To systematically analyzed the reporting status of core elements in publicly available clinical practice guideline(hereafter referred to as "guideline") protocols published domestically and internationally over the past decade, identified existing problems, and provided evidence to inform the standardized writing and publication of future guideline protocols.

ObjectiveA mouse model of vaccinia virus Tiantan strain (VTT)-induced encephalopathy was developed using AG6 mice. MethodsVTT was amplified by infecting Vero cells at a multiplicity of infection (MOI) of 0.01, followed by concentration and titration. After 72 h of incubation, virus-containing cells were collected and subjected to concentration. The concentrated viral suspension was serially diluted (10-fold dilutions) and added to 6-well plates containing confluent Vero cell monolayers for plaque assay. The number of plaques formed in each well was counted, and the virus titer was calculated based on the dilution factor. Fourteen 5-6-week-old AG6 mice (half male and half female, housed separately by sex) were randomly divided into a control group (n=3, PBS), a low-dose group (n=6, 1×10⁵ PFU), and a high-dose group (n=5, 5×10⁵ PFU). The mice were anesthetized by isoflurane inhalation and then infected via intranasal instillation. The mental state of the mice in each group was observed daily, and the body weight and mortality were recorded. On day 13 post-infection, 2% Evans Blue (4 mL/kg body weight) was administered via tail vein injection to assess blood-brain barrier (BBB) disruption. Subsequently, brain tissue samples were collected for immunofluorescence analysis to evaluate the activation of astrocytes and microglia. ResultsThe titer of purified VTT was 1×10⁷ PFU/mL. Compared with the control group, mice in the low-dose group showed no significant change in body weight, and no lethality was observed. In contrast, mice in the high-dose group exhibited significant weight loss starting on day 5 post-infection (P<0.05), accompanied by lethality. On day 13 post-infection, no Evans Blue extravasation was detected in the brain tissues of the low-dose group, while the olfactory bulb region of the high-dose group displayed distinct blue staining, indicating disruption of the BBB. Immunofluorescence analysis revealed no significant proliferation of astrocytes and microglia in the olfactory bulb region of the low-dose group on day 13 post-infection. In contrast, marked activation of glial cells was observable in the high-dose group. ConclusionAn animal model of VTT-induced encephalopathy in AG6 mice is successfully established, characterized by BBB disruption and reactive gliosis specifically localized to the olfactory bulb region, manifested as astrocytic and microglial proliferation.

Health economics evidence plays an important role in linking clinical value evidence with health resource allocation decisions in the development of clinical practice guidelines. It can not only effectively balance clinical effectiveness and economic feasibility but also avoid forming "idealized" recommendations that are detached from the affordability of the healthcare system or the burden-bearing capacity of patients. To promote guideline developers to use health economics evidence more standardizedly and fully, this paper conducts an in-depth analysis of the current application status, existing challenges, access channels, and application processes of health economics evidence in current guidelines, and on this basis, puts forward considerations and suggestions for strengthening and standardizing the application of health economics evidence in China's clinical practice guidelines.

Objective To investigate the impact of bicuspid aortic valve (BAV) on the rate of ascending aortic diameter re-dilatation following ascending aortoplasty. Methods A retrospective analysis was performed on the clinical data of patients who underwent aortic valve replacement (AVR) combined with ascending aortoplasty at Fuwai Hospital between 2010 and 2022. The rate of ascending aortic diameter re-dilatation after remodeling was calculated and compared between patients with tricuspid aortic valve (TAV) and BAV within the longitudinal aortotomy-sandwich technique and external wrapping technique groups. We explored whether BAV affects the rate of diameter re-dilatation after remodeling. Results A total of 84 patients were included, comprising 58 males and 26 females, with a mean age of (54.30±11.36) years (range: 22-76 years). The follow-up duration for all 84 patients ranged from 18.30 to 158.83 months, with a median follow-up time of 42.82 (28.06, 103.12) months. In the longitudinal aortotomy-sandwich technique group (n=47), the rate of re-dilatation ranged from –3.08 to 5.90 mm/year, with a median rate of 0.83 (0.27, 1.44) mm/year. There was no statistical difference in the rate of ascending aortic diameter re-dilatation between patients with TAV and BAV within this group [0.65 (0.34, 1.43) mm/year vs. 0.99 (0.18, 1.44) mm/year, P=0.762]. In the external wrapping technique group (n=37), the rate of re-dilatation ranged from –3.57 to 6.61 mm/year, with a median rate of 0.35 (–0.28, 0.96) mm/year. Similarly, there was no statistical difference in the rate of ascending aortic diameter re-dilatation between patients with TAV and BAV within this group [0.33 (–0.17, 0.77) mm/year vs. 0.58 (–0.28, 1.05) mm/year, P=0.778]. Multivariate analysis revealed that age was an independent protective factor for re-dilatation after the longitudinal aortotomy-sandwich technique (P=0.019), and preoperative ascending aortic diameter was an independent risk factor for re-dilatation after the external wrapping technique (P=0.030). Conclusion BAV does not significantly affect the rate of ascending aortic diameter re-dilatation following ascending aortoplasty.

