Acute-on-chronic liver failure (ACLF) is an acute deterioration of liver function occurring on the basis of chronic liver disease, accompanied by failure of the liver and extrahepatic organs, and is associated with a high short-term mortality rate. Liver transplantation is the only curative treatment for patients with ACLF. However, the shortage of donor livers and limitations of the organ allocation system mean that only a minority of patients can receive transplants. The current organ allocation system based on the model for end-stage liver disease (MELD) score may underestimate the urgency of liver transplantation for ACLF patients. Therefore, it is urgent to develop better assessment tools to determine which ACLF patients are most likely to benefit from liver transplantation. This article reviews the current mainstream definitions of ACLF, the selection of candidates for liver transplantation in ACLF, and the prognostic scoring systems for liver transplantation in ACLF, both domestically and internationally, in order to provide a reference for the prognostic assessment of liver transplantation in ACLF patients.

Depression is a common psychiatric disorder characterized by persistent low mood or mental disorders. Current treatments primarily focus on regulating neurotransmitter levels， but their effectiveness is limited. The mechanisms underlying its onset are complex， and there is no unified consensus. Abnormal signaling pathway transmission plays a crucial role in the development of depression， involving multiple pathways， including Toll-like receptor 4/nucleotide-binding oligomerization domain-like receptor protein 3 （TLR4/NLRP3）， nuclear factor-κB （NF-κB）， Janus kinase/signal transducer and activator of transcription （JAK/STAT）， mitogen-activated protein kinase/extracellular signal-regulated kinase （MAPK/ERK）， brain-derived neurotrophic factor/tyrosine kinase receptor B （BDNF/TrkB）， cyclic AMP/protein kinase A/cAMP response element-binding protein （cAMP/PKA/CREB）， and others. Traditional Chinese medicine（TCM） is based on a holistic approach and the principle of treatment based on the differentiation of syndromes， regulating the balance of multiple systems and organ functions from a macroscopic perspective. This approach has shown unique advantages in the treatment of depression. TCM attributes the onset of depression to dysfunction of the organ systems， involving liver Qi stagnation， heart spirit deficiency， kidney essence depletion， and spleen dysfunction. TCM compound treatments focus on soothing the liver， strengthening the spleen， calming the heart， and replenishing essence， with formulas such as Xiaoyaosan， Zishui Qinggan Yin， and Chahu Jia Guizhi Longgu Muli Tang. The active components of Chinese herbs mainly aim to tonify and regulate Qi， such as salidroside， ginsenoside Rb₁， astragaloside， and muscone. External TCM treatments， primarily acupuncture， aim to open the orifices and invigorate the spirit. Acupoints such as Baihui， Shenting， and Yintang are commonly used. Additionally， massage and moxibustion therapy can intervene in depression by regulating signaling pathways. This article reviews the core role of signaling pathways in the development of depression and the mechanism of TCM regulation of signaling pathways to intervene in depression， aiming to discover new therapeutic approaches that can improve the symptoms of depressed patients.

Objective There is limited research on the combined use of multiple drugs in the prevention and treatment of radiation-induced oral mucositis (RTOM). This study aims to investigate the synergistic effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF), Kangfuxin Liquid, and vitamin B₁₂ via mouthwash on RTOM, and provide a novel approach for the prevention and treatment of acute RTOM. Methods A total of 82 patients with head and neck cancer who underwent radical radiotherapy were randomly divided into four groups: a control group (vitamin B₁₂, 20 cases), observation group 1 (rhG-CSF + vitamin B₁₂, 20 cases), observation group 2 (Kangfuxin Liquid + vitamin B₁₂, 21 cases), and observation group 3 (rhG-CSF + Kangfuxin Liquid + vitamin B₁₂, 21 cases). After 4 weeks of therapy, the therapeutic effects of the four groups were compared. Results Compared to the control group, there was no statistically significant difference in the incidence of RTOM. However, the incidence of severe RTOM was significantly reduced in the observation groups, following the order of observation group 1 (20.00%) > observation group 2 (14.28%) > observation group 3 (9.52%). The initiation period of RTOM in observation group 3 was 24 days, exhibiting a considerable delay in comparison to the control group (16 days), observation group 1 (18 days), and observation group 2 (22 days). The levels of pain experienced by the groups receiving combined treatments were significantly reduced compared to the control group. Observation group 3 exhibited the most effective pain reduction. Conclusion The combined administration of rhG-CSF, Kangfuxin Liquid, and vitamin B₁₂ can prevent radiation-induced oral mucosal injury and promote mucosal healing. This regimen represents an effective strategy for the prevention and treatment of acute RTOM.

