Patients with Takayasu arteritis combined with aortic valve disease often have a poor prognosis following surgical valve replacement, frequently encountering complications such as perivalvular leakage, valve detachment, and anastomotic aneurysm. This article presents a high-risk case wherein severe aortic valve insufficiency associated with Takayasu arteritis was successfully managed through transcatheter aortic valve implantation via the transapical approach. The patient had satisfactory valve function with no complications observed during the six-month postoperative follow-up. This case provides a minimally invasive and feasible alternative for the clinical management of such high-risk patients.

With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

ObjectiveTo investigate the functional role and underlying molecular mechanisms of fumarylacetoacetate hydrolase （FAH） in the progression of glioblastoma （GBM）. MethodsDifferential expression analysis was performed on the TCGA-GBM， GSE4290， and GSE116520 datasets. Weighted gene co-expression network analysis （WGCNA） was used to identify key modules， and Cox regression and risk modeling were used to screen prognostic genes. Immune infiltration analysis of prognostic genes was carried out by using single-cell RNA sequencing panels. The clinical expression signature of FAH in GBM was analyzed in the TCGA and HPA databases. The functional role of FAH was validated by in vitro and in vivo experiments， and pathway analysis was performed to explore the underlying mechanisms. ResultsA total of 152 overlapping genes were identified across the three GBM datasets （P<0.05）. WGCNA revealed that the turquoise module was most strongly associated with tumor purity， stromal score， immune score， and ESTIMATE score （P<0.001）. Compared with normal tissues， three prognostic genes （CTSD， FAH， and THBD） were upregulated in GBM and correlated with immune infiltration （P<0.05）. FAH mRNA and protein levels were elevated in GBM tissues relative to normal tissues， and its expression was significantly associated with age stratification and TP53 mutation （P<0.05）. CCK-8 assay results showed that， compared with the shNC group， the proliferative activity of GBM cells in the shFAH group was reduced （P<0.001）. Transwell migration and invasion assays demonstrated that， relative to the shNC group， the numbers of migrated and invaded cells in the shFAH group decreased （P<0.05）. Western blot analysis revealed that the protein expression levels of PI3K， p-AKT， and p-mTOR in the shFAH group decreased compared with those in the shNC group （P<0.05）. In vivo subcutaneous xenograft experiments further confirmed that tumor volume and weight significantly decreased in the shFAH group compared with the shNC group （P<0.001）. ConclusionFAH promotes GBM progression by activating the PI3K/AKT/mTOR signaling pathway and may serve as a potential therapeutic target for GBM.

Metastatic castration-resistant prostate cancer (mCRPC) implies highly heterogeneous molecular tumor behavior, rapid disease progression and poorer prognosis, seriously threatening the lives of patients.Therefore, early identification and treatment are significant.Among the current clinical treatment regimens for mCRPC, abiraterone acetate, enzalutamide and docetaxel have demonstrated improvement in overall survival (OS).Furthermore, patients carrying homologous recombination repair mutation (HRRm) are sensitive to poly ADP-ribose polymerase inhibitors (PARPi).For patients with positive prostate specific membrane antigen (PSMA), Lutetium-177 (177Lu)-PSMA-617 radiation ligand therapy is a new and effective treatment method.Radium-223 has also been used as the first-line treatment for patients with bone pain symptoms.However, due to the rapid updates in the field of mCRPC drug therapy, clinicians find it difficult to keep up with the latest developments in this area.Emerging drugs have great potential, such as immune checkpoint inhibitors (ICIs) and antibody-drug conjugates (ADCs), but more evidence is needed, and molecular markers helping predict the efficacy of these drugs should be explored.This article reviews the advances in the drug therapy of mCRPC, with the aim of providing reference for clinical practice.

