This paper reports a case of hepatoblastoma that is inclined to misdiagnosis and missed diagnosis. The patient, a 6-month-old male, was admitted to Dermatology Department of Children’s Hospital of Nanjing Medical University and Beijing Children’s Hospital successively, because of a erythema on the neck for 6 months and a mass in the neck for 3 months. Abdominal ultrasonography and CT indicated the possibility of hepatic hemangioma, but further examination of alpha fetoprote and other indicators suggested hepatic malignant tumor. Therefore, surgery was performed to remove the liver mass, and postoperative pathology revealed hepatoblastoma. Postoperative chemotherapy was combined, and follow-up was conducted six months after the end of chemotherapy, with no recurrence of the disease. This article summarized the diagnosis and treatment process of this case and combined with literature review to provide experience for clinicians in the diagnosis and treatment of relevant cases.

Aging is comprehensively influenced by multiple fac-tors such as internal genes,cellular metabolism,external envi-ronment,and lifestyle habits.Among them,epigenetic regula-tion plays a core role.Epigenetic modifications,including DNA methylation,histone modification,heterochromatin remodeling,and non-coding RNA regulation,act in concert with the three-di-mensional genome architecture to precisely regulate gene expres-sion.This review elaborates on the factors influencing epigenetic regulation,as well as the mechanisms of how epigenetics affects the occurrence of organismal aging and the corresponding inter-vention strategies,providing relevant insights for uncovering the mechanisms of aging and preventing/treating aging-related disea-ses.

Objective To improve and refine the relevant regulations and guiding principles of warnings on drug instructions and labels in China.Methods This paper sorted out the drug instructions of small molecule anti-tumor drugs listed by the U.S.Food and Drug Administration(FDA)from 2005 to 2022,included the drugs mentioned in the QT interval prolongation risk,analyzed the clinical research and QT research results,and sorted out the identification and warning rules of the instructions.Results A total of 35 drugs were included,4 drugs wrote the risk of QT interval prolongation in the black box warning,21 drugs were wrote in the warning and precautions position,6 drugs were wrote in the adverse reaction section,and 2 drugs were only described under clinical pharmacology section.According to the severity of the QT interval prolongation caused by the drug and whether there were serious clinical consequences,they were displayed in the warnings(black box warnings),precautions(warnings and precautions)and adverse reactions in the instructions.Conclusion The aim of this article is to provide a reference for the writing of QT risk warning information of the instructions of domestic drug production enterprises and regulatory departments.It is recommended to clarify the severity of drug safety and the location of the instructions in clinical research,and continue to carry out safety monitoring and update the instructions in time after listing.

Objective:To evaluate the impact of Diagnosis-Intervention Packet(DIP)payment reform on medical service costs and efficiency for inpatients in public hospitals,and to compare differences between surgical and medical groups.Methods:A quasi-experimental design was employed,using 605 636 discharged patients from a tertiary hospital in Hebei Province between January 2020 and March 2025 as the sample.The difference-in-differences(DID)model was used to analyze the changes in key indicators between the DIP settlement group(intervention group)and the non-DIP settlement group(control group).Results:Total hospitalization costs,out-of-pocket expenses,and medication costs were significantly reduced in the DIP settlement group(P<0.05),while costs for examinations,nursing,laboratory tests,and treatments increased significantly(P<0.05).Material costs increased by 30.7%in the surgical group(P<0.1)and decreased by 19.8%in the medical group(P<0.01).In terms of efficiency,the average length of stay,time,and cost consumption index all decreased(P<0.01),while the proportion of medical services increased(P<0.01).The case mix index(CMI)showed no significant changes.Conclusion:The DIP reform effectively controlled costs and improved efficiency,but it also resulted in cost shifting and departmental disparities.Therefore,it is necessary to optimize cost control and departmental management policies.

