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.

Objective:To clarify the current situation, needs, and effectiveness of public health emergency response training for resident physicians, further improve the training content, and enhance their ability to respond to public health emergencies.Methods:A questionnaire survey was conducted among 794 resident physicians who were undergoing standardized residency training at 5 affiliated hospitals of Shanghai Jiao Tong University School of Medicine. The questionnaire included general information, emergency training status, training needs, and emergency training effectiveness. Chi-square test, analysis of variance, and least significant difference post hoc multiple comparisons were used to analyze the awareness, training needs, and training effectiveness of residents of different training years and specialties.Results:Overall, resident physicians showed high levels of awareness about public health emergencies, but there were differences in the awareness rate among resident physicians of different training years. In terms of "clusters of unexplained diseases" and "adverse reactions to mass immunizations and drug exposures", the awareness rate of senior resident physicians was higher than that of junior resident physicians ( χ2=9.41, P<0.05; χ2=10.90, P<0.05). In terms of training status and needs, resident physicians preferred emergency capability training that combines theory, skills, and simulation exercises. They also suggested to adding training content such as risk communication skills and conflict management skills. In terms of training effectiveness, the highest self-evaluation score for training effectiveness at the behavioral level was (8.32±1.52) points, with an average score of 8 points or above for each level, indicating a "good" level of effectiveness. Moreover, the training effectiveness of emergency response capabilities varied significantly for resident physicians with different specialties ( F=4.44, P<0.001). The training effectiveness of emergency response capabilities was higher for general resident physicians than for residents in pediatrics, obstetrics and gynecology, anesthesia, internal medicine, and surgery; higher for pediatric surgery residents than for residents in pediatrics and obstetrics and gynecology; and higher for emergency medicine residents than for residents in pediatrics and obstetrics and gynecology. Conclusions:The simulation training for public health emergency response should be strengthened. In addition to the improvement of medical abilities, it is necessary to provide training on relevant legal and regulatory knowledge, risk communication skills, and conflict management skills. The effectiveness of emergency response training varies among different clinical specialties, which may be related to the nature of the clinical professional background. In future course design, targeted emergency training courses can be set up based on professional background.

Objective:To evaluate the feasibility and outcomes of transnasal endoscopic clipping of the paraclival internal carotid artery (ICA) in skull base surgery.Methods:The paraclival ICA was anatomically dissected in cadaveric head specimens. The clinical data of 15 patients with skull base lesions involving the ICA who admitted to the Department of Otorhinolaryngology Head and Neck Surgery at Tianjin Huanhu Hospital from January 2021 to December 2023 were retrospectively analyzed. Among them, 4 patients underwent transnasal endoscopic clipping of the paraclival ICA and concurrent lesion resection. The surgical methods were summarized, and the key points and indications of this technique were analyzed.Results:Intraoperative clipping of the ICA was successful and hemostatic in all 4 patients. Postoperatively, 3 patients had no complications, while 1 patient developed delayed ischemic cerebral infarction. Two patients were cured, 1 patient was maintained on immunotherapy, and 1 patient died. During follow-up, the clip was in situ in 1 patient, had detached in another, and was obscured by temporal muscle coverage in the remaining 2 patients.Conclusions:Transnasal endoscopic clipping of the paraclival ICA represents a potential option for managing the ICA in skull base surgery. However, it carries significant risks and limitations, mandating careful patient selection based on specific circumstances.

Objective To explore the potential categories of frailty development trajectories in patients undergoing cardiac surgery from pre-operation to 6 months post-operation,and analyze the influencing factors.Methods By a longitudinal study design,patients undergoing elective heart valve replacement surgery or coronary artery bypass grafting in a tertiary general hospital in Zunyi City from August 2022 to June 2023 were selected by the convenience sampling method.Tilburg frailty scale was used to investigate the frailty level of cardiac surgery patients 1 day before surgery(T0),1 month(T1),3 months(T2)and 6 months after surgery(T3).The growth mixture model was used to identify the trajectory categories,and the influencing factors of different frailty trajectories were analyzed by binary Logistic regression.Results 261 patients were enrolled at T0,with 22,9,and 3 patients lost at T1 to T3,and 227 patients were finally included in the analysis.There were 2 types of trajectories being identified as the low frailty decline group and the high frailty maintenance group.Age,use of sedative and analgesic drugs,pace,and depression were the factors influencing the frailty in cardiac surgery patients(P＜0.05).Conclusion There are 2 kinds of frailty development trajectories in patients undergoing cardiac surgery.Medical staff should fonnulate precise interventions and nursing measures according to the factors influencing frailty,so as to improve frailty degree and quality of life of patients undergoing cardiac surgery.

