ObjectiveThis paper aims to conduct a secondary analysis of a randomized controlled trial on the treatment of myelodysplastic syndrome （MDS） with deficiency of both the spleen and kidney and blockage of toxin and blood stasis with an arsenic-containing traditional Chinese medicine compound， by applying the mixed model for repeated measure （MMRM） and the method of stratified composite outcome with win ratio. The analysis includes the assessment of hematological efficacy and the composite outcome evaluation of adverse reactions， so as to more comprehensively assess the therapy of this regimen. MethodsThe MMRM and win ratio methods were used to evaluate the efficacy of a prospective，multi-center，double-blind，randomized controlled study. The blood routine （hemoglobin concentration，neutrophil count， and platelet count） and biochemical indexes （aspartate aminotransferase，alanine aminotransferase，serum creatinine，and serum ferritin） of the patients were detected at the time of enrollment and at the end of each course of treatment in the laboratory department of Xiyuan Hospital. The patients' syndromes at the time of enrollment and after treatment were recorded and scored according to the therapy standard of traditional Chinese medicine for diseases and syndromes. MMRM was used to analyze the blood routine indexes of the experimental group and the control group. This method has the advantages of high data reliability and dynamic efficacy under intervention and time. The win ratio method was used to evaluate the composite outcome of traditional Chinese medicine syndrome scores and biochemical indexes according to the priority and to verify the clinical safety of arsenic-containing traditional Chinese medicine compound. ResultsThe results of MMRM analysis showed that the hemoglobin concentration of patients in the group with arsenic-containing traditional Chinese medicine compound increased significantly compared with that before treatment in the group，while that in the placebo group decreased significantly （P<0.01）. When compared with that after treatment in the placebo group，the hemoglobin concentration of patients in the group with arsenic-containing traditional Chinese medicine compound increased significantly，and the mean difference of least squares （LS） was statistically significant （P<0.01）. When compared with those before treatment in the group，there were no statistically significant differences in the neutrophil count and platelet count in both groups. After treatment，there were no statistically significant differences in the neutrophil count， platelet count， and the mean difference of LS between the two groups. The analysis results of win ratio showed that the group with arsenic-containing traditional Chinese medicine compound had a significant advantage in the comparison of composite outcomes，with a win ratio （95% CI） of 2.01 （1.24-3.27） （P<0.01），and that the possibility of "winning" in terms of safety was 2.01 times that of the placebo group. The safety advantage of the group with arsenic-containing traditional Chinese medicine compound mainly came from the traditional Chinese medicine syndrome scores，renal function indexes， and iron reserve capacity indexes，and the number of winning times was less than that of losing times in the comparison of liver function outcomes. ConclusionThe MMRM analysis proves that the arsenic-containing traditional Chinese medicine compound can significantly improve the hemoglobin concentration of patients with myelodysplastic syndrome with refractory cytopenia and multilineage dysplasia （MDS-RCMD） of the type of deficiency of both the spleen and kidney and blockage of toxin and blood stasis. This conclusion is not interfered with by time trends and individual relationships and methodologically improves the credibility of the therapy of the arsenic-containing traditional Chinese medicine compound in treating MDS. Four outcomes are evaluated by the win ratio method，namely traditional Chinese medicine syndromes，liver function，renal function， and iron reserve capacity，proving that the arsenic-containing traditional Chinese medicine compound has the comprehensive advantages of improving the survival quality of the patients and reducing adverse reactions. The win ratio outcome provides clear comparative indexes for the evaluation of adverse reactions，making it easier for regulatory authorities，medical staff， and patients to understand the safety of the arsenic-containing traditional Chinese medicine compound in clinical application.

