Based on spleen deficiency-phlegm dampness as the core pathogenesis of obesity， and integrating recent advances in modern medicine regarding the key role of immune inflammation in obesity， this paper proposes a multidimensional pathogenic network of "obesity-spleen deficiency-phlegm dampness-immune imbalance". Various traditional Chinese medicine （TCM） herbs that strengthen the spleen， regulate qi， and resolve phlegm and dampness can treat obesity by improving spleen-stomach transport and transformation， promoting water-damp metabolism， and regulating immune homeostasis. This highlights immune inflammation as an important entry point to elucidate the TCM concepts of "spleen deficiency-phlegm dampness" and the therapeutic principle of "strengthening the spleen and eliminating dampness to treat obesity". By systematically analyzing the intrinsic connection between "spleen deficiency generating dampness， internal accumulation of phlegm dampness" and immune dysregulation in obesity， this paper aims to provide theoretical support for TCM treatment of obesity based on dampness.

Pediatric acute liver failure (PALF) is a rare and critical clinical syndrome with a poor prognosis. Its etiology is complex, with a significant proportion of cases having remained classified as indeterminate or cryptogenic PALF. With the application of high-throughput sequencing technologies, a spectrum of disorders caused by specific genetic metabolic defects and characterized by stress-sensitive Recurrent acute liver failure (RALF) has been gradually unveiled, collectively termed Infantile liver failure syndrome (ILFS). Although the molecular mechanisms underlying the subtypes ILFS1, ILFS2, and ILFS3 differ by involving aminoacyl-tRNA synthetase defects, vesicular transport disorders, and autophagy abnormalities, respectively, they share a common clinical phenotype of RALF triggered by fever or infection. This article has systematically reviewed the clinical phenotypic spectrum, molecular genetic characteristics, differential diagnosis strategies, and therapeutic advances of the three ILFS subtypes, with the goal of improving early clinical recognition and precise intervention, and providing an important reference for evaluating the prognosis of different subtypes.
Humans ; Liver Failure, Acute/therapy* ; Infant ; Diagnosis, Differential

Objective: To evaluate the methodological quality and reporting quality of clinical practice guidelines or expert consensus on blood transfusion and blood use (BTBU) in China (hereinafter referred to as "guidelines/consensus"), providing reference for the development and updating of future BTBU guidelines/consensus. Methods: A systematic search was conducted in Chinese databases such as China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Data-base, relevant guideline release platforms, and professional association websites. BTBU-related guidelines/consensus published between January 2006 and December 2025 were included. According to the inclusion and exclusion criteria, after completing literature screening and data extraction, three evaluators independently assessed the quality of the included literature using the Scientificity, Transparency, and Applicability of Guidelines Rating Tool (STAR), the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ), and the International Practice Guideline Reporting Standards (RIGHT). Results: A total of 29 documents were included, including 5 guidelines, 22 consensus statements, and 2 protocols. The results of the STAR assessment showed that the total score was (21.7±8.8)%. The domain score ratios for registration, research protocol, funding, working group, conflict of interest, clinical question, evidence, consensus method, recommendation, accessibility and other domains were (2.2±12.1)%, 0, (36.7±25.1)%, (18.3±7.6)%, (19.2±15.3)%, (16.6±23.1)%, (15.1±6.3)%, (9.6±21.2)%, (54.3±18.4)%, (31.7±10.4)% and (10.3±31.0)%, respectively. For the AGREE Ⅱ assessment, the methodological quality of 26 articles was rated Grade B and 3 articles Grade C. The results of the RIGHT assessment indicated that the overall reporting rate of all guidelines/consensuses was (65.3±4.0)%. Conclusion: The methodological and reporting quality of current expert guidelines/consensus on BTBU in China still need improvement, and guidelines and consensus should be strictly formulated and standardized according to the standards of STAR, AGREE II and RIGHT.

Obsessive-compulsive disorder (OCD) is characterized by recurrent episodes of intrusive thinking and/or behavior, persistent and variable symptoms, and chronic recurrence. It is clearly recommended in the OCD treatment guidelines that psychotherapy can effectively improve clinical symptoms and play an important role in maintaining long-term efficacy. However, previous research and clinical practice paid little attention to the application of psychological interventions in OCD.Currently, there is insufficient understanding of psychotherapy for OCD, especially the proven first-line exposure and response prevention therapy (ERP), cognitive-behavioral therapy, and Morita therapy.Due to limited resources, they have not received effective intervention. Therefore, this article reviews the relevant research on psychological therapy intervention for OCD in recent years, summarizes the intervention effects of different psychological therapy methods on OCD and further elaborates on possible therapeutic mechanisms.Based on this, combined with the existing research, this article clarifies the effect of various behavioral psychological interventions and their combined treatment, and explores group and online forms of psychological intervention in order to increase the accessibility of psychotherapy for OCD patients.

