To systematically analyzed the reporting status of core elements in publicly available clinical practice guideline(hereafter referred to as "guideline") protocols published domestically and internationally over the past decade, identified existing problems, and provided evidence to inform the standardized writing and publication of future guideline protocols.

Background and Aims:Totally implantable venous access port(TIVAP)are widely used for chemotherapy,blood transfusion,and nutritional support in patients with malignancies.Among them,upper arm port(UAP)are increasingly recommended in clinical practice due to their advantages in avoiding thoracic complications and providing more concealed incisions.Currently,two main implantation techniques are used for UAP:the tunnel needle-transverse incision technique and the puncture point-transverse incision technique.This study aims to compare the clinical outcomes of these two techniques in patients with hematological malignancies,focusing on safety and cosmetic appearance,to provide evidence for clinical decision-making.Methods:A retrospective analysis was conducted on 412 patients with hematological malignancies who underwent UAP implantation at Xiangya Hospital of Central South University between December 2021 and December 2024.Based on the implantation method,patients were divided into the tunnel needle-transverse incision group(n=200)and the puncture point-transverse incision group(n=212).Intraoperative variables(operative time,intraoperative pain score,catheter kinking at the pocket,intraoperative blood loss)and postoperative indicators(incidence of complications and incision aesthetic satisfaction)were compared between the two groups.Results:There were no significant differences in baseline characteristics between the two groups(all P>0.05),indicating comparability.The puncture point-transverse incision group showed superior performance in operative time[(32.99±4.91)min vs.(41.42±5.35)min],catheter kinking rate(1.4％vs.8.5％),and incision aesthetic satisfaction(7.99±0.58 vs.6.26±0.86)compared with the tunnel needle-transverse incision group(all P<0.05).Although the puncture point group had slightly more intraoperative bleeding[(4.52±1.02)mL vs.(4.16±0.83)mL],the difference,while statistically significant,was of limited clinical relevance.No significant differences were observed between the two groups in intraoperative pain scores or incidence of postoperative complications(both P>0.05).Conclusion:The puncture point-transverse incision technique offers significant advantages in terms of operative efficiency,reduced catheter kinking,and improved incision aesthetics,without compromising safety.It represents a promising alternative to the traditional tunnel needle-transverse incision method and has strong potential for broader clinical adoption.The puncture point-transverse incision technique offers advantages such as shorter operative time,lower catheter kinking rate,and higher incision aesthetic satisfaction.It is a promising alternative to the traditional tunnel needle-transverse incision technique and has good potential for clinical application and promotion.

Myocardial fibrosis is a serious cause of heart failure and even sudden cardiac death. However, the mechanisms underlying myocardial ischemia-induced cardiac fibrosis remain unclear. Here, we identified that the expression of sterile alpha and TIR motif containing 1 (SARM1), was increased significantly in the ischemic cardiomyopathy patients, dilated cardiomyopathy patients (GSE116250) and fibrotic heart tissues of mice. Additionally, inhibition or knockdown of SARM1 can improve myocardial fibrosis and cardiac function of myocardial infarction (MI) mice. Moreover, SARM1 fibroblasts-specific knock-in mice had increased deposition of extracellular matrix and impaired cardiac function. Mechanically, elevated expression of SARM1 promotes the deposition of extracellular matrix by directly modulating P4HA1. Notably, by using the Click-iT reaction, we identified that the increased expression of ZDHHC17 promotes the palmitoylation levels of SARM1, thereby accelerating the fibrosis process. Based on the fibrosis-promoting effect of SARM1, we screened several drugs with anti-myocardial fibrosis activity. In conclusion, we have unveiled that palmitoylated SARM1 targeting P4HA1 promotes collagen deposition and myocardial fibrosis. Inhibition of SARM1 is a potential strategy for the treatment of myocardial fibrosis. The sites where SARM1 interacts with P4HA1 and the palmitoylation modification sites of SARM1 may be the active targets for anti-fibrosis drugs.