Objective:To investigate the predictive value of endothelial activation and stress index(EASIX)for the prognosis of patients with mantle cell lymphoma(MCL).Methods:A retrospective analysis was conducted to assess prognosis and compare the clinical features of patients diagnosed with MCL who were admitted to the Affiliated Hospital of Xuzhou Medical University from January 2010 to June 2023,had therapeutic indications and received standard treatment.Results:A total of 66 patients were included and divided into high EASIX group and low EASIX group,according to a cutoff value of 0.97 determined by the receiver operating characteristic(ROC)curve.Multivariate Cox regression analysis showed that prealbumin＜0.2 g/L,high EASIX,and ECOG PS score ≥2 were independent risk factors influencing overall survival(OS)in MCL patients.The median OS of patients in the high and low EASIX group was 13.0 and 37.5 months,and the median progression-free survival was 8.8 and 26.0 months,respectively.The proportions of patients with ECOG PS score ≥2 and prealbumin＜0.2 g/L at onset significantly increased in the high EASIX group compared to those in the low EASIX group.Conclusion:At the time of initial diagnosis,EASIX can serve as an independent prognostic indicator impacting OS in patients with MCL.Furthermore,patients in the high EASIX group experience a poorer prognosis and shorter survival duration compared with those in the low EASIX group.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective To investigate the expression of microRNA-221-3p(miR-221-3p)in breast cancer cells under hypoxia conditions,and the effects of knocking down its expression on the stemness maintenance and angiogenesis in breast cancer cells.Methods Human breast cancer cell line MCF-7 were cultured under normoxic and hypoxic conditions,and the expression of miR-221-3p in cells was detected by quantitative real-time polymerase chain reaction(RT-qPCR).MCF-7 cells were divided into normoxic group(MCF-7 cells were cultured under normoxic conditions),hypoxic group(MCF-7 cells were cultured under hypoxic conditions),hypoxia+miR-221-3p NC group(MCF-7 cells were cultured under hypoxic conditions and transfected with miR-221-3p NC),hypoxia+miR-221-3p inhibitor group(MCF-7 cells were cultured under hypoxic conditions and transfected with miR-221-3p inhibitor).The proliferation activity of cells in each group was detected by CCK-8 method;the number of cell tumor spheres in each group was detected by tumor sphere formation assay;the proportion of cells labeled with the stemness marker aldehyde dehydrogenase 1(ALDH1)in each group was detected by flow cytometry;the expression of cluster of differentiation 133(CD133),cluster of differentiation 44(CD44)and sex determination region Y-box protein 2(SOX2)of cells in each group was detected by Western blot;the number of human umbilical vein endothelial cells(HUVEC)tubes formed by cell supernatant culture in each group was detected by in vitro tube formation experiment;the expression of hypoxia-inducible factor-1α(HIF-1α)and vascular endothelial growth factor(VEGF)of cells in each group was detected by Western blot.Results Compared with normoxic group,the expression levels of miR-221-3p,and CD133,CD44,SOX2,HIF-1α,VEGF protein of cells in hypoxic group were significantly up-regulated(P<0.05),and the cell proliferation activity,the number of tumor spheres,the proportion of ALDH1+cells and the number of HUVEC tubes were significantly increased(P<0.05).Compared with hypoxia+miR-221-3p NC group,the expression levels of miR-221-3p,and CD133,CD44,SOX2,HIF-1α,VEGF protein of cells in hypoxia+miR-221-3p inhibitor group were significantly down-regulated(P<0.05),and the cell proliferation activity,the number of tumor spheres,the proportion of ALDH1+cells,and the number of HUVEC were significantly decreased(P<0.05).Conclusion Under hypoxic conditions,the expression of miR-221-3p in breast cancer cells is up-regulated,and knocking down the expression of miR-221-3p can reduce the stemness and angiogenesis ability of breast cancer cells.

Objective To explore the value of deep learning image reconstruction(DLIR)algorithm to improve the quality of low keV monochromatic portal vein images of energy spectrum CT.Methods Fifty patients who underwent enhanced upper abdominal energy spectrum CT scan were selected.Mixed-model adaptive statistical iterative reconstruction-Veo(50%ASIR-V)algorithm and high-deep learning image reconstruction(DLIR-H)algorithm were used to obtain monochromatic images at 40-70 keV(with intervals of 10 keV).The CT and standard deviation(SD)values of the portal vein trunk,left and right branches,and erector spinae muscle were measured in the transverse position,and the signal-to-noise ratio(SNR)and portal vein contrast-to-noise ratio(CNR)were calculated for objective evaluation.The portal vein image quality between the two algorithms and different energy was subjectively scored by two physicians.Results In terms of objective evaluation:compared with 50%ASIR-V,the CNR and SNR of portal vein in monochromatic DLIR-H images at the same keV between 40-70 keV energy levels were increased while the SD value was decreased(P＜0.05),and the CT value was unchanged;there was no statistical difference in the magnitude of change in CNR between the two algorithms at different energy levels(P＞0.05);there was a statistically significant difference in the magnitude of change in SNR and SD value(P＜0.05)and the magnitude of change was the largest at 40 keV;comparison between different energy levels of DLIR-H,the CNR and SD value of 40 keV DLIR-H were the highest(P＜0.05),and there was no significant difference in the SNR(P＞0.05).In terms of subjective evaluation:there was no significant difference between the subjective scores of the two algorithms at the same keV from 40-70 keV(P＞0.05),and the two reconstruction algorithms at 40 keV and 50 keV had the highest subjective scores between different keV.Conclusion The DLIR algorithm can reduce the noise of low keV monochromatic images,improve the image quality of portal vein.

