AIM:To evaluate the effects of periocular injection of triamcinolone acetonide combined with dexamethasone on ocular surface function and tear dynamics in patients with thyroid-associated ophthalmopathy(TAO).METHODS: In this single-center retrospective study, 26 TAO patients(52 eyes)treated between September 2020 and September 2023 received periocular injections of triamcinolone acetonide(20 mg)and dexamethasone(2.5 mg). Clinical parameters, including clinical activity score(CAS), ocular surface disease index(OSDI), Schirmer I test(SⅠt), tear film breakup time(BUT), tear meniscus height(TMH), corneal fluorescein staining(FL), meibomian gland loss, and lipid secretion score, were assessed at baseline, 1 wk, and 1 mo post-injection.RESULTS: There were statistically significant differences in CAS, OSDI, SⅠt, BUT, TMH, FL score, and meibomian gland secretion score before and after injection in the included patients(all P<0.05). At 1 wk after injection, there were differences in CAS, OSDI, SⅠt, BUT, TMH, FL score, and meibomian gland secretion score compared with those before injection(all P<0.0167). At 1 mo after injection, there were differences in CAS, OSDI, SⅠt, BUT, TMH, FL score, and meibomian gland secretion score compared with those at 1 wk after injection(all P<0.0167). At 1 mo after injection, there were no differences in CAS, OSDI, SⅠt, BUT, TMH, FL score, and meibomian gland secretion score compared with those before injection(all P>0.05). There was a difference in meibomian gland dropout score before and after injection in the included patients(P<0.05), but pairwise comparisons showed no differences(P=0.900, 0.306). During the treatment period, 1 patient experienced transient elevation of intraocular pressure(25 mmHg), which was alleviated after control with intraocular pressure-lowering medication, and no cases of secondary glaucoma occurred.CONCLUSION: Periocular injection of triamcinolone acetonide combined with dexamethasone provides short-term improvement in ocular surface symptoms, tear film stability and secretion in TAO patients. However, efficacy diminishes over time and does not reverse structural damage. Long-term maintenance therapy is recommended.

The connotation of "treat heat with cold" and "disperse fire constraint" differs， and under the guidance of these two principles， there are variations in the selection of acupoints， choice of needles， and manipulation techniques in clinical acupuncture. "Treat heat with cold" is used to clear and drain heat pathogens， while "disperse fire constraint" focuses on diffusing and dissipating fire from constraint. When both fire constraint and internal heat coexist， treatment should combine both "dispersing the fire" and "cooling the heat". In clinical acupuncture， for clearing heat and draining heat pathogens， acupoints on Governor vessel （督脉） and Yangming （阳明经） channel are commonly selected， with Jing-well points， Ying-spring points and He-sea points. To diffuse and dissipate fire constraint， acupoints on the Taiyang （太阳） and Shaoyang （少阳） channels are usually chosen， with Jing-river points and Ashi points as the primary options. In terms of needle choice， for heat syndrome， filiform needles， three-edged needles， and cupping are often used for clearing heat and resolving toxins； for fire constraint syndrome， moxibustion and fire needles are employed to expel fire from the body. Regarding manipulation techniques， draining method can be used in both conditions， with heat syndrome requiring shallow needling and quick removal， while fire constraint syndrome requiring deeper and longer retention of needles， having an emphasis on hand pressure coordination and smooth qi flow. In clinical practice， it is essential to distinguish the presence of "constraint" and the depth of the disease location to appropriately combine "dispersing fire" and "cooling heat".

