Objective: To address systemic challenges in the blood system, such as supply-demand imbalance, inefficient allocation, and inappropriate clinical use, while bridging gaps in current theories regarding the integration of social mobilization, institutional practice, and policy coordination. It sought to construct a system dynamics model spanning from macro to micro levels to analyze the blood management system holistically. Methods: Key variables were identified by a systematic literature search in both Chinese and English databases. An improved Delphi method was then employed to conduct expert consultations across different fields, leading to the selection and determination of core variable sets for each sub-model. Furthermore, by defining their logical relationships, a system dynamics model was constructed to systematically analyze the operation mechanism of the blood management system. Results: Four core sub-models were developed: 1) A macro "Dynamic Balance" model quantifying regional supply-demand equilibrium and inventory control; 2) a mobilization "Three-Layer Funnel" model analyzing how socio-cultural factors, service channels, and policy incentives influence donation behavior; 3) an institutional "Dual-Cycle Regulation" model revealing hospital blood usage is driven by both disease burden (demand cycle) and management practices (regulation cycle); and 4) an individual "Three-Layer Filter" model standardizing clinical transfusion decisions based on necessity, risk-benefit, and context. These were integrated into a "Multi-Layer Linkage and Feedback" model, elucidating bidirectional interactions among five levels: policy environment, regional supply, blood station mobilization, hospital application, and clinical decision-making. Conclusion: This study constructed a system dynamics model for blood management. By defining key variables and their logical relationships, it systematically analyzes the system′s operational mechanism. The integrated framework connects multiple levels—regional supply, voluntary donation, hospital blood use, and clinical decision-making—revealing their intrinsic linkages. Future efforts should employ systems thinking to synergistically enhance supply-side mobilization, demand-side management, systemic regulation, and decision standardization to build a safe, efficient, and sustainable blood security system.

Objective:To analyze the current situation of health-related quality of life (HRQOL) and its influencing factors among community-dwelling elderly with mild cognitive impairment (MCI) based on the health ecology model (HEM).Methods:From December 2023 to September 2024, a cross-sectional survey was conducted among 997 community-dwelling elderly in Beijing, Shandong, Chongqing and other regions. The EuroQol five-dimensional questionnaire 5 level (EQ-5D-5L), the Montreal cognitive assessment (MoCA), and the Pittsburgh sleep quality index (PSQI) were used to assess the subjects.Descriptive analysis, Mann-Whitney U test, Kruskal-Wallis test, and Tobit regression analysis were performed using Stata 18.0 software. Results:A total of 324 valid samples were finally obtained, and the health utility value of MCI elderly was 0.842(0.815, 0.951). Tobit regression analysis showed that ≥80 years old( β=-0.121, 95% CI=-0.193--0.050) in individual traits level, don't exercise( β=-0.196, 95% CI=-0.255--0.137) and poor quality of sleep ( β=-0.064, 95% CI=-0.116--0.013) in behavior characteristics level, and poor subjective economic status( β=-0.153, 95% CI=-0.261--0.045) in living and working conditions level were risk factors for the health utility value of the elderly with MCI. Drinking( β=0.096, 95% CI=0.022-0.171) in behavior characteristics level and participating in social activities( β=0.126, 95% CI=0.062-0.190) in interpersonal network level were protective factors for the health utility value of the elderly with MCI. Conclusions:The HRQOL of the community-dwelling elderly with MCI in China is low, and its influencing factors are multi-level. HEM should be combined to strengthen the intervention and management of the elderly with MCI from personal constitution to policy environment to improve their HRQOL.

Background and Aims:Gastric cancer remains a common malignancy worldwide with a poor prognosis and limited response to current therapies.Ferroptosis,a novel form of regulated cell death,has emerged as a promising therapeutic target in cancer.Terminal nucleotidyltransferase 5B(TENT5B)is downregulated in various tumors,but its role in gastric cancer and ferroptosis remains unclear.This study aimed to investigate the expression pattern and biological function of TENT5B in gastric cancer and to elucidate its underlying mechanisms in regulating ferroptosis.Methods:The expression of TENT5B in gastric cancer was analyzed using TCGA and GEO datasets,and further validated in gastric cancer tissues and cell lines by qRT-PCR and Western blotting.CCK-8,colony formation,wound healing,and Transwell assays were performed to evaluate the effects of TENT5B overexpression on cell proliferation and migration.Ferroptosis was assessed by measuring cell viability,lipid ROS,and MDA levels.Bioinformatics analysis,mRNA stability assays,and rescue experiments were conducted to explore the molecular mechanisms.A subcutaneous xenograft mouse model was used to validate the in vivo effects.Results:TENT5B was significantly downregulated in gastric cancer tissues and cells.Overexpression of TENT5B inhibited cell proliferation and migration while promoting ferroptosis.Mechanistically,TENT5B enhanced PRKAA2 mRNA stability and upregulated its expression,thereby exerting tumor-suppressive effects.In vivo,TENT5B overexpression suppressed tumor growth and elevated PRKAA2 expression.Conclusion:TENT5B functions as a tumor suppressor in gastric cancer by stabilizing PRKAA2 mRNA,promoting ferroptosis,and inhibiting cancer progression.These findings suggest that TENT5B may serve as a promising molecular target for ferroptosis-based therapeutic strategies in gastric cancer.