Objective To investigate the effect of different lymph node dissection methods on the prognosis of patients with stage ⅠA spread through air spaces (STAS)-positive lung adenocarcinoma measuring ≤2 cm. Methods The clinical data of 3 148 patients with lung adenocarcinoma who underwent surgery at the Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China from 2016 to 2018 were retrospectively analyzed. Patients with stage ⅠA STAS-positive lung adenocarcinoma measuring ≤2 cm were included and divided into two groups based on the extent of lymph node dissection: a systematic lymph node dissection (SLND) group and a limited lymph node dissection (LLND) group. Clinicopathological data between the two groups were compared, and a Cox proportional hazards regression model was used for multivariate survival analysis. Results A total of 209 patients (98 males and 111 females) were included. The mean age was (60.42±10.15) years (ranging from 28 to 83 years). All patients successfully completed the surgery. Univariate analysis revealed that the extent of lymph node dissection, past medical history, and micropapillary histological subtype were influencing factors for prognosis. Multivariate analysis indicated that the extent of lymph node dissection, age, and the micropapillary histological subtype were independent influencing factors for prognosis. Furthermore, among STAS-positive patients, those in the SLND group exhibited a better prognosis compared to those in the LLND group. Conclusion The extent of lymph node dissection is an independent prognostic factor for patients with stage ⅠA STAS-positive lung adenocarcinoma measuring ≤2 cm.Performing SLND may be more beneficial for their long-term prognosis.

Objective:In this study,we aimed to explore the clinical features and factors affecting prognosis by collecting data from patients with ocular adnexal mucosa-associated lymphoid tissue lymphoma(OAML).Methods:Clinical data of 54 patients diagnosed with ocular ad-nexal lymphoma(OAL)at The Second Affiliated Hospital of Soochow University between September 2010 and October 2024 were retro-spectively analyzed.Of these,39(72.2%)had mucosa-asso-ciated lymphoid tissue(MALT)lymphoma,which constituted the focus of this study.The Kaplan-Meier method was used to estimate the progression-free survival(PFS)and overall survival(OS)rates.The Log-rank test was applied to compare survival differences across pathological types and treatment groups.Correlation analysis and univariate Cox regres-sion were conducted to assess the impact of various factors on PFS.Variables with P<0.050 were subsequently included in multivariate Cox regression analysis to identify independent risk factors.Results:Among the 39 patients,the median age at onset was 64 years.Thirty-two and seven patients had unilateral orbital involvement and bilateral orbital involvement,respectively.All the patients underwent surgery.After surgery,the 5-year PFS and the 5-year OS of patients with MALT lymphoma were 54.21%and 100%,respectively.Univariate Cox re-gression analysis indicated that lesion location(P=0.011,hazard ratio[HR]=0.07),remission status after the first treatment(P<0.001,HR=0.082),and EBV infection(P=0.011,HR=0.207)significantly affected PFS.Multivariate regression analysis showed that remission status after the first treatment(P=0.034,HR=0.193)was an independent risk factor for prognosis.Patients who had not achieved complete re-sponse(CR)had a worse prognosis.Conclusions:Remission status after the first treatment is an important prognostic indicator in patients with MALT lymphoma.Close follow-up should be performed for patients who have not achieved complete remission after the first treat-ment.

Objective To explore the value of nomogram of hepatocellular carcinoma(HCC)ultrasonic feature regression model for predicting microvascular invasion(MVI).Methods A total of 400 HCC patients(432 lesions)confirmed by pathology were retrospectively collected and divided into training set and validation set at the ratio of 7∶3.There were 280 cases(302 lesions)in training set,including 160 cases(172 lesions)of MVI(+)and 120 cases(130 lesions)of MVI(—),while 120 cases(130 lesions)in validation set,including 70 cases(76 lesions)of MVI(+)and 50 cases(54 lesions)of MVI(-).Univariate and multivariate logistic regression analyses were performed to analyze ultrasonic manifestations of HCC.The independent predictors of MVI of HCC were screened out,and a regression model and nomogram were established,and the efficacy,calibration and clinical value of the nomogram for predicting MVI of HCC were evaluated.Results The maximum diameter of HCC(OR=2.564),margin regular or not(OR=0.412),internal echo uniform or not(OR=1.875),the presence or absence of capsule(OR=0.305)and Adler blood flow grade(OR=3.502)were all independent predictors of MVI of HCC(all P＜0.05).The sensitivity,specificity,accuracy and the area under the curve(AUC)of the nomogram for predicting MVI of HCC in training set was 84.88％,81.05％,83.11％and 0.950,respectively,while in validation set was 78.95％,77.78％,78.46％and 0.910,respectively.Calibration curve and decision curve analysis indicated that this nomogram had good calibration and high clinical net benefit in both training and validation sets.Conclusion Nomogram of ultrasound feature regression model could be used to effectively predict MVI of HCC.

Objective To investigate the clinical characteristics and prognostic risk factors in elderly patients with acute myeloid leukemia(AML).Methods A retrospective analysis was conducted on the clinical data of 101 elderly AML patients admitted to Affiliated Hospital of Jiaxing University from January 2022 to December 2024.All patients were treated with azacitidine+venetoclax regimen.The clinical characteristics of patients and the risk factors related to prognosis were explored.Results The median follow-up was 14 months.Among the 101 patients,74 achieved complete remission or complete remission with incomplete hematological recovery.The median overall survival(OS)of patients with aged ≥70 years,white blood cell count＞50 × 109/L,TP53 mutation,complex chromosomes,and high-risk European leukemia net(ELN)risk stratification was significantly shortened(P＜0.05).Multivariate analysis showed that age(HR=0.125,95％CI:0.023-0.662,P=0.015),white blood cell count(HR=0.145,95％CI:0.032-0.662,P=0.013),and ELN risk stratification(HR=100.397,95％CI:14.395-700.207,P＜0.001)were all independent influencing factors for OS in elderly AML patients.Conclusion Age,white blood cell count and ELN risk stratification are all independent influencing factors affecting OS in elderly AML patients.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.