OBJECTIVE To explore the regulatory effects of Buqi tongqiao formula on intestinal flora and immune balance in immunoglobulin A nephropathy （IgAN） rats based on the theory of “treating different diseases with the same therapy”. METHODS Male SD rats were randomly assigned to the Normal group and the modeling group. IgAN rat models were established in the modeling group by intragastric administration of bovine serum albumin， subcutaneous injection of carbon tetrachloride and castor oil mixture， and tail vein injection of lipopolysaccharide. Successfully modeled rats were then randomly divided into the model group （Model group）， Buqi tongqiao formula low-dose group （BQTQ-L group）， Buqi tongqiao formula high-dose group （BQTQ- H group）， and positive control group （BZP group）， with 15 rats in each group. BZP group received intragastric administration of benazepril hydrochloride （10 mg/kg）， while BQTQ-L and BQTQ-H groups were given Buqi tongqiao formula at doses of 9.81 and 19.62 g/kg （calculated as raw herb weight）， respectively. The Normal group and the Model group received an equal volume of normal saline intragastrically， once a day， for 8 consecutive weeks. The 24-hour urinary total protein （24 h UTP） contents were measured at weeks 8， 10， 12， 14 and 16 of the experiment. After the last administration， serum creatinine （Scr） and blood urea nitrogen （BUN） contents were detected. Renal histopathological changes and glomerular IgA immune complex deposition were examined. Additionally， alterations in gut microbiota composition， the proportions of peripheral T helper cell 17 （Th17） and regulatory T cell （Treg）， as well as the ratio of Th17 and Treg （Th17/Treg）， were analyzed across all groups. RESULTS Compared with the Model group， rats in both BQTQ-L and BQTQ-H groups showed alleviated mesangial cell hyperplasia， reduced matrix expansion， and decreased IgA immune complex deposition in the glomeruli. The 24 h UTP contents （at weeks 14 and 16 in the BQTQ-L group； at weeks 12， 14 and 16 in the BQTQ-H group）， Scr and BUN contents， IgA-positive area fluorescence intensities， relative abundances of Firmicutes， Th17 cell proportions， and Th17/Treg were significantly decreased in both BQTQ-L and BQTQ-H groups （P＜0.05）； while the Chao1， Observed species， Shannon， and Simpson （except for BQTQ-H group） indexes， the relative abundances of Bacteroidota， and the proportions of Treg were significantly increased （P＜0.05）. Differential microbiota included c_Clostridia （BQTQ-L group vs. Model group） and g_Ruminococcus （BQTQ-H group vs. Model group）， etc. CONCLUSIONS Buqi tongqiao formula may alleviate renal injury and exert a renal protective effect in IgAN rats by modulating intestinal flora homeostasis and Th17/Treg immune balance.