Objective:To examine the long-term efficacy and complications of fecal microbiota transplantation (FMT) for the treatment of diseases related to intestinal dysbiosis.Methods:This was a retrospective descriptive study. Relevant data were collected from the records of 15 000 patients who had undergone FMT and been followed up for more than 3 months during the period from May 2017 to September 2024. The patient cohort comprised 3746 male and 11 254 female patients aged (45.3±12.2) years. The inclusion criterion was meeting the indications for FMT. Application of this criterion yielded 8258 patients with constipation, 684 with Clostridium difficile infection, 1730 with chronic diarrhea, 510 with inflammatory bowel disease, 432 with radiation enteritis, 1940 with irritable bowel syndrome, 365 with autism, 870 with postoperative gastrointestinal dysfunction, and 211 with neurodegenerative diseases. The three routes of delivering FMT comprised infusion of an enterobacterial solution through a nasoenteric tube into the jejunum for 6 consecutive days (upper gastrointestinal FMT group, 11 125 patients), oral intake of enterobacterial capsules for 6 consecutive days (oral capsule FMT, 3597 patients), and a single injection of a bacterial solution into the colon via colonoscopy (lower gastrointestinal FMT group, 278 patients). Other treatments were discontinued during the treatment and follow-up period and administration of other medications was not recommended unless absolutely necessary. The primary outcomes were the efficacy of FMT after 3, 12 and 36 months of treatment, and improvement in chronic constipation, C. difficile infection, chronic diarrhea, inflammatory bowel disease, radiation enteritis, irritable bowel syndrome, post-surgery gastrointestinal dysfunction, and autism. Other outcomes included the occurrence of short-term (within 2 weeks after treatment) and long-term (within 36 months after treatment) adverse reactions.Results:At 3, 12 and 36 months after treatment, the overall rates of effectiveness of treatment were 71.8% (10 763/15 000), 64.4% (7600/11 808) and 58.8% (3659/6218), respectively. Specifically, the rates of clinical improvement were 70.3% (5805/8258), 62.6% (3970/6345), and 56.5% (1894/3352), respectively, for constipation; 85.8% (587/684), 72.3% (408/564), and 67.3% (218/324), respectively, for C.difficile infection; 81.0% (1401/1730), 78.1% (1198/1534), and 72.3% (633/876), respectively, for chronic diarrhea; 64.3% (328/510), 52.3% (249/476), and 46.6 % (97/208), respectively, for inflammatory bowel disease; 77.3% (334/432), 65.4% (212/324), and 53.6% (82/153), respectively, for radiculitis; 70.6% (1370/1940), 64.5% (939/1456), and 60.4% (475/786), respectively, for irritable bowel syndrome; 75.3% (275/365), 70.0% (201/287), and 63.6% (112/176), respectively, for autism; 65.3% (568/870), 54.3% (355/654), and 46.5% (114/245), respectively, for post-surgical gastrointestinal dysfunction; and 45.0% (95/211), 40.5% (68/168), and 34.7% (34/98), respectively, for neurodegenerative diseases. At 3, 12, and 36 months post-treatment, clinical improvement rates were 77.1% (8580/11 125), 67.1% (6437/9595), and 62.1% (3196/5145), respectively, in the upper gastrointestinal route group; and 57.3% (2062/3597), 53.6% (1115/2081), and 45.0% (453/1006), respectively, in the oral capsule group; and 43.5% (121/278) , 36.4% (48/132) and 14.9% (10/67), respectively, in the lower gastrointestinal route group. No serious adverse reactions occurred during treatment or follow-up. The most common adverse reactions in the upper gastrointestinal route group, oral capsule group, and lower gastrointestinal route group were respiratory discomfort (20.4%, 2269/11 125), nausea and vomiting on swallowing the capsule (7.6%, 273/3597), and diarrhea (47.5%, 132/278), respectively; these symptoms resolved at the end of treatment. At 36 months of follow-up, 19 patients reported exacerbation of symptoms of pre-existing diseases and there had been 16 deaths that were not directly related to FMT. Additionally, no systemic diseases had developed after FMT.Conclusion:FMT for the treatment of intestinal dysfunction associated with disorders of the intestinal flora and related extraintestinal diseases is effective and not associated with serious adverse events.

