Objective: To address systemic challenges in the blood system, such as supply-demand imbalance, inefficient allocation, and inappropriate clinical use, while bridging gaps in current theories regarding the integration of social mobilization, institutional practice, and policy coordination. It sought to construct a system dynamics model spanning from macro to micro levels to analyze the blood management system holistically. Methods: Key variables were identified by a systematic literature search in both Chinese and English databases. An improved Delphi method was then employed to conduct expert consultations across different fields, leading to the selection and determination of core variable sets for each sub-model. Furthermore, by defining their logical relationships, a system dynamics model was constructed to systematically analyze the operation mechanism of the blood management system. Results: Four core sub-models were developed: 1) A macro "Dynamic Balance" model quantifying regional supply-demand equilibrium and inventory control; 2) a mobilization "Three-Layer Funnel" model analyzing how socio-cultural factors, service channels, and policy incentives influence donation behavior; 3) an institutional "Dual-Cycle Regulation" model revealing hospital blood usage is driven by both disease burden (demand cycle) and management practices (regulation cycle); and 4) an individual "Three-Layer Filter" model standardizing clinical transfusion decisions based on necessity, risk-benefit, and context. These were integrated into a "Multi-Layer Linkage and Feedback" model, elucidating bidirectional interactions among five levels: policy environment, regional supply, blood station mobilization, hospital application, and clinical decision-making. Conclusion: This study constructed a system dynamics model for blood management. By defining key variables and their logical relationships, it systematically analyzes the system′s operational mechanism. The integrated framework connects multiple levels—regional supply, voluntary donation, hospital blood use, and clinical decision-making—revealing their intrinsic linkages. Future efforts should employ systems thinking to synergistically enhance supply-side mobilization, demand-side management, systemic regulation, and decision standardization to build a safe, efficient, and sustainable blood security system.

Lung cancer constitutes the most prevalent and lethal malignant tumor in China. Approximately 85% of lung cancer diagnoses correspond to the non-small cell histological subtype [non-small cell lung cancer (NSCLC)]. Despite surgery being the mainstay for early-stage disease, postoperative recurrence remains high and adjuvant chemotherapy offers limited benefit. In recent years, targeted therapy has demonstrated substantial advantages in driver mutation-positive NSCLC. To this end, the Lung Cancer Medical Education Committee of the Chinese Medical Education Association developed guidelines based on a systematic review of evidence through November 2025, using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach and a modified Delphi method. Focusing on epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), and addressing ROS proto-oncogene 1 (ROS1), B-Raf proto-oncogene serine/threonine kinase (BRAF) V600E mutation, and mesenchymal-epithelial transition factor (MET) exon 14 (METex14) skipping, the guideline covers molecular testing, neoadjuvant/adjuvant therapy, perioperative strategies, minimal residual disease monitoring, and postoperative surveillance. It defines testing requirements, specifies stage-directed and subtype-specific treatments, and standardizes minimal residual disease monitoring. These recommendations emphasize precision and feasibility to improve survival and quality of life.

