Based on the theory of "disease of both blood and water" in Essentials from the Golden Cabinet （《金匮要略》）， and in combination with the dynamic syndrome evolution of heart failure with preserved ejection fraction （HFpEF）， this paper systematically clarifies the pathomechanism of HFpEF， characterized by yang deficiency as the root， blood stasis as the pivotal factor and water retention as the manifestation. Accordingly， the therapeutic principles have been proposed， which are warming yang and banking up original qi to consolidate the root， activating blood and unblocking collaterals to smooth the mechanism， and promoting urination and regulating pivot to remove the branch. On this basis， a compound formula structure of "one monarch， one minister and one assistant" is established， forming an integrated intervention strategy that synergistically combines the three methods of warming yang， activating blood， and promoting urination through combined classical formulas. Zhenwu Decoction （真武汤）， which warms yang and dissolves rheum， is used to consolidate the root and directly target the source of yang deficiency， serving as the monarch； Guizhi Fuling Pills （桂枝茯苓丸）， which activates blood， promotes urination and unblocks the pivot， assists in interrupting the binding of blood stasis and water retention， serving as the minister； Tingli Dazao Xiefei Decoction （葶苈大枣泻肺汤）， which regulates qi， disperses retained fluids， and eliminates the manifestation， alleviates acute water-retention symptoms， serving as the assistant. This compound formula is warming without being drying， diuretic without being drastic， and dispels stasis without consuming blood， thereby achieving the therapeutic effects of warming yang， activating blood， and promoting urination.

The Dunhuang manuscript Fuxing Jue takes the "Tangye Jingfa Tu" as the core of its theory on prescription and compatibility. Its medication principles mainly include the "five elements principle of tonifying and purging" and the "five elements principle of elimination and transformation". Based on the differentiation of deficiency and excess in the five Zang organs， it flexibly applies medicinal properties， usage， and flavor transformation for tonifying and purging， forming its unique method of medication and compatibility. In Taiyin disease， "fullness syndrome" often occurs together with "diarrhea"， and these two conditions also serve as the primary indications for the middle-regulating formulas. Among them， Lizhong Wan （Tang） mainly address Taiyin deficiency. The three Xiexin Tang （Banxia Xiexin Tang， Gancao Xiexin Tang， Shengjiang Xiexin Tang） address Taiyin deficiency accompanied by pathogenic excess. The Sini Tangand Tongmai Sini Tang primarily treat dysfunction of the liver， spleen， and kidney with impaired opening and closing of Taiyin， manifesting as diarrhea. The medicinal flavors of middle-regulating formulas are pungent， sweet， and bitter， acting directly on the spleen of Taiyin. The pungent flavor induces purging of the spleen， sweet flavor tonifies the spleen， and bitter flavor eliminates lumps. When the constituent medicinal units of middle-regulating formulas are unified， the ratio of pungent to sweet flavors reflects the tonic and purgative strength of the formula. In addition， the two decoction methods， "short-term decoction to extract Qi" and "long-term decoction to extract flavor"， also influence the formula's tonifying and purgative effects. Based on the composition of flavors and special decoction methods， this article discusses the differences in the use of middle-regulating formulas for treating "“fullness syndrome" versus "diarrhea". Dysfunction of the spleen can give rise to various diseases. Therefore， middle-regulating formulas are not limited to treating "deficiency， cold， and dampness" syndromes. Later generations of physicians further modified Lizhong Tang to treat "excess， heat， and dryness" syndromes， laying a solid foundation for more flexible and effective clinical application of middle-regulating formulas.

