Objective To investigate the impact of intraoperative red blood cell (RBC) transfusion volume on the postoperative oxygenation index in lung transplant recipients. Methods This retrospective study analyzed the clinical data of patients who underwent lung transplantation at Wuxi People's Hospital Affiliated to Nanjing Medical University from 2021 to 2023. Patients were divided into a non-severe primary graft dysfunction (PGD) group and a severe PGD group based on whether their postoperative oxygenation index was>200 mm Hg at 0, 24, and 48 h. General patient data and intraoperative RBC transfusion volumes were compared between the two groups. A binary logistic regression model was constructed to explore the effect size (OR and its 95%CI) of RBC transfusion volume on postoperative oxygenation status at different time points (0, 24, and 48 h). The area under the receiver operating characteristic curve was calculated to evaluate the model's diagnostic performance. Results A total of 351 patients were included (260 males, 91 females), with ages ranging from 20 to 77 years. The OR for the effect of intraoperative RBC transfusion on poor oxygenation was 1.486 (95%CI 0.982 to 2.248, P=0.061) at 0 h postoperatively, 3.111 (95%CI 1.793 to 5.399, P<0.001) at 24 h, and 1.583 (95%CI 1.026 to 2.442, P=0.038) at 48 h. This indicated that as time progressed, the postoperative oxygenation status of lung transplant recipients was affected by the intraoperative transfusion volume. Furthermore, an RBC transfusion volume>975 mLhad a significant impact on patient oxygenation at 24 and 48 h postoperatively. Conclusion The volume of intraoperative RBC transfusion has a significant impact on the oxygenation status at 24 and 48 h postoperatively. Intraoperative RBC transfusion volume is associated with the occurrence of severe PGD after lung transplantation. Controlling the volume of RBC transfusion during lung transplantation may help reduce the incidence of severe PGD.

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.

BACKGROUND:Previous studies have shown that paeoniflorin has an ameliorative effect on fibrosis in liver and kidney organs,especially in hepatic fibrosis.However,the protective effect of paeoniflorin on angiotensin Ⅱ-induced fibrosis in cardiac fibroblasts remains unclear.OBJECTIVE:To investigate the protective effects of paeoniflorin on angiotensin Ⅱ-induced extracellular matrix deposition in cardiac fibroblasts and molecular mechanisms.METHODS:Angiotensin Ⅱ(1 μmol/L)was added to primary isolated cultured SD rat mammary rat cardiac fibroblasts for 48 hours as the model group.The paeoniflorin low and high dose groups were pretreated with different doses of paeoniflorin(50 and 100 μmol/L)for 2 hours,and then treated with angiotensinⅡ for 48 hours.The SIRT1 inhibitor group was treated with SIRT1 inhibitor EX527 10 μmol/L for 2 hours,followed by paeoniflorin(100 μmol/L)for 2 hours,and then co-incubation with angiotensin Ⅱ for 48 hours.The cell viability was detected using the cell counting kit-8 method(CCK-8)assay.The cell migration ability was detected by Transwell.The level of intracellular reactive oxygen species was detected by DHA fluorescent probe.The level of oxidative stress markers was detected by relevant kits.Protein expression of fibrosis-related genes was detected by western blot assay.The mRNA expression levels of extracellular matrix and fibrosis-related genes were detected by qRT-PCR.RESULTS AND CONCLUSION:(1)Compared with the control group,the proliferation and migration of cardiac fibroblasts were significantly increased after angiotensin Ⅱ intervention;the intracellular content of reactive oxygen species and malondialdehyde content were elevated;the activities of superoxide dismutase and catalase were decreased,and the mRNA expression levels of α-smooth muscle actin,type Ⅰ collagen,type Ⅲ collagen,fibronectin,connective tissue growth factor,and matrix metalloproteinase 9 were increased.Compared with the model group,paeoniflorin could dose-dependently inhibit the above effect changes(P＜0.01).(2)Compared with the model group,paeoniflorin up-regulated the protein expression of SIRT1 in dose-dependent manner(P＜0.001).(3)Compared with the high-dose paeoniflorin group,the number of cell migration and the expression level of α-smooth muscle actin,type Ⅰ collagen,and typeⅢ collagen were significantly increased in the SIRT1-inhibitor group(P＜0.01).All the experimental results show that paeoniflorin effectively attenuates the angiotensin Ⅱ-induced changes in cardiac fibroblast fibrosis possibly through up-regulating the expression of SIRT1,dose-dependently inhibits cardiac fibroblast oxidative stress and extracellular matrix deposition,and has a protective effect on cardiac fibroblast fibrosis.

