Transfusion and Anemia Expertise Initiative-Control/Avoidance of Bleeding developed a strategy for platelet and plasma infusion management in critically ill children based on systematic reviews and consensus meetings of international multidisciplinary experts. One good practice statement and six expert consensus statements were proposed for plasma and platelet transfusions in critically ill children following severe trauma, traumatic brain injury, and/or intracranial hemorrhage. This article introduces the specific methods and basis for the formation of recommendations in this part of the guide.

BACKGROUND:We have successfully established an animal model of small ear pig in southern Yunnan province with internal tension relieving technique combined with autologous Achilles tendon for anterior cruciate ligament reconstruction,and verified the stability and reliability of the model.However,whether internal tension relieving technique can promote the ligamentalization process of autologous Achilles tendon graft has not been studied. OBJECTIVE:To investigate the differences in the process of ligamentalization between conventional reconstruction and internal reduction reconstruction of the anterior cruciate ligament by gross view,histology and electron microscopy. METHODS:Thirty adult female small ear pigs in southern Yunnan province were selected.Anterior cruciate ligament reconstruction was performed on the left knee joint with the ipsilateral knee Achilles tendon(n=30 in the normal group),and anterior cruciate ligament reconstruction was performed on the right knee joint with the ipsilateral knee Achilles tendon combined with the internal relaxation and enhancement system(n=30 in the relaxation group).The autogenous right forelimb was used as the control group;the anterior cruciate ligament was exposed but not severed or surgically treated.At 12,24,and 48 weeks after surgery,10 animals were sacrificed,respectively.The left and right knee joint specimens were taken for gross morphological observation to evaluate the graft morphology.MAS score was used to evaluate the excellent and good rate of the ligament at each time point.Hematoxylin-eosin staining was used to evaluate the degree of ligament graft vascularization.Collagen fibers and nuclear morphology were observed,and nuclear morphology was scored.Ultrastructural remodeling was evaluated by scanning electron microscopy and transmission electron microscopy. RESULTS AND CONCLUSION:(1)The ligament healing shape of the relaxation group was better at various time points after surgery,and the excellent and good rate of MAS score was higher(P<0.05).Moreover,the relaxation group could obtain higher ligament vascularization score(P<0.05).(2)The arrangement of collagen bundles and fiber bundles in the two groups gradually tended to be orderly,and the transverse fiber connections between collagen gradually increased and thickened,suggesting that the strength and shape degree of the grafts were gradually improved,but the ligament remodeling in the relaxation group was always faster than that in the normal group at various time points after surgery.(3)The diameter,distribution density,and arrangement degree of collagen fibers in the relaxation group were better than those in the normal group at all time points,especially in the comparison of collagen fiber diameter between and within the relaxation group(P<0.05).

This article systematically analyzes the historical evolution of the name， medicinal parts， origin， harvesting， processing and other aspects of Houttuyniae Herba（HH） by referring to the medical books， prescription books and other documents of the past dynasties， combined with the research materials related to modern and contemporary times， in order to provide a basis for the development of famous classical formulas containing this herb. In ancient literature， HH was often referred to as "Ji" and "Jicai"， the name of "Ji" was first recorded in Mingyi Bielu during the Han and Wei dynasties， and the name of Yuxingcao was first seen in Lyuchanyan Bencao during the southern Song dynasty and has continued to this day. The origin of HH used throughout history is consistent， all of which are the whole herb or aboveground parts of Houttuynia cordata in Saururaceae family. HH recorded throughout history has a wide range of production areas， mostly self-produced self-marketing. In ancient times， fresh HH was often used as medicine by pounding its juice without involving any processing steps. Both fresh and dried products can be used as medicine， the fresh products uses the whole plant， while the dried products uses the aboveground parts， which are cleaned， selected and processed before use. Fresh products are harvested regardless of season， while dried products are harvested in both summer and autumn， with summer as the best. In ancient times， there were no specific requirements for the quality of HH， while in modern times， "intact stems and leaves with a strong fishy smell" are preferred. In addition， the medicinal properties of HH have undergone significant changes from ancient to modern times. In the early period， it was believed that its medicinal property was slightly warm， until the 1977 edition of Chinese Pharmacopoeia officially changed it to slightly cold. Both ancient and modern literature states that HH can be used for the treatment of carbuncle and malignant sores， Lyuchanyan Bencao for the first time introduced HH fresh juice can relieve summer heat， since Diannan Bencao recorded that it can be used for lung carbuncle， and gradually developed into the first choice for the treatment of lung carbuncle. Based on the research results， it is suggested that fresh herb or dried aboveground parts of H. cordata are used as medicine when developing famous classical formulas.

Objective:To observe the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) at different frequencies on cognitive impairment due to high-altitude hypoxia.Methods:Sixty officers and soldiers displaying cognitive impairment in a hypoxic high-altitude environment were randomly divided into 15Hz, 20Hz and 25Hz groups, each of 20. They were given rTMS at those frequencies for 30 days. Before the stimulation and after 15 and 30 days, event-related potentials, latencies of mismatched negativity (MMN) and P300 signals were recorded. The participants′ cognition was also evaluated using the Montreal Cognitive Assessment Scale (MoCA). Correlation between the electrophysiological indexes and the MoCA scores was computed.Results:After 15 days, all had shorter MMN latencies, higher total MoCA scores and better memory scores. The only significant difference among the three groups was in the average memory scores. After 15 days, MMN latency was significantly negatively correlated with the memory scores in all three groups ( r=0.44 to -0.54). Conclusions:rTMS at frequencies above 15Hz can effectively relieve cognitive impairment, especially memory dysfunction, resulting from high-altitude hypoxia.

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.

