By analyzing the current status of randomized controlled trials （RCTs） on functional dyspepsia （FD） and irritable bowel syndrome （IBS） comorbidity， we identified several critical issues which include insufficient repor-ting of FD and IBS subtypes， inadequate risk assessment of drug combination， lack of composite， objective， and long-term outcomes， and weak evidence support for clinical practice guidelines. It is suggested that future clinical research on FD-IBS comorbidity should further strengthen the application of real-world studies. The use of composite outcomes and long-term follow-up is recommended to improve the quality of evidence， while greater attention should be paid to patients' preferences and self-management to enhance the applicability of findings. Based on the existing issues in clinical studies of traditional Chinese medicine （TCM） for FD-IBS comorbidity， we propose to consolidate the foundation of TCM-specific efficacy evaluation to better reflect the advantages of syndrome differentiation and treatment， optimize real-world study designs to better support clinical decision- making， and introduce intelligent objective evaluation technologies to improve the objectivity and accuracy of TCM clinical efficacy assessment.

By analyzing the current status of randomized controlled trials （RCTs） on functional dyspepsia （FD） and irritable bowel syndrome （IBS） comorbidity， we identified several critical issues which include insufficient repor-ting of FD and IBS subtypes， inadequate risk assessment of drug combination， lack of composite， objective， and long-term outcomes， and weak evidence support for clinical practice guidelines. It is suggested that future clinical research on FD-IBS comorbidity should further strengthen the application of real-world studies. The use of composite outcomes and long-term follow-up is recommended to improve the quality of evidence， while greater attention should be paid to patients' preferences and self-management to enhance the applicability of findings. Based on the existing issues in clinical studies of traditional Chinese medicine （TCM） for FD-IBS comorbidity， we propose to consolidate the foundation of TCM-specific efficacy evaluation to better reflect the advantages of syndrome differentiation and treatment， optimize real-world study designs to better support clinical decision- making， and introduce intelligent objective evaluation technologies to improve the objectivity and accuracy of TCM clinical efficacy assessment.

Animal model research on spleen and stomach diseases in traditional Chinese medicine （TCM） is of great significance for elucidating the nature of diseases and syndromes and for revealing the mechanisms of action of Chinese herbal medicinals. At present， studies on classical TCM syndrome models of spleen and stomach diseases mainly focus on spleen deficiency syndrome， liver constraint syndrome， and damp-heat syndrome. Model construction is mostly based on the etiological and pathophysiological characteristics of syndrome， and model evaluation primarily involves macroscopic manifestations and physicochemical indicators. This paper summarizes the current research status of animal models integrating disease and syndrome for seven common spleen and stomach diseases， including chronic gastritis and gastric precancerous lesions， gastroesophageal reflux disease， functional dyspepsia， inflammatory bowel disease， irritable bowel syndrome， functional constipation， and functional diarrhea. The modeling methods and characteristics of disease-syndrome combined animal models for each disease are analyzed. It is proposed that future research on disease-syndrome integration in spleen and stomach diseases should move toward syste-matic， precise， and integrative development， and that interdisciplinary and cross-disciplinary research approaches should be adopted to enhance the predictive value and application efficiency of disease-syndrome combined animal models.

Objective To establish the method of thin layer chromatography （TLC） for identification and content quantitative determination of Shugantongluo capsules, and provide methodological reference for the quality control of Shugantongluo capsules. Methods Bupleuriradix, polygala tenuifolia yuanzhi, and acorus tatarinowii rhizoma were identified by TLC qualitatively. The content of Saikosaponin-a was determined by HPLC method. The chromatography was performed on Venusil XBP C₁₈（L） （4.6 mm×150 mm, 5 μm） with a stable temperature of 30℃. The mobile phase in isocratic elution consisted of acetonitrile-water （40∶60, V/V） at the flow rate of 1.0 ml/min with an injection volume of 20 μl. The detection wavelength was set at 210 nm. Results Clear spots were obtained with good separation in TLC identification which was highly specific. The Saikosaponin-a at the range of 25.00-500.0 μg/ml was linear with peak area （r=0.999 9）, the average recovery rate was 97.00%, and RSD was 2.60%. Conclusion These methods was easy to operate with accurate results, with good specificity and reproducibility, which could be uesd for the quality control for Shugantongluo capsules.

