Based on the "regulating the pivot and unblocking the stomach" theory， this article proposes that the core pathogenesis of bile reflux gastritis （BRG） is disharmony of the three pivots and imbalance between the gallbladder and the stomach. Specifically， the pivot of zang-fu （脏腑） organs （spleen and stomach） exhibits abnormal ascending and descending functions， while the pivot of opening and closing （shaoyang） shows impaired flow， and the pivot of mind （heart and brain） has disordered regulation. These three pivots interact， ultimately leading to bile reflux attacking the stomach， injuring the gastric mucosa， and causing symptoms such as epigastric distension， pain， acid regurgitation， and heartburn. Clinically， the treatment principle is unblocking and regulating the three pivots， harmonizing the gallbladder and descending stomach qi， which closely follows the different pathomechanisms of three-pivot dysregulation， applying treatment according to syndrome differentiation. The regulation of the pivot of zang-fu organs focuses on fortifying the spleen and harmonzing stomach， raising the clear and directing the turbid downward. The regulation of the opening-and-closing pivot emphasizes harmonizing shaoyang， promoting gallbladder function and bowel movement. The regulation of the mind pivot centers on calming the heart and the mind， and harmonizing the stomach to ensure smooth qi flow. "Unblocking and regulating three pivots" method aims to restore the physiological functions of the gallbladder and stomach， providing a conceptual framework for the clinical management of BRG.

Objective: To investigate the current status of institutional review board construction in blood collection and supply institutions in China, and to provide evidence for standardized management of transfusion medicine ethics. Methods: A questionnaire survey was conducted to assess the development of institutional review boards in blood collection and supply institutions in 31 provinces, municipalities and autonomous regions across the country, excluding hong kong, macao and taiwan. Data were statistically analyzed using the chi-square test and Mann-Whitney U test. Results: Among 83 blood collection and supply institutions, the establishment rate of institutional review boards was 66.27% (55/83), with a higher rate in blood centers than in central blood stations. Of the 55 ethics review committees, 83.64% (46/55) uploaded information and completed registration in the National Medical Research Registration and Filing Information System. The registration rate was higher in blood centers than in central blood stations. On average, each institutional review board conducted 3 initial reviews and approved 2 research projects. The number of initial review items and the number of approved research projects were higher in blood centers than in central blood stations. Common problems in both blood centers and central blood stations included the appointment of the main leader as the director or deputy director, insufficient allocation of ethics professionals, and the general absence of an ethical review system for emergencies. Most committees lacked independent venues, and continuous training coverage was incomplete. Meanwhile, blood collection and supply institutions generally showed high level of ethical recognition of existing blood donation incentive measures. Conclusion: Progress has been made in the construction of transfusion medicine ethics in China; however, shortcomings remain in independence, professional composition of committee members, continuous training, and emergency response systems, requiring targeted improvements.