Objective:To explore the effect of home-based online preoperative rehabilitation training on early postoperative recovery in patients with pulmonary nodules.Methods:This study is a randomized controlled study. Fifty patients with pulmonary nodules scheduled for elective surgery in Zhongshan Hospital from January 2023 to September 2023 were randomly divided into the control group and the study group ( n=25 in each group). Patients in the study group carried out home pre-rehabilitation training guided by mobile App before operation, including breathing training, resistance exercise, nutritional intervention and psychological counseling; there was no intervention for patients in the control group while waiting for operation. The lung function, 6-min walking distance, psychological status, nutritional status, postoperative complications, catheterization time, hospitalization time, hospitalization expenses and complications were compared between the two groups before and after operation. Results:There were no significant differences in age, sex, BMI, heart rate, respiratory rate, blood pressure, pulmonary function, nutritional status, location of pulmonary nodules, anesthesia mode, operation modality and surgical pathology results between two groups(all P>0.05). Compared with the control group, the study group had significantly improved forced vital capacity at admission, 1d and 30d after surgery ( Z=-2.338, Z=-2.203, Z=-2.348, all P<0.05), forced expiratory volume in one second (FEV1) ( Z=-3.241, Z=-3.262, Z=-3.564, all P<0.05), and the ratio of forced vital capacity (FVC) to FEV1 ( t=-3.186, t=-2.904, and t=-4.304, all P<0.05), increased 6 min walking distance ( t=-4.466, t=-4.144, t=-4.907, all P<0.05), improved anxiety ( Z=-3.164, Z=-4.425, Z=-3.622, all P<0.05), decreased depression ( Z=-2.598, Z=-3.799, Z=-3.439, all P<0.05); and improved nutritional status at admission and 1d after surgery ( Z=-3.061, Z=-3.648, all P<0.05). The incidence of postoperative complications was decreased ( χ 2=4.878, P<0.05), the time of catheterization was decreased ( Z=-4.056, P<0.001), the length of hospital stay was shortened ( Z=-4.345, P<0.001), and the cost of hospitalization was reduced ( Z=-2.590, P<0.05) in the study group. Conclusion:The home-based online prehabilitation training can effectively improve the cardiopulmonary function and physical fitness of patients, reduce the stress of surgery, and contribute to rapid recovery after surgery; it also can shorten the length of postoperative hospital stay and reduce medical costs.

Objective:To evaluate the clinical efficacy of transoral robotic surgery (TORS) in the treatment of malignant tongue base tumors.Methods:A multicenter study was conducted to collect and analyze the clinical data of patients with malignant tongue base tumors who underwent TORS at five otolaryngology-head and neck surgery centers in China, including Eye Ear Nose and Throat Hospital of Fudan University, Sun Yat-sen University Cancer Center, Tongji Hospital of Huazhong University of Science and Technology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, and the First Affiliated Hospital of China Medical University between January 2017 and January 2023. Among the patients, 38 were males and 11 were females, with a mean age of 59.0±8.8 years. Baseline characteristics, complications, and follow-up data were compared between groups. Independent sample t-tests or Mann-Whitney U tests was used for comparisons of continuous variables; chi-square tests or Fisher′s exact tests was applied for categorical variables. Survival analysis was performed using the Kaplan-Meier method to calculate overall survival and disease-free survival, and differences between groups were compared using the log-rank test. Results:Among the 49 patients, 41 (83.7%) were diagnosed with squamous cell carcinoma (SCC), with a p16 positive rate of 51.2% (21/41). There were no statistically significant differences between the p16-positive group ( n=21) and the p16-negative group ( n=20) in age, sex, or postoperative bleeding (all P>0.05). However, there was a significant difference in TNM stage between the two groups ( χ2=14.556, P=0.020), with the p16-positive group predominantly in stage I (66.7%) and the p16-negative group primarily in stages Ⅲ and Ⅳ (40.0% and 30.0%, respectively). The postoperative tracheotomy rate was 30.6% (15/49), and the incidence of postoperative bleeding was 6.1% (3/49). The 1-year and 3-year overall survival rates were 98.0% and 92.5%, respectively, while, the 1-year and 3-year disease-free survival rates were 89.2% and 84.9%, respectively. No significant differences were observed between the p16-positive and p16-negative groups in 3-year overall survival (100% vs. 83.8%, χ2=1.093, P=0.518) or 3-year disease-free survival (68.2% vs. 88.9%, χ2=2.161, P=0.382). Conclusion:TORS for malignant tongue base tumors demonstrates high clinical safety and favorable oncological outcomes.

