ObjectiveTo investigate the inhibitory effect of tauroursodeoxycholic acid （TUDCA） on neurogenic heterotopic ossification （NHO） after spinal cord injury and its potential mechanism. MethodsSPF-grade male C57BL/6 mice were used to establish an NHO model. The mice were randomly divided into three groups： sham operation group （laminectomy only）， NHO model group （spinal cord injury + intramuscular injection of cardiotoxin）， and TUDCA treatment group （NHO model + daily intragastric administration of TUDCA at 200 mg/kg for 4 consecutive weeks）. The area and maturity of heterotopic ossification were quantitatively assessed by micro-computed tomography（micro-CT） and hematoxylin-eosin（H&E） staining. Flow cytometry was used to quantify the interleukin（IL）-1β secretion level of M2 macrophages. RAW264.7 macrophages were cultured in vitro and divided into control， tumor necrosis factor（TNF）α， and TNFα+TUDCA （200 μmol/L） groups to detect the expression level of the polarization marker CD206. Additionally， macrophages were divided into control， TUDCA 200 μmol/L， and TUDCA 400 μmol/L groups to assess the IL-1β secretion level. ResultsCompared with the NHO group， the bone volume in the TUDCA-treated group was significantly reduced （12.69±1.13 vs. 7.647±1.19， P=0.003）. Compared with the TNFα group， qPCR results showed that the expression of the M2 macrophage marker CD206 was significantly upregulated in the TNFα+TUDCA group （0.55±0.019，1.11±0.023， P＜0.001）. Compared with the control group， ELISA results showed that TUDCA stimulation of macrophages significantly upregulated IL-1β secretion （404.7±24.38 vs. 652.8±32.61， P=0.003 7）. TUDCA administration upregulated IL-1β secretion by local muscle macrophages and inhibited heterotopic ossification formation. ConclusionsTUDCA might participate in inhibiting NHO formation by inducing M2 macrophage polarization and upregulating IL-1β secretion， thereby alleviating the development and progression of neurogenic heterotopic ossification after spinal cord injury. This finding provides experimental evidence for expanding the application of TUDCA in the treatment of complications following spinal cord injury.

OBJECTIVE To develop evidence-based clinical practice recommendations for the use of hemostatic drugs in special populations， so as to improve the efficacy and safety of medication.METHODS Led by the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital， a working group of 79 experts covering clinical pharmacy， obstetrics and gynecology， pediatrics and other fields was established. Clinical questions regarding the efficacy and safety of hemostatic drugs in special populations were screened through literature review and two rounds of Delphi questionnaire surveys. Intervention questions were structured using the population， intervention， comparison， and outcome framework， while management questions were additionally described using the population， clinical setting, management measure， and outcome framework. Databases including Medline， Embase， Cochrane Library， CNKI， Wanfang Data， and VIP were systematically searched to collect and screen relevant evidence. Recommendations were formulated through recommendation questionnaire surveys and expert consensus meetings， and the quality of evidence and strength of recommendations were graded according to the Grading of Recommendations Assessment， Development and Evaluation system. RESULTS &CONCLUSIONS A total of 8 clinical questions were finally determined， the consensus rates of all clinical questions and recommendations were more than 90%， and 8 recommendations on the use of hemostatic drugs in special populations were formulated. These recommendations cover special populations including children， women during pregnancy/puerperium/lactation， the elderly， patients with hepatic impairment， patients in the perioperative period of liver transplantation， patients with renal impairment/on dialysis/in the perioperative period of kidney transplantation， immunocompromised patients， and patients with hematological diseases. The recommendations specify the applicable scenarios， dose adjustment principles， monitoring indicators， and safety management strategies of hemostatic drugs in different special populations， which can provide a reference for the clinical application of hemostatic drugs in special populations and help clinicians and pharmacists develop individualized medication plans.

Xiang thinking is a cognitive approach that reflects the relationships between phenomena and their underlying principles by analyzing their external manifestations through methods such as analogy， reasoning， deduction， and symbolism. This article applied xiang thinking to analyze the etiology and pathogenesis of "wind， fire， phlegm， and blood stasis" in stroke， thereby exploring its impact on the principles of syndrome differentiation and treatment of this condition. Meanwhile， the article traced the construction process of xiang thinking， and interpreted the concept of "toxin pathogen" in traditional Chinese medicine from four perspectives， state， attribute， origin， and law. Furthermore， the relationship between the process of constructing xiang thinking and the origin of etiology， identification methods， pathogenesis evolution， and treatment strategies for stroke with syndrome of combined blood stasis and toxin was explored， so as to provide insights into research on the etiology and pathogenesis of stroke， as well as clinical diagnosis and treatment approaches.