Wu Jutong's academic thoughts are inherited from Ye Tianshi and traced back to Zhongjing,and have a unique under-standing and play of the evil invading Shaoyang.Wu Jutong believes that Shaoyang has two major functional characteristics:ascending and pivoting.The principle of treating evil invading Shaoyang is to follow the ascending nature of Shaoyang and restore the pivoting function of Shaoyang.For Shaoyang fire-heat syndrome,follow Shaoyang to ascend and disperse to penetrate heat,and often use light,scavenging and dispersing products;for Shaoyang phlegm-fluid syndrome,creat Xiangfu Xuanfuhua Decoction to benefit the liver and gallbladder and resolve phlegm-fluid;for malaria invading Shaoyang,turn the pivot to stop malaria,and use Xiaochaihu Decoction and Qinghao Biejia Decoction for the treatment;for yin evil invading Shaoyang and Jueyin,Xiao Chaihu Decoction and Bupleurum chinense DC.are often used to turn the pivot of Shaoyang and warm and unchoke Jueyin.The contraindications of Xiao Chaihu Decoction are al-so summarized.

Aim To identify the underlying target of bullatine A(BA)against rheumatoid arthritis(RA)u-sing limited proteolysis-small molecule mapping(LiP-SMap)drug target proteomics and to provide a scientif-ic basis for clinical application of Aconiti brachypodi Radix in the treatment of RA.Methods LiP-SMap drug target proteomics was employed to perform bioin-formatics analysis for comparing and validating the dif-ferential protein expression after BA intervention.A collagen-induced arthritis(CIA)model was estab-lished in DBA/1 mice using bovine type Ⅱ collagen.The mice were then divided into the CIA model group,methotrexate-positive control group(MTX group),and BA groups(10 mg·kg-1 and 20 mg·kg-1)based on their clinical scores.After drug intervention,the thera-peutic efficacy against RA was assessed by joint index scores and foot thickness measurements.Histopatholog-ical changes in the arthritic joints of CIA mice were e-valuated using hematoxylin and eosin(HE)staining.Enzyme-linked immunosorbent assay(ELISA)was employed to detect inflammatory cytokines interleukin-17(IL-17)and total IgG and IgG3 anti-collagen-spe-cific antibodies levels from the serum of CIA mice.Flow cytometry was used to detect the expression levels of intracellular Th17 cells(IL-17+CD4+T cells)and Th1 cells(IFN-γ+CD4+T cells).Fluorescent quanti-tative PCR was performed to detect the expression of genes related to differential proteins.Results The proteomic analysis identified Serpinb1a as a protein with strong binding affinity to BA,and KEGG enrich-ment analysis indicated IL-17 signaling pathway was a crucial pathway of BA in against RA.BA treatment significantly reduced clinical scores and foot thickness,improved local arthritis symptoms in CIA mice,and al-leviated inflammatory cell infiltration into arthritic joints(P＜0.05).Differential protein validation re-sults showed that BA had strong affinity with Serpinb1a(-5.92 kJ·mol-1)and downregulated the expres-sion of Serpinb1a mRNA.Furthermore,the administra-tion of BA markedly reduced serum IL-17 A levels from CIA mice,inhibited the expression of intracellular IL-17 A and IFN-γ cytokines in splenic CD4+T cells(P＜0.05),and significantly downregulated the transcrip-tional expression of IL-17F(P＜0.05).Conclusion BA exhibits therapeutic effects on collagen-induced arthritis,and its mechanism of action may involve the regulation of Serpinb1a and the IL-17 signaling path-way.