BACKGROUND:Exercise has a regulatory effect on intestinal flora and glucose metabolism,but the effects of high-intensity intermittent exercise on intestinal flora and glucose metabolism in patients with type 2 diabetes mellitus are unclear. OBJECTIVE:To investigate the effects of high-intensity intermittent exercise on glucose metabolism and intestinal flora in patients with type 2 diabetes mellitus. METHODS:Eleven patients with type 2 diabetes mellitus were recruited,among which,two were lost to the follow-up and nine were finally enrolled.High-intensity intermittent exercise intervention was conducted 3 times per week for 6 continuous weeks.Fasting blood and fecal samples were collected before and after the intervention.Glucose metabolism indexes were detected in the blood samples,and intestinal flora was detected in the fecal samples.Changes in glucose metabolism indexes and intestinal flora indexes of the patients with type 2 diabetes mellitus before and after the intervention were compared. RESULTS AND CONCLUSION:After 6 weeks of high-intensity intermittent exercise intervention,fasting blood glucose and glycosylated serum protein levels in patients were significantly reduced(P<0.05),and fasting insulin,although not significantly changed,was decreased compared with before intervention.Alpha diversity analysis showed that the diversity(Shannon index),richness(Chao index)and coverage(Coverage index)did not change significantly.Venn diagrams showed that the relative abundance of Bacteroidetes,Actinobacteria,Proteobacteria,and Fusobacteria in the intestinal flora of the patients increased,and the relative abundance of Firmicutes decreased,and a significant decrease was seen in Ruminococcus_torques and Ruminococcus_gnavus in the Firmicutes,which were both positively correlated with the abnormalities of the glycemic metabolism-related indicators,as well as with other disease development.All these findings indicate that high-intensity intermittent exercise intervention has an improvement effect on the glycemic metabolism-related indexes of patients with type 2 diabetes mellitus,and the abundance of beneficial flora in the intestinal tract increases,and the abundance of harmful flora decreased,enhancing the stability of the intestinal flora in patients.

BACKGROUND:The regulation of intestinal flora by exercise is closely related to human health,but intestinal flora involves many factors.Existing studies have lacked consistent evidence on the effect of exercise on the intestinal flora of college students. OBJECTIVE:To explore the effects of exercise on intestinal flora diversity and species composition of college students. METHODS:Through systematic search of PubMed,Web of Science,Embase,Medline,Cochrane Library,CNKI,WanFang Database and VIP database,eight empirical studies were selected and included,and semi-quantitative analysis was performed on them. RESULTS AND CONCLUSION:In terms of the species diversity of the intestinal flora,both high-intensity interval training and Tai Chi exercise significantly enhance the species diversity of intestinal flora in college students,while aerobic exercise does not have a significant effect on the enhancement of intestinal flora diversity in college students.In terms of the species composition of the intestinal flora,all three exercise modalities significantly alter the compositional structure of the intestinal flora in college students,which can increase the abundance of beneficial bacteria such as Ruminalococcus,Faecalis prevotelli,Blautia,and decrease the abundance of harmful bacteria such as Escherichia spp.Compared with high-intensity interval training,aerobic and Tai Chi exercise causes more elevated abundance of beneficial bacteria.In addition to changes in intestinal flora characteristics,exercise improves body composition,cardiorespiratory function,and executive function in college students,and these health benefits are closely linked to exercise-induced changes in intestinal flora that can produce health benefits for the body through metabolic regulation,barrier function,and neuromodulation.Although studies have confirmed the association between exercise and intestinal flora,the mechanism by which exercise affects intestinal flora has not yet been clarified,and at the same time,localizing the flora related to the host health is the key to targeting intestinal flora as a therapeutic target in the future,all of which are worthy of further attention and investigation.

To introduce and analyze guideline terminology related to clinical question formulation, evidence retrieval and appraisal, and recommendation development.