ObjectiveTo investigate the protective effect of liver-targeted fibroblast growth factor 21 （FGF21） overexpression against CCl₄-induced acute liver injury （ALI） and its association with silent information regulator 1/glutathione peroxidase 4 （SIRT1/GPX4） expression and ferroptosis-related markers. MethodsFemale ICR mice （8 weeks old） were randomly divided into Control， CCl₄， adeno-associated virus （AAV）-FGF21， and AAV-FGF21 + CCl₄ groups. Liver-targeted FGF21 overexpression was achieved via tail vein injection of AAV8-FGF21 virus with green fluorescent protein （GFP） labeling. ALI was induced by intraperitoneal injection of CCl₄ （0.3 mL/kg）， with sample collection at 12 hours. Body weight and liver weight were recorded to calculate the liver weight/body weight. Alanine aminotransferase （ALT） and aspartate aminotransferase （AST） levels were measured using a biochemical analyzer. FGF21 expression in liver tissues was detected by immunofluorescence. Hepatic histopathology was evaluated by HE staining. RT-qPCR was performed to assess mRNA expression of ferroptosis and iron metabolism-related genes （ACSL4， PTGS2， HJV， FPN， GPX4）， FGF21， and SIRT1. Protein expression of FGF21， SIRT1， and GPX4 were determined by Western blot. Iron content， malondialdehyde （MDA）， glutathione （GSH）， and superoxide dismutase （SOD） activity in liver homogenate were quantified using assay kits. ResultsCompared with the Control group， the FGF21 mRNA and protein expression elevated in CCl₄ group； serum ALT/AST levels and liver weight/body weigh increased. The HE staining results showed that the liver cell membranes were ruptured. The mRNA levels of ACSL4 and PTGS2， the iron content and MDA levels all increased （P<0.01）. The mRNA levels of SIRT1， GPX4， HJV， and FPN， the GSH level and SOD activity all decreased （P<0.05）， and the protein levels of SIRT1 and GPX4 both decreased （P<0.05）. Compared with the CCl₄ group， the serum levels of ALT and AST in the AAV-FGF21 + CCl4 group were decreased （P<0.01）， and the liver/body ratio of mice decreased （P<0.01）. The results of HE staining showed that the degree of liver injury was alleviated. The mRNA levels of ACSL4 and PTGS2， iron content and MDA level all decreased （P<0.01）， while the mRNA levels of SIRT1， GPX4， HJV， FPN， GSH level and SOD activity all increased （P<0.05）. The protein levels of SIRT1 and GPX4 both increased （P<0.05）. ConclusionFGF21 overexpression is associated with enhanced SIRT1/GPX4 expression and suppression of ferroptosis features， thereby contributing to the alleviation of CCl₄-induced ALI.

