OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

This paper discusses the pathogenesis and treatment strategies of skin cancer based on the theory of "spleen deficiency-sweat pore obstruction-toxin accumulation". It is believed that although the disease is located in the skin and body hair， it is not only the localized disorder but closely related to the imbalance of qi and blood of zang-fu （脏腑） organs. The core of the disease is the synergistic disorder of spleen， sweat pore， and skin and body hair. The disease progression follows a dynamic evolution from spleen deficiency with loss of nourishment， initial closure of sweat pore to binding of dampness and stasis with obstruction of sweat pore， and then to cancer toxin consolidation with damage to sweat pore. Based on this， three principles of building earth， opening sweat pore and attacking toxin are established. The method of fortifying spleen and raising the clear aims to consolidate the root and restore validity， with commonly used prescriptions including modifications of Buzhong Yiqi Decoction （补中益气汤）， Liujunzi Decoction （六君子汤） and Guipi Decoction （归脾汤）. The method of opening sweat pores with acrid-moistening medicinals is suggested when dredging and unblocking the sweat pore， commonly using acrid and warm dispersing medicinals， supplemented with herbs that nourish fluids and moisten dryness. The method of clearing heat and removing toxin is to break cancer toxin directly， and modifications of prescriptions such as Wuwei Xiaodu Beverage （五味消毒饮）， Xiaolei Pills （消瘰丸） and Xihuang Pills （犀黄丸） are commonly used. These approaches provide valuable ideas for the prevention and treatment of skin cancer with traditional Chinese medicine.

This paper discusses the pathogenesis and treatment strategies of skin cancer based on the theory of "spleen deficiency-sweat pore obstruction-toxin accumulation". It is believed that although the disease is located in the skin and body hair， it is not only the localized disorder but closely related to the imbalance of qi and blood of zang-fu （脏腑） organs. The core of the disease is the synergistic disorder of spleen， sweat pore， and skin and body hair. The disease progression follows a dynamic evolution from spleen deficiency with loss of nourishment， initial closure of sweat pore to binding of dampness and stasis with obstruction of sweat pore， and then to cancer toxin consolidation with damage to sweat pore. Based on this， three principles of building earth， opening sweat pore and attacking toxin are established. The method of fortifying spleen and raising the clear aims to consolidate the root and restore validity， with commonly used prescriptions including modifications of Buzhong Yiqi Decoction （补中益气汤）， Liujunzi Decoction （六君子汤） and Guipi Decoction （归脾汤）. The method of opening sweat pores with acrid-moistening medicinals is suggested when dredging and unblocking the sweat pore， commonly using acrid and warm dispersing medicinals， supplemented with herbs that nourish fluids and moisten dryness. The method of clearing heat and removing toxin is to break cancer toxin directly， and modifications of prescriptions such as Wuwei Xiaodu Beverage （五味消毒饮）， Xiaolei Pills （消瘰丸） and Xihuang Pills （犀黄丸） are commonly used. These approaches provide valuable ideas for the prevention and treatment of skin cancer with traditional Chinese medicine.

In response to the clinical needs of cancer treatment and rehabilitation, Professor Lin Hongsheng proposed the Wuzhi Wuyang (five treatments and rehabilitation) concept on the basis of years of clinical experience and the Guben Qingyuan (consolidate the foundation and clear the source) theory. Wuzhi Wuyang emphasizes the importance of treatment and rehabilitation and aims to provide personalized and stage-specific treatment and rehabilitation plans by integrating the advantages of traditional Chinese medicine (TCM) and modern medicine to achieve comprehensive life-cycle management for patients with cancer. The proposal of Wuzhi Wuyang has provided new ideas and methods for the treatment, prevention, and rehabilitation of cancer, along with valuable references for clinical practice and academic research. This article summarizes the connotation of Wuzhi Wuyang and its application in the comprehensive management of cancer prevention and treatment with TCM.

