The prescription of Qidong Yixin oral liquid is derived from the experience of national medical master Ren Jixue in treating viral myocarditis （VMC）. It has the functions of tonifying Qi， nourishing the heart，calming the mind， and relieving palpitations. It is used to treat VMC and angina pectoris of coronary heart disease caused by deficiency of both Qi and Yin. However，the understanding of its efficacy evidence， advantageous aspects， dosage and administration， and medication safety remains insufficient in clinical practice. Therefore，the development of the Expert Consensus on the Clinical Application of Qidong Yixin Oral Liquid （hereinafter referred to as consensus） was initiated. Consensus strictly followed the process and methods of the expert consensus on the clinical application of Chinese patent medicines of the China Association of Chinese Medicine，successively completing multiple tasks such as the consensus project initiation，determination of clinical problems，evidence search and evaluation，formation of recommendation opinions and consensus suggestions，solicitation of opinions，peer review， submission for review and release， and so on. Consensus formed a total of 10 recommendation opinions and 12 consensus suggestions，clarifying the clinical positioning，efficacy advantages，syndrome differentiation，dosage and administration，combination therapy，timing of medication，adverse reactions，contraindications， and precautions of Qidong Yixin oral liquid，indicating that it has good clinical advantages and safety in the treatment of VMC and angina pectoris of coronary heart disease，providing norms and references for physicians to safely and rationally apply Qidong Yixin oral liquid. Consensus was reviewed and approved for release by the Standardization Office of the China Association of Chinese Medicine on December 23， 2024. Standard number：GSCACM-376-2024.

This article provides a systematic interpretation and review of the Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design. Developed based on the Grading of Recommendations Assessment, Development and Evaluation methodology, the guideline address five core themes: ICU layout, room design, infection control, infrastructure, and staff spaces, and put forward 17 evidence-based recommendations, including 5 good practice statements. This article briefly introduces the guideline development methods and evidence characteristics, and focuses on summarizing key recommendations, including high-visibility layouts, single-bed ward settings, natural lighting and noise reduction strategies, integrated infection prevention and control design, remote monitoring, and flexible capacity expansion capabilities. Furthermore, it delves into the applicability and localized implementation pathways within China's healthcare environment, analyzing limitations in terms of evidence quality, specialty applicability, and cost-effectiveness. Furthermore, by integrating the Chinese Guidelines for the Construction and Development of Critical Care Medicine (2025 Edition) and current domestic practices, the article proposes tiered and phased implementation recommendations. This article aims to provide domestic healthcare institutions with a scientific reference that balances international cutting-edge concepts with China's real-world conditions for the construction and renovation of ICUs, thereby promoting the development of intensive care environments centered on patient safety, healthcare worker well-being, and infection control.

Objective To investigate the current nursing practice of nurses specializing in nutritional support in ICUs and analyze their influencing factors in order to improve the training program and promote the development of standardized and precise nursing practice.Methods Convenience sampling method was used to select nutritional support nurses in ICUs in 29 provinces(autonomous regions and municipalities)from October 2023 to March 2025,and the self-developed questionnaire on nursing practice behaviors of nutritional support nurses in ICUs was used to conduct the survey.SPSS 21.0 software was used for descriptive analysis and multiple linear regression analysis.Results A total of 774 questionnaires were distributed,and 766 valid questionnaires were collected,with a recovery rate of 98.97％,and the score of the questionnaire on nursing practice behaviors of nurses specializing in nutritional support in ICU was(90.41±1 1.82).The results of multiple linear regression analysis showed that gender,presence of a nutritional support nursing team in the hospital,a standardized process of nutritional support nursing in the department,clear positional responsibilities of the nutritional support nursing team members,and inclusion of the nutritional support status of the patients in the quality management of the department were the factors influencing the nursing practice behavior scores of the nurses specializing in nutritional support in ICUs(P＜0.05).Conclusion Nurses in the ICUs have a high level of nursing practice behavior,but there is a need for further standardization in parenteral nutrition infusion and monitoring of complications.ICU nursing managers should formulate improvement strategies to address the weaknesses of clinical practice,strengthen nutritional support training,and improve the quality management program,and further improve the practical ability of nurses specializing in nutritional support.

