ObjectiveTo explore the characteristics and regulatory mechanisms of cholestatic liver injury （CLI） caused by traditional Chinese medicine based on data mining， network pharmacology， and molecular docking. MethodChina National Knowledge Infrastructure and PubMed were searched for the relevant literature on CLI caused by traditional Chinese medicine from inception to 2024， and the information was standardized， summarized， and analyzed by cluster analysis. The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）， Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine （TCMIP）， GeneCards， Online Mendelian Inheritance in Man （OMIM）， and DisGeNET were used to retrieve the active ingredients and targets of core medicines. The Venn diagram was established to map the common targets shared by the core medicines and CLI. Cytoscape 3.10.2 was used to construct the protein-protein interaction （PPI） network of the common targets. DAVID was used for gene ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment of the core targets. Finally， molecular docking was performed by AutoDock Vina. ResultA total of 849 eligible articles were included in this study， from which 64 active ingredients of 39 herbal medicines that can cause cholestasis were counted and categorized according to the 2020 edition of the Pharmacopoeia of the People's Republic of China. The frequency of the medidicnes followed a descending order of heat-clearing medicines， exterior-releasing medicines， blood-activating and stasis-resolving medicines， purgative medicines， phlegm-resolving and cough- and dyspnea-relieving medicines， tonics， wind- and dampness-expelling medicines， interior-warming medicines， urination-promoting and dampness-draining medicines， Qi movement-regulating medicines， hemostatics， toxin-removing， worm-killing， and itch-relieving medicines， astringent medicines， dampness-eliminating medicines， and tranquiling medicines. The cluster analysis revealed that the reports of CLI caused by heat-clearing medicines accounted for the highest proportion of 39.69%. Among the heat-clearing medicines， Gardeniae Fructus （92 articles， accounting for 10.84%）， Scutellariae Radix （76 articles， 8.95%）， and Sophorae Flavescentis Radix （69 articles， 6.95%） were frequently reported. The core targets of cholestasis induced by Chinese herbal medicines reported to cause CLI mainly included tumor necrosis factor （TNF）， peroxisome proliferator activated receptor alpha （PPARA）， farnesoid X receptor （FXR）， glutamic-pyruvic transaminase 2 （GPT2）， superoxide dismutase 1 （SOD1）， interferon gamma （IFN-γ）， interleukin-6（IL-6）， CD36， Apolipoprotein A1（APOA1）， Angiotensin converting enzyme（ACE）， Cytochrome P450 3A4 enzyme（CYP3A4）， Protein kinase B1（Akt1）， APOB， albumin（ALB）， ATP binding cassette transporter A4（ABCB4）， SLC10A1， Estrogen Receptor alpha （ESR1）， signal transducer and activator of transcription1（STAT1）， β-actin（ACTB）， Endothelin 1（EDN1）， ABCG2， and peroxisome proliferator activated receptor gamma（PPARG）. The signaling pathways involved included bile secretion， ABC transporter， steroid biosynthesis， DNA adducts， drug metabolism， cytochrome P450， peroxisomes， primary bile acid biosynthesis， retinol metabolism， and Toll-like receptor. The molecular docking results showed that the active ingredients （e.g.， baicalin and berberine） of the heat-clearing medicines reported by high frequency to cause CLI had high binding affinity to the targets including ABCG2， IFN-γ， EDN1， IL-6 and SOD1， with the binding energy in the range of -13 kcal·mol^-1 to -9 kcal·mol^-1， and the regulatory pathways were highly correlated with transporters， microvascular function regulation， inflammation， and oxidative stress， which was consistent with the cluster analysis. ConclusionThe available reports about the Chinese herbal medicines causing CLI mainly focused on heat-clearing medicines， and the core targets included ABCG2， IFN-γ， EDN1， IL-6， and SOD1. The regulatory pathways were mainly related to transporters， microvascular function regulation， inflammation， and oxidative stress.