Objective To explore the risk factors for mineral and bone disorder in maintenance hemodialysis patients, and to construct and validate a nomogram prediction model. Methods A total of 306 patients undergoing maintenance hemodialysis at Shanghai Eighth People’s Hospital from January 2021 to May 2025 were selected as study subjects and randomly divided into a training set (n＝214) and a validation set (n＝92) in a 7∶3 ratio. In the training set, patients were divided into a normal bone mineral metabolism group and an abnormal bone mineral metabolism group, and related factors were compared between the two groups. The multivariate logistic regression analysis was used to identify the influencing factors of mineral and bone disorder in maintenance hemodialysis patients in the training set, and a nomogram prediction model was constructed. ROC curves were drawn to evaluate the ability of the nomogram model for predicting mineral and bone disorder in these patients. Calibration curves and Hosmer-Lemeshow goodness-of-fit test were used to analyze the consistency of the predictive probability of nomogram model and actual probability of mineral and bone disorder in these patients. The decision curve was used to assess the clinical benefit using nomogram prediction model. Results Among the 306 hemodialysis patients, 254 patients had mineral and bone disorder, accounting for 83.01%. Among the 214 patients in the training set, 177 had mineral and bone disorder, accounting for 82.71%. In the training set, age, gender, body mass index (BMI), hypertension rate, dialysis age, blood urea nitrogen (BUN), hemoglobin (Hb), albumin (ALB), alkaline phosphatase (ALP), serum creatinine (SCr), uric acid (UA), estimated glomerular filtration rate (eGFR), and rate of taking phosphate binders were statistically significant different between the two groups (P＜0.05). The multivariate logistic regression analysis showed higher age, female, hypertension, longer dialysis duration, decreased eGFR, and not taking phosphate binders were identified as risk factors for mineral and bone disorder in maintenance hemodialysis patients (P＜0.01). The nomogram prediction model was constructed. The area under the ROC curve of the model for mineral and bone disorder in the training set and validation set was 0.895 (95%CI 0.850-0.941) and 0.881 (95%CI 0.830-0.932), respectively, with maximum Youden indice of 0.650 and 0.600, sensitivity of 0.856 and 0.849, and specificity of 0.794 and 0.751. The Hosmer-Lemeshow test showed the nomogram prediction model had good consistency in predictive probabilities with actual probabilities in training set and validation set. The decision curve showed the nomogram model could bring clinical net benefits when the threshold probabilities in the training set and validation set were less than 0.96 and 0.91. Conclusions The nomogram prediction model constructed based on six independent risk factors including age, gender, hypertension, dialysis duration, eGFR, and using phosphate binders or not, shows good discrimination and calibration, with good clinical predictive ability, which could provide guidance for the management of maintenance hemodialysis patients.

Diarrhea-predominant irritable bowel syndrome （IBS-D） exhibits typical characteristics of psychosomatic comorbidity. Its core pathogenesis is considered to involve simultaneous disorders of both the body and the spirit， for which the former is attributed to liver constraint and spleen deficiency， and dysfunction of large intestine conduction， whereas the latter is induced by spirit restlessness of zang （脏） organs， and gate insecurity of the corporeal soul. Based on this understanding， the therapeutic principle of "simultaneous regulation of body and spirit" is established. For regulating the body， the methods include soothing the liver， fortifying the spleen， consolidating the intestines， and stopping diarrhea， with emphasis on the front-mu （募） points of the related zang-fu （脏腑） organs and acupoints of the foot yangming （阳明） stomach channel and foot taiyin （太阴） spleen channel. For regulating the spirit， the methods include calming the brain spirit， tranquilizing the zang organs spirit， and securing the corporeal soul gate， mainly selecting acupoints of Governer Vessel （督脉） and the back-shu （背俞） points of the corresponding zang-fu organs. Needle manipulation techniques for supplementation and drainage are flexibly applied according to the deficiency or excess nature of the syndrome. In addition， comprehensive application of moxibustion， electroacupuncture， and auricular therapy is emphasized， with the aim of providing clinical insights for diagnosis and treatment.

The legal and regulatory system for the import of blood products in China has undergone a three-stage evolution of"safety first,demand-driven and standard upgrading",ultimately forming a dual control framework that centers on infectious disease prevention and control as well as quality approval.While the current policy effectively ensures biosafety,it also faces several deep-seated contradictions.These include the worsening imbalance between supply and demand,limited access to clinically needed blood products,and insufficient alignment with international standards.Moreover,strict regulation has also constrained technological innovation and market diversification.To address these challenges,it is suggested to establish a synergy mechanism that integrates a"clinical urgent need list,"hierarchical supervision,and mutual recognition of Good Manufacturing Practice(GMP).By implementing dynamic access,risk classification management,and international certification mutual recognition,it is possible to achieve compatible development between the safety baseline and medical accessibility.

Blood products play a pivotal role in modern medical treatment and healthcare system,and the clinical demand in China continues to grow.However,there is a significant supply gap for raw plasma domestically,with over 60％of human albumin relying on imports.The regulatory framework for imported blood products in China has undergone multiple rounds of adjustments,establishing a comprehensive lifecycle oversight system centered around the《Law of the People's Republic of China on the Administration of Drugs》and the《Measures for the Administration of Batch Release of Biological Products》.While ensuring safety,this framework has also led to issues such as insufficient clinical supply and elevated corporate costs because of stringent market access requirements,complex approval procedures,and tariff barriers.Specifically,import market access barriers have imposed a'dual-certification'burden,and tariff barriers have increased the costs of some products,exacerbating the financial burden on patients.In response to these challenges,it is recommended to establish an interdepartmental information-sharing platform,promote mutual recognition of international quality standards,form a rapid approval team for urgently needed medications,and reduce or exempt tariffs for clinically critical products.