Objective:To evaluate the safety and efficacy of secondary transport on extracorporeal membrane oxygenation (ECMO) for critically ill children.Methods:This was a retrospective cohort study. Data from 222 pediatric patients who underwent ECMO transport from May 2019 to May 2024 at 5 ECMO centers and Chinese Database of Pediatric Extracorporeal Life Support Organization were collected. The cases were divided into primary and secondary transport groups by nature of transport. The clinical data, including demographics, ECMO indications, transport distance, pre-transport lab results, prognosis and complications were analyzed. Two independent samples t-test, Wilcoxon test, and χ2 test or Fisher′s exact probability method were used to compare the differences between 2 groups and evaluate the safety and efficacy of secondary transport. Results:Among the 222 children transported with ECMO, there were 135 males and 87 females, with an age of 3.0 (0.2, 7.0) years. There were 202 cases in the primary transport group and 20 cases in the secondary transport group. All secondary transport patients had failed attempts at weaning ECMO before transfer. The patients in the secondary transport group were older, had higher rates of surgical cannulation, circulatory support, and pre-ECMO lactate levels compared to the primary transport group (7.0 (2.8, 10.0) vs. 3.0 (0.2, 6.0) years old, 55.0% (11/20) vs. 3.6% (7/202), 80.0% (16/20) vs. 41.6% (84/202), (10±4) vs. (7±6) mmol/L, Z=3.41, χ 2=66.31, 10.99, t=2.24, all P<0.05). In the secondary transport group, the vasoactive-inotropic scores of patients on circulatory support and the oxygenation index for patients requiring respiratory support were higher than those in the primary transport group (83±33 vs. 82±68, 51.0±1.8 vs. 37.4±10.2, t=2.36, 2.63, respectively; both P<0.05). There were no statistically significant differences between the 2 groups in sex, transport distance, pre-ECMO creatinine, arterial blood gas BE values, and ECMO duration (all P>0.05). No life-threatening complications occurred during the transport in either group. Two patients in the secondary transport group underwent heart transplantation, and 1 patient underwent radiofrequency ablation. The overall survival rate between the 2 groups showed no statistically significant difference (45.0% (9/20) vs. 55.4% (112/202), χ2=1.15, P>0.05). Conclusions:Secondary ECMO transport for critically ill children don't increase mortality or life-threatening complications during transport. ECMO patients who cannot receive effective treatment locally can benefit from secondary transport to an advanced ECMO center provides further treatment opportunities.

By analyzing the current application of multi-modal data in the diagnosis of gastric "inflammation-cancer" transformation， this study explored the feasibility and strategies for constructing a disease-syndrome integrated diagnosis and treatment system. Based on traditional Chinese medicine （TCM） phenomics， we proposed utilizing multi-modal data from literature research， cross-sectional studies， and cohort follow-ups， combined with artificial intelligence technology， to establish a multi-dimensional diagnostic and treatment index system. This approach aims to uncover the complex pathogenesis and transformation patterns of gastric "inflammation-cancer" progression. Additionally， by dynamically collecting TCM four-diagnostic information and modern medical diagnostic information through a long-term follow-up system， we developed three major modules including information extraction， multi-modal phenotypic modeling， and information output， to make it enable real-world clinical data-driven long-term follow-up and treatment of chronic atrophic gastritis. This system can provide technical support for clinical diagnosis， treatment evaluation， and research， while also offering insights and methods for intelligent TCM diagnosis.

This consensus will introduce the characteristics of fillers used in the surgical cavities of domestic nasal surgery patients based on relevant literature and expert opinions. It will also provide recommendations for the selection of cavity fillers for different nasal diseases, with chronic sinusitis as a representative example.
Humans ; Nasal Cavity/surgery* ; Nasal Surgical Procedures ; China ; Consensus ; Sinusitis/surgery* ; Dermal Fillers

Objective To establish a classification tree model for non-alcoholic fatty liver disease(NAFLD)among aircrews,screen for influencing factors of NAFLD,so as to provide scientific basis for prevention and intervention decisions for NAFLD.Methods Aircrews who underwent recuperation at a sanatorium from January 2019 to December 2023 were selected as the research objects.Their annual physical examination data were collected and the NAFLD detection rate was calculated.Age,body mass index(BMI),blood pressure,waist circumference,blood routine,biochemistry indexes,and thyroid function were incorporated,and a NAFLD risk model was constructed using classification regression tree method.The predictive performance of the NAFLD classification tree model was evaluated through model misclassification matrix,risk statistics,and receiver operating characteristic curve.Results A total of 4088 aircrews were included in the study,and NAFLD was detected in 380 persons(380/4088,9.30%).The NAFLD model consisted of three layers,and five explanatory variables affecting the onset of NAFLD were extracted,including BMI,triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT),and total bilirubin(TBIL).BMI was located at the top of the classification tree and was the most important risk factor for NAFLD in aircrews.The area under the curve(AUC)of the model was 0.853.The predictive accuracy of NAFLD was 90.9%,indicating that the model has good accuracy and fitting effect.Conclusion In this study,the detection rate of NAFLD in aircrews was 9.30%.BMI,TG,HDL-C,ALT,and TBIL are risk factors for the onset of NAFLD.NAFLD is mainly related to weight gain and lipid metabolism disorders caused by unhealthy lifestyles.