Tumor metabolic reprogramming and immune escape synergistically promote tumor progression, in which methionine (Met) metabolism plays a key role through epigenetic regulation and immune microenvironment remodelling. This paper systematically summarzes the mechanisms by which aberrant Met metabolism leads to “methionine addiction” and maintains the malignant phenotype of tumor cells, and describes its multiple modulations of the immune system: inducing T-cell depletion, promoting the polarization of M2-type macrophages, inhibiting the activity of NK cells, and enhancing the function of tumor-associated fibroblasts. Furthermore, therapeutic strategies targeting Met metabolism, including methionine-restricted diets, metabolic enzyme (MAT2A, NNMT) inhibitors, and epigenetic targets (PRMT5 inhibitors), are explored to provide theoretical reference for the development of Met-targeted therapies.

This study investigates the neuroprotective potential of extracellular vesicles (EVs) delivering quercetin-3-O-β-d-glucuronic acid (QG-EVs) in cerebral ischemia-reperfusion injury (CIRI). Targeted brain delivery of QG-EVs was confirmed, with neuron cells identified as pivotal in modulating CIRI through single-cell RNA sequencing (scRNA-seq). Activating transcription factor 4 (Atf4) was highlighted as a critical regulatory factor, and in vitro studies revealed that silencing Atf4 diminished the neuroprotective effects of QG-EVs, increasing oxidative stress levels and neuronal apoptosis. In a CIRI mouse model, the knockdown of Atf4 attenuated the protective outcomes provided by QG-EVs, further affirming the role of Atf4 in mediating neuroprotection. Behavioral assessments and protein analysis showed that QG-EVs significantly reduced neuronal damage and pro-apoptotic markers, while improving neurological function via Atf4 upregulation. The outcomes hint at the potential of QG-EVs as a beneficial therapeutic modality to mitigate neuronal damage in CIRI by enhancing Atf4 expression, highlighting its potential for improving ischemic stroke outcomes.

Objective:To analyze the early risk factors of necrotizing pneumonia (NP) in children with Mycoplasma pneumoniae pneumonia (MPP) and construct a clinical prediction model.Methods:In this case-control study, the clinical data of MPP patients who were hospitalized at Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology, from January 2021 to May 2024 were retrospectively analyzed.According to whether NP occurred, the children were divided into the NP group and the non-NP (NNP) group.A total of 62 and 124 children were included in the NP and NNP groups after nearest neighbor matching at a ratio of 1∶2 (with a caliper value of 0.02), respectively.LASSO regression was used to select the optimal factors, and the multivariate Logistic regression analysis was used to establish a clinical prediction model.Internal and external validation of the prediction model was then conducted.The receiver-operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive ability and calibration of the prediction model.The clinical decision curve analysis (DCA) was used to evaluate its clinical predictive value.Results:The LASSO regression analysis showed that white blood cells (WBC), neutrophil percentage, C-reactive protein (CRP), procalcitonin, D-dimer, ferritin, fever duration, and lung consolidation were factors influencing the occurrence of NP in children with MPP ( P<0.05).The ROC analysis showed that the area under the curve (AUC) of the prediction model was 0.838 (95% CI: 0.765-0.911, P<0.001) in the training set, 0.834 (95% CI: 0.755-0.913, P<0.001) in the validation set, and 0.924 (95% CI: 0.902-0.981, P<0.001) in the external validation set.Bootstrap was used for repeated sampling for 1 000 times for internal validation, and the calibration curve showed that the model had good early consistency.The clinical DCA showed that the model had good clinical application value. Conclusions:WBC, CRP, D-dimer, ferritin, fever duration and lung consolidation have good value for the early prediction of MPNP in children.