ObjectiveTo analyze the infection characteristics of human respiratory syncytial virus (HRSV) among children hospitalized with acute lower respiratory tract infection (ALRTI) in a specialized pediatric hospital in Shanghai, so as to provide evidence-based support for optimizing the prevention and control strategies and clinical diagnosis and treatment of respiratory tract infections in children in this region. MethodsA retrospective analysis was performed to the clinical and etiological data of 29 260 children hospitalized for ALRTI in Shanghai Children’s Hospital from January 2021 to December 2024. HRSV and 12 other common respiratory pathogens were detected with multiplex polymerase chain reaction (PCR) and capillary electrophoresis. Demographic and clinical data were collected for statistical analyses. A total of2 412 cases with positive HRSV were divided into the severe group and the non-severe group. Clinical characteristics between the two groups were compared using the Mann-Whitney U test and the chi- square (χ²) test. Additionally, the related influencing factors of severe HRSV infection were explored. ResultsThe overall positivity rate of HRSV from 2021 to 2024 was 8.24% (2 412/29 260), with statistically significant differences observed across the four years (χ²=389.42, P<0.001). The highest positivity rate was in 2021 (14.76%), with a high prevalence throughout the year. In 2022, when non-pharmaceutical interventions (NPIs) were implemented, the HRSV positivity rate was the lowest (4.93%), with a winter-dominant epidemic pattern. In 2023, after the NPIs were lifted, the HRSV positivity rate showed a slight rebound (8.14%), presenting a double-peak pattern. In 2024, the HRSV positivity rate slightly decreased compared to that in 2023 (6.29%), exhibiting a winter and spring-dominant epidemic pattern. Among the hospitalized children with ALRTI, the HRSV positivity rate in males (8.85%) was higher than that in females (7.51%), and the difference was statistically significant (χ²=17.33, P<0.001). Age distribution showed that 82.26% (1 984/2 412) of HRSV infections occurred in children aged 3 years old and below. Besides, as age increased, the infection rate of HRSV showed a gradually decreasing trend (P<0.001). Among the 2 412 children with HRSV infection, the proportion of severe cases was 22.31% (538/2 412), while the non-severe cases accounted for 77.69% (1 874/2 412). Compared with non-severe cases, severe cases were more frequently presented with high fever, longer duration of wheezing, as well as higher rates of underlying diseases or co-infection with Mycoplasma pneumoniae (P<0.001). ConclusionThe prevalence intensity of HRSV varied yearly from 2021 to 2024. After the removal of NPIs in 2023, a slight rebound with a double-peak epidemic pattern was observed. HRSV remained a common pathogen in children hospitalized for ARLTI, and children aged 3 years old and below constituted the highest proportion for infection. Compared with non-severe cases, those with severe HRSV infections were more prone to presenting with high fever and a longer duration of wheezing. Children with positive HRSV who had underlying diseases or co-infection with Mycoplasma pneumonia were more likely to develop severe conditions.

Objective To systematically review the studies on predictive models for delayed graft function (DGF) after kidney transplantation. Methods Databases including China Biology Medicine Database, China National Knowledge Infrastructure, Wanfang Database, VIP Database, PubMed, Web of Science and CINAHL were searched to collect studies on predictive models for DGF after kidney transplantation published from the establishment of each database to June 29, 2025. Two researchers screened the literatures according to the inclusion and exclusion criteria, evaluated the quality of the literatures using the prediction model risk of bias assessment tool (PROBAST), and conducted a meta-analysis of the common predictors of the models using R software. Results A total of 12 literatures were included, involving 14 predictive models with sample sizes ranging from 103 to 24 653 cases. Donor serum creatinine level, cold ischemia time, donor age and donor body mass index were the top four common predictors. All the predictive models were at high risk of bias and low in applicability. The results of meta-analysis showed that abnormal donor body mass index, advanced donor age, prolonged cold ischemia time and elevated donor serum creatinine level were all associated with an increased risk of DGF after transplantation (all P<0.01), but there was high heterogeneity among the studies. Fixed-effect model and random-effect model were used to re-pool the effect sizes separately. The results indicated that the fixed-effect model and random-effect model had good consistency in terms of donor body mass index, donor age and cold ischemia time, while there was a significant difference in the effect sizes of the two models for donor serum creatinine level. Conclusions The predictive models for DGF risk after kidney transplantation have good predictive performance, but the overall risk of bias is high. In the future, large-sample, multicenter and high-quality prospective clinical studies should be carried out to optimize the predictive models, so as to improve their predictive ability and clinical application value.

Objective​ To evaluate the clinical characteristics and influencing factors of fatigue in patients with rheumatoid arthritis （RA）， with the aim of providing guidance for clinical treatment. Methods​ Based on the multicenter real-world cohort of the China Registry of Traditional Chinese Medicine for Rheumatism （CERTAIN） platform， patients with RA enrolled from 2019 to 2025 were included. Demographic data， disease assessment indicators， laboratory indices， and traditional Chinese medicine （TCM） syndrome patterns were collected to analyze the TCM syndromes and clinical characteristics of RA patients with fatigue. Spearman correlation analysis and logistic regression analysis were used to identify factors associated with fatigue in RA. Results​ A total of 3 021 patients with RA were included， among whom 2 007 （66.43%） had fatigue. Compared with the non-fatigue group， the fatigue group was older and had a longer disease duration， with significantly higher scores for the 28-joint Disease Activity Score （DAS28）， swollen joint count （SJC）， tender joint count （TJC）， Health Assessment Questionnaire （HAQ）， pain visual analog scale （VAS）， and patient global assessment （PGA） （P<0.01）. Among TCM syndromes， fatigue was more common in patients with dampness-heat obstruction， cold-dampness obstruction， and liver-kidney deficiency syndromes （P<0.05）. Multivariate analysis revealed that morning stiffness duration exhibited a stepwise association with fatigue， while poor appetite， insomnia with frequent dreaming， restlessness， high HAQ scores， and high pain VAS scores were identified as risk factors. ConclusionFatigue is a prominent symptom in patients with RA and is more common among those with dampness-heat obstruction， cold-dampness obstruction， and liver-kidney deficiency syndromes. It is closely associated with disease activity， pain， functional limitation， sleep， and emotional status.