Aim To investigate the dynamic changes of neuronal cells at different time points following acute cerebral ischemia-reperfusion injury by establishing a model of brain ischemia-reperfusion injury.Methods Thirty male Sprague-Dawley(SD)rats were ran-domly divided into six groups:sham group and cere-bral ischemia-reperfusion injury(IR)groups at differ-ent time points.Focal cerebral ischemia-reperfusion injury model was established using the middle cerebral artery occlusion(MCAO)technique.The Longa sco-ring method was used to assess neurobehavioral scores in rats.After successful model preparation,routine paraffin sections were made,and TUNEL staining and immunohistochemistry staining with NeuN antibody were performed to observe cell apoptosis and neuronal cell survival,respectively.Immunohistochemistry stai-ning was also performed to investigate the changes in glial fibrillary acidic protein(GFAP)as a marker for astrocytes,ionized calcium-binding adapter molecule 1(IBA-1)as a marker for microglia,and CD31 as a marker for endothelial cells at different time points.Results No significant changes were observed in neu-ronal cells of the sham group at different time points.In the cerebral ischemia-reperfusion injury groups,cell apoptosis was activated at IR3h and increased in quan-tity with morphological damage as time progressed.Ne-uN+neurons showed signs of ischemic injury after IR3h,with abnormal cell morphology.From 12 h,Ne-uN+neurons decreased in a time-dependent manner and reached their peak severity at 24 h.GFAP+astro-cytes decreased significantly after IR3h,while poorly labeled GFAP+astrocytes increased at IR 6 h and al-most disappeared in the infarcted area at 24 h and 48 h.The number of IBA-1+microglia-positive cells de-creased at IR3h,and their volume increased at IR6h.Microglial cell death was observed in the infarcted area at IR12h.CD31+endothelial cells around the infarc-ted cortex and striatum increased significantly after IR3h and persisted until 48 h.Conclusions After cerebral ischemia-reperfusion injury,the number of ap-optotic cells increases with the prolongation of time,and NeuN+neurons exhibit the most severe damage at 24 h.GFAP+astrocytes and microglial cells gradually die over time.The number of CD31+endothelial cells increases significantly around the infarcted cortex and striatum after 3 h of reperfusion and persists until 48 h.

Aim To investigate the effects of berberine(BBR)combined with 5'-n-ethylformamidoadenosine(NECA)on myocardial H9c2 and HL-1 cell damage induced by hypoxia/reoxygenation(H/R).Methods H9c2 and HL-1 cells were divided into the Control group,BBR group,NECA group,combined administra-tion group,H/R group,BBR+H/R group,NECA+H/R group,and combined administration+H/R group.CCK-8 was used to detect cell viability in each group.The TMRE kit was used to detect MMP.DCFH-DA was used to detect ROS content.The Mito SOX Red fluorescent probe was used to detect mitochondrial su-peroxide.The expressions of COX Ⅳ,Tom20,and Tim23 were detected by Western blot.The expression of COX Ⅳ and Tom20 genes was detected by qRT-PCR.Results In H9c2 cells,the cell viability and TMRE fluorescence intensity in the H/R group were significantly decreased compared with the Control group.The protein expressions of COX Ⅳ,Tom20,and Tim23,gene expressions of COX Ⅳ and Tom20,ROS,and mitochondrial superoxide contents were significant-ly increased.Compared with the H/R group,the cell viability of BBR and NECA were enhanced after ad-ministration alone.The contents of ROS and mitochon-drial superoxide were significantly decreased.In HL-1 cells,cell viability in the H/R group was significantly decreased compared with the Control group.The con-tents of ROS and mitochondrial superoxide were signifi-cantly increased.Compared with the H/R group,BBR and NECA alone and combined administration en-hanced cell viability.The contents of ROS and mito-chondrial superoxide were significantly decreased.Conclusion The administration of BBR and NECA a-lone or in combination can reduce the production of mi-tochondrial superoxide and cell ROS,thereby allevia-ting mitochondrial damage,alleviating oxidative stress damage,and ultimately reducing H/R-induced myocar-dial cell damage.

Objective:To understand the real experience and needs of early exercise rehabilitation in elderly patients with total hip arthroplasty (THA), so as to provide a preliminary basis for intervention research to meet the needs of patients.Methods:Using the purposive sampling method, a total of 12 elderly patients with THA from the First Affiliated Hospital of Naval Medical University from June to September 2021 were selected as the research objects for semi-structured in-depth interviews. Colaizzi 7-step method was used to analyze, summarize and extract the data.Results:The early exercise rehabilitation experience and needs of elderly THA patients could be summarized into four themes such as postoperative exercise being a difficult journey, the need for professional support, the need for external support and internally driven needs and 14 sub themes.Conclusions:There are various problems and needs for early exercise rehabilitation in elderly patients undergoing THA. It is necessary to strengthen communication among doctors, nurses and patients, understand their true feelings and provide personalized care and rehabilitation guidance to improve their treatment experience and enhance their satisfaction.

