Based on the collateral disease theory， this paper systematically reviews the mechanism laws and the prevention and treatment strategies for the comorbidity of rheumatoid arthritis （RA） and coronary heart disease （CHD）. It is believed that the collateral vessels serve as the core pathways connecting the limbs and joints with the zang-fu （脏腑） organs. The comorbidity of RA and CHD follows a progressive transmission pattern from wang bi （尪痹）， vessel bi （脉痹） to heart bi （心痹）. In this sequence， wang bi refers to damp-heat obstructing the qi collaterals of the limbs and joints. Vessel bi is characterized by the binding of phlegm and stasis， along with hyperactive changes in the collateral pathways， and pathogenic factors penetrating the blood vessels. Heart bi occurs when latent toxins damage the collaterals and lead to failure of heart yang. In terms of prevention and treatment strategies， the principle of "treating disease before it arises" should be adopted as guidance， taking overall therapeutic goal as preventing pathogenic factors from penetrating inward along the collaterals， that is from the body surface and limbs into the zang-fu organs. At the wang bi stage， treatment focuses on clearing heat and draining dampness， diffusing and unblocking qi collaterals， while at the vessel bi stage， it is recommended to clear up phlegm， dissolve stasis， and unblock blood collaterals. At the heart bi stage， treatment should focus on activating blood and unblocking the collaterals， restoring yang and diffusing bi.

Based on the collateral disease theory， this paper systematically reviews the mechanism laws and the prevention and treatment strategies for the comorbidity of rheumatoid arthritis （RA） and coronary heart disease （CHD）. It is believed that the collateral vessels serve as the core pathways connecting the limbs and joints with the zang-fu （脏腑） organs. The comorbidity of RA and CHD follows a progressive transmission pattern from wang bi （尪痹）， vessel bi （脉痹） to heart bi （心痹）. In this sequence， wang bi refers to damp-heat obstructing the qi collaterals of the limbs and joints. Vessel bi is characterized by the binding of phlegm and stasis， along with hyperactive changes in the collateral pathways， and pathogenic factors penetrating the blood vessels. Heart bi occurs when latent toxins damage the collaterals and lead to failure of heart yang. In terms of prevention and treatment strategies， the principle of "treating disease before it arises" should be adopted as guidance， taking overall therapeutic goal as preventing pathogenic factors from penetrating inward along the collaterals， that is from the body surface and limbs into the zang-fu organs. At the wang bi stage， treatment focuses on clearing heat and draining dampness， diffusing and unblocking qi collaterals， while at the vessel bi stage， it is recommended to clear up phlegm， dissolve stasis， and unblock blood collaterals. At the heart bi stage， treatment should focus on activating blood and unblocking the collaterals， restoring yang and diffusing bi.

Based on the understanding of "kidney storing essence and marrow nourishing bone"， and in combination with the modern pathological characteristics of ankylosing spondylitis （AS）， this paper systematically elucidates the dynamic pathogenesis evolution of "heat bi （inflammatory activity）-marrow deficiency （bone marrow edema）-bone damage （bone structural damage）" in AS. It is proposed that in the heat bi stage， there is kidney deficiency with pathogenic invasion and heat congesting the meridians. In the marrow deficiency stage， heat consumes kidney essence， leading to marrow injury and collateral obstruction. In the bone damage stage， kidney exhaustion and marrow emptiness occur， with phlegm-stasis congealing on bone. Accordingly， a stage-specific treatment strategy for AS is established. In the heat bi stage， treatment focuses on supplementing the kidney and replenishing essence， clearing heat and unblocking collaterals. In the marrow deficiency stage， the main approach is to supplement the kidney and benefit marrow， unblock collaterals and reduce edema. In the bone damage stage， it is suggested to supplement the kidney and replenish essence， benefit marrow and strengthen bone， resolve phlegm and expel stasis.

Based on the understanding of "kidney storing essence and marrow nourishing bone"， and in combination with the modern pathological characteristics of ankylosing spondylitis （AS）， this paper systematically elucidates the dynamic pathogenesis evolution of "heat bi （inflammatory activity）-marrow deficiency （bone marrow edema）-bone damage （bone structural damage）" in AS. It is proposed that in the heat bi stage， there is kidney deficiency with pathogenic invasion and heat congesting the meridians. In the marrow deficiency stage， heat consumes kidney essence， leading to marrow injury and collateral obstruction. In the bone damage stage， kidney exhaustion and marrow emptiness occur， with phlegm-stasis congealing on bone. Accordingly， a stage-specific treatment strategy for AS is established. In the heat bi stage， treatment focuses on supplementing the kidney and replenishing essence， clearing heat and unblocking collaterals. In the marrow deficiency stage， the main approach is to supplement the kidney and benefit marrow， unblock collaterals and reduce edema. In the bone damage stage， it is suggested to supplement the kidney and replenish essence， benefit marrow and strengthen bone， resolve phlegm and expel stasis.