Objective:To analyze the current situation of health-related quality of life (HRQOL) and its influencing factors among community-dwelling elderly with mild cognitive impairment (MCI) based on the health ecology model (HEM).Methods:From December 2023 to September 2024, a cross-sectional survey was conducted among 997 community-dwelling elderly in Beijing, Shandong, Chongqing and other regions. The EuroQol five-dimensional questionnaire 5 level (EQ-5D-5L), the Montreal cognitive assessment (MoCA), and the Pittsburgh sleep quality index (PSQI) were used to assess the subjects.Descriptive analysis, Mann-Whitney U test, Kruskal-Wallis test, and Tobit regression analysis were performed using Stata 18.0 software. Results:A total of 324 valid samples were finally obtained, and the health utility value of MCI elderly was 0.842(0.815, 0.951). Tobit regression analysis showed that ≥80 years old( β=-0.121, 95% CI=-0.193--0.050) in individual traits level, don't exercise( β=-0.196, 95% CI=-0.255--0.137) and poor quality of sleep ( β=-0.064, 95% CI=-0.116--0.013) in behavior characteristics level, and poor subjective economic status( β=-0.153, 95% CI=-0.261--0.045) in living and working conditions level were risk factors for the health utility value of the elderly with MCI. Drinking( β=0.096, 95% CI=0.022-0.171) in behavior characteristics level and participating in social activities( β=0.126, 95% CI=0.062-0.190) in interpersonal network level were protective factors for the health utility value of the elderly with MCI. Conclusions:The HRQOL of the community-dwelling elderly with MCI in China is low, and its influencing factors are multi-level. HEM should be combined to strengthen the intervention and management of the elderly with MCI from personal constitution to policy environment to improve their HRQOL.

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 collect oral exhaled odor spectrum of patients of chronic atrophic gastritis(CAG)with yin deficiency syndrome and detect their gut microbiota;To elucidate the mechanism of odor changes from the perspective of gut microbiota changes;To provide a basic research for the objectification of TCM olfactory diagnosis in CAG.Methods Totally 110 patients with CAG,including 55 patients with CAG yin deficiency syndrome,55 patients with CAG non-yin deficiency syndrome,and 30 healthy individuals were collected.The electronic nose technology was used to collect the oral exhaled odor spectrum of all subjects,and an improved Transformer model was used to identify the breath odor spectrum of CAG yin deficiency syndrome patients and healthy individuals,CAG non-yin deficiency syndrome patients and healthy individuals,CAG yin deficiency syndrome patients and CAG non-yin deficiency syndrome patients.At the same time,16S rRNA high-throughput sequencing method was used to detect the gut microbiota of the subjects'fecal samples,and the correlation analysis between the odor spectrum characteristics of CAG yin deficiency syndrome and gut microbiota was conducted.Results ① Analysis and recognition of odor spectrum characteristic.Amplitude characteristics:The response curves A,C,D,G,H,I and J of the odor spectrum in the CAG yin deficiency syndrome group and the CAG non-yin deficiency syndrome group were all lower in amplitude than those in the healthy group(P<0.01,P<0.05).Slope characteristics:The slopes of response curves A,B,C,D,E,G,H,I and J in the odor spectrum of the CAG yin deficiency syndrome group and the CAG non-yin deficiency syndrome group were lower than those of the healthy group(P<0.01,P<0.05).Pattern recognition:The accuracy of pattern recognition between the CAG yin deficiency syndrome group and the healthy group reached 0.904,with an area under ROC curve(AUC)of 0.91;the accuracy of pattern recognition between the CAG non-yin deficiency syndrome group and the healthy group reached 0.885,AUC=0.89;the accuracy of pattern recognition between the CAG yin deficiency syndrome group and the CAG non-yin deficiency syndrome group reached 0.747,AUC=0.75.