The mother formula of Ruyizhenbao formula was the 25-flavor Zhumu Fang recorded in the Four Medical Codes,which was called Ruyi 25-flavor Zhumu Fang in the 16th century book Tibetan Medicine Ruyi Daquan.Later,in the book Qianwan Sheli,licorice was added to the formula,forming a 26-flavor basic formula of Ruyizhenbao.With the development of Tibetan medicine history,various doctors added and subtracted medicinal flavors to the basic formula.Finally,it was developed by Qinrenorbu into Ruyizhenbao formula composed of 30 herbs,which was published in the Treasure Source of Tibetan Medicine Secrets and was included in the Drug Standard of the Ministry of Health(Tibetan medicine)in 1995,becoming the formula standard of Ruyizhenbao formula.Through systematically sorting out Tibetan medicine literature from past dynasties,the formula name,medicinal taste composition,and changes of Ruyizhenbao formula recorded in different literature was comprehensively analyzed.Through primary literature research,the various claims about the origin of Ruyizhenbao formula published to date have been verified one by one to clarify its past and present,and to clarify its origin.The mother formula of Ruyizhenbao is the 25-flavor mother powder recorded in the Four Medical Codes.The basic formula is the Ruyizhenbao formula composed of 26 herbs in Qianwan Sheli,and the standard formula is the Ruyizhenbao formula composed of 30 herbs in the Treasure Source of Tibetan Medicine Secrets.

Objective:To investigate the expression of miRNAs in thymus of patients with myasthenia gravis(MG)and the re-lated mechanism of action,so as to provide theoretical and experimental basis for clinical diagnosis and treatment.Methods:miRNA microarray technology was used to analyze the differential miRNA expression in MG patients thymus.Fluorescence quantitative PCR and in situ hybridization were used to verify the expression of miR-19a-3p in thymus tissue.The TALL-104 cell line was transfected with miR-19a-3p mimics to observe the effects of miR-19a-3p on cell proliferation,apoptosis and expressions of related molecules(BCL2 and SOCS3).Results:Compared to normal thymus tissue,a total of 282 differentially expressed miRNAs were detected in the thymus of MG patients,among which 103 were up-regulated and 179 were down-regulated.The target genes of differentially expressed miRNAs were mainly related to nuclear molecules,cytoplasmic membrane-like structures and organelle related molecules.Quantita-tive fluorescence PCR and in situ fluorescence hybridization confirmed that the expression of miR-19a-3p in MG patients thymus was significantly lower than that in normal control group.Compared with the control group,miR-19a-3p mimics transfection could signifi-cantly inhibit the apoptosis of TALL-104 cells,increase the expression of BCL2 and decrease the expression of SOCS3(P<0.05).Conclusion:The expression of miRNA in the thymus of MG patients is significantly different from that of non-MG patients,and miR-19a-3p inhibits T cell apoptosis through up-regulation of BCL2 and down-regulation of SOCS3.

