Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is the primary cause of mortality in sepsis, with its core pathophysiological mechanism being severe ischemia and hypoxia in critical units—composed of microcirculation and the mitochondria of functional cells—resulting from disruptions in blood flow and oxygen flow following a dysregulated host response. Due to the systemically convergent yet clinically heterogeneous nature of the host response, current understanding and management strategies for hemodynamics remain inconsistent, often leading to inadequate resuscitation or overtreatment. To improve the quality of care, based on a systematic review of the "blood flow-oxygen flow" theory, an expert panel emphasizes reevaluating septic shock from an integrated perspective of blood flow and oxygen flow, and has formulated the Expert Consensus on Blood Flow and Oxygen Delivery Phenotyping and Clinical Management of Septic Shock (2025). The consensus proposes that clinical typing of blood flow-oxygen flow should comprehensively consider cardiac function, vascular tone, oxygen flow utilization status in critical units, and disease trajectory, while optimizing subtype identification by integrating host response phenotypes and artificial intelligence technologies. It advocates establishing a continuous assessment system through multi-site oxygen flow monitoring for organ perfusion, peripheral perfusion monitoring, and critical care ultrasound. Under the framework of the "critical care triangle", the consensus promotes the implementation of individualized, bundled management strategies, providing guidance for multiple management points to restore blood flow-oxygen flow matching, reduce the risk of organ failure, and decrease patient mortality.

OBJECTIVE To explore the pharmacokinetic characteristics of 3 blood-absorbed components of Xiangshao sanjie oral liquid in rats with hyperplasia of mammary gland （HMG）. METHODS Female SD rats were divided into control group and HMG group according to body weight， with 6 rats in each group. The HMG group was given estrogen+progesterone to construct HMG model. After modeling， two groups were given 1.485 g/kg of Xiangshao sanjie oral liquid （calculated by crude drug） intragastrically， once a day， for 7 consecutive days. Blood samples were collected before the first administration （0 h）， and at 5， 15， 30 minutes and 1， 2， 4， 8， 12， 24 hours after the last administration， respectively. Using chlorzoxazone as the internal standard， the plasma concentrations of ferulic acid， paeoniflorin and rosmarinic acid in rats were detected by UPLC-Q/TOF-MS. The pharmacokinetic parameters [area under the drug time curve （AUC0－24 h， AUC0－∞）， mean residence time （MRT0－∞）， half-life （t1/2）， peak time （tmax）， peak concentration （cmax）] were calculated by the non-atrioventricular model using Phoenix WinNonlin 8.1 software. RESULTS Compared with the control group， the AUC0－24 h， AUC0－∞ and cmax of ferulic acid in the HMG group were significantly increased （P＜0.05）； the AUC0－24 h， AUC0－∞ ， MRT0－∞ ， t1/2 and cmax of paeoniflorin increased， but there was no significant difference between 2 groups （P＞0.05）； the AUC0－24 h and MRT0-∞ of rosmarinic acid were significantly increased or prolonged （P＜0.05）. C ONCLUSIONS In HMG model rats， the exposure of ferulic acid， paeoniflorin and rosmarinic acid in Xiangshao sanjie oral liquid all increase， and the retention time of rosmarinic acid is significantly prolonged.

Objective: To explore the current status and influencing factors of eating behaviors in adolescents, so as to provide a theoretical foundation for health promotion education among adolescents. Methods: Based on the database from Survey of Chinese Family Health Index (2021), by a random number table method, 1 065 teenagers were selected from the provincial capitals of 22 provinces and 5 autonomous regions in China, as well as 4 municipalities directly under the central government. A general characteristic questionnaire, Patient Health Questionnaire-9 (PHQ-9), Short Form of the Family Health Scale (FHS-SF), 10-item Short Version of the Big Five Personality(BFP-10), Content-based Media Exposure Scale (CM-E) and Sakata Eating Behavior Scale Short Form(EBS-SF) were used to collect information. Multivariate stepwise linear regression analysis was employed to identify and analyze related factors of eating behaviors among adolescents. Receiver operating characteristic was used to validate the predictive ability of the EBS-SF score for overweight and obesity among adolescents. Results: The average scores of BFI-10,C-ME, FHS-SF, PHQ-9 and EBS-SF were (33.08±4.64)(19.20±4.55)(38.48±6.65)(6.09±5.63)(16.75±4.36), respectively. Multivariate linear regression showed that family type (other types), agreeableness, conscientiousness, family health and depression were the main related factors of EBS-SF scores among adolescents( B =2.61,-0.42,0.20,-0.11,0.23, P <0.05).The analysis of receiver operating characteristic curve showed that the EBS-SF scores had a good ability in predicting obesity among male adolescents ( AUC= 0.73, P <0.01). Conclusions Family type, big five personality, family health,depression are the related factors of eating behaviors among adolescents. EBS-SF scores are predictive of obesity in adolescents, which would provide a new perspective for promoting healthy eating habits among adolescents.