② Species composition:At the genus level,compared with the healthy group,the abundance of Actinomyces,Escherichia-Shigella and Tyzzerella in the CAG yin deficiency syndrome group increased(P<0.05),while the abundance of Prevotella,Sutterella and Subdoligranulum decreased(P<0.05);the abundance of[Ruminococcus]_gnavus_group and Escherichia-Shigella in the CAG non-yin deficiency syndrome group increased significantly(P<0.01),while the abundance of Prevotella and Subdoligranulum decreased(P<0.05).Compared with the CAG yin deficiency syndrome group,the non-yin deficiency syndrome group showed significant enrichment of the Dialister(P<0.05).③ Correlation analysis between odor spectrum characteristics and gut microbiota in CAG yin deficiency syndrome:This study identified 17 bacterial genera that showed positive and negative correlations with the amplitude and slope characteristics of the odor spectrum in CAG yin deficiency syndrome,namely Lachnospiraceae_NK4A136_group,Lachnospiraceae_ND3007_group,Faecalibacterium,UCG-002,UCG-005,Coprococcus,CAG-352,Parabacteroides,Actinomyces,Streptococcus,Anaerostipes,Blautia,Dorea,[Eubacterium]_hallii_group,Phascolarctobacterium,Clostridium_sensu_stricto_1,Enterobacter.The above-mentioned bacterial genera could be classified into the following bacterial families:Trichomonas,Clostridia,Porphyromonas,Actinobacteria,Ruminococcus,Streptococcus,Bacteroidetes,Clostridium,Veillonellaceae and Enterobacteriaceae.Conclusion The use of electronic nose technology can accurately identify the oral exhaled odor of patients with CAG yin deficiency syndrome,CAG non-yin deficiency syndrome,and healthy individuals;the odor spectrum characteristics of patients with CAG yin deficiency syndrome are correlated with multiple bacterial genera,and the changes in related metabolites and gases produced by the disruption of their gut microbiota may be one of the biological bases for the changes in oral exhaled odor in CAG yin deficiency syndrome.

Objective Chronic atrophic gastritis(CAG)is often accompanied by intestinal flora disorder and intestinal symptoms,forming the phenomenon of"stomach disease involving intestine".This study explored the dynamic correlation between intestinal symptoms and qi-stagnation degree in patients with CAG qi-stagnation syndrome and analyzed the characteristics of gut microbiota from the perspective of"spleen-stomach system serving as the pivotal hub of qi movement"in TCM.Methods According to the syndrome element differentiation method,410 patients with CAG were divided into four groups:non-qi-stagnation group,mild qi-stagnation group,moderate qi-stagnation group and severe qi-stagnation group.Correlation analysis and 16S intestinal flora sequencing technology were used to analyze the correlation and differential flora between the degree of CAG qi-stagnation and intestinal symptoms.Results Patients with CAG qi-stagnation syndrome were often accompanied by intestinal symptoms such as frequent flatulence,poor defecation and alternating loose-constipated stools.The frequency of cases was significantly positively correlated with the degree of qi-stagnation"non-mild-moderate-severe"(P<0.05).There was a difference in the abundance of gut microbiota between the four groups of CAG qi-stagnation none,mild,moderate and severe.The relative abundance of Streptococcus,Subdoligranulum,Eubacterium_coprostanoligenes_group and Haemophilus was positively correlated with the degree of qi-stagnation.The relative abundance of Ruminococcus_torques_group and Butyricicoccus showed a negative correlation,and Haemophilus was statistically significant among the four groups(P<0.05).Conclusion This study can provide clinical evidence and micro-mechanism for the connotation of"gastrointestinal co-morbidities"and"different diseases with the same syndrome",which may open up new ideas for clinical diagnosis and treatment.