Objective: To investigate the prevalence of abnormal foot arch morphology and its associated factors among primary and secondary school students in Ganzhou City, so as to provide evidence for the prevention of such abnormalities. Methods: From November 2023 to May 2024, a questionnaire was conducted among 1 013 primary and secondary school students, who were selected from one primary school and one nine year continuous school with stratified cluster random sampling method. Professional equipment, including 2D foot scanning and plantar pressure plates, was utilized to screen pupils for abnormal foot arch morphology (including flatfoot and high arched foot). The Chi square was employed for intergroup comparisons, whilst multifactorial Logistic regression analysis was utilized to investigate the associated factors for the occurrence of foot morphological abnormality of arch among students. Results: The prevalence rate of flatfoot among primary and secondary school students at 61.1%, with bilateral cases accounting for 37.5% and unilateral cases for 23.6%; the prevalence of high arched foot was 8.0%, comprising 3.9% in both feet and 4.0% in one foot. The prevalence rates of flatfoot among boys and girls were 68.7% and 53.6% respectively. Multivariate Logistic regression analysis revealed that boys had a 1.45 times higher risk of developing flatfoot compared to girls ( OR =1.45, 95% CI = 1.05- 2.02), primary and secondary students aged 6-8 and 9-10 had 4.00, 3.81 times higher risk of flatfoot respectively compared to those aged 15-16 ( OR =4.00, 3.81, 95% CI =2.18-7.36, 2.08-6.99) (all P <0.05). Compared to girls, boys had a lower risk of developing high arched foot ( OR=0.52, 95%CI =0.28-0.95), primary and secondary students who frequently corrected their sitting and standing posture also had a lower risk of high arched foot ( OR = 0.30, 95% CI =0.10-0.88) (both P <0.05). Conclusions The prevalence of abnormal foot arch morphology among primary and secondary school students is relatively high, with exercise habits, and postural behaviour identified as associated factors. It is recommended to enhance early screening and behavioural interventions for key populations, thereby advancing the prevention and correction of foot morphological abnormality of arch.

ObjectiveTo investigate the clinical features and outcomes of recompensation in patients with autoimmune hepatitis （AIH）-related decompensated cirrhosis， to identify independent predictive factors， and to construct a nomogram prediction model for the probability of recompensation. MethodsA retrospective cohort study was conducted among the adult patients with AIH-related decompensated cirrhosis who were admitted to The Fifth Medical Center of PLA General Hospital from January 2015 to August 2023 （n=211）. The primary endpoint was achievement of recompensation， and the secondary endpoint was liver-related death or liver transplantation. According to the outcome of the patients at the end of the follow-up， the patients were divided into the recompensation group （n=16） and the persistent decompensation group（n=150）.The independent-samples t test was used for comparison of normally distributed continuous data with homogeneity of variance， and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data with heterogeneity of variance； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups； the Kaplan-Meier method was used for survival analysis； the Cox proportional-hazards regression model was used to identify independent predictive factors， and a nomogram model was constructed and validated. ResultsA total of 211 patients were enrolled， with a median age of 55.0 years and a median follow-up time of 44.0 months， and female patients accounted for 87.2%. Among the 211 patients， 61 （with a cumulative proportion of 35.5%） achieved recompensation. Compared with the persistent decompensation group， the recompensation group had significantly higher white blood cell count， platelet count （PLT）， total bilirubin （TBil）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bile acid， prothrombin time， international normalized ratio （INR）， SMA positive rate， Model for End-Stage Liver Disease （MELD） score， Child-Pugh score， and rate of use of glucocorticoids （all P0.05）， as well as significantly lower age at baseline， number of complications， and death/liver transplantation rate （all P0.05）. At 3 and 12 months after treatment， the recompensation group had continuous improvements in AST， TBil， INR， IgG， MELD score， and Child-Pugh score， which were significantly lower than the values in the persistent decompensation group （all P0.05）， alongside with continuous increases in PLT and albumin， which were significantly higher than the values in the persistent decompensation group （P0.05）. The multivariate Cox regression analysis showed that baseline ALT （hazard ratio ［HR］=1.067， 95% confidence interval ［CI］： 1.010 — 1.127， P=0.021）， IgG （HR=0.463，95%CI：0.258 — 0.833， P=0.010）， SMA positivity （HR=3.122，95%CI：1.768 — 5.515， P0.001）， and glucocorticoid therapy （HR=20.651，95%CI：8.744 — 48.770， P0.001） were independent predictive factors for recompensation， and the nomogram model based on these predictive factors showed excellent predictive performance （C-index=0.87，95%CI：0.84 — 0.90）. ConclusionAchieving recompensation significantly improves clinical outcomes in patients with AIH-related decompensated cirrhosis. Baseline SMA positivity， a high level of ALT， a low level of IgG， and corticosteroid therapy are independent predictive factors for recompensation. The predictive model constructed based on these factors can provide a basis for decision-making in individualized clinical management.