Joint hypermobility (JH) refers to the ability of joints to move beyond the 'normal' limits, which can be either physiologic or pathologic. Hypermobility spectrum disorders (HSDs) are a group of joint hypermobility-related clinical conditions. HSDs primarily affects the musculoskeletal system, predisposing the joints to subluxations or dislocations, and chronic pain. HSDs, however, may also manifest with symptoms such as fatigue, gastrointestinal disorders, and autonomic nervous system dysfunction, indicating multisystemic involvement that may impact psychological well-being. Although HSDs is usually not life-threatening, it is associated with poor quality of life. Currently, the molecular basis of HSDs remains unclear. The diagnosis of HSDs requires comprehensive medical evaluation and assessment. The main differential conditions/diagnoses include asymptomatic joint hypermobility, hypermobile Ehlers-Danlos syndrome (hEDS), and various musculoskeletal inflammatory or degenerative diseases. Asymptomatic joint hypermobility, HSDs, and hEDS are now viewed as a continuous spectrum. Due to limited awareness of the condition, individuals with asymptomatic joint hypermobility may experience overdiagnosis and overtreatment, while patients with HSDs may encounter prolonged misdiagnoses or underdiagnoses. Furthermore, individuals presenting with psychological symptoms may have all their somatic complaints erroneously attributed to psychological factors. These factors collectively impose unnecessary psychological and economic burdens on patients and their families. The multi-systemic and heterogeneous nature of HSDs necessitates a multi-disciplinary team (MDT) approach with a case manager in both the diagnosis and management processes. Additionally, patient education and self-management play pivotal roles in optimizing chronic disease management. This review aims to summarize the current state of diagnosis and management of HSDs and raise awareness of HSDs, providing a basis for the establishment and refinement of a multi-disciplinary diagnostic and management framework for HSDs in China.

Deep phenotyping is a precise and comprehensive approach used for the precise analysis and comprehensive assessment of multi-system phenotypes of the patients. The approach uses symptoms, signs, various medical examination and laboratory results, and other relevant medical information. In the clinical diagnosis and medical research of rare bone diseases, deep phenotyping plays a pivotal role. The realization of precision medicine primarily comprises three key dimensions: deep phenotyping, stratified medicine, and targeted therapy. The deep phenotyping is the basis for the latter two. Deep phenotyping not only facilitates fine subtyping of diseases, but also allows for the in-depth understanding of genetic data. The use of deep phenotyping requires stand- ardized terminology and specific procedures. Moreover, deep phenotyping shows substantial potential using the application of artificial intelligence technology particularly when combining with multi-omics techniques.

Blau syndrome is a rare genetic disorder characterized by the a mix of granulomatous arthritis, uveitis, and dermatitis. Patients typically manifest multisystem involvement, including ocular, skin, and skeletal abnormalities. Blau syndrome is extremely rare, with a global incidence of less than one in a million among children. In this multidisciplinary consultation, we present a case of a 21-year-old young female patient having multisystemic involvement since early childhood. She was presented with multiple joint swelling, skin lesions, increased eye discharge, and accompanied by hypertension and arterial abnormalities, and received a diagnosis of uveitis. The patient had been receiving steroid treatment since the age of 6 and has tried various medications, with some improvement in joint swelling and ocular symptoms. Through this rare disease multidisciplinary consultation, we aim to provide guidance in the molecular diagnosis of the patient, multisystem assessment, and the selection and formulation of treatment plans. Additionally, we hope that by reporting this case, clinical physicians can gain a better understanding of the diagnosis and comprehensive treatment strategies for Blau syndrome, thereby improving the management and treatment of rare diseases.

The Ehlers-Danlos syndromes (EDS) are a group of rare hereditary connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. The clinical and genetic hetero- geneity of EDS frequently leads to underdiagnosis and misdiagnosis. Genetic testing is an essential approach to clarify the underlying diagnosis. Recent research has preliminarily established genotype-phenotype correlations and introduced the novel concept of " disease spectrum" in some subtypes. These studies deepen our understanding of EDS etiology and provide important insights into clinical management. Published in 2023, the Chinese Guidelines for Diagnosis and Treatment of the Ehlers-Danlos Syndromes(the Guidelines) recommend performing genetic testing with deep phenotyping for patients who meet the clinical diagnostic criteria or are suspected of having EDS. However, it should be noted that the clinical diagnosis might differ from the molecular diagnosis. Furthermore, cutting-edge approaches such as periodic data reanalysis, integration of RNA sequencing into family-based whole-genome sequencing, and third-generation sequencing may facilitate the reclassification of variants of uncertain significance or resolve undiagnosed cases. This article summarizes recent progress in the genetics research of EDS, with the hope of offering a valuable resource for clinical diagnosis, treatment and scientific research to optimize the quality of life of patients with EDS.