyze the relationship among thyroid autoimmunity (TAI), thyroid function, and gestational diabetes mellitus (GDM) in early pregnant women in Xi'an.Methods:A prospective study included pregnant women who underwent prenatal check-ups at the Northwest Women's and Children's Hospital from November 2020 to October 2021, with a gestational age of 6 to 14 weeks. Thyroid function, thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), and urinary iodine levels were measured, and the prevalence of thyroid disease and GDM was monitored. The subjects were divided into four groups: TPOAb positive only, TgAb positive only, both TPOAb and TgAb positive, and both TPOAb and TgAb negative, to compare the differences in the prevalence of thyroid disease and GDM among the groups. Statistical analysis was performed using Kruskal-Wallis rank-sum test, Bonferroni correction, Chi-square test, and a multivariate logistic regression model was used to analyze the relationship between TAI, thyroid disease, and GDM. Results:A total of 20 243 early pregnant women were included in this study, among which 1 615 (7.98%) were positive for TPOAb only; 865 (4.27%) were positive for TgAb only; 1 672 (8.26%) were positive for both TPOAb and TgAb (both positive group); and 16 091 (79.49%) were negative for both TPOAb and TgAb (both negative group). The thyroid stimulating hormone levels in the TPOAb positive only group, TgAb positive only group, and both positive group were significantly higher than those in the both negative group, respectively (Bonferroni correction, all P<0.05); the free thyroxine level in the TPOAb positive only group was significantly lower than that in the both negative group ( P<0.05). After adjusting for age, pre-pregnancy body mass index, and urinary iodine levels, multivariate logistic regression analysis showed that compared to the both negative group, the risk of developing hypothyroidism during pregnancy was significantly increased in the both positive group ( OR=11.49, 95% CI: 2.84-46.39); the risk of developing subclinical hypothyroidism during pregnancy was significantly increased in the TgAb positive only group ( OR=1.99, 95% CI: 1.05-3.76) and the both positive group ( OR=3.74, 95% CI: 2.49-5.63); the risk of developing GDM was significantly increased in the TgAb positive only group ( OR=1.43, 95% CI: 1.04-1.96) and the both positive group ( OR=1.94, 95% CI: 1.53-2.46). Among early pregnant women with normal thyroid function, after adjusting for age, pre-pregnancy body mass index, and urinary iodine levels, multivariate logistic regression analysis showed that compared to the both negative group, the risk of developing GDM was significantly increased in the TgAb positive only group ( OR=1.46, 95% CI: 1.06-2.02) and the both positive group ( OR=1.80, 95% CI: 1.40-2.32). Conclusion:TgAb positive only is a risk factor for subclinical hypothyroidism and GDM. Screening for thyroid autoantibodies, especially TgAb, during pregnancy helps in the early identification of high-risk pregnant women for thyroid dysfunction and GDM.

OBJECTIVE To investigate the ameliorating effect and mechanism of the effective substance groups from Artemisia ordosica(Abbreviated as HSH)on rheumatoid arthritis(RA)based on cluster of differentiation 4/lymphocyte cell-specific protein-tyrosine kinase/zeta-chain-associated protein kinase of 70 kDa/interleukin-17(CD4/LCK/ZAP70/IL-17)signaling pathway.METHODS The rats were divided into normal group,model group,HSH low-dose,medium-dose and high-dose groups(2.7,10.8,21.6 mg/kg)and positive control group(Tripterygium glycosides tablet,6.3 mg/kg),with 10 rats in each group.Except for normal group,RA rat model was induced by complete Freund's adjuvant in other groups.After modeling,each group was given relevant medicine or normal saline intragastrically,once a day,for 28 consecutive days.The changes in ankle joint swelling and arthritis index in rats were determined;the pathological changes of ankle joint tissue were observed;the levels of inflammatory factors[IL-1β,IL-21,IL-17A,IL-2,interferon-γ(IFN-γ)and IL-6]in serum and joint fluid of rats were determined;the levels of Th1,Th17 and Treg cells in the whole blood and spleen of rats were detected;protein and mRNA expressions of LCK,proto-oncogene tyrosine-protein kinase Fyn(Fyn),ZAP70,CD45,RAR-related orphan receptor γt(RORγt),and forkhead box protein 3(Foxp3)in ankle synovial tissue were determined.RESULTS Compared with normal group,the changes in ankle joint swelling,arthritis index,the levels of IL-1β,IL-21,IL-17A,IL-2,IFN-γ and IL-6 in serum and joint fluid,the levels of Th1,Th17 cells and Th17/Treg value in whole blood and spleen,and the protein and mRNA expression levels of LCK,Fyn,ZAP70,CD45,and RORγt in ankle joint synovium were all significantly increased/elevated(P＜0.05).The level of Treg cells in the spleen,as well as the protein and mRNA expression levels of Foxp3 in the ankle joint synovium were significantly decreased(P＜0.05).Compared with model group,most of the above-mentioned indicators were significantly reversed in the positive control group and all dose groups of HSH(P＜0.05).The degree of pathological changes in ankle joint tissues was markedly improved,and inflammation was alleviated.CONCLUSIONS HSH can regulate the cascade reactions in the CD4/LCK/ZAP70/IL-17 pathway within the T-cell receptor signaling pathway,thereby modulating the Th17/Treg balance.This leads to the suppression of inflammatory responses and the alleviation of synovial tissue damage in rats with RA.