AIM:To clarify the molecular mechanism by which astragaloside Ⅳ(AS-Ⅳ)suppresses oxida-tive stress and alleviates cerebral ischemia-reperfusion injury(CIRI)via the PTEN-induced kinase 1(PINK1)/parkin mi-tophagy-associated pathway.METHODS:A middle cerebral artery occlusion/reperfusion(MCAO/R)model was estab-lished in Sprague-Dawley rats.The animals were allocated to sham,MCAO/R,AS-Ⅳ,and mitochondrial division inhibi-tor-1(Mdivi-1)treatment groups.The rats in AS-Ⅳ and Mdivi-1 groups were intraperitoneally injected once daily with AS-Ⅳ(20 mg/kg)for 7 d,while those in Midivi-1 group also received intraperitoneal injection of Mdivi-1(1.2 mg·kg-1·d-1).The rats in sham and MCAO/R groups were given equivalent volume of distilled water.Neurological deficits were as-sessed using Zea Longa scoring,infarcted area volumes were measured using TTC staining,and brain tissue pathology was examined using hematoxylin and eosin staining.The levels of malondialdehyde(MDA)and superoxide dismutase(SOD)were assessed by ELISA,while those of reactive oxygen species(ROS)were measured using flow cytometry.The expres-sion levels of PINK1,parkin and microtubule-associated protein 1 light chain 3(LC3)were quantified using Western blot and RT-qPCR.RESULTS:AS-Ⅳ administration significantly alleviated neuronal and mitochondrial damage in MCAO/R model rat brains(P＜0.05),together with significant reductions in the cerebral infarct volume and neurological dysfunc-tion(P＜0.05).Significant increases in PINK1,parkin and LC3 protein and mRNA levels were observed in response to AS-Ⅳ(P＜0.05),SOD activity rose,and ROS and MDA levels declined significantly(P＜0.05).The co-administration of Mdivi-1 abrogated the protective benefits of AS-Ⅳ,inhibited activation of the PINK1/parkin pathway,down-regulated LC3 at the mRNA and protein levels,and significantly increased mitochondrial damage.Mdivi-1 also markedly reduced autophagosome formation and SOD activity level,but increased both ROS and MDA levels,cerebral infarct volume,and the severity of neurological deficits(P＜0.05).CONCLUSION:Astragaloside Ⅳ activates the PINK/parkin-mediated mitophagy pathway,inhibits oxidative stress and alleviates CIRI in rats.

Objective To investigate the low-dose CT image denoising and generalization performance of the existing mainstream deep learning based denoising networks.Methods The public AAPM Mayo challenge dataset was used to train the denoising network using 3 image-domain methods(REDCNN,WGAN-VGG,CTformer)and 2 projection-image dual-domain methods(VVBP-UNet,CLEAR),separately.The denoising networks were evaluated quantitatively for peak signal-to-noise ratio(PSNR),structural similarity index,root mean square error,number of network parameters and floating point operations,and their generalization performance was analyzed on the AbdomenCT-1K Dataset.Results Image-domain denoising networks effectively suppressed low-dose CT image noise,with REDCNN demonstrating the best denoising performance and achieving a PSNR of 42.0988 dB.The dual-domain denoising networks were better at preserving tiny tissue structures while removing image noise,with VVBP-UNet performing the best and increasing PSNR to 42.150 9 dB.Conclusion The projection-image dual-domain method exhibits superior denoising and generalization performances than the image-domain method,despite requiring a relatively large amount of network parameters and computations.When computing resources are sufficient,the denoising results obtained by dual-domain method better fulfill the requirements for clinical diagnosis.

The prevalence of periodontitis in China is as high as 74.2％,making it the leading cause of tooth loss in adults and severely impacting both oral and overall health.The treatment of periodontitis and periodontal tissue regeneration are global challenges of significant concern.GE Shaohua's group at School and Hospital of Stomatology,Shandong University has focused on the key scientific issue of"re-modeling the periodontal inflammatory microenvironment and optimizing tissue repair and regeneration".They have elucidated the mechanisms underlying the persistence of periodontitis,developed bioactive ma-terials to enhance stem cell regenerative properties,and constructed a series of guided tissue regeneration barrier membranes to promote periodontal tissue repair,leading to the establishment of a comprehensive technology system for the treatment of periodontitis.Specific achievements and progress include:(1)Elucidating the mechanism by which key periodontal pathogens evade antimicrobial autophagy,leading to inflammatory damage;developing intelligent antimicrobial hydrogels and nanosystems,and creating metal-polyphenol network microsphere capsules to reshape the periodontal inflammatory microenviron-ment;(2)Explaining the mechanisms by which nanomaterial structures and electroactive interfaces regu-late stem cell behavior,developing optimized nanostructures and electroactive biomaterials,thereby effec-tively enhancing the regenerative repair capabilities of stem cells;(3)Creating a series of biphasic heterogeneous barrier membranes,refining guided tissue regeneration and in situ tissue engineering techniques,stimulating the body's intrinsic repair potential,and synergistically promoting the structural regeneration and functional reconstruction of periodontal tissues.The research outcomes of the group have innovated the fundamental theories of periodontal tissue regeneration,broken through foreign technologi-cal barriers and patent blockades,established a cascade repair strategy for periodontal regeneration,and enhanced China's core competitiveness in the field of periodontal tissue regeneration.