BACKGROUND:Blood flow restriction resistance exercise is an emerging mode of resistance exercise that restricts blood flow at lower loads,achieving effects similar to or even better than high-load exercises.Current research on its specific mechanisms and applications in obesity improvement is still limited.Exploring the potential mechanisms of blood flow restriction resistance exercise and its application in obese populations could provide a novel exercise prescription option for this group.OBJECTIVE:To explore the potential mechanisms of blood flow restriction resistance exercise on obesity-related metabolism by comparing the effect of a single session of traditional resistance exercise and blood flow restriction resistance exercise on serum metabolites in obese young men.METHODS:Twenty-five obese young men underwent a single session of traditional resistance exercise(n=13)or blood flow restriction resistance exercise(n=12).Venous blood samples were collected before exercise,immediately post-exercise,1 hour post-exercise,and 24 hours post-exercise.High-performance liquid chromatography-tandem mass spectrometry was used to analyze the serum metabolome,focusing on the metabolites of the three major energy substances(carbohydrates,lipids,and amino acids)and related metabolic pathways.RESULTS AND CONCLUSION:(1)Both resistance exercise and blood flow restriction resistance exercise induced acute changes in the serum metabolomic profile.(2)In the traditional resistance exercise group,two carbohydrate differential metabolites,four lipid differential metabolites,and three amino acid differential metabolites were identified.In the blood flow restriction resistance exercise group,10 lipid differential metabolites and 3 amino acid differential metabolites were discovered.(3)Both traditional resistance exercise and blood flow restriction resistance exercise significantly affected the serum metabolites in obese young men,with the greatest impact observed 1 hour post-exercise.Comparatively,blood flow restriction resistance exercise had a broader and more prolonged effect on the metabolites.(4)Traditional resistance exercise showed a more pronounced regulation of carbohydrate metabolites,particularly in the consumption of D-galactose and glycerol,while blood flow restriction resistance exercise exhibited unique advantages in the regulation of lipid and amino acid metabolites,such as an increase in phospholipids and the potential promotion of fatty acid oxidation via aspartic acid.These differences may be related to inflammation regulation and insulin sensitivity,but further research is needed to verify their clinical significance.

Objective:To investigate the role and molecular mechanisms of signal transducer and activator of tran-scription 3(STAT3)in the paraventricular nucleus(PVN)of the hypothalamus in regulating body weight and energy metabolism in mice.Methods:AAV2/9-hSyn-Cre-EGFP virus was stereotactically injected into the PVN of STAT3Flox/Flox mice to conditionally knock out(CKO)STAT3 in the PVN.STAT3 expression was verified via immunoflu-orescence staining and Western blot.Body weight and temperature were monitored,glucose tolerance was assessed using glucose tolerance tests in mice,and morphological changes in the liver,interscapular brown adipose tissue(IBAT),in-guinal white adipose tissue(IWAT),and quadriceps muscle were evaluated via hematoxylin-eosin(HE)staining.RT-qPCR was used to measure mRNA levels of platelet-derived growth factor receptor α(PDGFRα),peroxisome prolifera-tor-activated receptor γ(PPARγ),hormone-sensitive lipase(HSL),and adipose triglyceride lipase(ATGL)in these tissues.Results:STAT3 protein expression in the PVN of CKO mice was significantly reduced,and the number of STAT3-positive neurons was also decreased.Compared to wild-type(WT)mice,CKO mice exhibited increased body weight,impaired thermogenesis in IBAT,and reduced glucose tolerance.HE staining revealed lipid droplet accumula-tion in hepatocytes of the liver,enlarged adipocytes with hypertrophic lipid droplets and leukocyte infiltration in adipose tissues,and intermuscular fat deposition in the quadriceps muscle.RT-qPCR analysis showed decreased mRNA levels of PDGFRα,HSL,and ATGL in the liver;upregulated PPARγ mRNA but downregulated HSL and ATGL mRNA in IBAT and IWAT;and reduced PPARγ and HSL mRNA levels in the quadriceps muscle of CKO mice.Conclusion:The STAT3 signaling pathway in the PVN is critical for maintaining systemic energy balance and serves as a key node in met-abolic regulation.