Objective:To explore the current status of kinesiophobia in pregnant women with pregnancy-related low back pain (PLBP) and its influencing factors, so as to inform the clinical development of intervention programs.Methods:Convenience sampling was used to select 270 pregnant women with PLBP who underwent routine obstetric examination from August to November 2023 at the Obstetrics Clinic of Affiliated Obstetrics and Gynecology Hospital of Jiangnan University. Pregnant women were surveyed using the General Information Questionnaire, Tampa Scale for Kinesio-Phobia, Falls Efficacy Scale-International, Pregnancy Exercise Self-efficacy Scale, and Low Back Pain Knowledge Questionnaire. Multiple linear regression was used to explore the factors influencing kinesiophobia in pregnant women with PLBP.Results:In 270 pregnant women with PLBP, the kinesiophobia score was (47.78±8.80) and the prevalence of kinesiophobia was 89.3% (241/270). Multiple linear regression analysis showed that lower extremity edema, pain, fear of falling, exercise self-efficacy, and knowledge of low back pain were the factors influencing kinesiophobia in pregnant women with PLBP ( P<0.05) . Conclusions:Pregnant women have a high level of kinesiophobia, and there are many influencing factors. Healthcare professionals should consider a variety of factors to develop an intervention program to reduce kinesiophobia and increase activity levels in pregnant women with PLBP.

Objective:To explore the current status of kinesiophobia in pregnant women with pregnancy-related low back pain (PLBP) and its influencing factors, so as to inform the clinical development of intervention programs.Methods:Convenience sampling was used to select 270 pregnant women with PLBP who underwent routine obstetric examination from August to November 2023 at the Obstetrics Clinic of Affiliated Obstetrics and Gynecology Hospital of Jiangnan University. Pregnant women were surveyed using the General Information Questionnaire, Tampa Scale for Kinesio-Phobia, Falls Efficacy Scale-International, Pregnancy Exercise Self-efficacy Scale, and Low Back Pain Knowledge Questionnaire. Multiple linear regression was used to explore the factors influencing kinesiophobia in pregnant women with PLBP.Results:In 270 pregnant women with PLBP, the kinesiophobia score was (47.78±8.80) and the prevalence of kinesiophobia was 89.3% (241/270). Multiple linear regression analysis showed that lower extremity edema, pain, fear of falling, exercise self-efficacy, and knowledge of low back pain were the factors influencing kinesiophobia in pregnant women with PLBP ( P<0.05) . Conclusions:Pregnant women have a high level of kinesiophobia, and there are many influencing factors. Healthcare professionals should consider a variety of factors to develop an intervention program to reduce kinesiophobia and increase activity levels in pregnant women with PLBP.

Objective:To explore the effect of home-based online preoperative rehabilitation training on early postoperative recovery in patients with pulmonary nodules.Methods:This study is a randomized controlled study. Fifty patients with pulmonary nodules scheduled for elective surgery in Zhongshan Hospital from January 2023 to September 2023 were randomly divided into the control group and the study group ( n=25 in each group). Patients in the study group carried out home pre-rehabilitation training guided by mobile App before operation, including breathing training, resistance exercise, nutritional intervention and psychological counseling; there was no intervention for patients in the control group while waiting for operation. The lung function, 6-min walking distance, psychological status, nutritional status, postoperative complications, catheterization time, hospitalization time, hospitalization expenses and complications were compared between the two groups before and after operation. Results:There were no significant differences in age, sex, BMI, heart rate, respiratory rate, blood pressure, pulmonary function, nutritional status, location of pulmonary nodules, anesthesia mode, operation modality and surgical pathology results between two groups(all P>0.05). Compared with the control group, the study group had significantly improved forced vital capacity at admission, 1d and 30d after surgery ( Z=-2.338, Z=-2.203, Z=-2.348, all P<0.05), forced expiratory volume in one second (FEV1) ( Z=-3.241, Z=-3.262, Z=-3.564, all P<0.05), and the ratio of forced vital capacity (FVC) to FEV1 ( t=-3.186, t=-2.904, and t=-4.304, all P<0.05), increased 6 min walking distance ( t=-4.466, t=-4.144, t=-4.907, all P<0.05), improved anxiety ( Z=-3.164, Z=-4.425, Z=-3.622, all P<0.05), decreased depression ( Z=-2.598, Z=-3.799, Z=-3.439, all P<0.05); and improved nutritional status at admission and 1d after surgery ( Z=-3.061, Z=-3.648, all P<0.05). The incidence of postoperative complications was decreased ( χ 2=4.878, P<0.05), the time of catheterization was decreased ( Z=-4.056, P<0.001), the length of hospital stay was shortened ( Z=-4.345, P<0.001), and the cost of hospitalization was reduced ( Z=-2.590, P<0.05) in the study group. Conclusion:The home-based online prehabilitation training can effectively improve the cardiopulmonary function and physical fitness of patients, reduce the stress of surgery, and contribute to rapid recovery after surgery; it also can shorten the length of postoperative hospital stay and reduce medical costs.