Heterotopic ossification is an important pathological link leading to disability in ankylosing spondylitis （AS）. Imbalance of bone immune microenvironment is the initiating factor for heterotopic ossification in AS， while abnormal osteogenic potential of bone marrow mesenchymal stem cells （BMSCs） is the core link. From the perspective of "bone sweat pore-kidney visceral manifestation" in traditional Chinese medicine， it is believed that dysfunction of "kidney visceral manifestation" is the basis for the induction of heterotopic ossification by bone immune microenvironment and BMSCs， and "bone sweat pore" is their important setting. Accordingly， it is proposed that the kidney and sweat pore should be nourished and regulated to reshape the bone immune microenvironment and BMSCs function， and that obstruction should be removed and the marrow should be unblocked to eliminate the pathological factors that lead to AS heterotopic ossification. This provides a new perspective and basis for the treatment of AS with traditional Chinese medicine.

Stasis-heat is a pathological factor associated with numerous exogenous and internal injuries, representing a pivotal mechanism in disease progression. Its primary cause is fire-heat toxicity. Based on the theory of qi and the holistic perspective of traditional Chinese medicine, this concept emphasizes that the biochemistry of all natural phenomena relies on the dynamic movement of qi ascending, descending, exiting, and entering. Within six qi, "fire" includes sovereign and ministerial fires. While physiological ministerial fire is the source power of life, pathological ministerial fire manifests as violent, intense energy that readily interacts with blood, leading to the formation of stasis-heat. Therefore, this article examines the formation and treatment of stasis-heat resulting from ministerial fire dysfunction. From the perspectives of ministerial fire gasification, the shape and quality of meridians, and the elevation of ministerial fire, it elucidates why the "pericardium-sanjiao-gallbladder" axis is regarded as pivotal. Furthermore, when the "pericardium-sanjiao-gallbladder" ministerial fire axis is unfavorable, and the stagnation of ministerial fire elevation and blockage is crucial to stasis-heat formation. Additionally, the depletion of essence and blood in the liver and kidneys, preventing the proper storage of ministerial fire, forms the pathological foundation. Drawing upon The Inner Canon of Yellow Emperor, this article explores therapeutic principles based on the rules of odor treatment: "when fires in the interior, the treatment of salty and cold, accompanied by bitter and pungent, acid to astringe, bitter to disperse." These principles are applied to achieve specific therapeutic goals: tempering the excess of ministerial fire to cool the nutritive level and transform stasis; adjusting the imbalance of elevation and depression to vent heat and unblock stasis; and restoring the misplaced fire by nourishing blood to expel stasis. Through these approaches, the article aims to reestablish the proper circulation of ministerial fire, dissipate blood stasis, and ultimately eliminate stasis-heat, thereby offering an integrated perspective on its pathogenesis and treatment.

Height， as one of the crucial indicators for assessing children’s growth and development， has consistently been a global focus. With economic development and improvements in social living standards， the clinical management needs for children with short stature have been increasingly growing. While growth hormone brings hope to children with short stature， it also triggers ethical challenges such as medical standardization， expansion of indications， equitable accessibility， and informed consent. To avoid the ethical issues related to the use of pediatric growth hormone， multidimensional and comprehensive clinical management should be implemented for children with short stature， including strictly adhering to medical standards and ethical guidelines， enhancing public awareness， and promoting the standardized development of recombinant human growth hormone （rhGH） therapy and ethics.

Objective To explore the status of working ability of patients with ankylosing spondylitis(AS)in China from multi-center,multi-level and multi-dimensional perspectives,and analyze the influencing factors of working ability in AS patients,so as to improve the outcome of working ability disorder in AS patients.Methods The demographic data,working ability and disease-related information of 253 AS patients admitted to 10 hospitals in 9 centers in China from Mar.2022 to Sep.2023 were collected.Work productivity and activity impairment questionnaire was used to investigate the working status.The influencing factors of working ability disorder were analyzed,and the correlations of the work ability with the severity of disease,self-assessment,and mental health status were discussed.Results A total of 253 patients with AS were enrolled,of which 197(77.87％)were employed,76(30.04％)were in normal working status,and 177(69.96％)had disorder in working ability.Multivariate logistic regression analysis showed that the course of AS,Bath ankylosing spondylitis functional index,Bath ankylosing spondylitis measurement index,functional assessment of chronic illness therapy-fatigue,ankylosing spondylitis disease activity score-erythrocyte sedimentation rate,Assessment of Spondyloarthritis International Society health index,depression,anxiety,and patient global assessment were important factors affecting the working ability of patients.Conclusion There is a high proportion of work ability disorder in Chinese AS patients,and the severity of the disease,psychological state and self-reported outcome are closely related to the status of work ability.

