Acute-on-chronic liver failure （ACLF） is a syndrome of acute liver function decompensation in patients with chronic liver disease and is characterized by a high short-term mortality rate. Liver transplantation is an effective radical treatment method for ACLF and can significantly improve the survival rate of patients. However， in the context of a shortage of donor organs globally， how to achieve a balance between saving lives and avoiding futile transplantation while optimizing organ utilization is a critical challenge in clinical decision-making. This article systematically reviews the evolution of the evaluation and decision-making system for liver transplantation in ACLF patients and points out s that the core of this system has shifted from relying solely on the MELD score to a model based on multidimensional prognostic assessment， dynamic evaluation， and multidisciplinary collaboration. In the future， the integration of Eastern and Western criteria， the application of artificial intelligence for precise prediction， and the establishment of a more equitable priority and allocation system will be the key directions for development in this field.

Objective To establish a risk prediction model for cerebral edema after mechanical thrombectomy in acute cerebral infarction (ACI) based on multimodal computed tomography (CT) parameters. Methods A total of 220 ACI patients who underwent mechanical thrombectomy at The People’s Hospital of Bozhou between January 2022 and June 2025 were enrolled. All patients underwent preoperative conventional non-contrast CT, CT perfusion imaging, and multiphase CT angiography. Based on the presence or absence of cerebral edema at 72 hours postoperatively, patients were divided into cerebral edema and non-cerebral edema groups. General data and multimodal CT parameters were compared between the two groups. Multivariable logistic regression model was used to analyze the influencing factors of postoperative cerebral edema. A nomogram prediction model was constructed based on the multivariable analysis results, and the efficacy of the model was validated. Results The incidence of postoperative cerebral edema was 23.64% (52/220). Multivariable logistic regression analysis showed that time from onset to recanalization (OR=1.081, 95%CI=1.017-1.149), cerebral blood flow (OR=0.903, 95%CI=0.828-0.984), time to peak (OR=1.171, 95%CI=1.041-1.317), mean transit time (OR=2.815, 95%CI=1.823-6.178), and collateral circulation score (OR=0.960, 95%CI=0.930-0.990) were influencing factors for cerebral edema after mechanical thrombectomy in ACI patients (P<0.05). A nomogram model was constructed based on these factors. The calibration curve indicated good model fit, and the decision curve demonstrated net benefit. The area under the receiver operating characteristic curve for predicting cerebral edema after mechanical thrombectomy in patients with ACI was 0.961, with a sensitivity of 88.46% and a specificity of 91.07%. The Hosmer–Lemeshow goodness-of-fit test showed good model fit (χ²=1.766, P=0.962). Conclusion A risk prediction model for cerebral edema after mechanical thrombectomy in ACI patients was constructed using multimodal CT parameters. The model demonstrated high sensitivity and specificity.

Objective To establish a risk prediction model for cerebral edema after mechanical thrombectomy in acute cerebral infarction (ACI) based on multimodal computed tomography (CT) parameters. Methods A total of 220 ACI patients who underwent mechanical thrombectomy at The People’s Hospital of Bozhou between January 2022 and June 2025 were enrolled. All patients underwent preoperative conventional non-contrast CT, CT perfusion imaging, and multiphase CT angiography. Based on the presence or absence of cerebral edema at 72 hours postoperatively, patients were divided into cerebral edema and non-cerebral edema groups. General data and multimodal CT parameters were compared between the two groups. Multivariable logistic regression model was used to analyze the influencing factors of postoperative cerebral edema. A nomogram prediction model was constructed based on the multivariable analysis results, and the efficacy of the model was validated. Results The incidence of postoperative cerebral edema was 23.64% (52/220). Multivariable logistic regression analysis showed that time from onset to recanalization (OR=1.081, 95%CI=1.017-1.149), cerebral blood flow (OR=0.903, 95%CI=0.828-0.984), time to peak (OR=1.171, 95%CI=1.041-1.317), mean transit time (OR=2.815, 95%CI=1.823-6.178), and collateral circulation score (OR=0.960, 95%CI=0.930-0.990) were influencing factors for cerebral edema after mechanical thrombectomy in ACI patients (P<0.05). A nomogram model was constructed based on these factors. The calibration curve indicated good model fit, and the decision curve demonstrated net benefit. The area under the receiver operating characteristic curve for predicting cerebral edema after mechanical thrombectomy in patients with ACI was 0.961, with a sensitivity of 88.46% and a specificity of 91.07%. The Hosmer–Lemeshow goodness-of-fit test showed good model fit (χ²=1.766, P=0.962). Conclusion A risk prediction model for cerebral edema after mechanical thrombectomy in ACI patients was constructed using multimodal CT parameters. The model demonstrated high sensitivity and specificity.