Objective To apply the International Classification of Diseases,the 11th Revision(ICD-11)Traditional Medicine 1(TM1)chapter and International Classification of Functioning,Disability,and Health(ICF)in the diagnosis,func-tional analysis and assessment of musculoskeletal diseases and dysfunctions,and propose traditional Chinese medicine(TCM)rehabilitation intervention programs.Methods ICD-11 TM1 and ICF were used for diagnosing musculoskeletal diseases and dysfunctions,as well as for func-tional analysis and assessment.The classification,coding,etiology,pathogenesis,clinical manifestations and di-agnostic criteria of musculoskeletal diseases and dysfunctions in ICD-11 TM1 were examined.ICF classification was employed to analyze and assess relevant functional characteristics,including body functions and activity lim-itations,to clarify assessment content and grading disabilities.TCM rehabilitation intervention programs were de-signed.Results The adoption of ICD-11 TM1 enabled standardized diagnosis and coding of the primary functional impairments of musculoskeletal system diseases in the field of TCM rehabilitation.The physical functional impairments in-volved in musculoskeletal system diseases and functional disorders,including joint range of motion and muscle strength,and the activity limitations involved walking and dressing,etc.The TCM rehabilitation intervention inte-grated a variety of intervention methods such as acupuncture and Tuina,which can significantly improve the body functions and activities of patients.Conclusion The combined application of ICD-11 TM1 and ICF can establish a refined and standardized system for diag-nosis,functional analysis,and assessment,as well as an integrated TCM rehabilitation intervention program in the field of TCM rehabilitation.This approach is not only applicable to clinical rehabilitation practice but also to clinical rehabilitation management and quality control,particularly in TCM electronic medical records and medi-cal record statistics.

Juvenile idiopathic arthritis(JIA)is the most prevalent joint disease in childhood.The disease is defined as arthritis of unknown etiology,involving one or more joints,with onset before the age of 16 years and symptomatic duration of more than 6 weeks.Temporomandibular joint(TMJ)arthritis is a common manifestation of JIA,but it often develops insidiously.Failing to diag-nose and treat it promptly may lead to maxillofacial dysfunction and dentofacial deformity,and negatively affect the patient's quality of life.Therefore,early diagnosis and disease management of TMJ arthritis are crucial.This article reviews the occurrence of JIA-TMJ arthritis and its progress in clinical diagnosis and disease treatment in recent years,aiming to provide some reference for den-tists in the clinical diagnosis and treatment of JIA.

BACKGROUND:Previous studies have shown that paeoniflorin has an ameliorative effect on fibrosis in liver and kidney organs,especially in hepatic fibrosis.However,the protective effect of paeoniflorin on angiotensin Ⅱ-induced fibrosis in cardiac fibroblasts remains unclear.OBJECTIVE:To investigate the protective effects of paeoniflorin on angiotensin Ⅱ-induced extracellular matrix deposition in cardiac fibroblasts and molecular mechanisms.METHODS:Angiotensin Ⅱ(1 μmol/L)was added to primary isolated cultured SD rat mammary rat cardiac fibroblasts for 48 hours as the model group.The paeoniflorin low and high dose groups were pretreated with different doses of paeoniflorin(50 and 100 μmol/L)for 2 hours,and then treated with angiotensinⅡ for 48 hours.The SIRT1 inhibitor group was treated with SIRT1 inhibitor EX527 10 μmol/L for 2 hours,followed by paeoniflorin(100 μmol/L)for 2 hours,and then co-incubation with angiotensin Ⅱ for 48 hours.The cell viability was detected using the cell counting kit-8 method(CCK-8)assay.The cell migration ability was detected by Transwell.The level of intracellular reactive oxygen species was detected by DHA fluorescent probe.The level of oxidative stress markers was detected by relevant kits.Protein expression of fibrosis-related genes was detected by western blot assay.The mRNA expression levels of extracellular matrix and fibrosis-related genes were detected by qRT-PCR.RESULTS AND CONCLUSION:(1)Compared with the control group,the proliferation and migration of cardiac fibroblasts were significantly increased after angiotensin Ⅱ intervention;the intracellular content of reactive oxygen species and malondialdehyde content were elevated;the activities of superoxide dismutase and catalase were decreased,and the mRNA expression levels of α-smooth muscle actin,type Ⅰ collagen,type Ⅲ collagen,fibronectin,connective tissue growth factor,and matrix metalloproteinase 9 were increased.Compared with the model group,paeoniflorin could dose-dependently inhibit the above effect changes(P＜0.01).(2)Compared with the model group,paeoniflorin up-regulated the protein expression of SIRT1 in dose-dependent manner(P＜0.001).(3)Compared with the high-dose paeoniflorin group,the number of cell migration and the expression level of α-smooth muscle actin,type Ⅰ collagen,and typeⅢ collagen were significantly increased in the SIRT1-inhibitor group(P＜0.01).All the experimental results show that paeoniflorin effectively attenuates the angiotensin Ⅱ-induced changes in cardiac fibroblast fibrosis possibly through up-regulating the expression of SIRT1,dose-dependently inhibits cardiac fibroblast oxidative stress and extracellular matrix deposition,and has a protective effect on cardiac fibroblast fibrosis.