This study was aimed at summarizing the epidemiological characteristics and spatial-temporal changes of hemorrhagic fever with renal syndrome(HFRS)in Hubei Province,China from 2005 to 2021,to provide scientific evi-dence for HFRS prevention and control.Data on individual HFRS cases and population information in Hubei Province from 2005 to 2021 were collected from the China Disease Pre-vention and Control Information System.The temporal,spa-tial,and demographic distribution characteristics of HFRS cases are described,and statistical methods such as medians,rates,and composition ratios were used for analysis.Joinpoint re-gression and Spearman's rank correlation were used to analyze the temporal trends in incidence rates or composition ratios.Global autocorrelation and hotspot analysis were conducted for spatial clustering analysis.Binary logistic regression was per-formed to analyze risk factors for HFRS mortality.A total of 5 790 HFRS cases were reported from 2005 to 2021,including 117 deaths.The average annual incidence rate was 0.57 per 100 000 population,and the case fatality rate was 2.02％.The overall incidence rate of HFRS in Hubei Province showed an increasing trend(AAPC=4.05％,95％CI:1.32％-6.78％),whereas the case fatality rate showed a decreasing trend over the years(r,=-0.72,P=0.002).HFRS exhibited a bimodal pattern,with peaks in the spring/summer months(May to July)and in the autumn/winter months(November to January of the following year).The incidence rate during the autumn/winter peak was slightly higher than that in the spring/summer peak.The incidence rate in males was higher than in females(RR=2.96,95％CI:2.79-3.14).The three age groups with the highest incidence rates were 60-64 years(747 cases,1.55 per 100 000),65-69 years(515 cases,1.39 per 100 000),and 55-59 years(762 cases,1.23 per 100 000).The incidence rate(2005:0.05 per 100 000;2021:0.08 per 100 000)and proportion(2005:2.69％;2021:1.94％)of HFRS cases in individuals 14 years or younger showed no significant trend over the years(AAPC=0.14％,95％CI:-0.03％-0.31％;AAPC=-3.64％,95％CI:-8.79％-1.50％).The incidence rate(2005:0.58 per 100 000;2021:1.59 per 100 000)and proportion(2005:14.80％;2021:44.31％)in the age group of 60 years or a-bove showed an increasing trend over the years(AAPC=10.52％,95％CI:4.38％-16.66％;AAPC=175.98％,95％CI:143.20％-208.75％).HFRS cases exhibited significant spatial clustering(P＜0.05).The hotspots of HFRS in Hubei Province shifted from the northern region(Xiangyang,Suizhou,Jingmen)in 2005-2007 to the southern region(Qianjiang,Xiantao,Tianmen,Jingzhou)in 2020-2021.Older age(OR=1.02,95％CI:1.01-1.04)and the period of 2005-2008 versus 2017-2021(OR=0.98,95％CI:0.97-0.99)were associated with relatively higher risk of HFRS mortality.In recent years,the HFRS epidemic in Hubei Province has continued to escalate,and areas such as Qianjiang City and other ares in the middle and lower reaches of the Yangtze River have experienced high incidence rates.The population 60 years of age or above is gradually becoming more susceptible to the disease.Targeted measures should be implemented to curb the rising trend of HFRS.

Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

Chronic graft-versus-host disease(cGVHD)is one of a major complication that affecting the long-term survival and living quality of patients after allogeneic hematopoietic stem cell transplantation,with the incidence of 30％-70％.Unlike acute GVHD,cGVHD involves a large number of immune cells and cytokines in addition to T cell,which is activated abnormally by the donor,and cytokine storms,which characterized by infiltration of donor lymphocytes and damage to host target organ.Recent studies have further made progress in targeting related immune cells and cytokines.In this review,the pathogenesis and therapeutic prospects of cGVHD were summarized from the perspectives of classical innate and adaptive immunity.