Objective To specifically extract and analyze nascent proteins synthesized by bone marrow mesenchymal stem cells(BMSCs)after transplantation into ischemic hearts using a technique employing mutant methionyl-tRNA synthetase(MetRSL247G)for nascent protein labeling,in order to explore the potential mechanisms of action in BMSCs post-transplantation.Methods Point mutation at position 274 of the MetRS gene in BMSCs was induced via lentiviral infection to enable azidonorleucine(ANL)-mediated labeling of nascent proteins in BMSCs.The labeling efficiency was verified by means of fluorescent non-canonical amino-acid tagging(FUNCAT).Thirty healthy female C57BL/6J mice(8-10 weeks old)were divided into control and experimental groups,with 15 mice in each group.The acute myocardial infarction model was constructed by ligating the left anterior descending coronary artery in experimental group,while control mice underwent only thoracotomy without coronary ligation.After modeling,both groups received intramyocardial injections of MetRSL247G-modified BMSCs(MetRSL247G-BMSCs)at 3 different sites in the peri-infarct ischemic region.Mice were intraperitoneally injected with ANL every 6 hours for 4 times on postoperative days 0,2,and 6(n=5 for each time point)respectively,euthanized 24 h after the last injection,and cardiac tissues were isolated.The newly synthesized and labeled proteins produced by BMSCs after transplantation into the myocardium of experimental and control groups were collected,using an enrichment technique for ANL-tagged proteins and liquid chromatography-tandem mass spectrometry(LC-MS)analysis.Gene ontology(GO)analysis,Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis,protein-protein interaction(PPI)analysis,and heatmap visualization analysis were performed to identify differentially expressed proteins at the 3 time points and screen key pathways and genes.Results Under fluorescence microscopy,the MetRSL247G lentivirus-infected BMSCs were observed to be labelled with mCherry signals,confirming the successful construction of the MetRSL247G-BMSCs cell line.Green fluorescent signals were detected only in nascent proteins in culture medium containing both MetRSL247G-BMSCs and ANL,validating the sensitivity and specificity of the labeling method.GO analysis revealed that differentially expressed proteins were primarily involved in basic cellular biological processes such as extracellular exosome formation,extracellular matrix organization,and focal adhesion.KEGG and PPI analyses indicated that the differential proteins were mainly involved in complement and coagulation cascade pathway,actin cytoskeleton regulation pathway,and apoptosis pathway.Heatmap analysis showed significantly upregulated expression of anti-apoptosis and cell adhesion-related factors in experimental group on day 1(P＜0.05),upregulated anti-apoptotic factors,pro-apoptotic factors,and cell adhesion-related factors on day 3(P＜0.05),and upregulated anti-apoptotic factors,cell differentiation-related factors,and cell adhesion-related factors on day 7(P＜0.05)compared with control group.Expression of apoptosis-inducing factor 1 was significantly downregulated on days 1 and 7(P＜0.05).On day 3,most differentially expressed proteins,including anti-apoptosis factors(Protein S100-A11,Clusterin,Gelsolin),pro-apoptosis factor(Cathepsin B),cell differentiation-related factor(Transgelin-2),and cell adhesion-related factors(Cofilin-1,Periostin,Fibronectin)were significantly upregulated(P＜0.05).Conclusions The MetRSL247G mutation enables BMSCs to incorporate ANL and synthesize labeled proteins,confirming the feasibility of this nascent protein labeling technique.Nascent proteins of BMSCs in ischemic myocardium primarily contribute to extracellular exosome secretion and extracellular matrix organization.BMSCs may adapt to and respond to ischemic and hypoxic environments by influencing complement and coagulation cascades,activating inflammatory factors,regulating actin cytoskeleton structure,and modulating apoptosis,thereby maintaining the survival of BMSCs.