Objective To compare the efficacies of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in the treatment of post-chronic aplastic anemia(CAA)myelodysplastic syndrome(MDS)and primary MDS.Methods A retrospective analysis was conducted on 32 patients who received allo-HSCT treatment in Department of Hematology,North China University of Science and Technology Affiliated Hospital between Feb.2012 and Feb.2022,including 12 patients with post-CAA MDS and 20 patients with primary MDS.The overall survival rate,cumulative incidence of relapse(CIR)rate,non-relapse mortality(NRM)rate,and event-free survival rate were compared between the 2 groups.Results The median follow-up time for CAA to progress to MDS was 120(72-180)months.All the patients were followed up for 36(3-79)months after allo-HSCT.The 3-year overall survival rate of the post-CAA MDS group was significantly higher than that of the primary MDS group(83.8%vs 45.0%,P=0.035).The 3-year CIR of the post-CAA MDS group was significantly lower than that of the primary MDS group(16.7%vs 55.0%,P=0.021).There was no significant difference in the event-free survival rates or NRM rates between the 2 groups(both P＞0.05).Conclusion The post-CAA MDS patients have better survival after allo-HSCT than the primary MDS patients.Early allo-HSCT treatment may improve the prognosis.

With the rapid development of population aging in various countries around the world,the health and elderly care industry has been paid high attention.The standardization of smart health and elderly care technology and services is particularly important.This paper firstly reviewed the policies related to healthy elderly care in China.By analyzing the industrial standards and provincial standards issued,this paper focused on the policies proposed by the Shanghai Municipal Government for the standardization of smart health and elderly care,as well as the researches on the standard system and the construction of standard families.Shanghai group standards in the field of smart health and elderly care were summarized,including the guidelines for the construction of standard systems,elderly care service platforms,community elderly cafeterias,portable health monitoring terminals,indoor sports services,and home-based elderly care safety monitoring.A series of case analyses of the standardized implementation of the above aspects were also provided.Through standardization research and practice in recent years,it has been fully demonstrated that the standard research plays an important leading role in the field of smart health and elderly care.

Objective: To analyze the regulatory effect of Atractylodes macrocephala Koidz. extract on the immune function of mice, so as to provide a reference for the study of the mechanism of Atractylodes macrocephala Koidz. regulating immune function. Methods: Forty-eight SPF healthy male ICR mice were randomly divided into control group and low (0.5 g/kg), medium (2.0 g/kg), and high (4.0 g/kg) dose groups, with 12 mice in each group. The mice in control group were given the pure water by gavage once a day, while the mice in each dose group were given the corresponding dose of Atractylodes macrocephala Koidz. extract by gavage once a day. The delayed allergy test was performed for 28 consecutive days. Sixty SPF healthy male ICR mice were randomly divided into a control group, polyinosinic acid injection group (model group), and low, medium, and high dose groups, with 12 mice in each group. The mice in control group were given the pure water by gavage once a day, while the mice in each dose group were given the corresponding dose of Atractylodes macrocephala Koidz. extract by gavage once a day for 14 consecutive days. On days 13 and 14 of administration, the mice in the model group and each dose group were intraperitoneally injected with sterile polyinosinic acid solution to perform the immunosuppressive experiment induced by polyinosinic acid. The mouse ear pieces were weighed, and the thymus and spleen of the mice were weighed and stained with HE to calculate the pathological scores. Peripheral blood was collected for blood cell detection and T cell classification. Results: Mice in each group had normal feeding, activity, and growth status, and no abnormality was observed. In the delayed allergy test, compared with the control group, the degree and rate of ear swelling in the low, medium and high dose groups were higher, the white blood cell count in the medium dose group was higher, and the absolute values of lymphocytes in the low and medium dose groups were higher (all P<0.05). Compared with the control group, the pathological scores of the thymus and spleen in the model group were higher (both P<0.05). In the immunosuppressive experiments in mice induced by polyinosinic acid, compared with the model group, the pathological score of the thymus in the high dose group was lower (P<0.05), and the boundary between the thymus cortex and medulla was improved. Conclusions Atractylodes macrocephala Koidz. extract can increase the degree of ear swelling and peripheral blood white blood cell count in mice. High dose of Atractylodes macrocephala Koidz. extract can improve the thymus injury induced by polyinosinic acid, and has an immunomodulatory effect.