AIM:To investigate the effects of emo-din on autophagy and apoptosis in rats with severe pneumonia(KP)caused by K.pneumoniae and its possible mechanism.METHODS:The KP rat model was established by infecting K pneumonia was treat-ed with Emodin.The rats were grouped into Sham surgery group,KP group,low concentration Emodin group,medium concentration Emodin group,high concentration Emodin group,and Emodin+sirtinol(SIRT1 activity inhibitor)group;Arterial partial pres-sure of carbon dioxide(PaCO2),arterial partial pres-sure of oxygen(PaO2)and arterial oxygen saturation(SaO2)were measured by blood gas analyzer;the white blood cells and neutrophils in bronchoalveo-lar lavage fluid(BALF)were measured by Wright-Gi-emsa staining;HE staining was applied to detect pathological changes in lung tissue in each group;ELISA was applied to detect the expression of IL-6,TNF-α,and IL-1β in lung tissues of each group;elec-tron microscopy scanning was applied to observe the autophagy of cells in lung tissues of each group;the expression of LC3B in lung tissues was observed by immunofluorescence staining;TUNEL method was applied to detect changes in cell apoptosis in lung tissue of rats in each group;Western blot was applied to detect the expression of silent informa-tion regulatory factor(SIRT1),adenosine monophos-phate activated protein kinase(AMPK),LC3-Ⅱ,LC3-Ⅰ,c-caspase-3,and caspase-3 proteins in lung tissue.RESULTS:K.pneumoniae caused severe lung tissue damage in rats with pneumonia,increased inflam-matory infiltration and cytokine release in the lungs,arterial blood PaO2 and SaO2 levels de-creased,PaCO2 levels increased,white blood cells and neutrophils count increased in BALF,increased cell apoptosis rate and c-caspase-3/caspase-3 level,and the cell autophagy and the levels of autophagy related proteins LC3-Ⅱ/LC3-Ⅰ were decreased(all P＜0.05),after Emodin treatment,SIRT1/AMPK signal-ing pathway was activated,PaO2 and SaO2 levels in arterial blood were increased,PaCO2 levels was de-creased,inflammatory reaction was inhibited,cell apoptosis in lung tissue was inhibited(all P＜0.05),and cell autophagy level was restored,sirtinol,a SIRT1 inhibitor,partially reversed the therapeutic ef-fect of Emodin on KP rats after inhibiting SIRT1/AMPK signaling pathway(P＜0.05).CONCLUSION:Emodin may enhance autophagy of lung tissue cells and inhibit apoptosis of rat lung tissue cells by acti-vating SIRT1/AMPK pathway,which may provide po-tential therapeutic options for KP.

Objective To explore the optimal grouping scheme of diagnosis related groups (DRG) for acquired immunodeficiency syndrome(AIDS) patients and develop cost criteria to provide a reference for implementing DRG payment reform in this region. Methods Information on the first pages of 1987 cases of AIDS patients from Nantong AIDS designated hospitals between 2018 and 2022 was collected, the influencing factors of hospitalization costs were analyzed by applying univariate and multiple linear regression and screening out the classification nodes, and the DRG grouping scheme was constructed by using a decision tree model. Results Complications or comorbidities, number of other diagnoses, and case type were used as classification nodes to form a total of 6 case combinations and corresponding hospitalization cost criteria. The difference in hospitalization cost between groups was statistically significant (P<0. 001), the reduction in variation(RIV) value was 51. 0％, and the coefficient of variation(CV) value of each group was less than 1 (0. 33～0. 63), with good inter-group heterogeneity and intra-group homogeneity. Conclusion The grouping scheme constructed based on the decision tree model is more reasonable, and the standard cost can objectively reflect the actual level of medical consumption of patients, providing a reference for improving DRG grouping and cost payment for AIDS patients in the region.

The 2025 American Society of Clinical Oncology(ASCO)Annual Meeting was held in Chicago from May 30 to June 3,2025.As one of the largest and most influential academic events in global oncology,the ASCO meeting brought together numerous world-class oncology experts.It focused on the unmet clinical needs in gastrointestinal malignancies such as hepatocellular carcinoma,cholangiocarcinoma,and pancreatic cancer,and presented a wealth of cutting-edge research findings and therapeutic innovations.These advances provide important evidence-based support for the diagnosis and treatment of hepatobiliary and pancreatic cancers.Based on the latest achievements presented at ASCO 2025,this article discusses the hot topics and future directions in the management of hepatobiliary and pancreatic tumors.

Objective To address personnel management challenges in large comprehensive hospitals by developing a comprehensive personnel information management system for refined multi-campus administration.Methods A centralized data-base was employed to construct a personnel information management system compatible with both"interactive management"and"independent management"modes.The system progressively implemented functions including personnel information manage-ment,meal card and subsidy administration,and shift scheduling.Results The system achieved effective interconnections be-tween subsystems,significantly improving personnel management efficiency,data governance,risk prevention capabilities,and operational decision-making.Personnel data were efficiently utilized across multiple scenarios.Conclusion The multi-campus comprehensive personnel information management system meets the refined requirements of multi-campus personnel administration and provides valuable experience for the development and expansion of subsequent hospital operation management information sys-tems.