Objective:To clarify the effect of methotrexate on blood uric acid levels and the incidence of hyperuricemia in patients with rheumatic and musculoskeletal diseases (RMDs).Methods:The clinical data were collected from 349 patients with RMDs who took methotrexate for more than 52 weeks and 429 patients with RMDs who did not take methotrexate, who were treated at Anqing Medical Center of Auhui Medical University from June 1, 2022 to June 30, 2024, to compare the differences in serum uric acid concentration and the incidence of hyperuricemia before and after 24 weeks of methotrexate administration in the two groups of patients with RMDs. The changes in serum uric acid concentration and serum creatinine value in the MTX na?ve patients who had taking MTX for 0, 24 and 52 weeks were compared. The relationship between serum uric acid concentration and methotrexate dosage was analyzed. Measurement data were compared using t-test or ANOVA, repeated measures analysis of variance, and count data were compared using χ2 test. Results:①At week 0, there was no significant difference in serum uric acid concentration [(300±63)μmol/L vs. (306±64)μmol/L, t=-1.416, P=0.157] and the incidence of hyperuricemia [9.3%(40/429) vs. 10.3%(36/349) , χ2=0.215, P=0.643] between the two groups. At week24, the serum uric acid concentration (307±70)μmol/L vs. (246±89)μmol/L was statistically significantly ( t=10.909, P<0.001) different. The incidence of hyperuricemia (11.0%, 47/429) vs. (4.6%, 16/349), was statistically significantly different ( χ2=10.497, P<0.001). There was a statistically significant difference in serum uric acid concentration between week 0 and week 24 in the methotrexate group ( t=10.237, P<0.001), and there was a statistically significant difference in the incidence of hyperuricemia ( χ2=8.312, P=0.004). ②The overall serum uric acid concentrations at week 0, weeks 24, and weeks 52 were (306±64)μmol/L, (246±89)μmol/L, and (247±66)μmol/L, respectively. The difference in overall serum uric acid concentration was statistically significant ( F= 29.506, P<0.001). There was no significant difference in serum uric acid concentration between weeks 24 and 52 ( P=1.000). There were significant differences in serum creatinine levels between weeks 0, 24 and 52 ( P<0.001). There was no significant difference in serum creatinine levels between weeks 0 ,52, weeks 24 and 52 ( P=0.077, P=1.000). There were statistically significant differences in the overall serum uric acid concentration and serum creatinine value at weeks 0, 24 and 52 of medication ( P<0.001).③ There was no significant difference in serum uric acid concentration before and after taking hydroxychloroquine, cyclosporine, tripterygium wilfordii, mycophenolate mofetil, tofacitinib, etanercept and adalimumab alone for weeks 0 and 24(all P>0.05). ④There was no significant difference in serum uric acid concentration between patients taking different doses of methotrexate (7.5 mg once weekly, 10 mg once weekly, 12.5 mg once weekly, 15 mg once weekly) at weeks 0 and 24 weeks(all P>0.05). Conclusion:MTX, as an anti-rheumatic drug, reduces the serum uric acid level and the incidence of hyperuricemia in patients with RMDs during the treatment.

Objective:To construct a risk prediction model for early post-injury respiratory failure in patients with traumatic cervical spinal cord injury (TCSCI) and validate its efficacy.Methods:A retrospective cohort study was conducted to analyze the clinical data of 393 TCSCI patients admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2020 to October 2024, including 294 males and 99 females, aged 18-82 years [59(45, 72)years]. Among them, 76 patients had respiratory failure (19.3%). The patients were randomly divided into the training set ( n=275) and validation set ( n=118) at a ratio of 7∶3. According to the presence of respiratory failure within one week after admission, 275 patients in the training set were divided into respiratory failure group ( n=53) and non-respiratory failure group ( n=222). The demographic data, injury characteristics, laboratory test results, and imaging findings of the patients were collected. Risk factors were determined through univariate analysis and multivariate Logistic regression analysis and a nomogram prediction model was constructed. The area under the receiver operating characteristic (ROC) curve (AUC) and Hosmer-Lemeshow test were used to evaluate the discrimination and calibration of the model. Decision curve analysis (DCA) was plotted to evaluate the clinical effectiveness of the prediction model. Results:The results of the univariate analysis showed that there were significant differences in history of respiratory diseases, causes of injury, Glasgow coma scale (GCS), American Spinal Injury Association (ASIA) classification, ASIA-motor score (AMS), injury severity score (ISS), clinical pulmonary infection score (CPIS), hypoproteinemia and cervical vertebra fracture and dislocation between the respiratory failure group and non-respiratory failure group in the training set ( P<0.05). The results of multivariate Logistic regression analysis indicated that GCS, ASIA classification, CPIS, and hypoproteinemia were independent risk factors for early post-injury respiratory failure in TCSCI patients ( P<0.05). Based on the above four variables, a Logistic regression equation was constructed: Logit( P)=2.361-0.675×ASIA classification+0.419×CPIS-0.358×GCS+0.854×hypoproteinemia. In the prediction model established based on this equation, the AUC was 0.96 (95% CI 0.94, 0.99) in the training set and 0.89 (95% CI 0.82, 0.96) in the validation set. In the calibration curves of the training set and validation set, the prediction curve and reference curve were approximately overlapping, with the average absolute errors of 0.04 and 0.03. DCA results demonstrated that both the training and validation sets exhibited positive net benefits when threshold probabilities fell within ranges of 0%-78% and 0%-87%, respectively. Conclusion:The risk prediction model for early post-injury respiratory failure in TCSCI patients based on GCS, ASIA classification, CPIS and hypoproteinemia has good predictive efficacy and clinical practicability.