Objective:To develop the Home-based Self-management Efficacy Questionnaire for Stable Chronic Obstructive Pulmonary Disease (COPD) Patients and test its reliability and validity.Methods:Guided by the individual and family self-management theory and self-management efficacy theory, a preliminary questionnaire was developed through literature analysis, semi-structured interviews, and expert inquiries. From September to November 2022, convenience sampling was used to select stable COPD patients of the Respiratory Department of Tongji University Shanghai Pulmonary Hospital as participants for investigation for project analysis and exploratory factor analysis of the questionnaire. From December 2022 to January 2023, a survey was conducted on stable COPD patients who visited the Respiratory Department of Tongji University Shanghai Pulmonary Hospital and Yancheng Third People's Hospital to conduct confirmatory factor analysis and reliability testing on the questionnaire.Results:A total of 220 and 290 questionnaires were distributed respectively, and 214 and 280 valid questionnaires were collected, with effective response rates of 97.27% (214/220) and 96.55% (280/290), respectively. The Home-based Self-management Efficacy Questionnaire for COPD Patients included six dimensions and 28 items. The questionnaire's total Cronbach's α coefficient was 0.910, and the half-confidence coefficient was 0.806. The content validity index at the questionnaire level was 0.928, and the content validity index at the item level was 0.800 to 1.000. The exploratory factor analysis showed that a total of six common factors were extracted, with a cumulative variance contribution rate of 63.943%. Confirmatory factor analysis showed that the model fitted well and the questionnaire factor structure was stable.Conclusions:The the Home-based Self-management Efficacy Questionnaire for Stable COPD has been developed with good reliability and validity, providing a reference for medical and nursing staff to evaluate the home self-management efficacy of stable COPD patients.

This article comprehensively discusses the concept of workplace ostracism, measurement tools, theoretical basis, the current situation of workplace ostracism among nurses, and research on related variables. It proposes targeted strategies to address workplace ostracism among nurses, aiming to reduce the occurrence of workplace ostracism incidents among nurses. This is of great significance for constructing a harmonious work environment and promoting individual mental health.

Objective To explore the microstructural alterations in the white matter of patients with Parkinson's disease(PD)with depression(PD-D)by Tract-based Spatial Statistics(TBSS),with the aim of identifying neuroimaging biomarkers for early diagnosis.Methods Participants with PD were recruited from the Parkinson Progression Marker Initiative database and categorized into PD-D group(n=50)and PD without depression(PD-ND)group(n=31)based on the Geriatric Depression Scale(GDS-15).Age-and gender-matched healthy volunteers were also included in healthy control(HC)group(n=23).All subjects underwent brain MRI-DTI scans.TBSS was utilized to compare fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(AD),and radial diffusivity(RD)values among groups and to perform Pearson correlation analysis with clinical PD data.Results Compared with HC group,FA values were significantly reduced and MD values were significantly increased in bilateral cingulate(hippocampus),crus,parahippocampal,inferior fronto-occipital fasciculus,inferior longitudinal fasciculus,uncinate fasciculus,superior longitudinal fasciculus(SLF),SLF(temporal),thalamic radiation and corticospinal tract of PD-D group(all P＜0.05).Compared with PD-ND group,MD values were significantly higher in the left cingulum(cingulate gyrus),left inferior fronto-occipital fasciculus,left SLF,left SLF(temporal),left thalamic radiation and left corticospinal tract of PD-D group,while AD values were significantly higher in the left SLF of PD-D group(all P＜0.05).Correlation analysis revealed that AD values in the left SLF were positively correlated with Epworth sleepiness scale score and GDS-15 score(r=0.192,P=0.043;r=0.443,P＜0.01).MD values in the differential brain regions were negatively correlated with Montreal cognitive assessment scale scores(r=-0.187,P=0.047)and positively correlated with GDS-15 scores(r=0.485,P＜0.01).Conclusion This study demonstrate that TBSS can reveal microstructural changes in the brains of PD-D patients,which may serve as neuroimaging biomarkers and provide guidance for clinical diagnosis and treatment.

OBJECTIVE The non-volatile and volatile chemical components in Yin-Qiao-Qing-Re Tablets were analyzed sepa-rately using ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS/MS)and Gas Chromatography Mass Spectrometry(GC-MS).METHODS The non-volatile components were analyzed using a Waters ACQUITY UPLC BEH C18 column(2.1 mm×100 mm,1.7 μm),with a mobile phase consisting of 0.1％formic acid aqueous solution(A)and acetonitrile(B)for gradient elution,a flow rate of 0.35 mL·min-1,an injection volume of 5 μL,and a column temperature of 30 ℃;the volatile components were analyzed using an Agilent SH-I-5MS column(5％Phenyl Methyl Silox,30 m×250 μm,0.25 μm);the procedure was temperature-programmed,with an injection volume of 1 μL,a split ratio of 10∶1,a flow rate of 1.0 mL·min-1,and an inlet temperature of 200 ℃.RESULTS A total of 134 non-volatile chemical components and 23 volatile components were analyzed and identified from Yin-Qiao-Qing-Re Tablets,among which 49 compounds were confirmed through comparison with reference stand-ards.The non-volatile components mainly include 27 flavonoids,21 organic acids,15 lignans,14 iridoids,12 phenylethanoid glyco-sides,11 saponins,10 alkaloids,5 terpenes,4 amino acids,3 phenylpropanoids,3 nucleosides,3 xanthones,3 phenolic glycosides,2 chromones and 1 carbohydrate.The volatile components mainly include 11 monoterpenes,5 alcohols and phenols,3 alkenes,2 ke-tones,1 ester,and 1 hydrocarbon.CONCLUSION This study rapidly identifies the chemical components of Yin-Qiao-Qing-Re Tablets,laying a preliminary foundation for research on the pharmacodynamic substances of Yin-Qiao-Qing-Re Tablets and the im-provement of quality control standards.