Objective:To construct and validate a predictive model for postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic urological surgery.Methods:This retrospective study included the medical records of 932 patients who underwent robot-assisted laparoscopic urological surgery at the First Affiliated Hospital of Zhejiang University School of Medicine from January 2020 to February 2022. The patients were divided into a training group ( n=559) and a validation group ( n=373) at a 6∶4 ratio. Logistic regression analysis was used to determine the independent risk factors for PPCs, and a nomogram prediction model was constructed based on these factors. The performance of the model was evaluated using the receiver operating characteristic curve and calibration curve, and the clinical benefit was assessed using the clinical decision curve analysis. Results:The independent risk factors for PPCs included advanced age (>60 yr), smoking history, respiratory tract infection within 1 month, preoperative low SpO 2 (<96%), and prolonged length of postoperative hospital stay ( P<0.05), and the body mass index (18.5-<28.0 kg/m 2) was a protective factor. The nomogram prediction model developed based on the aforementioned 6 influencing factors had an area under the receiver operating characteristic curve of 0.81 (95% confidence interval 0.76-0.86) in training group and 0.80 (95% confidence interval 0.75-0.86) in validation group. The calibration curve indicated a good consistency between the predicted and actual occurrence curves, and the clinical decision curve analysis showed good accuracy and net benefit of the prediction model. Conclusions:The predictive model for PPCs is successfully constructed based on age, low body mass index, smoking history, history of respiratory tract infection within 1 month, preoperative low SpO 2 and prolonged length of postoperative hospital stay and has good predictive performance in patients undergoing robot-assisted laparoscopic urological surgery.

Spinal cord injury(SCI)is a central nervous system disease that can lead to motor,sensory,and autonomic dysfunction.Depending on the state of immune microenvironment,macrophage polarization can differentiate into M1/M2 phenotypes.The regulation of macrophage polarization by stem cells in many pathophysiological processes of SCI has become a hot topic of research in recent years.This review summarizes the relationship between macrophage polarization and SCI,and how mesenchymal stem cells(MSCs)and neural stem cells(NSCs)regulate macrophage polarization to improve SCI through paracrine secretion,delivery molecules,derived exosomes,and metabolic reprogramming pathways.It also summarizes the mechanism by which stem cells regulate the macrophage polarization phenotypes to promote SCI recovery through signaling pathways such as Janus tyrosine kinase/signal transducer and activator of transcription(JAK/STAT),Notch,Toll-like receptor 4/nuclear factor kappa-B(TLR4/NF-κB),phosphatidylinositol 3 kinase/protein kinase B(PI3K/Akt).The aim is to provide theoretical support for the treatment of SCI by regulating macrophage polarization with stem cells and to offer new perspectives for exploring the mechanism of stem cell therapy for SCI.

Atherosclerosis(AS)is an inflammatory cardiovascular disease characterized by plaque accumulation in the arterial wall,leading to increased morbidity and mortality of related cardiovascular disorders.The main pathological mechanisms of AS include lipid deposition,oxidative stress,and chronic inflammation,with disease progression involving endothelial cell dysfunction,macrophage polarization,foam cell formation,and smooth muscle cell proliferation or apoptosis.Mitochondria are essential organelles that provide energy for cellular metabolism,and the mitochondrial quality control(MQC)system is the fundamental mechanism maintaining mitochondrial functional homeostasis.MQC dysfunction can induce vascular phenotype changes through pathways such as oxidative stress,apoptosis,and inflammation,thereby promoting the progression of AS.Therefore,targeting MQC to regulate mitochondrial function may become a new direction for the treatment of AS.This review summarizes the molecular mechanisms of MQC,including mitochondrial biogenesis,mitochondrial dynamics,and mitochondrial autophagy(mitophagy),and further elucidates the role of abnormal MQC in the pathological processes of AS,aiming to provide a scientific basis for identifying potential targets to delay the progression of AS and developing related drugs.

Objective:To understand the workflow and key tasks of the transformation of scientific and technological achievements in public hospitals,and propose optimization strategies from the perspective of managers.Methods:Based on the research method of Grounded Theory,semi-structured interviews were conducted among 23 managers of scientific and technological achievements transformation in public hospitals,and relevant concepts and categories were summarized by three stages coding with NVivo 12.Results:Through the three stages of coding,64 initial concepts,19 categories and 4 main categories were sorted out,and a framework diagram of the process of transforming scientific and technological achievements in public hospitals covering four stages was constructed.Conclusion:The scientific and technological achievements of public hospitals can be divided into four phases:project initiation and demand docking,research and development process and achievements incubation,achievements transformation and market docking,product promotion and industrial development,which can be used to achieve high-quality development of scientific and technological achievements through standardized management of the whole process,excavation of high-quality results,enhancement of humanistic construction,accumulation of scientific research experience,and standardization of qualification of technological managers.

Recent studies have shown that the physiological homeostasis of oral mucosal cells is regulated by the circadian clock.Dis-ruption or dysfunction of the circadian clock is closely associated with the development of oral squamous cell carcinoma(OSCC).Research based on the circadian clock offers a novel perspective on the pathogenesis and therapeutic strategies for OSCC.However,there is current-ly limited research on this topic,and people generally have insufficient understanding and recognition of the circadian clock.Given the complexity and challenges of circadian clock which is the fourth dimension of medical research,we organize relevant experts based on summarizing the current research results of circadian clock in the pathogenesis and precision diagnosis and treatment of OSCC,combining the scientific principles of the circadian clock's role and their long-term research experience,then summarizes and recommends the con-sensus opinions for the research of circadian clock in the pathogenesis mechanism and precision diagnosis and treatment of human OSCC,with the hope of providing guidance for the basic research and clinical application of circadian clock or circadian rhythm in the pathogene-sis mechanism and precision diagnosis and treatment of oral and maxillofacial squamous cell carcinoma.