Background and Aims:Totally implantable venous access ports(TIVAP)are widely used in patients requiring long-term intravenous therapy.Traditional butterfly needle puncture fixation methods have limitations,including low success rates,increased pain,and risk of needle-stick injury.This study aimed to design an adjustable puncture protection kit for butterfly needles and evaluate its clinical utility using a simulated device.Methods:A prospective randomized controlled trial was conducted with 70 patients implanted with upper arm ports in the Hematology Department of Xiangya Hospital,Central South University,from January to December 2024.The patients were divided into a study group and a control group,with 35 cases in each,using a randomized block design.The study group underwent puncture with the simulated adjustable protection kit,while the control group used the traditional finger fixation method.Outcomes compared included first-attempt success rate,vertical puncture rate,pain score,puncture time,and complication rate.Results:The baseline characteristics of the two groups were balanced.The study group had significantly higher first-attempt puncture success rate and vertical puncture rate than the control group(94.3%vs.77.1%;91.4%vs.57.1%,both P<0.05).In the experimental group compared with the control group,pain scores were lower(1.80±1.13 vs.2.94±1.33,P<0.05),and puncture time was shorter[(31.31±9.05)s vs.(41.80±23.97)s,P<0.05].There was no significant difference in the incidence of puncture-related complications between the two groups(2.9%vs.14.3%,P>0.05).Conclusion:The simulated adjustable butterfly needle puncture protection kit effectively improves puncture success,enhances efficiency,reduces patient pain,and demonstrates good clinical safety.This innovative design provides a promising solution for reducing needle-stick injury risks and optimizing port puncture procedures,although larger,multicenter,and long-term studies are warranted.

BACKGROUND:Blood flow restriction resistance exercise is an emerging mode of resistance exercise that restricts blood flow at lower loads,achieving effects similar to or even better than high-load exercises.Current research on its specific mechanisms and applications in obesity improvement is still limited.Exploring the potential mechanisms of blood flow restriction resistance exercise and its application in obese populations could provide a novel exercise prescription option for this group.OBJECTIVE:To explore the potential mechanisms of blood flow restriction resistance exercise on obesity-related metabolism by comparing the effect of a single session of traditional resistance exercise and blood flow restriction resistance exercise on serum metabolites in obese young men.METHODS:Twenty-five obese young men underwent a single session of traditional resistance exercise(n=13)or blood flow restriction resistance exercise(n=12).Venous blood samples were collected before exercise,immediately post-exercise,1 hour post-exercise,and 24 hours post-exercise.High-performance liquid chromatography-tandem mass spectrometry was used to analyze the serum metabolome,focusing on the metabolites of the three major energy substances(carbohydrates,lipids,and amino acids)and related metabolic pathways.RESULTS AND CONCLUSION:(1)Both resistance exercise and blood flow restriction resistance exercise induced acute changes in the serum metabolomic profile.(2)In the traditional resistance exercise group,two carbohydrate differential metabolites,four lipid differential metabolites,and three amino acid differential metabolites were identified.In the blood flow restriction resistance exercise group,10 lipid differential metabolites and 3 amino acid differential metabolites were discovered.(3)Both traditional resistance exercise and blood flow restriction resistance exercise significantly affected the serum metabolites in obese young men,with the greatest impact observed 1 hour post-exercise.Comparatively,blood flow restriction resistance exercise had a broader and more prolonged effect on the metabolites.(4)Traditional resistance exercise showed a more pronounced regulation of carbohydrate metabolites,particularly in the consumption of D-galactose and glycerol,while blood flow restriction resistance exercise exhibited unique advantages in the regulation of lipid and amino acid metabolites,such as an increase in phospholipids and the potential promotion of fatty acid oxidation via aspartic acid.These differences may be related to inflammation regulation and insulin sensitivity,but further research is needed to verify their clinical significance.