Objective:To analyze the early risk factors of necrotizing pneumonia (NP) in children with Mycoplasma pneumoniae pneumonia (MPP) and construct a clinical prediction model.Methods:In this case-control study, the clinical data of MPP patients who were hospitalized at Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology, from January 2021 to May 2024 were retrospectively analyzed.According to whether NP occurred, the children were divided into the NP group and the non-NP (NNP) group.A total of 62 and 124 children were included in the NP and NNP groups after nearest neighbor matching at a ratio of 1∶2 (with a caliper value of 0.02), respectively.LASSO regression was used to select the optimal factors, and the multivariate Logistic regression analysis was used to establish a clinical prediction model.Internal and external validation of the prediction model was then conducted.The receiver-operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive ability and calibration of the prediction model.The clinical decision curve analysis (DCA) was used to evaluate its clinical predictive value.Results:The LASSO regression analysis showed that white blood cells (WBC), neutrophil percentage, C-reactive protein (CRP), procalcitonin, D-dimer, ferritin, fever duration, and lung consolidation were factors influencing the occurrence of NP in children with MPP ( P<0.05).The ROC analysis showed that the area under the curve (AUC) of the prediction model was 0.838 (95% CI: 0.765-0.911, P<0.001) in the training set, 0.834 (95% CI: 0.755-0.913, P<0.001) in the validation set, and 0.924 (95% CI: 0.902-0.981, P<0.001) in the external validation set.Bootstrap was used for repeated sampling for 1 000 times for internal validation, and the calibration curve showed that the model had good early consistency.The clinical DCA showed that the model had good clinical application value. Conclusions:WBC, CRP, D-dimer, ferritin, fever duration and lung consolidation have good value for the early prediction of MPNP in children.

Objective To explore and analyze the application effect of hospital quality monitoring system in medical quality management.Methods 800 patients from March 2021 to March 2022 were selected as the control group and routine medical quality management was adopted;and 800 patients from April 2022 to April 2023 were selected as the experimental group and the hospital quality monitoring system was adopted for medical quality management.Results The complication rate and re-admission rate after implementation were significantly lower than before implementation,with statistical significance(P＜0.05).The satisfaction of patients after implementation was significantly higher than before implementation,and the difference was statis-tically significant(P＜0.05).The score of medical service quality after implementation was significantly higher than before im-plementation,and the difference was statistically significant(P＜0.05).Conclusion The application effect of hospital quality monitoring system in medical quality management is remarkable,and it is worthy of promotion.

Xiang thinking is the key way of thinking to construct the life model of human body in traditional Chinese medicine （TCM）， and the theory of ascending and descending of qi movement is an important manifestation of xiang thinking in the theory of TCM. Based on the theory of qi movement， this paper interpreted the mechanism of ischemic stroke through the perspective of xiang thinking "earth weakness - wood constraint - fire hyperactivity"， as "earth weakness in the central and dampness accumulated to phlegm" "wood constraint and stirring wind led to blood stasis" and "fire hyperactivity and fire toxin showed flaming upward" due to disorder of qi movement. Combined with the "xiang of medicinal properties and therapy methods" to discuss the treatment and prescriptions of ischaemic stroke， applying wind medicinals to elevate ji-earth （己土） and yi-wood （乙木）， so that phlegm and stasis can be eliminated， and cold medicinals to descend jia-wood （甲木） and wu-earth （戊土） so that fire toxin can be cleared， with a view to restore ascending and descending of qi movement for ischaemic stroke.

To investigate tick species and prevalence of Anaplasmataceae and spotted fever group Rickettsia(SFGR)in ticks collected from sheep and goats in Leibo county,Sichuan Province.Ticks were preliminary identified by morphological characters and the genomic DNAs of ticks were ex-tracted.Molecular detection was performed by PCR targeting gene fragment of tick ITS-2,gltA and ompA genes of Rickettsia spp.,16S rRNA and rpoB genes of Anaplasma spp.and Ehrlichia spp.Positive PCR products were sequenced and phylogenetic trees were built based on these genes.The results showed that a total of 353 adult ticks collected from sheep and goats were identified as H.longicornis.The total prevalence of SFGR in H.longicornis was 22.66％(80/353)with only R.raoultii detected,which was closely related to R.raoultii(JQ792163)isolated from Dermacentor niveus in Tibet.The total prevalence of Anaplasmataceae was 87.82％(310/353)with six Ana-plasma species(A.bovis,A.capra,A.marginale,Anaplasma cf.marginale,Anaplasma sp.,Can-didatus A.mediterraneum)and two Ehrlichia species(E.chaffeensis and Ehrlichia sp.)detec-ted.Go-infection was found in some H.longicornis as high as 7.37％(26/353).The results indica-ted that H.longicornis may be the dominant tick species in Leibo county with high infections rates of Anaplasmataceae and SFGR.The close monitoring of the tick-borne pathogens should be strengthened in the future research work.