Blood transfusion is an important life-support measure in modern medicine. As clinical demand for transfusion continues to rise, blood supply remains under persistent strain, making the efficient utilization of this precious medical resource a critical component of blood management. Accurate prediction of transfusion needs is of great significance for optimizing blood resource allocation and conserving blood products. Traditional transfusion decision-making relies on clinical experience and simplified scoring systems, which are insufficient to meet the demands of precision medicine. Machine learning (ML) technology can integrate multidimensional data—including demographic characteristics, laboratory indicators, surgical information, and dynamic physiological waveforms—to construct high-performance predictive models, offering a new approach to transfusion prediction. This article systematically reviews the application progress of ML in transfusion prediction across clinical scenarios such as trauma, the perioperative period, and obstetrics. In trauma, ML has been applied to early massive transfusion prediction, prehospital transfusion decision-making, and precise prediction in pediatric trauma. In the perioperative field, applications span specialties including traumatic brain injury, orthopedic surgery, cardiovascular and major vascular surgery, and hepatic surgery. In obstetrics, models can effectively predict postpartum hemorrhage and transfusion requirements associated with cesarean section. Studies have shown that algorithms such as random forest, gradient boosting machines, and deep neural networks achieve area under the receiver operating characteristic curve (AUC) values of 0.83-0.98 in massive transfusion prediction, 0.75-0.97 in perioperative scenarios, and 0.80-0.89 in obstetric transfusion prediction—significantly outperforming traditional scoring tools. However, current studies are generally limited by single-center retrospective designs, insufficient external validation, and inadequate reporting standards; limited model interpretability and challenges in clinical integration further constrain practical translation. Future research should focus on constructing multicenter data cohorts, integrating multimodal data, conducting prospective implementation studies, and deeply embedding models within electronic health record systems, thereby advancing the application of ML to optimize clinical transfusion decision-making.

Objective: To explore the effect of relative deprivation on emotional attention among college students from single parent families, so as to provide evidence for psychological crisis prevention and campus mental health services. Methods: From January to June 2023, 478 college students from North China University of Science and Technology were selected by convenience sampling method. Participants with high and low levels of relative deprivation were screened by using the extreme grouping method, and 48 valid participants were finally included. A 2 (single parent/non single parent) ×2 (high/low relative deprivation) design was adopted. One way ANOVA was conducted on four eye tracking indicators, followed by stratified analyses according to family structure. Results: Overall, participants showed attentional bias toward low valence faces, as indicated by first fixation direction ( t = 2.17) and first fixation duration proportion ( t =-4.28) (both P <0.05). Three factor repeated-measures ANOVA showed a significant interaction between family structure and picture type ( F =23.08, P <0.05). Stratified analysis showed that, in the single parent subgroup, the interaction between relative deprivation and picture type was significant ( F =13.28, P <0.01), whereas this interaction was not significant in the non single parent subgroup ( F =2.18, P >0.05). Further interaction analysis showed that relative deprivation had a partial interaction effect between singleparent background and emotional attentional bias ( β =0.14, Bootstrap 95% CI =0.11-0.47, P <0.05). Conclusions College students from single parent families may show enhanced attentional bias toward negative emotional cues through increased relative deprivation. Students with both single parent background and high relative deprivation are a high risk group.

With the rapid advancement of medical technology and the increasing complexity of clinical environments, competence in clinical ethical decision-making has become an indispensable core competency for exemplary physicians. However, traditional medical ethics education has long been confronted with the persistent challenges of theory-practice dissociation and the disconnect between pedagogical settings and clinical realities. Thus, how to construct a "Clinical Ethics" curriculum that aligns with the objectives of training high-caliber medical professionals has emerged as a critical and challenging issue in current medical education reform. To effectively address this challenge, the Office of Education at Peking University Third Hospital, since 2021, has assembled a multidisciplinary "Clinical Ethics" teaching and management team comprising faculty from Peking University School of Humanities and key clinical specialists from the hospital. In 2022, the "Clinical Ethics" elective course was formally launched for fourth-year students in the eight-year MD program who had completed coursework in "Medical Ethics" and organ-system-based curricula, with the aim of exploring and operationalizing a pre-clinical ethics education model tailored for senior medical students. The course employs a modular instructional design encompassing "theoretical review-case-based deliberation-clinical workshop", which effectively facilitates the deep integration of medical humanities with clinical practice.Following four years of iterative refinement through the "plan-act-observe-reflect" cycle, the course has demonstrated positive outcomes in enhancing students' ethical awareness and decision-making capabilities, and has preliminarily established a sustainable collaborative mechanism among the multidisciplinary faculty team. This article systematically delineates the course development background, pedagogical model and methodological innovations, and the multidisciplinary collaborative framework, alongside reflections and summaries based on implementation outcomes, with the intent of providing references for the future development of "Clinical Ethics" curricula.