Objective To explore the preoperative assessment of the differentiation degree of hepatocellular carcinoma(HCC),based on the imaging features observed on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI HCC.Methods A retrospective analysis was conducted on the data of 198 patients with HCC confirmed by surgery or biopsy pathology,all of whom underwent Gd-EOB-DTPA enhanced examination before operation.According to pathological results,HCC patients were divided into poorly-differentiated group(group A,69 cases),moderately-differentiated group(group B,97 cases)and well-differentiated group(group C,32 cases).The signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR),relative intensity ratio(RIR,,RIR2),and enhancement ratio(ER)of hepatobiliary phase HCC were calculated and analyzed.Results The CNR was the high-est in the group A and the lowest in the group C.Conversely,the SIHCC unenhanced,SIHCC hepatobiliary phase,and RIR1,RIR2 all were the highest in the group C and the lowest in the group A.There were statistically significant differences between the group C and the group B,as well as the group C and the group A(P＜0.05).Regarding signal characteristics during the hepatobiliary phase,the group A had the highest proportion of low/slightly low signal,while the group C had the lowest proportion.A statistically significant difference was observed between the group C and the group A(P＜0.05).Conclusion The Gd-EOB-DTPA enhanced MRI is helpful to preoperative assessment the differentiation degree of HCC.The higher the signal in the hepatobiliary phase,the smaller the CNR,the larger val-ues for the SIHCCunenhanced,SIHCC hepatobiliaryphase and RIR1,RIR2 are associated with the better the differentiation degree of HCC.

Objective To explore the correlation between serum angiotensin-converting enzyme(SACE),matrix metalloproteinase-9(MMP-9)and haptoglobin(HPT)with pulmonary infection in patients with schizophrenia.Methods A total of 83 patients with schizophrenia were selected and divided into the infected group(40 cases)and the non-infected group(43 cases)according to whether they had pulmonary infection.Data of antipsychotic drugs,length of hospital stay,course of disease and electroconvulsive therapy were collected.Serum SACE,MMP-9 and HPT levels were detected by enzyme-linked immunosorbent assay.Spearman correlation analysis was used to determine serum SACE,MMP-9 and HPT and pulmonary infection in patients with schizophrenia.Logistic regression was used to analyze risk factors for pulmonary infection in patients with schizophrenia,and receiver operating characteristic(ROC)curves were used to evaluate the predictive value of serum SACE,MMP-9 and HPT in patients with pulmonary infection.Results Before treatment,the types of antipsychotic drugs≥2,the proportion of electroconvulsive therapy,serum SACE,MMP-9 and HPT levels were higher in the infected group than those in the non-infected group(P＜0.05).After treatment,there were no significant differences in serum SACE,MMP-9 and HPT levels between the infected group and the non-infected group(P＞0.05).Serum SACE,MMP-9 and HPT were positively correlated with pulmonary infection in patients with schizophrenia(P＜0.05).More than 2 types of antipsychotic drugs,electroconvulsive therapy and elevated SACE,MMP-9 and HPT were risk factors for pulmonary infection in schizophrenia patients(P＜0.05).The ROC curve analysis showed that the combined serum SACE,MMP-9 and HPT for pneumonia in schizophrenic patients were better than each of these indicators alone in predicting pulmonary infection in patients with schizophrenia.Conclusion Serum SACE,MMP-9 and HPT are related with pulmonary infection in patients with schizophrenia,and which can be used as potential indicators for predicting pulmonary infection in patients with schizophrenia.