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.

Emerging evidence suggests that dysbiosis of the gut microbiota is associated with the pathogenesis of Parkinson's disease (PD), a prevalent neurodegenerative disorder. The microbiota-gut-brain axis plays a crucial role in the development and progression of PD, and numerous studies have demonstrated the potential therapeutic benefits of modulations in the intestinal microbiota. This review provides insights into the characterization of the gut microbiota in patients with PD and highlights associations with clinical symptoms and underlying mechanisms. The discussion underscores the increased influence of the gut microbiota in the pathogenesis of PD. While the relationship is not fully elucidated, existing research demonstrates a strong correlation between changes in the composition of gut microbiota and disease development, and further investigation is warranted to explain the specific underlying mechanisms.
Humans ; Parkinson Disease/microbiology* ; Gastrointestinal Microbiome/physiology* ; Dysbiosis/microbiology*

Objective:Traditional salivary gland surgery involves incisions in the visible facial and cervical regions, leaving postoperative scars that affect cosmesis. This study aims to investigate the clinical efficacy, safety, and application value of robot-assisted endoscopic resection of benign submandibular and parotid gland lesions via a postauricular approach, while clarifying its advantageous differences compared with endoscopic surgery. Methods:Clinical data of 23 patients who underwent robot-assisted endoscopic surgery via a postauricular approach（11 parotid gland cases and 12 submandibular gland cases） from January 2017 to February 2025 were retrospectively analyzed. Meanwhile, A matched control group of patients who received postauricular endoscopic surgery during the same period was selected as the control group in a 1∶1 ratio（11 parotid gland cases and 12 submandibular gland cases）. Indicators such as operation time, intraoperative blood loss, complications, and postoperative aesthetic satisfaction scores（Numeric Satisfaction Scale, NSS） were collected and compared between the two groups. The inclusion criteria were limited to benign lesions of the parotid superficial lobe（diameter ≤5 cm, without deep lobe involvement） and benign submandibular gland lesions（diameter ≤4 cm, without extension through the mylohyoid muscle）. Results:All robot-assisted surgeries were successfully completed without conversion to open surgery. In the robot group, there were 7 male patients（mean age 39.5 years） and 16 female patients（mean age 35.9 years）. For parotid gland surgeries, the mean operation time was （114.00±38.35） minutes. For submandibular gland surgeries, the mean operation time was（140.00±30.75） minutes.Temporary facial paralysis occurred in 0 of patients after robotic submandibular gland surgery （vs.8% in the endoscopic group） and 18% after robotic parotid gland surgery （vs.27 % in the endoscopic group）,all of which resolved within 1 month, with no occurrence of salivary fistula or infection. Patients had high aesthetic satisfaction（NSS scores: 8.90±1.20 for parotid surgeries and 9.00±0.70 for submandibular surgeries）. No tumor recurrence was observed during the 8-77 month follow-up period. Conclusion:Robot-assisted endoscopic salivary gland surgery via a postauricular approach is safe and feasible. With three-dimensional high-definition visualization and precise mechanical manipulation, it outperforms traditional endoscopic surgery in reducing blood loss, lowering the risk of nerve injury, and achieving long-term cosmetic outcomes. It is particularly suitable for young patients and cases with benign lesions of the parotid superficial lobe or submandibular gland that have high aesthetic demands. However, this surgical approach is not suitable for deep parotid lobe tumors, and its long-term efficacy requires verification through large-sample studies.
Humans ; Robotic Surgical Procedures/methods* ; Retrospective Studies ; Endoscopy/methods* ; Submandibular Gland/surgery* ; Parotid Gland/surgery* ; Female ; Male ; Operative Time ; Salivary Glands/surgery* ; Adult ; Middle Aged