Objective:To investigate the association between photodynamic diagnosis(PDD)and treatment efficacy of 5-aminolevu-linic acid(ALA)photodynamic therapy(PDT)in patients with cutaneous squamous cell carcinoma in situ(cSCCis).Methods:A pro-spective cohort study was conducted among the patients with cSCCis who underwent ALA-PDT in Department of Dermatology,Huashan Hospital,Fudan University,from January 2020 to November 2024.All patients were diagnosed with cSCCis based on biopsy,and invasive squamous cell carcinoma was excluded.Clinical information was collected and PDD was performed before treatment,and the patients were divided into moderate fluorescence group and strong fluorescence groups based on fluorescence intensity.All patients received six sessions of PDT treatment at an interval of 1-2 weeks.The primary endpoint was the initial complete clearance rate at 3 months after the last treatment session,and secondary endpoints were the sustained complete clearance rate at 12 months after the last treatment session and treatment failure rate.The multivariate regression analysis,the survival curves,and the Cox regression analysis were used to investigate the association between PDD fluorescence intensity and treatment efficacy,as well as other influencing factors for treatment efficacy.Results:Compared with the strong fluorescence group,the moderate fluorescence group had significantly lower initial complete clearance rate[57.14%(8/14)vs.93.33%(28/30),odds ratio OR=0.100,P=0.010]and sustained complete clearance rate[42.86%(6/14)vs.76.67%(23/30),OR=0.230,P=0.030)].The multivariate regression analysis showed that moderate fluores-cence was an independent risk factor for initial complete clearance(OR=0.030,P=0.030).The moderate fluorescence group had a significantly higher treatment failure rate than the strong fluorescence group[57.14%(8/14)vs.23.33%(7/30),P=0.030].The survival analysis and the Cox regression analysis showed that moderate fluo-rescence was an independent risk factor for PDT treatment failure(hazard ratio=3.040,P=0.048).There were no significant differences in adverse reactions between the two groups.Conclusion:PDD fluorescence intensity can predict the efficacy of ALA-PDT in patients with cSCCis.Moderate fluorescence indicates a higher risk of treatment failure,which can help to guide clinicians in develop-ing individualized treatment strategies.

Objective:To investigate the clinical efficacy of the upper eyelid orbicularis oculi muscle bicuspid flap in the correction of excessive width deformities following incisional double eyelid blepharoplasty.Methods:A retrospective analysis was conducted on 30 female patients with excessive width deformities after incisional double eyelid surgery, treated at Sichuan Provincial People′s Hospital between June 2022 and June 2023. The patients′ ages ranged from 30 to 55 (43.1±6.9) years. All patients underwent primary correction using the upper eyelid orbicularis oculi muscle bicuspid flap technique. Preoperative incision lines were designed, and intraoperatively, previous adhesions were thoroughly released. Residual orbicularis oculi muscle was identified superficial to the orbital septum, and both superficial and deep surfaces of the muscle were dissected. The transitional zone between the orbicularis oculi and frontalis muscle was transversely transected deep to the orbital rim, while preserving the medial and lateral attachments of the orbicularis oculi to create a double-pedicle flap. After flap creation, it was repositioned inferiorly to the anterior surface of the tarsal plate along the incision line. This maneuver prevented direct adhesion between the skin and the levator palpebrae superioris muscle and established a tissue step-off, thereby forming a new, natural double eyelid fold. Outcomes were evaluated at 6 months postoperatively, including double eyelid width, fold morphology, scar appearance, complications, and patient satisfaction.Results:The postoperative double eyelid width was (1.9±0.4) mm, significantly reduced from the preoperative width of (5.7±0.9) mm ( P<0.001). The postoperative morphological score was (-0.1±0.6), significantly improved compared to the preoperative score of (-2.4±0.9) ( P<0.001). There was no statistically significant difference in scar scores before (1.7±1.3) and after (1.6±0.8) surgery ( P=0.459). Overall patient satisfaction was 90% (27/30). No major complications such as infection, upper eyelid hollowing, multiple folds, obvious scarring, significant hematoma, persistent bleeding, or lagophthalmos occurred; all patients achieved primary healing. Three patients exhibited mild bilateral asymmetry, and two reported a foreign body sensation in the eye. Conclusions:The upper eyelid orbicularis oculi muscle bicuspid flap is an effective technique for correcting excessive width deformities following incisional double eyelid surgery. It results in reduced eyelid width, natural fold formation, minimal complications, and high patient satisfaction.