Objectives:To develop a new type of multifunctional rectangle transoral exposure retractor(MRTER)and explore its clinical application value.Methods:From 2020 to 2025,we performed 310 cases of transoropharyngeal atlantoaxial surgery,of which 162 cases used Codman retractors[Codman group,72 males and 90 females,aged 9-67 years old,47 cases were with simple atlantoaxial dislocation(AAD),115 cases were with basilar invagination],and 148 cases used the MRTER retractor system(MRTER group,63 males and 85 females,aged 6-72 years old,39 cases were with AAD,109 cases were with basilar invagination).The main clinical symptoms of the patients included cervical pain and restricted mobility in 49 cases,torticollis in 54 cases,weak and numbness of the limbs in 259 cases,finger inflexibility in 43 cases,walking instability in 178 cases,and bladder dysfunction in 5 cases.After admission,a transoral atlantoaxial reduction and plate internal fixation(TARP)was performed.Among the patients,86 with AAD did not undergo a soft palate split,and 224 patients with basilar invagination underwent a soft palate split to expand the exposure and then un-derwent transoral release and reduction+TARP procedures.Intraoperative oral opening distance(D value)and o-ral floor field of view area(S value)were measured to evaluate the exposure ability of the retractor system.The global reduction rate of atlantoaxial dislocation was measured on the cervical sagittal CT film,and the JOA score improvement rate at the final follow-up was calculated to evaluate the effect of the operation.Re-sults:The surgical procedure of 310 patients was smooth,the operation time was 138±25min in Codman group and 118±31min in MRTER group(P＜0.05);The surgical blood loss was 105±45mL in Codman group and 113±28mL in MRTER group(P＞0.05).The intraoperative measured D value was 4.0±2.1cm in Codman group and 4.2±1.9cm in MRTER group(P＞0.05);the S value was 6.3±2.8cm2 in Codman group and 7.1±3.1cm2 in MRTER group(P＜0.05).After operation,the symptoms of headache and neck pain were significantly relieved;the symptoms of limb numbness,weakness and walking instability were improved to varying degrees.The overall reduction rate of AAD was 81.3％in Codman group,and 82.5％in MRTER group(P＞0.05);JOA improvement rate was 71％in Codman group,and 73％in MRTER group(P＞0.05).Conclusions:The new MRTER exposure system provides an effective auxiliary tool for the implementation of atlantoaxial transoropha-ryngeal surgery.

Objective To investigate the prevalence of specific IgE antibodies against Alternaria alternata and Aspergillus fumigatus in serum samples from clinical allergy patients across selected provinces in China.Methods Data on specific IgE antibodies for Alternaria A.and Aspergillus F.were collected from 20 hospital laboratories in 17 cities spanning 11 provinces.The study analyzed the levels of specific IgE and their variations across different provinces and seasons.Results A total of 27 471 cases of Alternaria A.and 32 843 cases of Aspergillus F.specific IgE data were included.The national average positive rate of Alternaria A.IgE was 10.40%,with the highest rate of 22.68%in Jiangsu and the lowest rate of 2.06%in Guangxi.For Aspergillus F.specific IgE,the average positive rate was 4.24%,with Hubei province having the highest rate(7.25%)and Hunan province the lowest(1.23%).The difference in IgE levels for both Alternaria A.and Aspergillus F.among provinces were statistically significant(H=9 955,16 993,all P<0.0001).Among patients,5.85%had Alternaria A.specific IgE levels at grade 3 or above,while only 0.57%had Aspergillus F.specific IgE levels at this level.When examining seasonal variations using data from Liaoning,Hunan and Anhui provinces,significant seasonal changes were observed for both Alternaria A.and Aspergillus F.IgE antibodies(HAlternaria A=347.6,338.0,401.3,HAspergillus F=196.6,133.7,231.7,all P<0.0001).Conclusion The sensitization to Alternaria A.and Aspergillus F.exhibits distinct geographical characteristics and vary significantly with seasons.Given the relatively high IgE levels associated with Alternaria A.,it should be given adequate clinical attention.