The Dunhuang manuscript Fuxing Jue takes the "Tangye Jingfa Tu" as the core of its theory on prescription and compatibility. Its medication principles mainly include the "five elements principle of tonifying and purging" and the "five elements principle of elimination and transformation". Based on the differentiation of deficiency and excess in the five Zang organs， it flexibly applies medicinal properties， usage， and flavor transformation for tonifying and purging， forming its unique method of medication and compatibility. In Taiyin disease， "fullness syndrome" often occurs together with "diarrhea"， and these two conditions also serve as the primary indications for the middle-regulating formulas. Among them， Lizhong Wan （Tang） mainly address Taiyin deficiency. The three Xiexin Tang （Banxia Xiexin Tang， Gancao Xiexin Tang， Shengjiang Xiexin Tang） address Taiyin deficiency accompanied by pathogenic excess. The Sini Tangand Tongmai Sini Tang primarily treat dysfunction of the liver， spleen， and kidney with impaired opening and closing of Taiyin， manifesting as diarrhea. The medicinal flavors of middle-regulating formulas are pungent， sweet， and bitter， acting directly on the spleen of Taiyin. The pungent flavor induces purging of the spleen， sweet flavor tonifies the spleen， and bitter flavor eliminates lumps. When the constituent medicinal units of middle-regulating formulas are unified， the ratio of pungent to sweet flavors reflects the tonic and purgative strength of the formula. In addition， the two decoction methods， "short-term decoction to extract Qi" and "long-term decoction to extract flavor"， also influence the formula's tonifying and purgative effects. Based on the composition of flavors and special decoction methods， this article discusses the differences in the use of middle-regulating formulas for treating "“fullness syndrome" versus "diarrhea". Dysfunction of the spleen can give rise to various diseases. Therefore， middle-regulating formulas are not limited to treating "deficiency， cold， and dampness" syndromes. Later generations of physicians further modified Lizhong Tang to treat "excess， heat， and dryness" syndromes， laying a solid foundation for more flexible and effective clinical application of middle-regulating formulas.

To explore the advantages of traditional Chinese medicine （TCM） and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications （DMC）， refine key pathophysiological insights and treatment principles， and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine， hosted by the China Association of Chinese Medicine， was held in Beijing， 2024. Experts in TCM， Western medicine， and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis， diagnostic and treatment challenges， and mechanism research related to DMC， ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development， research prioritization， and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM， strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.

This study systematically dissects the core pathogenesis of chronic heart failure （CHF） featured by internal deficiency and external excess，imbalance of Qi，blood，Yin，and Yang，and intermingling of phlegm，blood stasis，and fluid retention. According to the traditional Chinese medicine （TCM） therapeutic principles of simultaneously treating root cause and symptoms，regulating Yin and Yang，replenishing Qi and activating blood，and promoting urination to relieve edema，this article deeply explores the formula-syndrome correspondence of Qili Qiangxin （QLQX） capsules in the treatment of CHF，providing a solid theoretical basis for the multi-effect characteristics of this drug. CHF is a common critical cardiovascular disease in clinical practice，and its pathological process involves multiple links including myocardial injury，neurohumoral disturbance，and ventricular remodeling. Its TCM pathogenesis is complex and involves multiple Zang-Fu organs，making it difficult for a single therapeutic method to achieve comprehensive coverage. QLQX capsules，formulated based on classical TCM theory，perfectly matches the pathogenic characteristics of CHF. Modern pharmacological studies have confirmed that QLQX capsules possess definite cardiotonic，diuretic，and vasodilatory effects. The active ingredients of QLQX capsules can rapidly and effectively alleviate the core clinical symptoms such as chest tightness，shortness of breath，decreased exercise tolerance，limb edema，palpitations，and fatigue of CHF patients by enhancing myocardial contractility and coronary blood flow，improving renal water excretion function，dilating peripheral blood vessels，and reducing cardiac load，thereby significantly improving patients' quality of life. On the basis of analyzing the symptomatic treatment of CHF with QLQX capsules，this study further expounds that the drug can intervene in ventricular remodeling through multiple pathways and targets，regulate the pathological mechanism of CHF，improve vascular endothelial function，mediate the activation of related signaling pathways，inhibit the transdifferentiation of cardiac fibroblasts，and regulate myocardial energy metabolism，thus delaying disease progression. QLQX capsules exert significant benefits in reducing composite cardiac events，improving New York Heart Association （NYHA） cardiac function classification，left ventricular ejection fraction （LVEF），6-minute walking distance （6MWD），and quality of life，demonstrating favorable clinical value. With the TCM pathogenesis of CHF as the guiding principle and modern pharmacology as the evidence，this study systematically clarifies the core advantage of QLQX capsules in treatment based on syndrome differentiation and multi-target synergy through the in-depth integration of TCM theory and modern pharmacology. It provides academic support with both theoretical depth and practical value for TCM intervention in CHF，and contributes TCM wisdom and schemes to the construction of a chronic disease management system with Chinese characteristics.