Objective:To evaluate the clinical efficacy of transoral robotic surgery (TORS) in the treatment of malignant tongue base tumors.Methods:A multicenter study was conducted to collect and analyze the clinical data of patients with malignant tongue base tumors who underwent TORS at five otolaryngology-head and neck surgery centers in China, including Eye Ear Nose and Throat Hospital of Fudan University, Sun Yat-sen University Cancer Center, Tongji Hospital of Huazhong University of Science and Technology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, and the First Affiliated Hospital of China Medical University between January 2017 and January 2023. Among the patients, 38 were males and 11 were females, with a mean age of 59.0±8.8 years. Baseline characteristics, complications, and follow-up data were compared between groups. Independent sample t-tests or Mann-Whitney U tests was used for comparisons of continuous variables; chi-square tests or Fisher′s exact tests was applied for categorical variables. Survival analysis was performed using the Kaplan-Meier method to calculate overall survival and disease-free survival, and differences between groups were compared using the log-rank test. Results:Among the 49 patients, 41 (83.7%) were diagnosed with squamous cell carcinoma (SCC), with a p16 positive rate of 51.2% (21/41). There were no statistically significant differences between the p16-positive group ( n=21) and the p16-negative group ( n=20) in age, sex, or postoperative bleeding (all P>0.05). However, there was a significant difference in TNM stage between the two groups ( χ2=14.556, P=0.020), with the p16-positive group predominantly in stage I (66.7%) and the p16-negative group primarily in stages Ⅲ and Ⅳ (40.0% and 30.0%, respectively). The postoperative tracheotomy rate was 30.6% (15/49), and the incidence of postoperative bleeding was 6.1% (3/49). The 1-year and 3-year overall survival rates were 98.0% and 92.5%, respectively, while, the 1-year and 3-year disease-free survival rates were 89.2% and 84.9%, respectively. No significant differences were observed between the p16-positive and p16-negative groups in 3-year overall survival (100% vs. 83.8%, χ2=1.093, P=0.518) or 3-year disease-free survival (68.2% vs. 88.9%, χ2=2.161, P=0.382). Conclusion:TORS for malignant tongue base tumors demonstrates high clinical safety and favorable oncological outcomes.

The education concepts of four famous traditional Chinese medicine（TCM） doctors（XIAO Longyou， SHI Jinmo， KONG Bohua and WANG Fengchun） in Beijing during the Republic of China were compared， the commonalities in their education concepts of TCM were sorted out， and the root system of the cultivation and growth of talents in TCM， as well as the direction and way of further development were searched， so as to improve the quality of the inheritance and development of TCM. Based on the systematic review of text and opinion method（SrTO） developed by the centre for evidence-based health care at the Joanna Briggs Institute（JBI） in Australia， this study was conducted to collate and analyze the relevant information， including 14 books， 115 journal papers and 7 documents. Related theory construction and practice of early tutor and academic education have been summarized from college， continuing and tutor education， academic research， examination， and so on. And then the connections and commonalities between the different forms of education in the period were summarized to form a SrTO-based narrative， opinion， text assessment and review instrument（NOTARI） summary table. The findings revealed that these four esteemed TCM doctors and educators， through their substantial influence on TCM education in Beijing， emphasized the importance of classics in teaching and clinical practice， underscored the cultivation of virtue， preserved the traditional teaching model， and championed the establishment of TCM schools. They also put forward novel requisites for the compilation of curricula， teaching materials， and books. Moreover， they advocated for a unified perspective on TCM and western medicine， fostering talent capable of bridging the gap between the two. They encouraged the standardization of TCM teaching examination system， and actively participated in scientific research and book writing. The four TCM doctors transcended the traditional boundaries of TCM practice， fostering a new TCM model of education-clinical-research， and profoundly influencing the contemporary TCM colleges and teacher education.