Objective To investigate the existing nuclear radiation health emergency response capacity of local health systems at nuclear power plant sites in Guangdong Province. Methods The health administrative departments of all nuclear power plants sites in Guangdong Province, along with radiation health protection institutions, designated nuclear radiation treatment hospitals, and township health centers, were selected as the study subjects using the purposive sampling method. A series of standardized questionnaires on the capacities for nuclear radiation health emergency response, developed uniformly by the National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, were adopted to separately investigate the capacities for nuclear radiation health emergency response in the study subjects. Results There were 13 health administration departments, 15 radiological health protection institutions, 18 designated hospitals for nuclear radiation medical response, and 18 township health centers located in the nuclear power plants sites in Guangdong Province. Among the 13 health administration departments, the Health Commission of Guangdong Province met all 15 criteria for nuclear radiation health emergency response capacities. All six prefecture-level health administrative departments possessed more than 10 capacities for nuclear radiation health emergency response, while only one of the six county-level departments had more than 10 such capacities. Among radiation health protection institutions, the provincial-level institution possessed all 18 capacity for nuclear radiation health emergency response; of the six prefectural-level institutions, only four had more than 10 capacities; none of the eight county-level institutions or 18 township health centers possessed more than 10 capacities. Among designated nuclear radiation treatment hospitals, provincial-level institution met all 32 capacities for nuclear radiation health emergency response; of the eight prefecture‑level hospitals, only four meet more than ten such capacities; and of the nine county‑level hospitals and 18 township health centers, none possess more than 10 capacities. Conclusion Provincial- and prefectural-level nuclear radiation emergency capacity in Guangdong Province is adequate, whereas county-level and township health centers have obvious weaknesses in organizational structure, personnel training, equipment reserves, funding, and technical reserves; emergency response capacity needs urgent enhancement.

Objective​ To analyze the current status of nuclear radiation health emergency response capacity in areas of the nuclear power plants in Guangdong Province, and to formulate a construction plan for municipal-level nuclear radiation health emergency response teams. Methods Provincial-, municipal-, and county-level administrative regions in the nuclear power plant host areas of Guangdong Province were selected as the study subjects. A series of questionnaires designed by the National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, were used to assess the capacity of nuclear radiation health emergency response. Based on the findings, a construction plan for municipal-level nuclear radiation health emergency response teams was formulated. Results A total of 13 administrative regions which host nuclear power plants were involved, including one provincial-level, six municipal-level, and six county-level regions. The availability rates of 31 capacity indicators of nuclear radiation health emergency response among 13 administrative regions ranged from 15% to 100%, with an average of 51%. Provincial-level capacity of nuclear radiation health emergency response was relatively well established, county-level radiation monitoring and protection capacity was nearly absent, municipal-level regions possessed basic capacity, but with obvious regional disparities and a general lack of specialized facilities and materials required for the treatment of nuclear radiation injuries, making them the key level for improvement in nuclear radiation health emergency response. The Construction Plan for Municipal-Level Nuclear Radiation Health Emergency Response Teams specifies that the total number of team members should be no fewer than 30 to ensure rapid response and immediate arrival at the scene. The List of Key Professional Equipment proposes the prioritized allocation of five categories of equipment: personal basic equipment, contamination detection and classification equipment, decontamination equipment, medical treatment equipment, and command and logistical support equipment. Conclusion Nuclear radiation health emergency response capacity in Guangdong Province requires further improvement, particularly in standardized development of municipal-level nuclear radiation health emergency response teams. The Construction Plan for Municipal-Level Nuclear Radiation Health Emergency Response Teams defines capacity requirements and provides a list of essential equipment, offering a practical reference for other regions.