Objective:To explore the values of reticulin fiber staining (RFS) in evaluating bone marrow (BM) involvement of lymphoma and in grading of BM biopsy from adult lymphoma patients.Methods:Retrospectively,354 cases of adult lymphoma were collected from November 2023 to May 2024 at Peking University Cancer Hospital. BM samples were stained with RFS and immunohistochemical staining (IHC), and flow cytometry (FCM) was also performed with the BM aspirations simultaneously. RFS was graded according to the European Consensus, as high grade (grade 2-3) indicating BM involvement in the study. BM involvement was considered as definite if no less than two positive findings among IHC, FCM, and RFS. Statistical analyses were performed via SPSS software (V23.0).Results:In this series, 52.3% (185/354) of the patients were male; 35.0% (124/354) aged >60 years; BM involvements were found in 34.5% (122/354) cases with high grade of RFS, which, in turn, were lymphoblastic leukemia/lymphoma (ALL/LBL) group (4/4), indolent B-cell lymphoma (IndBCL) group (49.1%, 53/108), transformed B-cell lymphoma (TrBCL) group (2/5), invasive B-cell lymphoma (InvBCL) group (26.5%, 41/155), T and NK cell lymphoma (TNKCL) group (27.3%, 12/44) and classical Hodgkin lymphoma (CHL) group (26.3%, 10/38); if classified by specific types, T-ALL/LBL (2/2), B-ALL/LBL (2/2) and CLL/SLL (8/10) ranked top three. In terms of the positive rate of BM involvement evaluated by RFS, no significant difference was seen between either gender or age groups ( χ2=3.416, P=0.332 and χ2=4.200, P=0.241); however, significant differences were observed between different lymphoma groups and types ( χ2=29.961, P=0.012 and χ2=102.546, P<0.001, respectively). BM invasion rates indicated by IHC and FCM were 25.4% (90/354) and 13.8% (49/354), respectively. The overall BM invasion rate was 24.3% (86/354), and the sensitivity of RFS, IHC, and FCM was 90.8%, 97.8%, and 55.8%, and specificity was 84.1%, 99.6%, and 98.9%, respectively. Overall, the concordance rate of RFS with IHC and FCM was 83.6% and 74.0%, respectively, including 85.8% and 74.2% for InvBCL group, 79.6% and 75.0% for IndBCL group, 84.1% and 75.0% for TNKCL group, 81.6% and 73.7% for CHL group, 5/5 and 2/5 for TrBCL group, and 4/4 and 3/4 for ALL/LBL group. Conclusions:In the evaluation of BM involvement status of adult lymphoma, high sensitivity and specificity are observed by RFS, and high concordance is also noted with both IHC and FCM. Thus, the BM infiltrating status of adult lymphoma could be evaluated more accurately by a combined usage of the three methods.

Objective:To evaluate the dosimetric characteristics of intensity-modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT) in radiation therapy planning for patients with bilateral breast cancer after breast-conserving surgery.Methods:On the computed tomography localization images of 18 patients with bilateral breast cancer, target volumes and organs at risk were contoured to develop both IMPT and VMAT plans for each patient. Two IMPT plans were designed based on the clinical target volume (CTV) with robust optimization (RO-IMPT) and the planning target volume (PTV) without RO (NonRO-IMPT), respectively. The RO-IMPT, NonRO-IMPT, and VMAT plans were normalized such that the prescription dose could cover 95% of the target volume. The dosimetric parameters of target volumes and organs at risk were evaluated, and the dosimetric characteristics of the two techniques were compared.Results:In terms of target volumes, the RO-IMPT group showed significantly lower D1%, Dmean, and homogeneity index (HI) and a significantly higher D99% of the CTV than those of the PTV in the VMAT group ( t=-8.96, -8.21, -8.13, 4.96, P<0.05). The NonRO-IMPT group showed significantly lower D1%, Dmean, and HI and a significantly higher conformity index of the PTV than those of the PTV in the VMAT group ( t=-7.75, -6.25, -6.11, 7.53, P<0.05). In terms of organs at risk, the two IMPT groups showed significantly lower values than the VMAT group for the V5- V30 and Dmean of the whole lungs, V5- V40 and Dmean of the heart, D1% and Dmean of the left anterior descending coronary artery, D1% of the spinal cord, Dmean of normal tissues, and Dmean of the skin ( t= -28.47 to -3.25, P<0.05). There was no significant difference in any other evaluation indices ( P>0.05). Conclusions:Both IMPT and VMAT can meet the clinical requirements of radiotherapy plans following breast-conserving surgery for bilateral breast cancer. IMPT has apparent advantages over VMAT in protecting organs at risk.