AIM:To explore the mechanisms behind the inhibition of lymphangiogenesis in pregnant rats with obstructive nephropathy and assess the protective effects on kidney function.METHODS:Forty nulliparous female Wi-star rats were randomly assigned to four groups:sham operation,sham operation+pregnancy,model,and Esaxerenone groups,with 10 rats in each group.Renal injury was induced in the model and Esaxerenone groups via unilateral ureteral obstruction(UUO).The other two groups underwent ureteral dissociation without ligation.Nine weeks post-UUO,female rats in the sham operation+pregnancy,model,and Esaxerenone groups were mated with male rats(2:1 ratio)to establish a rat model of obstructive nephropathy during pregnancy.Starting the day after UUO,rats in the Esaxerenone group re-ceived Esaxerenone at 1 mg·kg-1·d-1.On the 18th day of pregnancy,24-hour urine was collected using metabolic cages.The following day,the rats were sacrificed,serum samples collected,and the contralateral kidney removed.Blood urea ni-trogen(BUN)was measured using standard biochemical methods,and endogenous creatinine clearance rate(Ccr)was calculated.Kidney tissue pathology was assessed using HE,Masson,and Sirius red staining.Serum aldosterone levels were determined via ELISA.Immunohistochemistry,real-time PCR,and Western blot were employed to assess mineralo-corticoid receptor(MR)activation,lymphangiogenesis,signaling pathways,and fibrosis-related markers.RESULTS:Renal function tests revealed increased BUN levels and decreased Ccr in the model group(P<0.01).Pathological exami-nation showed dilated renal tubules,significant collagen deposition,and inflammatory cell infiltration in the model group.ELISA results indicated a significant increase in serum aldosterone levels in the model group(P<0.01).Immunohisto-chemistry showed enhanced nuclear translocation of MR in the kidneys of the model group post-activation.Western blot and real-time PCR demonstrated a marked increase in neutrophil gelatinase-associated lipocalin(NGAL)expression in the model group(P<0.01).Additionally,the expression of vascular endothelial growth factor C(VEGF-C)and its receptor VEGFR3 was significantly elevated in the renal tubulointerstitium of the model group,as shown by both immunohistochem-istry and real-time PCR(P<0.01).The PI3K/Akt signaling pathway was activated in the model group,with significantly increased phosphorylation levels observed primarily in renal tubular epithelial and interstitial cells(P<0.01).Collagen type III(Col III)expression,primarily in the renal tubulointerstitium,was also significantly upregulated in the model group,consistent with real-time PCR results(P<0.01).Esaxerenone treatment improved renal function,reduced patho-logical damage,inhibited aldosterone secretion,and downregulated the expression of MR,NGAL,VEGF-C,VEGFR3,phosphorylated PI3K,phosphorylated Akt,and Col III(P<0.01).CONCLUSION:Esaxerenone mitigates aldosterone-induced MR activation,modulates the PI3K/Akt signaling pathway,reduces lymphangiogenesis in the contralateral kidney of pregnant rats with obstructive nephropathy,decreases collagen deposition,and delays the progression of renal intersti-tial fibrosis.