Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

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 investigate the current status and influencing factors of ICU nurses' perception of risks and benefits of family presence during resuscitation, and to provide scientific evidence for the formulation of relevant policies in medical institutions.Methods:A convenience sampling method was used to recruit 370 ICU nurses from four Class Ⅲ Grade A hospitals in Taizhou between October and December 2024. A general information questionnaire, the Chinese version of the Family Presence Risk-Benefit Scale (FPR-BS), and the Chinese version of the Family Presence Self-Confidence Scale (FPS-CS) were used. Hierarchical multiple linear regression was applied to explore the influencing factors of ICU nurses' perception of risks and benefits of family presence during resuscitation.Results:A total of 370 questionnaires were distributed, and 357 valid questionnaires were collected, with a valid response rate of 96.49%. The total score of the Chinese version of FPR-BS among 357 ICU nurses was (50.25±10.54), and the total score of the Chinese version of FPS-CS was (40.36±8.19). Hierarchical multiple linear regression analysis showed that gender, age, years of work experience, educational level, number of times participating in resuscitation, and self-confidence regarding family presence during resuscitation were influencing factors of risk-benefit perception ( P<0.05) . Conclusions:ICU nurses' perception of the risks and benefits of family presence during resuscitation was at a relatively low to moderate level. Self-confidence regarding family presence during resuscitation was correlated with risk-benefit perception. When implementing policies on family presence during resuscitation, medical institutions should first improve nurses' self-confidence in this regard and provide targeted support.

Objective To identify the taste critical quality attribute and design and optimize the flavor-correcting formulation of the traditional Chinese medicine oral preparation Qingre Jiedu Oral Liquid,in order to improve its taste and enhance patient medication adherence.Methods The taste assignment method was employed to identify the taste critical quality attribute of Qingre Jiedu Oral Liquid.Based on human sensory evaluation and the standardized Euclidean distance in electronic tongue analysis,suitable types of corrigent were determined.Subsequently,under constraints such as maximum allowable dosage,solubility,and sweetness,the optimal taste formulation for the sugar-free intermediate of Qingre Jiedu Oral Liquid was determined using Box-Behnken experimental design combined with electronic tongue and human sensory evaluation results.The study was reviewed and approved by the Ethics Committee of Beijing University of Chinese Medicine(Ethics Approval Number 2020BZYLL0609).Results The quantitative score for bitter taste of Qingre Jiedu Oral Liquid accounted for 30.36%,confirming bitterness as the taste critical quality attribute requiring attention.The optimal taste formulation for the sugar-free intermediate of Qingre Jiedu Oral Liquid was determined to be 120 mg·mL?1 erythritol,12 mg·mL?1 acesulfame potassium,and 2.4 mg·mL?1 stevioside.This formulation achieved an 11.75-point improvement in sensory evaluation scores compared to the original commercially available oral liquid.Conclusion This study successfully improved the taste of Qingre Jiedu Oral Liquid and established a comprehensive strategy for flavor-correcting formulation optimization,including a method for identifying taste critical quality attribute.This strategy provides a referential paradigm for palatability enhancement of similar traditional Chinese medicine oral preparations,laying a crucial technical foundation for elevating the clinical value of Chinese herbal medicines and promoting the high-quality development of traditional Chinese medicine(TCM).

Objective To prepare a mouse model of asthenozoospermia(AZS)with high sperm DNA fragmentation(SDF)using corticosterone(CORT)and sodium benzoate(NaB).Methods Fifty 3-week-old male ICR mice were divided randomly into CORT-treated(n=30)and NaB-treated(n=20)groups.The CORT group was further divided into the following six groups(n=5 per group):high CORT(500 μg/mL),medium CORT(200 μg/mL),and low CORT(10 μg/mL)drinking water group,drinking water control group,CORT injection(40 mg/kg)group,and injection control group(normal saline).The animals were modeled continuously for 50 d.Mice in the NaB group were further divided into four groups(n=5 per group):high NaB(500 mg/kg),medium NaB(300 mg/kg),and low NaB(100 mg/kg)gavage groups,and control group(normal saline).The animals were modeled continuously for 50 d.The physiological state of the mice in each group was observed and mass changes were recorded continuously.The sperm motility capacity and DNA fragmentation index(DFI)of the sperm were observed from the tail of the epididymis after the end of the modeling.Results The rate of mass change in the CORT-injection moding group showed a downward trend.There was no significant difference(P＞0.05)in the high NaB gavage group,and the rate of body mass change in the high NaB gavage group was significantly decreased compared with the control group(P＜0.05).The percentages of forward motility sperm were significantly decreased in the CORT injection group(P＞0.05)and the percentage in the high NaB gavage group(P＜0.05),compared with the control group.The DFI was increased in the CORT injection group compared with the control group,but the difference was not significant(P＞0.05),and the DFI in the high NaB gavage group was significantly increased compared with the control group(P＜0.05).Conclusions Intragastric gavage with NaB 500 mg/(kg·d)for 50 d is an ideal method for constructing an animal model of AZS with high SDF.