Objective To establish a risk prediction model for cerebral edema after mechanical thrombectomy in acute cerebral infarction (ACI) based on multimodal computed tomography (CT) parameters. Methods A total of 220 ACI patients who underwent mechanical thrombectomy at The People’s Hospital of Bozhou between January 2022 and June 2025 were enrolled. All patients underwent preoperative conventional non-contrast CT, CT perfusion imaging, and multiphase CT angiography. Based on the presence or absence of cerebral edema at 72 hours postoperatively, patients were divided into cerebral edema and non-cerebral edema groups. General data and multimodal CT parameters were compared between the two groups. Multivariable logistic regression model was used to analyze the influencing factors of postoperative cerebral edema. A nomogram prediction model was constructed based on the multivariable analysis results, and the efficacy of the model was validated. Results The incidence of postoperative cerebral edema was 23.64% (52/220). Multivariable logistic regression analysis showed that time from onset to recanalization (OR=1.081, 95%CI=1.017-1.149), cerebral blood flow (OR=0.903, 95%CI=0.828-0.984), time to peak (OR=1.171, 95%CI=1.041-1.317), mean transit time (OR=2.815, 95%CI=1.823-6.178), and collateral circulation score (OR=0.960, 95%CI=0.930-0.990) were influencing factors for cerebral edema after mechanical thrombectomy in ACI patients (P<0.05). A nomogram model was constructed based on these factors. The calibration curve indicated good model fit, and the decision curve demonstrated net benefit. The area under the receiver operating characteristic curve for predicting cerebral edema after mechanical thrombectomy in patients with ACI was 0.961, with a sensitivity of 88.46% and a specificity of 91.07%. The Hosmer–Lemeshow goodness-of-fit test showed good model fit (χ²=1.766, P=0.962). Conclusion A risk prediction model for cerebral edema after mechanical thrombectomy in ACI patients was constructed using multimodal CT parameters. The model demonstrated high sensitivity and specificity.

In 2025,Severe Liver Disease and Artificial Liver Group and Nutrition and Regeneration in End-Stage Liver Disease Group of Chinese Society of Hepatology,Chinese Medical Association,convened a panel of national experts to jointly develop China's first guideline for the diagnosis and treatment of acute-on-chronic liver failure(ACLF).Based on the latest research findings and clinical practice in China and globally,this guideline establishes a standardized definition of ACLF and provide recommendations for its diagnosis,treatment,and clinical management.This article gives an interpretation of the key points in the guideline,in order to provide a reference for standardized diagnosis and treatment of ACLF.

OBJECTIVE: To explore the clinical and genetic characteristics of a child with intellectual development disorder and seizures due to a variant of AP2M1 gene. METHODS: Clinical data of a child with intellectual development disorder and epilepsy who was admitted to the Department of Pediatric Neurology of the Third Affiliated Hospital of Zhengzhou University in January 2021 were retrospectively analyzed. Peripheral blood samples of the child and his parents were collected for whole exome sequencing. Candidate variant was verified by Sanger sequencing and pathogenicity analysis. The three-dimensional structure of the AP2M1 protein was visualized using Chimera v1.10.1 software. Pathogenicity of candidate variant was classified according to the Standards and Guidelines for the Interpretation of Sequence Variants from the American College of Medical Genetics and Genomics American College of Medical Genetics (ACMG). With "AP2M1 gene" "epilepsy" "intellectual disability" as the keywords, relevant cases were searched from CNKI, Wanfang Data knowledge service platform and PubMed databases with the search time spanning from the establishment of the database to September 2024. This study was approved by the Medical Ethics Committee of the Third Affiliated Hospital of Zhengzhou University (Ethics No.: 2020-57). RESULTS: The child was a 8-years-and-6-months-old boy, who could raise his head at 3 months and sit alone at 8 months old. He could not walk alone at 1 year old and underwent 2 months' rehabilitation treatment, and could walk alone and call his parents at 1-and-a-half-years-old. At 4-years-and-10-months-old, he started to have frequent seizures, manifesting as low level of consciousness, body shaking, accompanied by blinking, lasting about a few seconds several times a day and could be relieved. With the treatment of sodium valproate combined with lamotrigine, the convulsions were controlled, but his movement and cognition were lagged behind. DNA sequencing revealed that he has harbored a novel variant of the AP2M1 gene (NM_004068.3) c.508C>T (p.Arg170Trp). Sanger sequencing confirmed that both of his parents were of the wild-type. According to the guidelines from the American College for Medical Genetics and Genomics (ACMG), the variant was rated as pathogenic (PS2+PS4+PM1+PM2+PP2+PP3). The difference between the wild-type and mutant AP2M1 proteins can be clearly viewed through its three-dimensional structure. Two previous reports have included 5 cases due to the same variant. Common manifestations have included seizures (100%, 5/5), motor retardation (100%, 5/5), intellectual impairment (100%, 5/5), autism spectrum disorder (60%, 3/5), ataxia (100%, 5/5), and special facial features (20%, 1/5). CONCLUSION The c.508C>T (p.Arg170Trp) variant of the AP2M1 gene may underlie the intellectual retardation and seizure in this child.
Humans ; Male ; Child ; Intellectual Disability/genetics* ; Seizures/genetics* ; Exome Sequencing ; Mutation

In 2025， Severe Liver Disease and Artificial Liver Group and Nutrition and Regeneration in End-Stage Liver Disease Group of Chinese Society of Hepatology， Chinese Medical Association， convened a panel of national experts to jointly develop China’s first guideline for the diagnosis and treatment of acute-on-chronic liver failure （ACLF）. Based on the latest research findings and clinical practice in China and globally， this guideline establishes a standardized definition of ACLF and provide recommendations for its diagnosis， treatment， and clinical management. This article gives an interpretation of the key points in the guideline， in order to provide a reference for standardized diagnosis and treatment of ACLF.