This study systematically dissects the core pathogenesis of chronic heart failure （CHF） featured by internal deficiency and external excess，imbalance of Qi，blood，Yin，and Yang，and intermingling of phlegm，blood stasis，and fluid retention. According to the traditional Chinese medicine （TCM） therapeutic principles of simultaneously treating root cause and symptoms，regulating Yin and Yang，replenishing Qi and activating blood，and promoting urination to relieve edema，this article deeply explores the formula-syndrome correspondence of Qili Qiangxin （QLQX） capsules in the treatment of CHF，providing a solid theoretical basis for the multi-effect characteristics of this drug. CHF is a common critical cardiovascular disease in clinical practice，and its pathological process involves multiple links including myocardial injury，neurohumoral disturbance，and ventricular remodeling. Its TCM pathogenesis is complex and involves multiple Zang-Fu organs，making it difficult for a single therapeutic method to achieve comprehensive coverage. QLQX capsules，formulated based on classical TCM theory，perfectly matches the pathogenic characteristics of CHF. Modern pharmacological studies have confirmed that QLQX capsules possess definite cardiotonic，diuretic，and vasodilatory effects. The active ingredients of QLQX capsules can rapidly and effectively alleviate the core clinical symptoms such as chest tightness，shortness of breath，decreased exercise tolerance，limb edema，palpitations，and fatigue of CHF patients by enhancing myocardial contractility and coronary blood flow，improving renal water excretion function，dilating peripheral blood vessels，and reducing cardiac load，thereby significantly improving patients' quality of life. On the basis of analyzing the symptomatic treatment of CHF with QLQX capsules，this study further expounds that the drug can intervene in ventricular remodeling through multiple pathways and targets，regulate the pathological mechanism of CHF，improve vascular endothelial function，mediate the activation of related signaling pathways，inhibit the transdifferentiation of cardiac fibroblasts，and regulate myocardial energy metabolism，thus delaying disease progression. QLQX capsules exert significant benefits in reducing composite cardiac events，improving New York Heart Association （NYHA） cardiac function classification，left ventricular ejection fraction （LVEF），6-minute walking distance （6MWD），and quality of life，demonstrating favorable clinical value. With the TCM pathogenesis of CHF as the guiding principle and modern pharmacology as the evidence，this study systematically clarifies the core advantage of QLQX capsules in treatment based on syndrome differentiation and multi-target synergy through the in-depth integration of TCM theory and modern pharmacology. It provides academic support with both theoretical depth and practical value for TCM intervention in CHF，and contributes TCM wisdom and schemes to the construction of a chronic disease management system with Chinese characteristics.

ObjectiveTo investigate the role and related mechanisms of mast cells （MCs） in alcoholic cardiomyopathy （ACM）. MethodsAn ACM model was established in C57BL/6 mice by feeding them with alcohol liquid diet， and some model mice were intervened with cromolyn sodium， a mast cell stabilizer. Cardiac function， myocardial remodeling and the expression of related proteins were evaluated by echocardiography， tissue staining and Western blot. In vitro， neonatal rat ventricular cardiomyocytes （NRVCs） were stimulated with mast cell granules （MCGs） and/or alcohol， and pathway inhibitors were used to explore the underlying mechanisms. ResultsLong-term alcohol feeding caused significant cardiac dysfunction and mast cells activation in mice， accompanied by increased expressions of chymase， NOX2， NOX4 and apoptosis-related protein cleaved Caspase-3 （c-Caspase3） in myocardial tissues （P＜0.05）. Pretreatment with cromolyn sodium improved cardiac function， inhibited mast cell activation， and reduced the expressions of the above proteins. In vitro experiments showed that treatment with MCGs or alcohol alone up-regulated the expressions of c-Caspase3， NOX2， NOX4 and phosphorylated PKCβ1 （p-PKCβ1） in cardiomyocytes， and the combined stimulation of the two had a synergistic effect. Protease-activated receptor 2 （PAR2） inhibitor down-regulated the MCG-induced expressions of the above proteins. PKCβ1 inhibitor also inhibited the MCG-induced expressions of c-Caspase3， NOX2 and NOX4. Chymase inhibitor exerted a partial inhibitory effect on MCG-induced cardiomyocyte apoptosis. ConclusionDuring the development of ACM， mast cells are activated， and the released MCGs may promote cardiomyocyte apoptosis through the PAR2-PKCβ1-NOX2/NOX4 signaling pathway， in which chymase plays an important role.