Objective To collect oral exhaled odor spectrum of patients of chronic atrophic gastritis(CAG)with yin deficiency syndrome and detect their gut microbiota;To elucidate the mechanism of odor changes from the perspective of gut microbiota changes;To provide a basic research for the objectification of TCM olfactory diagnosis in CAG.Methods Totally 110 patients with CAG,including 55 patients with CAG yin deficiency syndrome,55 patients with CAG non-yin deficiency syndrome,and 30 healthy individuals were collected.The electronic nose technology was used to collect the oral exhaled odor spectrum of all subjects,and an improved Transformer model was used to identify the breath odor spectrum of CAG yin deficiency syndrome patients and healthy individuals,CAG non-yin deficiency syndrome patients and healthy individuals,CAG yin deficiency syndrome patients and CAG non-yin deficiency syndrome patients.At the same time,16S rRNA high-throughput sequencing method was used to detect the gut microbiota of the subjects'fecal samples,and the correlation analysis between the odor spectrum characteristics of CAG yin deficiency syndrome and gut microbiota was conducted.Results ① Analysis and recognition of odor spectrum characteristic.Amplitude characteristics:The response curves A,C,D,G,H,I and J of the odor spectrum in the CAG yin deficiency syndrome group and the CAG non-yin deficiency syndrome group were all lower in amplitude than those in the healthy group(P<0.01,P<0.05).Slope characteristics:The slopes of response curves A,B,C,D,E,G,H,I and J in the odor spectrum of the CAG yin deficiency syndrome group and the CAG non-yin deficiency syndrome group were lower than those of the healthy group(P<0.01,P<0.05).Pattern recognition:The accuracy of pattern recognition between the CAG yin deficiency syndrome group and the healthy group reached 0.904,with an area under ROC curve(AUC)of 0.91;the accuracy of pattern recognition between the CAG non-yin deficiency syndrome group and the healthy group reached 0.885,AUC=0.89;the accuracy of pattern recognition between the CAG yin deficiency syndrome group and the CAG non-yin deficiency syndrome group reached 0.747,AUC=0.75.② Species composition:At the genus level,compared with the healthy group,the abundance of Actinomyces,Escherichia-Shigella and Tyzzerella in the CAG yin deficiency syndrome group increased(P<0.05),while the abundance of Prevotella,Sutterella and Subdoligranulum decreased(P<0.05);the abundance of[Ruminococcus]_gnavus_group and Escherichia-Shigella in the CAG non-yin deficiency syndrome group increased significantly(P<0.01),while the abundance of Prevotella and Subdoligranulum decreased(P<0.05).Compared with the CAG yin deficiency syndrome group,the non-yin deficiency syndrome group showed significant enrichment of the Dialister(P<0.05).③ Correlation analysis between odor spectrum characteristics and gut microbiota in CAG yin deficiency syndrome:This study identified 17 bacterial genera that showed positive and negative correlations with the amplitude and slope characteristics of the odor spectrum in CAG yin deficiency syndrome,namely Lachnospiraceae_NK4A136_group,Lachnospiraceae_ND3007_group,Faecalibacterium,UCG-002,UCG-005,Coprococcus,CAG-352,Parabacteroides,Actinomyces,Streptococcus,Anaerostipes,Blautia,Dorea,[Eubacterium]_hallii_group,Phascolarctobacterium,Clostridium_sensu_stricto_1,Enterobacter.The above-mentioned bacterial genera could be classified into the following bacterial families:Trichomonas,Clostridia,Porphyromonas,Actinobacteria,Ruminococcus,Streptococcus,Bacteroidetes,Clostridium,Veillonellaceae and Enterobacteriaceae.Conclusion The use of electronic nose technology can accurately identify the oral exhaled odor of patients with CAG yin deficiency syndrome,CAG non-yin deficiency syndrome,and healthy individuals;the odor spectrum characteristics of patients with CAG yin deficiency syndrome are correlated with multiple bacterial genera,and the changes in related metabolites and gases produced by the disruption of their gut microbiota may be one of the biological bases for the changes in oral exhaled odor in CAG yin deficiency syndrome.

Objective Chronic atrophic gastritis(CAG)is often accompanied by intestinal flora disorder and intestinal symptoms,forming the phenomenon of"stomach disease involving intestine".This study explored the dynamic correlation between intestinal symptoms and qi-stagnation degree in patients with CAG qi-stagnation syndrome and analyzed the characteristics of gut microbiota from the perspective of"spleen-stomach system serving as the pivotal hub of qi movement"in TCM.Methods According to the syndrome element differentiation method,410 patients with CAG were divided into four groups:non-qi-stagnation group,mild qi-stagnation group,moderate qi-stagnation group and severe qi-stagnation group.Correlation analysis and 16S intestinal flora sequencing technology were used to analyze the correlation and differential flora between the degree of CAG qi-stagnation and intestinal symptoms.Results Patients with CAG qi-stagnation syndrome were often accompanied by intestinal symptoms such as frequent flatulence,poor defecation and alternating loose-constipated stools.The frequency of cases was significantly positively correlated with the degree of qi-stagnation"non-mild-moderate-severe"(P<0.05).There was a difference in the abundance of gut microbiota between the four groups of CAG qi-stagnation none,mild,moderate and severe.The relative abundance of Streptococcus,Subdoligranulum,Eubacterium_coprostanoligenes_group and Haemophilus was positively correlated with the degree of qi-stagnation.The relative abundance of Ruminococcus_torques_group and Butyricicoccus showed a negative correlation,and Haemophilus was statistically significant among the four groups(P<0.05).Conclusion This study can provide clinical evidence and micro-mechanism for the connotation of"gastrointestinal co-morbidities"and"different diseases with the same syndrome",which may open up new ideas for clinical diagnosis and treatment.