Diabetic nephropathy （DN） is a serious chronic microvascular complication of diabetes mellitus （DM） and a major cause of end-stage renal disease （ESRD）. It is characterized by gradual and progressive decline of renal function， which eventually leads to glomerular sclerosis， interstitial fibrosis and other serious lesions. Although modern medical treatment can partially relieve the symptoms， there are limitations such as single therapeutic effect， low long-term therapeutic effect， and severe side effects. Traditional Chinese medicine （TCM）， with a wide effect range， lasting efficacy， and high safety， often exerts unique therapeutic effect in the clinical treatment of DN. Nuclear factor E₂-related factor 2 （Nrf2）， an anti-oxidative stress transcription factor， has received much attention. It can regulate multiple upstream and downstream factors such as heme oxygenase-1 （HO-1）， NAD（P）H： quinone oxidoreductase 1 （NQO1）， nuclear factor-κB （NF-κB）， NOD-like receptor thermal protein domain-associated protein 3 （NLRP3） inflammasome， glutathione peroxidase 4（GPX4）， and p62， playing a role in cell protection by intervening in different mechanisms. A large number of studies have found that TCM active ingredients and compound prescriptions can inhibit oxidative stress， inflammation， pyroptosis， apoptosis， and ferroptosis or promote autophagy by regulating the signaling pathway composed of Nrf2 and the above-mentioned related factors， thus protecting the kidney function， reducing proteinuria， alleviating kidney fibrosis， and significantly ameliorating DN. This review briefly summarized the structure and function of Nrf2， clarified the regulation mechanism of Nrf2 in DN， focused on the main studies on the intervention of DN by the effective components and compound formulas of TCM through the targeted activation of the Nrf2 signaling pathway in the past five years， and discussed the huge potential of Nrf2 signaling pathway as a target for the treatment of DN. The aim is to provide reference for the development and promotion of new drugs in clinical practice and promote the innovation and development of the treatment methods for DN in the future.

Objective:To investigate the clinical efficacy of the upper eyelid orbicularis oculi muscle bicuspid flap in the correction of excessive width deformities following incisional double eyelid blepharoplasty.Methods:A retrospective analysis was conducted on 30 female patients with excessive width deformities after incisional double eyelid surgery, treated at Sichuan Provincial People′s Hospital between June 2022 and June 2023. The patients′ ages ranged from 30 to 55 (43.1±6.9) years. All patients underwent primary correction using the upper eyelid orbicularis oculi muscle bicuspid flap technique. Preoperative incision lines were designed, and intraoperatively, previous adhesions were thoroughly released. Residual orbicularis oculi muscle was identified superficial to the orbital septum, and both superficial and deep surfaces of the muscle were dissected. The transitional zone between the orbicularis oculi and frontalis muscle was transversely transected deep to the orbital rim, while preserving the medial and lateral attachments of the orbicularis oculi to create a double-pedicle flap. After flap creation, it was repositioned inferiorly to the anterior surface of the tarsal plate along the incision line. This maneuver prevented direct adhesion between the skin and the levator palpebrae superioris muscle and established a tissue step-off, thereby forming a new, natural double eyelid fold. Outcomes were evaluated at 6 months postoperatively, including double eyelid width, fold morphology, scar appearance, complications, and patient satisfaction.Results:The postoperative double eyelid width was (1.9±0.4) mm, significantly reduced from the preoperative width of (5.7±0.9) mm ( P<0.001). The postoperative morphological score was (-0.1±0.6), significantly improved compared to the preoperative score of (-2.4±0.9) ( P<0.001). There was no statistically significant difference in scar scores before (1.7±1.3) and after (1.6±0.8) surgery ( P=0.459). Overall patient satisfaction was 90% (27/30). No major complications such as infection, upper eyelid hollowing, multiple folds, obvious scarring, significant hematoma, persistent bleeding, or lagophthalmos occurred; all patients achieved primary healing. Three patients exhibited mild bilateral asymmetry, and two reported a foreign body sensation in the eye. Conclusions:The upper eyelid orbicularis oculi muscle bicuspid flap is an effective technique for correcting excessive width deformities following incisional double eyelid surgery. It results in reduced eyelid width, natural fold formation, minimal complications, and high patient satisfaction.

Nonalcoholic fatty liver disease （NAFLD） is one of the most common complications of type 2 diabetes mellitus （T2DM）. Cell death caused by iron-lipid disorder is a new mode of regulating programmed cell death， which is characterized by lipid peroxidation induced by the accumulation of lipid reactive oxygen species and excessive accumulation of iron ions induced by iron metabolism disorders. Among them， iron homeostasis disorder and metabolic pathway disorder are the main causes of iron-lipid disorder， which play an important role in a variety of pathological processes related to cell death. Because the liver is an important organ for iron storage and lipid metabolism， iron-lipid disorder is an ideal target for liver disease， and inhibition of iron-lipid disorder may become a new strategy for the treatment of NAFLD. However， the pathogenic relationship and mechanism between NAFLD and iron-lipid disorder have not been fully elucidated. Based on the complex molecular regulation mechanism of iron-lipid disorder， by expounding the role of iron-lipid disorder in NAFLD and its related mechanism， this paper summarizes the research status of traditional Chinese medicine on the target treatment of NAFLD in recent years， so as to provide a new perspective and point out a new direction for the treatment of NAFLD in the future.

Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia caused by absolute or relative insufficiency of insulin secretion. As the disease progresses， patients begin to suffer from diabetic nephropathy， diabetic cardiomyopathy， non-alcoholic fatty liver disease or other complications， which increase the burden on the patients. Moreover， the number of patients is increasing， which brings a heavy burden to the society. Ferroptosis is a new type of programmed cell death which has attracted wide attention in recent years. It refers to the cell death caused by the excessive accumulation of lipid peroxide under the overload of iron ions. Studies have discovered that ferroptosis exists in diabetes mellitus and its complications. Inhibiting ferroptosis can greatly slow down the occurrence and progression of diabetes mellitus and its complications. Chinese medicine， the unique medical treasure in China， acts in a multi-pathway， multi-target manner and is praised for the cheap price， low toxicity， and mild side effects. It has been widely used in the treatment of diabetes mellitus and its complications and has demonstrated definite therapeutic effects， bringing the good news for the majority of patients. The regulation of ferroptosis by Chinese medicine may be a new direction for the treatment of diabetes mellitus and its complications in the future. This paper briefly describes the mechanism of ferroptosis， explores the relationship of ferroptosis with diabetes mellitus and its complications， summarizes the research status of Chinese medicine interventions， and puts forward suggestions， aiming to provide a reference for further research on the treatment of diabetes mellitus and its complications with Chinese medicine.

Diagnostic criteria, as a critical component of clinical practice guidelines, play a direct role in guiding clinicians' diagnostic and treatment decisions. Although China has increasingly emphasized the development and updating of clinical guidelines in recent years, research focusing on the diagnostic criteria within these guidelines remains limited. This paper aims to explore the types of diagnostic criteria, the issues they present, and the processes involved in their formulation. Based on this analysis, suggestions are proposed to improve the recommendation and application of diagnostic criteria in Chinese guidelines.

Diagnostic criteria, as a critical component of clinical practice guidelines, play a direct role in guiding clinicians' diagnostic and treatment decisions. Although China has increasingly emphasized the development and updating of clinical guidelines in recent years, research focusing on the diagnostic criteria within these guidelines remains limited. This paper aims to explore the types of diagnostic criteria, the issues they present, and the processes involved in their formulation. Based on this analysis, suggestions are proposed to improve the recommendation and application of diagnostic criteria in Chinese guidelines.

Background and purpose:Actinic keratosis(AK)is a precancerous condition with the potential to develop into cutaneous squamous cell carcinoma.5-Aminolevulinic acid photodynamic therapy(ALA-PDT)has emerged as a new treatment option for AK due to its high clearance rates and non-invasive cosmetic advantages.However,its efficacy in treating Olsen grade 3 AK,characterized by hyperkeratosis,remains controversial.This study aimed to investigate the efficacy and safety of ALA-PDT in treating Olsen grade 3 AK and to identify factors influencing treatment outcomes.Methods:A total of 38 patients with Olsen grade 3 AK who visited the Department of Dermatology,Huashan Hospital,Fudan University,between January 2020 and July 2023 underwent four consecutive sessions of ALA-PDT and were followed up for one year post-treatment(ethics number:2019-491).All patients met the inclusion and exclusion criteria.Treatment efficacy was assessed by the initial complete clearance(ICC)at 3 months and the sustained complete clearance(SCC)at 12 months after treatment.Baseline clinical and pathological characteristics were collected.Univariate and multivariate logistic regression analyses were performed to explore risk factors for treatment failure in Olsen grade 3 AK patients receiving ALA-PDT.Subgroup analyses were conducted to further investigate risk factors associated with treatment resistance and recurrence.This study was registered on Chinese Clinical Trial Registry(chiCTR1800019213).The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)checklist was followed for this study.Results:A total of 38 patients were included in this study,including 8 in the case group and 29 in the control group.One patient was lost to follow-up 6 months after treatment.At 3 months post-treatment,86.84%of patients achieved ICC(33/38).At the 12-month follow-up,87.88%of the patients who achieved ICC maintained SCC(29/33).No serious adverse reactions were reported during treatment and follow-up.Multivariate logistic regression analysis indicated that lesions located in multiple anatomical subunits was an independent risk factor for treatment failure(P=0.02,OR=28.43).Subgroup analysis confirmed that this factor was independently associated with treatment resistance(P=0.03,OR=97.54).Conclusion:ALA-PDT is effective and safe for treating Olsen grade 3 AK,offering a non-invasive treatment option for these patients.However,patients with lesions located in multiple anatomical subunits are more prone to treatment failure,warranting increased clinical attention in this population.