Implementation science aims to facilitate the efficient dissemination and sustainable application of evidence based interventions, and has accordingly generated a variety of theories, models, and frameworks. Among these, the Exploration, Preparation, Implementation, and Sustainment (EPIS) frameworkfunctions both as a process model and a determinant framework, emphasizing the staged and iterative nature of implementation, and systematically explaining the influence of multilevel factors on implementation processes and outcomes through four dimensions: outer context, inner context, bridging factors, and innovation factors. The EPIS framework has been widely applied in health and public service settings internationally, yet its use in China based research remains relatively limited. This article systematically introduces the core components and application methods of the EPIS framework, and illustrates its value in identifying key influencing factors, developing implementation strategies, and optimizing implementation outcomes through case examples from the health sector, aiming to provide a methodological reference for implementation research and the promotion of evidence based interventions in China.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

Objective:To investigate the clinical characteristics and independent risk factors of severe disease in patients with anti-nuclear matrix protein (NXP) 2 antibody-positive juvenile dermatomyositis (JDM).Methods:A retrospective cohort study was conducted, including 219 anti-NXP2 antibody-positive JDM patients admitted to 23 children′s hospitals across China from July 2011 to July 2023. Patients were classified into severe and non-severe groups based on classification criteria for severe dermatomyositis. Demographic characteristics, clinical manifestations, and laboratory parameters were compared between the 2 groups using independent sample t-test, Mann-Whitney U test, or χ2 test. Univariate and multivariate Logistic regression analyses were performed to identify risk factors for severe disease. The receiver operating characteristic curve was employed to calculate optimal cut-off values. Results:Among the 219 patients, 108 were male and 111 were female, with an age at onset of 6.3 (3.5, 9.4) years. The severe group comprised 69 patients, and the non-severe group 150 patients. The severe group had significantly higher rates of fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, as well as elevated levels of ferritin-to-albumin ratio (FAR), creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) (all P<0.05). Multivariate analysis identified anti-Ro52 antibody positivity ( OR=13.26, 95% CI 1.37-128.29) and elevated FAR ( OR=1.90, 95% CI 1.09-2.31) as independent risk factors for severe anti-NXP2 antibody-positive JDM (both P<0.05). Receiver operating characteristic curve analysis revealed that a FAR cutoff value of 6.82 predicted severe disease with an area under the curve of 0.87 (95% CI 0.81-0.94, P<0.001), sensitivity of 0.85, and specificity of 0.70. All patients received glucocorticoid therapy, and the severe group received higher proportions of steroid pulse therapy, cyclophosphamide, mycophenolate mofetil, intravenous immunoglobulin, biologics, and adjuvant treatments compared to the non-severe group (all P<0.05). In terms of outcomes, 2 patients (2.9%) in the severe group died (due to neurological involvement and intestinal perforation, respectively), while the remaining patients achieved complete clinical response or remission. All patients in the non-severe group achieved remission. Conclusions:The primary clinical features of anti-NXP2 antibody-positive JDM included fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, and elevated levels of CK, AST, LDH, and FAR. Furthermore, anti-Ro52 antibody positivity and a FAR>6.82 were identified as independent risk factors.