Skeletal muscle atrophy refers to a pathological condition characterized by muscle fiber atrophy as well as decreased muscle mass and muscle strength induced by various predisposing factors. It falls under the category of “flaccidity syndrome” in traditional Chinese medicine， and its pathogenesis is mainly associated with disturbed protein homeostasis， mitochondrial dysfunction and oxidative stress injury. Active ingredients of traditional Chinese medicine exerts synergistic regulatory effects via multiple pathways， thus possessing unique advantages in the clinical prevention and treatment of skeletal muscle atrophy. This paper reviews the mechanisms by which active ingredients of traditional Chinese medicine alleviate skeletal muscle atrophy. Existing studies have demonstrated that such active ingredients can ameliorate skeletal muscle atrophy through multiple approaches： regulating protein metabolic balance （geniposide， matrine， schisandrin A， etc.） and oxidative stress （astragaloside Ⅳ， Gastrodia elata polysaccharide， Angelica sinensis polysaccharide， etc.）， improving mitochondrial function （parthenolide， berberine， curcumin， etc.）， facilitating myogenesis and myogenic differentiation （cucurbitacin Ⅱb， saikosaponin A， saikosaponin D， etc.）， suppressing inflammatory response （ursolic acid， triptolide， emodin， etc.）， ameliorating insulin resistance （akebiasaponin D， etc.）. In the future， active ingredients of traditional Chinese medicine are expected to achieve breakthroughs in clinical treatment for skeletal muscle atrophy， providing novel ideas and strategies for the prevention and treatment of degenerative disorders.

Osteoporosis is a systemic disease, and epidemiological projections indicate that by 2050, approximately 23.43% of the Chinese population over 50 years of age will be affected. Given the poor prognosis associated with osteoporosis, the exploration of safe and effective natural products is of considerable significance. Studies investigating the chemical constituents of traditional Chinese medicine in cellular and/or animal models have demonstrated bone-protective effects. Although most of these compounds lack clinical data, they hold considerable potential as lead candidates for drug development. In-depth study of the structure-activity relationship of these natural products not only contributes to elucidating the mechanisms of action but also provides a theoretical basis for the development of novel antiosteoporosis therapies. This review summarizes natural products with potential antiosteoporotic effects reported between 2020 and 2024. Overall, plant-derived natural compounds exhibit antiosteoporotic effects by regulating bone remodeling, inflammation, and oxidative stress, highlighting their promise as multitarget therapeutic candidates.

ObjectiveTo investigate the risk factors for atherosclerosis （AS） in rheumatoid arthritis （RA） patients and its correlation with traditional Chinese medicine （TCM） syndromes. MethodsA cross-sectional study was conducted， enrolling 16,082 RA patients from 122 medical centers nationwide. Patient demographics， disease assessment data including disease activity （DAS-28）， tender joint count （TJC）， swollen joint count （SJC）， patient's global assessment （PGA）， evaluator's global assessment （EGA）， and visual analogue scale （VAS）， major clinical symptoms including insomnia， loss of appetite， irritability， and fatigue， and laboratory indicators including blood routine， inflammatory markers， liver and kidney function， metabolic indices， and coagulation markers were collected through questionnaire. Based on the four examinations in TCM， patients were classified into eight TCM syndromes， which were wind-damp obstruction， cold-damp obstruction， damp-heat obstruction， phlegm-stasis obstruction， blood stasis obstructing the collaterals， qi-blood deficiency， liver-kidney insufficiency， and qi-yin deficiency. Patients who experienced AS events were included in the event group （564 cases）， while those without AS events were included in the non-event group （15,518 cases）. Intergroup difference tests were used to screen potential risk factors， and binary logistic regression analysis was employed to assess the correlation between TCM syndromes and rheumatoid arthritis with atherosclerosis （RA-AS）. ResultsCompared to the non-event group， patients in the event group had longer disease duration， higher body weight， and older age （P＜0.05）， and showed significantly higher DAS28， TJC， SJC， PGA， EGA， VAS， ESR， low-density lipoprotein cholesterol （LDL-C）， triglycerides （TG）， total cholesterol （TC）， and D-dimer levels， and lower high-density lipoprotein cholesterol （HDL-C）， with more severe symptoms of insomnia， irritability， and fatigue （P＜0.05）. Damp-heat obstruction syndrome was the most prevalent in both groups， with a higher proportion in the event group （393/564， 69.68%） than in the non-event group （4578/15,518， 29.50%） showing significant difference （P＜0.05）. Logistic regression analysis showed that patients with damp-heat obstruction syndrome had a 5.326-fold higher risk of developing RA-AS compared to those without this syndrome （OR=5.326， 95%CI 4.517 to 7.089， P＜0.001）. ConclusionThe occurrence of RA-AS is associated with TCM syndromes， disease activity， inflammatory markers and lipid metabolic indices， and damp-heat obstruction syndrome is an independent risk factor for RA-AS.

To evaluate the clinical value of nebulized indocyanine green(ICG) combined with near-infrared fluorescence imaging for intraoperative detection of air leaks during pulmonary resection.