OBJECTIVE: Hepatocellular carcinoma (HCC) is sensitive to ferroptosis, a new form of programmed cell death that occurs in most tumor types. However, the mechanism through which ferroptosis modulates HCC remains unclear. This study aimed to investigate the oncogenic role and prognostic value of FANCD2 and provide novel insights into the prognostic assessment and prediction of immunotherapy. METHODS: Using clinicopathological parameters and bioinformatic techniques, we comprehensively examined the expression of FANCD2 macroscopically and microcosmically. We conducted univariate and multivariate Cox regression analyses to identify the prognostic value of FANCD2 in HCC and elucidated the detailed molecular mechanisms underlying the involvement of FANCD2 in oncogenesis by promoting iron-related death. RESULTS: FANCD2 was significantly upregulated in digestive system cancers with abundant immune infiltration. As an independent risk factor for HCC, a high FANCD2 expression level was associated with poor clinical outcomes and response to immune checkpoint blockade. Gene set enrichment analysis revealed that FANCD2 was mainly involved in the cell cycle and CYP450 metabolism. CONCLUSION To the best of our knowledge, this is the first study to comprehensively elucidate the oncogenic role of FANCD2. FANCD2 has a tumor-promoting aspect in the digestive system and acts as an independent risk factor in HCC; hence, it has recognized value for predicting tumor aggressiveness and prognosis and may be a potential biomarker for poor responsiveness to immunotherapy.
Humans ; Carcinoma, Hepatocellular/diagnosis* ; Liver Neoplasms/diagnosis* ; Immunotherapy ; Fanconi Anemia Complementation Group D2 Protein/metabolism* ; Prognosis ; Male ; Female ; Middle Aged ; Biomarkers, Tumor/metabolism*

Objective:To develop a nomogram model for predicting the risk of ventilator-associated pneumonia (VAP) in patients with mechanical ventilation (MV) and to validate the stability of the prediction performance of the model.Methods:The patients with MV admitted to the Department of Critical Care Medicine of General Hospital of Ningxia Medical University from January 2019 to December 2022 were retrospectively selected according to the order of admission. The patients with MV were divided into the non-VAP group and the VAP group according to whether VAP occurred. The clinical data of the two groups, including general information, disease, medication, condition, and operation-related indicators were collected as candidate predictors of the model for comparison. Multivariate logistic stepwise forward regression analysis was used to screen the predictors that finally entered the model, and a nomogram model was constructed. The model discrimination was evaluated by the area under the receiver operating characteristic curve (AUC), the diagnostic test results of the model at the predicted threshold were calculated, the Hosmer-Lemeshow test was used to evaluate the model fit, and the Bootstrap resampling was used 1 000 times for internal validation, and model calibration and clinical applicability were evaluated by calibration curve and decision analysis curve, respectively.Results:A total of 1 250 patients with MV were included, including 1 102 patients in the non-VAP group and 148 patients in the VAP group, and the prevalence of VAP was 11.8%. The detection of multidrug-resistant organisms, chronic kidney disease, brain injury, oxygenation index, the place of tracheal intubation, reintubation, use of bronchoscopy, use of antibiotics, and MV duration were model predictors of VAP. The AUC of the nomogram model was 0.917 (95% CI: 0.895-0.939), the maximum Youden index of 0.697 corresponded to a prediction threshold of 0.096. The model accuracy, sensitivity and specificity were 0.836, 0.865, and 0.832, respectively. The positive predictive value and the negative predictive value were 0.409 and 0.979, respectively. The Hosmer- Lemeshow test indicated that the model fit well ( P=0.938). The results of the internal validation of the model showed that the predicted risk of the calibration curve was generally consistent with the actual risk, and the decision threshold probability of the decision analysis curve ranged from 2% to 90%. Conclusions:The nomogram model developed in this study is simple, convenient and has relatively stable prediction performance, which can be externally validated to evaluate the extrapolation of the model, and provide a basis for individualized clinical prediction of the risk of VAP in patients with MV.