AIM: To address the problem of cognitive overload and deviation from core teaching objectives caused by information redundancy in traditional case-based teaching in ophthalmology, Occam's Razor principle was innovatively applied to construct a set of streamlined case-based teaching resources, and their effectiveness was subsequently validated.METHODS:This was a prospective randomized controlled trial. Intern students from the 2019 and 2020 cohorts of the five-year clinical medicine program who completed their ophthalmology clerkship at the Department of Ophthalmology, Tangdu Hospital, Air Force Medical University between June 2023 and May 2025 were enrolled. By using a random number table, they were randomly assigned to an experimental group and a control group. Cases refined by Occam's Razor principle(removing irrelevant information and focusing on core principles, clinical reasoning, and the diagnostic and therapeutic workflow)were adopted for the experimental group, whereas the original complete cases were used for the control group. Teaching effectiveness was assessed through knowledge tests, classroom performance evaluation, teaching case assessment, and student satisfaction.RESULTS:Totally 120 students were included in this study and all of them completed the research. There were 60 students in the experimental group(43 males and 17 females, mean age 21.72±0.76 y)and 60 students in control group(41 males and 19 females, mean age 21.68±0.57 y)(all P>0.05). The score rates on the ocular trauma section and on the case analysis questions were significantly higher in the experimental group than in the control group(83.21%±7.96% vs 74.25%±11.01%; 84.31%±8.08% vs 67.62%±11.63%; both P<0.001). Teacher evaluations indicated that the experimental group achieved better scores than the control group in aspects such as identification of key case points and logical clinical reasoning(all P<0.001). A significantly lower cognitive load score was observed in the experimental group, whereas higher scores were obtained for clarity of case structure, thought-provoking quality, and teaching value(all P<0.001). The teaching satisfaction rate reached 95% in the experimental group, which was higher than the 83% observed in the control group(P<0.05).CONCLUSION: Refined cases guided by Occam's Razor principle can significantly reduce cognitive load, enhance medical students' efficiency in mastering core diagnostic and therapeutic principles, improve the precision of clinical reasoning, and strengthen execution of clinical procedures, thereby providing an innovative pathway for clinical teaching reform.

OBJECTIVE To optimize the forming process of Kaixin granules and establish its physical fingerprint.METHODS Using particle forming rate， hygroscopicity rate， dissolution rate， and angle of repose as indices， the key process parameters of the granule forming process were determined by Plackett-Burman design. The analytic hierarchy process （AHP） combined with the entropy weight method was used to comprehensively weight the indices， and the forming process of Kaixin granules was optimized and validated by Box-Behnken response surface methodology. A physical fingerprint of Kaixin granules was established based on the following physical indices： angle of repose， Hausner ratio， bulk density， tapped density， moisture content， hygroscopicity ratio， and relative uniformity index， with similarity evaluation was performed. Cluster analysis and partial least squares discriminant analysis （PLS-DA） were performed using SPSS 20.0 and the SPSSPRO online analysis platform， respectively.RESULTS The key process parameters were ethanol volume fraction， ethanol amount， and the drug-excipient ratio. The optimal forming conditions were as follows： ethanol volume fraction of 87%， ethanol amount of 27%， and a drug-excipient ratio of 1∶1. Validation showed that the average comprehensive scores of three batches were 97.82， with an RSD of 0.19%. The similarity of the physical fingerprints of ten batches of Kaixin granules prepared under the optimal forming process were greater than 0.98. The results of cluster analysis showed that the ten batches were divided into two groups： S4， S5， S7， S8 and S10 in one cluster， and S1-S3， S6 and S9 in another. The variable importance in projection values of Hausner ratio， relative uniformity index， bulk density， and moisture content were greater than 1.CONCLUSIONS The optimized forming process is stable and feasible. The established physical fingerprint can effectively characterize the overall physical properties of Kaixin granules. Hausner ratio， relative uniformity index， bulk density， and moisture content are the key physical indices.

To introduce the general thinking, guidelines, work objectives and elaboration process of the general technical requirements adopted by volume Ⅳ of the Chinese Pharmacopoeia 2025 Edition, and to summarize and figure out the main characteristics on dosage forms, physico-chemical testing, microbial and biological testing, reference standards and guidelines The newly revised general chapters of pharmacopoeia give full play to the normative and guiding role of the Chinese Pharmacopoeia standard, track the frontier dynamics of international drug regulatory science and the elaboration of monographs, expand the application of state-of-the-art technologies, and steadily promote the harmonization and unification with the ICH guidelines； further enhance the overall capacity of TCM quality control, actively implement the 3 R principles on animal experiments, and practice the concept of environmental-friendly； replace and/or reduce the use of toxic and hazardous reagents, strengthen the requirements of drug safety control This paper aims to provide a full-view perspective for the comprehensive, correct understanding and accurate implementation of general technical requirements included in the Chinese Pharmacopoeia 2025 Edition.