Objective:To investigate the use of treatment measures in patients with severe postpartum hemor-rhage and massive blood transfusion.Methods:A retrospective analysis was conducted on the clinical data of parturients from 18 medical institutions who gave birth between January 2019 and June 2023,with postpartum hemorrhage≥ 1000 ml within 24 hours after delivery and red blood cell(RBC)transfusion≥4 U.According to the amount of RBC transfusion,the patients were divided into massive-transfusion(MT)group(≥ 10 U)and non-massive-transfusion(non-MT)group(4-＜10 U).The high-risk factors for postpartum hemorrhage,causes of hemorrhage,and medical and surgical treatment measures were compared between the two groups.Results:A total of 575 patients were included(134 cases in MT group and 441 cases in non-MT group).In the MT group,the proportions of multiparous women,gravidity≥2,preterm birth,previous cesarean section,placenta previa,and placenta accreta were significantly higher than those in the non-MT group,with statistically significant differences(P＜0.05).The primary cause of postpartum haemorrhage in the MT group was placental factors(58.2％),whereas uterine atony was the main cause in the non-MT group(52.2％).Analysis of medication treatment showed that carboprost tromethamine was the most frequently used secondary uterotonic in both groups(73.1％and 80.5％).Surgical management analysis revealed that the proportion of surgical interventions was higher in the MT group than that in the non-MT group.Among the 44 patients who underwent hysterectomy,33 cases un-derwent hysterectomy during cesarean section,with the primary cause of postpartum haemorrhage being placen-tal factors(29 cases,87.9％).Conclusion:Patients with severe postpartum haemorrhage requiring massive transfusion need extensive pharmacological and surgical interventions.It is crucial to reduce risk factors,particu-larly by decreasing the incidence of primary cesarean sections,optimize uterotonic use,and ultimately minimize the occurrence of severe postpartum haemorrhage and massive transfusion.

Objective:To explore the application effect of the BOPPPS[bridge-in(B), objective(O), pre-assessment(P), participatory learning(P), post-assessment(P), Summary(S) ]model combined with scenario-based teaching in out-of-school first aid training for school-aged children, aiming to offer insights for relevant educational practices.Methods:A quasi-experimental study was conducted. Using cluster sampling, 131 school-aged children participating in Wuhan first aid summer camp from July to August 2024 were selected as participants. Among them, 65 children enrolled in July 2024 were assigned to the control group and received training using traditional teaching methods, while 66 children enrolled in August 2024 were assigned to the experimental group and underwent training designed with the BOPPPS model integrated with scenario-based teaching according to the time of entry into the camp. After the training, theoretical exam scores, learning process evaluations, and training satisfaction were compared between the two groups.Results:The control group included 31 boys and 34 girls, aged (9.32 ± 1.83) years; the experimental group included 34 boys and 32 girls, aged (9.71 ± 1.73) years. After the intervention, the total scores of theoretical examination, learning process evaluation, and training satisfaction in the experimental group were (90.27 ± 4.41), (42.79 ± 1.39), and (21.43 ± 2.41) points, respectively, which were higher than those in the control group (82.05 ± 6.29), (38.85 ± 1.91), and (19.54 ± 3.02) points, and the differences were statistically significant ( t=6.94, 3.15, 4.16, all P<0.05). Conclusions:This out-of-school first aid training for school-aged children leveraged the professional expertise of a tertiary grade A hospital′s pediatric department. The integration of the BOPPPS model with scenario-based teaching effectively enhanced the first aid competencies of school-aged children and improved their satisfaction with the training.

The effective integration of ideological and political education into medical courses is one of the most important aspects of medical teaching reform and a key approach to fostering students'moral character.Based on the Outcomes-Based Education(OBE)philosophy,this article focuses on the learning outcomes of Medical Immunology ideological and political education,integrating relevant ideological and political elements with modular teaching content to form a themed"Medical Immunology Ideological and Politi-cal"teaching goal with distinctive features of Medical Immunology.Through a blended learning model of online and offline teaching methods,students are guided to learn modular teaching content.This study creatively integrates Medical Immunology theory with ideo-logical and political elements,carries out"Medical Immunology Ideological and Political"through professional knowledge,and achieves the goal of subtle and deep-seated ideological and political education.Moreover,it effectively improves students'comprehensive learning and application abilities,enabling them to apply what they have learned.