Glucagon and insulin are the main regulatory factors for blood glucose and jointly maintain the homeostasis of energy me-tabolism in the body,but the internal mechanism of the mutual regulation and influence between them remains complex and unclear.The liver is one of the key target organs for both insulin and glucagon,playing a crucial role in maintaining the homeostasis of glucose and lipid metabolism.Insulin resistance is often accompanied by abnormal glucose and lipid metabolism in the liver,which may affect the functional activity of glucagon in the liver.There is a glucagon-related feedback loop between the liver and the pancreas,known as the"liver-α-cell axis",which may play a critical role in understanding the metabolic effect of glucagon in the state of insulin resis-tance.In addition to the regulation of glucose homeostasis,the physiological action of glucagon has been extended to lipid and amino acid metabolism.Therefore,abnormal regulation of glucagon metabolism may further lead to the imbalance of glucose,lipid,and amino acid metabolism.This article briefly reviews the regulatory mechanism of glucagon in liver glucose homeostasis,lipid metabolism,and amino acid metabolism in physiological condition and the state of insulin resistance.

Objective:To compare the differences of clinical characteristics of temporal lobe epilepsy with bilateral hippocampal sclerosis (TLE-bHS) with those of temporal lobe epilepsy with unilateral hippocampal sclerosis (TLE-uHS).Methods:A retrospective analysis was performed. Forty-eight patients with confirmed TLE-bHS enrolled in Epilepsy Center, Department of Neurology, Second Affiliated Hospital, Medical School of Zhejiang University from January 2013 to January 2022 were chosen, and 101 patients with confirmed TLE-uHS admitted to our hospital at the same time period were selected as controls. Clinical data such as onset age, disease course, past medical history, seizure frequency, anti-seizure medications, video EEG and neuropsychological test results, and outcomes were analyzed.Results:Compared with the TLE-uHS group, the TLE-bHS group had higher male proportion, elder onset age, shorter disease course, higher seizure frequency, more types of past and currently used anti-seizure medications, lower proportion of autonomic nerve with aura, higher proportion of no aura at onset, higher proportion of slow head background movement in video EEG, and lower memory quotient, verbal memory scores and non-verbal memory scores, with significant differences ( P<0.05); the differences in ratio of past medical history and ratio of distributions of regions with interictal epileptiform abnormalities between the 2 groups were statistically significant ( P<0.05): the TLE-bHS group had significantly higher proportion of previous intracranial infection/encephalitis and higher ratio of bilateral temporal epileptiform abnormalities than the TLE-uHS group, while the TLE-uHS group had significantly higher proportion of patients with febrile convulsion history and higher ratio of unilateral temporal epileptiform abnormalities ( P<0.05). Only 10 patients (20.8%) in the TLE-bHS group received non-drug therapy, including anterior temporal lobectomy in 3 patients (Engel grading I in postoperative follow-up for 2 years), neuroregulatory therapy in 4, and ketogenic diet in 4; of the 55 patients (54.5%) in the TLE-uHS group who underwent anterior temporal lobectomy, 48 patients (87.3%) had Engel grading I, 1 patient (1.8%) had grading II, 4 (7.3%) had grading III, and 2 (3.6%) had grading IV after 2 years of follow-up. Conclusion:Differences in onset age, disease course, past medical history, seizure frequency, anti-seizure medications, and video EEG and neuropsychological test results can help to discriminate patients with TLE-bHS or with TLE-uHS.