As a symbiotic microbial community within the human body,the gut microbiota plays a crucial role in modulating various physiological processes,including metabolism,immunity,and endocrine function.During allogeneic hematopoietic stem cell transplantation(allo-HSCT),the hematopoietic and immune systems undergo significant changes,which are also influenced by the gut microbiota.Specifically,regarding hematopoietic function,the gut microbiota facilitates the multi-lineage differentiation of hematopoietic stem cells via NOD1-STATs and TLRs-MyD88 signaling pathways,and promotes rapid granulomonocytic lineage differentiation under infection stress.Consequently,early-stage primary graft dysfunction following transplantation may be associated with gut microbiota dysbiosis.In terms of immune function,the gut microbiota enhances the expression of antigen-presenting molecules on intestinal epithelial cells,thereby initiating acute graft-versus-host disease(aGVHD)in the gastrointestinal tract.Moreover,the gut microbiota regulates intestinal immune function through metabolites such as short-chain fatty acids,bile acids,and indole derivatives.Dysbiosis of the gut microbiota can lead to disrup-tion of the intestinal mucus barrier and immune barrier functions,further promoting the onset and progression of aGVHD in the gastrointestinal tract.Therefore,targeting the gut microbiota has emerged as an attractive therapeutic strategy and has been clinically applied.Notably,fecal microbiota transplantation combined with immunosuppressive therapy has shown significant efficacy in alleviating clinical severity and improving prognosis in steroid-refractory aGVHD,demonstrating high safety and manageable adverse reactions,representing a novel breakthrough in its treatment.

Objective To prepare a mouse model of asthenozoospermia(AZS)with high sperm DNA fragmentation(SDF)using corticosterone(CORT)and sodium benzoate(NaB).Methods Fifty 3-week-old male ICR mice were divided randomly into CORT-treated(n=30)and NaB-treated(n=20)groups.The CORT group was further divided into the following six groups(n=5 per group):high CORT(500 μg/mL),medium CORT(200 μg/mL),and low CORT(10 μg/mL)drinking water group,drinking water control group,CORT injection(40 mg/kg)group,and injection control group(normal saline).The animals were modeled continuously for 50 d.Mice in the NaB group were further divided into four groups(n=5 per group):high NaB(500 mg/kg),medium NaB(300 mg/kg),and low NaB(100 mg/kg)gavage groups,and control group(normal saline).The animals were modeled continuously for 50 d.The physiological state of the mice in each group was observed and mass changes were recorded continuously.The sperm motility capacity and DNA fragmentation index(DFI)of the sperm were observed from the tail of the epididymis after the end of the modeling.Results The rate of mass change in the CORT-injection moding group showed a downward trend.There was no significant difference(P＞0.05)in the high NaB gavage group,and the rate of body mass change in the high NaB gavage group was significantly decreased compared with the control group(P＜0.05).The percentages of forward motility sperm were significantly decreased in the CORT injection group(P＞0.05)and the percentage in the high NaB gavage group(P＜0.05),compared with the control group.The DFI was increased in the CORT injection group compared with the control group,but the difference was not significant(P＞0.05),and the DFI in the high NaB gavage group was significantly increased compared with the control group(P＜0.05).Conclusions Intragastric gavage with NaB 500 mg/(kg·d)for 50 d is an ideal method for constructing an animal model of AZS with high SDF.

Objective:To investigate the current status and influencing factors of ICU nurses' perception of risks and benefits of family presence during resuscitation, and to provide scientific evidence for the formulation of relevant policies in medical institutions.Methods:A convenience sampling method was used to recruit 370 ICU nurses from four Class Ⅲ Grade A hospitals in Taizhou between October and December 2024. A general information questionnaire, the Chinese version of the Family Presence Risk-Benefit Scale (FPR-BS), and the Chinese version of the Family Presence Self-Confidence Scale (FPS-CS) were used. Hierarchical multiple linear regression was applied to explore the influencing factors of ICU nurses' perception of risks and benefits of family presence during resuscitation.Results:A total of 370 questionnaires were distributed, and 357 valid questionnaires were collected, with a valid response rate of 96.49%. The total score of the Chinese version of FPR-BS among 357 ICU nurses was (50.25±10.54), and the total score of the Chinese version of FPS-CS was (40.36±8.19). Hierarchical multiple linear regression analysis showed that gender, age, years of work experience, educational level, number of times participating in resuscitation, and self-confidence regarding family presence during resuscitation were influencing factors of risk-benefit perception ( P<0.05) . Conclusions:ICU nurses' perception of the risks and benefits of family presence during resuscitation was at a relatively low to moderate level. Self-confidence regarding family presence during resuscitation was correlated with risk-benefit perception. When implementing policies on family presence during resuscitation, medical institutions should first improve nurses' self-confidence in this regard and provide targeted support.