In this study,the similarities and differences of plasma collection and quality control in China and abroad were analyzed by comparing the related regulations,standards,guidelines and literatures.Rational and constructive suggestions were proposed,aiming to optimize domestic plasma management and promote the improvement of plasma-related standards.There was little difference on facilities and safety control process of plasma between China and the developed countries(United States,EU and Japan),However,significant differences existed on plasma station setting,donor screening standards,collection interval,volume limits,plasma testing modes and tests,plasma quarantine standard and utilization of recovered plasma.The United States sets the industry benchmark and is worthy of reference for our country both in plasma collection and quality control.

The blood products industry,both domestically and internationally,exhibits distinct features in product research,development,and technological innovation.International companies possess extensive expertise in developing immunoglobulins,coagulation factors,and recombinant plasma protein products,demonstrating continuous advancements-particularly in specific immunoglobulin development,long-acting formulation optimization,and manufacturing process improvements.In recent years,Chinese enterprises have also achieved notable progress in related fields,especially in immunoglobulin process refinement and the development of novel recombinant coagulation factor products.However,there remains significant scope for improvement in areas such as the application of recombinant protein technologies,efficient utilization of plasma resources,and the adoption of advanced manufacturing techniques.Additional challenges include the accumulation of patented technologies,the supply of critical raw materials,and access to comprehensive epidemiological data.Driven by ongoing advances in gene recombination technologies,innovations in drug delivery systems,digital transformation,and the rise of personalized medicine,the blood products industry is poised for broader development prospects.To foster sustained and stable domestic industry growth and enhance global competitiveness,Chinese blood product enterprises should intensify their technological accumulation,upgrade manufacturing processes,and optimize plasma resource utilization.

Objective To investigate the CT and MRI features of giant cell reparative granuloma(GCRG)in lateral skull base.Methods The CT,MRI and clinicopathological data of 8 patients with GCRG in lateral skull base were collected and analyzed.Results All of the eight lesions were unilateral and solitary(three on the left side and five on the right side),with widespread involvement affecting two or more bony structures of the lateral skull base.All lesions showed expansile and lytic bone destruction on CT scans,the margins were clear(7/8),and the sclerotic changes could be seen at the margin of all eight lesions.On MRI,the lesions revealed heterogeneous isointense and hypointense on T1WI,and heterogeneous hypointense with focal cystic changes on T2WI,without fluid-fluid levels.The enhanced scan showed heterogeneous enhancement.Seven cases extended to the middle cranial fossa,caused com-pression of the temporal lobe brain tissue,with thickened and strengthened adjacent meninges.Conclusion The GCRG in lateral skull base has certain characteristic appearances on CT and MRI;understanding these characteristic manifestations can provide a basis for accurate diagnosis.

Objective To analyze the role and mechanism of PD-L1 in oral cancer metastasis based on TCGA and GEO databases.Methods The expression characteristics and clinical significance of the PD-L1 in oral cancer were analyzed using the TCGA database.PD-L1 mRNA levels were detected by quantitative reverse transcription-polymerase chain reaction(RT-qPCR)in various oral cancer cell lines.CCK-8,scrath test,Transwell-migration,and matrigel-invasion assays were employed to assess the effects of PD-L1 on proliferation,migration,and invasion of oral cancer cells.The interaction network between PD-L1 and functional genes in patients with oral cancer was constructed using STRING software and the GEO database,and key pathways were screened by Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis.The regulatory relationship between PD-L1 and key genes was validated by RT-qPCR.Results TCGA data revealed that PD-L1 was highly expressed in patients with oral cancer and was correlated with lymph node metastasis(P＜0.01).PD-L1 was also highly expressed in oral cancer cell lines and its inhibition significantly inhibited the proliferation,migration,and invasion of Cal27 and SCC25 cells(P＜0.05).KEGG analysis indicated that PD-L1 activated the Janus kinase(JAK)/signal transducer and activator of transcription(STAT)pathway by upregulating C-X-C motif chemokine ligand(CXCL)9 and CXCL10,thereby promoting STAT1 expression to regulate oral cancer metastasis.Inhibition of the JAK/STAT pathway further suppressed the proliferation,migration,invasion,and expression of STAT1,CXCL9,and CXCL10 in Cal27 and SCC25 cells(P＜0.05).Conclusions PD-L1 may promote oral cancer cell proliferation,migration,and invasion by upregulating CXCL9 and CXCL10 to regulate the JAK/STAT pathway and enhance STAT1 expression,ultimately driving oral cancer growth and metastasis.