Objective To investigate the risk factors of hip instability in elderly patients with femoral neck fracture after hemiarthroplasty(HA).Methods The medical records of 133 patients with femoral neck fracture who received HA treatment in the Department of Orthopedics of our hospital from January 2015 to October 2022 were retrospectively collected.According to whether the patients suffered hip dislocation after surgery,the patients were divided into dislocation group(n=35)and non-dislocation group(n=98).Demographic variables such as age,sex and body mass index(BMI)were recorded in the two groups.Complications such as diabetes,hypertension,heart disease and chronic obstructive pulmonary disease(COPD)were recorded.Prosthetic type,surgical approach,soft tissue repair type,blood loss and other surgical phase variables were recorded.Central marginal Angle(CEA),extraneous Angle(ABA),eccentricity,lower limb length difference(LLD),acetabular width,acetabular depth,and femoral head coverage(FCR)were measured on radiographs.Wald method was used to establish Logistic regression model to elucidate the risk factors of dislocation after HA.Results The proportion of COPD in the dislocation group was significantly higher than that in the control group(P＜0.05),and there was no significant difference in baseline characteristics between the two groups(P＞0.05).There was no significant difference between the two groups(P＞0.05).There were no significant differences in CEA,ABA,LLD,acetabular width,eccentricity and FCR between 2 groups(P＞0.05),but the acetabular depth and depto-width ratio in luxation group were significantly lower than those in control group(P＜0.05).Gender,COPD,CEA,acetabular width-to-depth ratio and LLD were independent risk factors for hip instability after HA(P＜0.05).Conclusion In this study,COPD,male,LLD,and small CEA and acetabular broad-to-depth ratio are independent risk factors for hip instability after HA,and therefore HA is not recommended for the treatment of femoral neck fractures in elderly patients with these conditions.

Objective To explore the correlation between thyroid antibody levels and early renal injury in patients with type 2 diabetes mellitus(T2DM)combined with Hashimoto's thyroiditis(HT).Methods A total of 375 T2DM patients hospitalized in The Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2022 were selectedas the study subjects,and 197 healthy people were selected as the control subjects.The patients with T2DM were divided into simple T2DM group(n=191)and T2DM combined with HT group(HT,n=184).According to the urinary albumin/creatinine ratio(UACR)level,T2DM patients with HT were divided into microalbuminuria subgroup(MUAlb,30≤UACR≤300 mg/g,n=70)and normal albuminuria subgroup(NUAlb,UACR<30 mg/g,n=114).According to whether the thyroid antibody was positive,they were divided into thyroid peroxides antibody[TPOAb(+)]subgroup(n=56),thyroglobulin antibody[TGAb(+)]subgroup(n=40)and TGAb and TPOAb double antibody positive subgroup(n=88).Results Compared with the NC group,the smoking,drinking,urinary creatinine,alpha 1-microglobulin,UACR,FPG,HbA1c,LDL-C,TC,and TG in the HT and T2DM groups increased(P<0.05),while HDL-C decreased(P<0.05).Compared with the NUAlb subgroup,the MUAlb subgroup showed age,DM duration,FPG,HbA1c,TGAb,TPOAb,thyroid stimulating hormone(TSH)increased(P<0.05),while FT3 and eGFR decreased(P<0.05).Spearman correlation analysis showed that UACR was positively correlated with age,HbA1c,TPOAb,TGAb,TSH(P<0.01),and negatively correlated with FT3(P<0.01).The UACR of the TGAb(+)+TPOAb(+)subgroup was higher than that of the TGAb(+)and TPOAb(+)subgroups(P<0.05).Logistic regression analysis showed that TSH,TGAb,TPOAb,and HbA1c were risk factors for MUAlb,while FT3 was a protective factor for MUAlb.Conclusions In T2DM with HT patients with normal thyroid function,TPOAb and TGAb are closely related to the occurrence of early renal injury.