Juvenile idiopathic arthritis(JIA)is the most prevalent joint disease in childhood.The disease is defined as arthritis of unknown etiology,involving one or more joints,with onset before the age of 16 years and symptomatic duration of more than 6 weeks.Temporomandibular joint(TMJ)arthritis is a common manifestation of JIA,but it often develops insidiously.Failing to diag-nose and treat it promptly may lead to maxillofacial dysfunction and dentofacial deformity,and negatively affect the patient's quality of life.Therefore,early diagnosis and disease management of TMJ arthritis are crucial.This article reviews the occurrence of JIA-TMJ arthritis and its progress in clinical diagnosis and disease treatment in recent years,aiming to provide some reference for den-tists in the clinical diagnosis and treatment of JIA.

With the development of artificial intelligence， machine learning has shown great potential in the field of medical health. Machine learning conducts a comprehensive analysis of patient data including clinical features， blood tests， and imaging examinations and establishes corresponding mathematical models to achieve the diagnosis and treatment of diseases and the prediction of disease conditions， thereby guiding disease management. With reference to the latest research findings， this article reviews the application of machine learning in chronic hepatitis C and related research advances.

[Objective] To retrospectively analyze the detection results of alanine aminotransferase (ALT) unqualified repeat blood donors in Guangzhou, so as to provide evidence for further expanding the repeat blood donor pool, reducing the rate of blood discarding and improving the qualified rate of blood test. [Methods] Blood donors with unqualified ALT in Guangzhou Blood Center from January 2018 to April 2024 were selected as the research objects. The past blood donation and population characteristics were analyzed according to the number of blood donations and ALT unqualified times. [Results] Among repeat blood donors with previous ALT disqualification, 99.5% to 99.7% did not have reactive markers for transfusion-transmitted diseases (TTD), which was higher than the rate among first-time blood donors with unqualified ALT (95.8%) (P<0.05). The rate of single-item ALT disqualification in repeat blood donors was higher in males than in females (P<0.05); it also varied by age (18-25 years > 26-35 years > 36-45 years > over 45 years) (P<0.05); and by quarter (third and fourth quarters > first and second quarters) (P<0.05). The ALT unqualified rate was significantly higher whole blood donors than that of platelet donors and returning blood donors (P<0.05). The overall ALT level (51.0 U/L), individual ALT level (56.0 U/L) and individual ALT unqualified rate (66.7%) of repeat blood donors with multiple ALT disqualifications were higher than those of repeat blood donors with single-item ALT disqualifications (26.0 U/L, 38.5 U/L, and 33.3%, respectively) (P<0.05). Moreover, as the number of ALT disqualifications increased, the overall level of ALT in repeat blood donors also increased (P<0.05), and the average level of individual ALT and individual ALT unqualified ratio tended to increase. Repeat blood donors with frequent ALT disqualifications had higher ALT levels (69.0 U/L). [Conclusion] The ALT unqualified rates of repeat blood donors were mostly non-specific elevation without TTD. Repeat blood donors with multiple ALT disqualifications tend to have continuous high ALT. Moreover, and with the increase of ALT disqualifications times, the overall ALT levels the average individual ALT levels and individual ALT unqualified rates showed an increasing trend.

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.