Lung cancer （LC） is a significant global public health issue， with both its incidence and mortality rates ranking among the highest worldwide. The age-standardized incidence and mortality rates are increasing annually， posing a serious threat to the life and health of LC patients. Radical surgical resection is the primary treatment for malignant lung tumors. However， postoperative multidimensional functional impairments， including respiratory， mucosal， and psychological functions， are common. These impairments not only reduce patients' quality of life and affect their treatment tolerance and duration， but also negatively correlate with prognosis， facilitating disease recurrence and metastasis. At present， postoperative functional dysfunction after LC surgery remains a key clinical challenge that urgently needs to be addressed. There is a lack of standardized and regulated postoperative rehabilitation treatment management and traditional Chinese medicine （TCM） differentiation and treatment strategies for LC. Focusing on the core underlying pathogenesis of "Qi sinking" after LC surgery， and guided by the classical TCM theory of "lungs governing Qi"， this study， based on the core concept of the "five perspectives on treatment" theory， innovatively proposes the respiratory dysfunction as the core pathogenesis of "Qi sinking in the chest" during the rapid rehabilitation phase， mucosal dysfunction as the core pathogenesis of "Yin deficiency and Qi sinking" during the postoperative adjuvant treatment phase， and the psychological dysfunction as the core pathogenesis of "Qi sinking with emotional constraint" during the consolidation phase. Accordingly， stage-specific dynamic functional protection strategies are constructed. In the rapid rehabilitation phase， the strategy emphasizes tonifying Qi and uplifting sinking Qi， with differentiation and treatment based on the principle of ''descending before ascending''. In the adjuvant treatment phase， the approach focuses on nourishing Yin and uplifting Qi， with prescription combinations that integrate unblocking and tonification. In the consolidation phase， the strategy aims to resolve constraint and uplift Qi， with clinical treatment emphasizing a combination of dynamic and static methods. At each stage of functional rehabilitation， clinical differentiation and treatment should support healthy Qi and eliminate pathogenic factors simultaneously. This study is the first to propose the concept of postoperative functional protection in TCM， offering a new approach for TCM differentiation and treatment in the full-cycle， stage-based， and dynamic protection of postoperative function in LC patients. It is expected to contribute to the construction and development of an integrated TCM-Western medicine comprehensive program for cancer prevention and treatment in China.

Tumor treatment-related adverse reactions are a major focus of clinical concern， among which recurrent aphthous oral ulcers （RAU） associated with targeted therapy for lung cancer （LC） are among the most painful and distressing for patients. Currently， modern medical interventions show limited efficacy， and there is an urgent need for more effective treatment strategies. This study differentiates RAU associated with targeted therapy for LC from chemotherapy-related and ordinary oral ulcers， elucidates the pathophysiological basis of such ulcers， and traces the theoretical origin of "Yin deficiency and Qi collapse". Based on the new system of "five perspectives on diagnosis and treatment" for tumor prevention and treatment， with a focus on the core and symptom perspectives and rooted in the traditional concept of "lung dominating Qi"， we innovatively propose the concept of "medicine-induced ulcer" and are the first to introduce the theory of "Yin deficiency and Qi collapse" into the syndrome differentiation and treatment of RAU associated with targeted therapy for LC （i.e.， medicine-induced ulcer）. We propose that "Yin deficiency and Qi collapse" is the core pathogenesis of medicine-induced ulcers， in which the collapse of formless Qi is the key to their onset， while the deficiency and stasis of tangible Yin and blood constitute the root of recurrence. A hierarchical strategy for syndrome differentiation and treatment is established： first treating the collapse of formless Qi， then replenishing tangible deficiencies， and concurrently preventing recurrence. We emphasize that treatment should address both root and manifestation， with appropriate prioritization. In the acute phase， while relieving symptoms and promoting ulcer healing by nourishing Qi， uplifting collapse， and generating body fluids， attention should also be paid to nourishing spleen Yin， facilitating the circulation of nutritive Qi， and alleviating stasis to target the root pathogenesis and reduce recurrence. A verified case is presented to support this approach. This study enriches the theoretical framework and clinical methods of traditional Chinese medicine （TCM） in the treatment of RAU associated with targeted therapy for LC， promotes symptom management of treatment-related adverse reactions through integrated TCM and Western medicine， and provides theoretical support for the construction and development of a comprehensive differentiation and treatment system for lung cancer prevention， treatment， and rehabilitation.