Objective To study how lipid bilayer fluidity modulates the interaction between β1 integrin and CD40L,as well as the formation of CD40L-mediated tumor cell contact interfaces.Methods Supported lipid bilayers(SLB)with different fluidities were prepared through adjusting the 1,2-dioleoyl-sn-glycero-3-[N-(5-amino-l-carboxypentyl)iminodiacetic acid]succinyl nickel salt(DGS-NTA)content.The functionalization of lipid bilayers was achieved by anchoring fluorescently labeled CD40L molecules onto the membrane surface.The contact interface formation of PC9 cells on the functionalized lipid bilayers was observed through confocal fluorescence imaging and fluorescence recovery after photobleaching(FRAP)experiments,and data of two dimensional(2D)reaction kinetics of β1 integrin and CD40L were extracted from Zhu-Golan plots.Results The diffusion coefficient of molecules in lipid bilayer was negatively correlated with DGS-NTA content.High fluidity of lipid bilayer promoted CD40L accumulation at cell contact interface and expanded the cell contact area.The 2D dissociation constants(2D Kd)of β1 integrin-CD40L complexes were approximately 13,31 and 65 molecules/μm2 for the three lipid bilayers with high,moderate and low fluidities,respectively.Conclusions High fluidity of lipid bilayers significantly facilitates diffusion and aggregation of CD40L to the cell contact interface,thus enhancing β1 integrin-CD40L interaction and the stability of cell contact interfaces.

Objective:To evaluate the effect of enhance recovery after surgery-multidisciplinary treatment (ERAS-MDT) modality on elderly patients with knee osteoarthritis who underwent unicompartmental knee arthroplasty.Methods:This was a single-center, retrospective study: from August 2018 to September 2023, the data of 68 elderly patients (11 males and 57 females, aged from 75 to 91 years) who suffered from knee osteoarthritis came to Departmentof Orthopaedic Surgery, Beijing Geriatrics Hospital and underwent unicompartmental knee arthroplasty were collected and analyzed. The 36 patients who managed by ERAS-MDT modality were allocated to observational group, while the 32 patients who managed by the traditional treatment modality were allocated to the control group. The visual analogue score (VAS) was used to evaluate the pain extent, while the Oswestry disability index (ODI) was used for assessing the functional status. The efficiency was evaluated by the time interval between admission and surgery, time of the first off-bed ambulation training and hospital stays. The incidence rate of perioperative complications was collected. The modified MacNab criterion was used to assess the patient′s opinion of treatment satisfaction at the final follow-up.Results:The mean follow-up period was (8.3 ± 2.6) months. No significant differences were found pertaining to the demographic and baseline characteristics between the two groups ( P>0.05). All patients showed significantly improvement in leg pain and functional disability during the postoperative follow-up; the VAS and ODI scores in the observational group were significantly lower than that in the control group at the early postoperative follow-ups. The efficiency of diagnosis and treatment in the observational group were significantly higher than those in the control group, including the time interval between admission and surgery, time of the first off-bed ambulation training and the hospital stay: (2.8 ± 0.6) d vs. (3.7 ± 0.9) d, (0.9 ± 0.2) d vs. (2.1 ± 0.3) d and (14.8 ± 1.2) d vs. (17.7 ± 1.5) d, and there were statistical differences ( P<0.01). The incidence rate of perioperative complications in the observational group was significantly lower than that in the control group: 2.8% (1/36) vs. 18.8% (6/32), and there was statistical difference ( P<0.05). At the final follow-up, 94.4% (34/36) of patients in the observational group and 75.0% (24/32) of patients in the control group were satisfied with the treatment, the between-group difference was statistical significant ( P<0.05). Conclusions:Improved labor division and perioperative measurements can be implemented with the application of ERAS-MDT modality. Elderly patients who suffered from knee osteoarthritis would benefit from this improved treatment modality, achieving better treatment efficiency, enhanced recovery after surgery, as well as reduced incidence rate of perioperative complications.