In recent years, significant progress has been made in the treatment of chronic constipation, with high-quality studies emerging in areas such as fecal microbiota transplantation (FMT), sacral neuromodulation (SNM), acupuncture, and surgical techniques. The therapeutic approach is shifting from a traditional "medication and surgery" model toward an integrated strategy that includes dietary and defecation habit adjustment, FMT, SNM, acupuncture, pharmacotherapy, and surgery. Although FMT can partially improve stool frequency and consistency, its standardization and long-term efficacy require further validation. SNM demonstrates limited effectiveness in treating chronic constipation and is relatively cost-inefficient. Electroacupuncture remains controversial, though some studies support its value. Biofeedback therapy is recommended by multiple guidelines as the first-line treatment for dyssynergic defecation (DD), with portable home-based biofeedback systems showing considerable potential. For internal rectal prolapse (IRP) and rectocele (RC), various surgical options exist without a clear superiority, though laparoscopic ventral rectopexy (VMR) is increasingly favored due to its low recurrence rate and high patient satisfaction. In the surgical management of slow transit constipation (STC), total colectomy with ileorectal anastomosis remains the mainstream approach, while subtotal colectomy is gaining attention as an alternative.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective To explore the effect of hypoxia-inducible factor-1α(HIF-1α)inhibitor LW6 on ferroptosis in septic cardiomyopathy rats.Methods Rat septic cardiomyopathy model was prepared using cecal ligation and puncture(CLP)method.Thirty-six specific pathogen-free(SPF)6-8 weeks male SD rats were randomly divided into the sham-operated group,CLP group,CLP+solvent group,LW6 group,ferrostatin-1(Fer-1)group,and LW6+Fer-1 group.The degree of myocardial damage in each group was evaluated through hematoxylin-eosin stai-ning and detection of lactate dehydrogenase and creatine kinase content in cardiac tissue.Myocardial mitochondrial damage was observed by transmission electron microscopy.Ferroptosis level was determined by detecting iron ion concentration,reduced glutathione,malondialdehyde,and reactive oxygen species.Protein expression levels of HIF-1α,solute carrier family 7 member 11(SLC7A11),and glutathione peroxidase 4(GPX4)in cardiac tissue were detected by Western blotting.Results Compared with the CLP group and the CLP+solvent group,the LW6 group could ameliorate myocardial damage,alleviate mitochondrial damage,inhibit ferroptosis-related indicators(all P＜0.05),reduce HIF-1α protein expression levels(P＜0.05),and enhance SLC7A11 and GPX4 protein expression levels(both P＜0.05).Conclusion LW6 decreases HIF-1α expression and ferroptosis levels through the SLC7A11/GPX4 pathway,and ameliorates sepsis-induced cardiomyopathy.

In recent years, significant progress has been made in the treatment of chronic constipation, with high-quality studies emerging in areas such as fecal microbiota transplantation (FMT), sacral neuromodulation (SNM), acupuncture, and surgical techniques. The therapeutic approach is shifting from a traditional "medication and surgery" model toward an integrated strategy that includes dietary and defecation habit adjustment, FMT, SNM, acupuncture, pharmacotherapy, and surgery. Although FMT can partially improve stool frequency and consistency, its standardization and long-term efficacy require further validation. SNM demonstrates limited effectiveness in treating chronic constipation and is relatively cost-inefficient. Electroacupuncture remains controversial, though some studies support its value. Biofeedback therapy is recommended by multiple guidelines as the first-line treatment for dyssynergic defecation (DD), with portable home-based biofeedback systems showing considerable potential. For internal rectal prolapse (IRP) and rectocele (RC), various surgical options exist without a clear superiority, though laparoscopic ventral rectopexy (VMR) is increasingly favored due to its low recurrence rate and high patient satisfaction. In the surgical management of slow transit constipation (STC), total colectomy with ileorectal anastomosis remains the mainstream approach, while subtotal colectomy is gaining attention as an alternative.