Acute lung injury （ALI） is a critical respiratory emergency caused by various non-cardiogenic factors， including severe pulmonary and extrapulmonary infections， lung contusion， and sepsis. Its pathological features are centered on alveolar-capillary barrier dysfunction， uncontrolled inflammatory responses， and impaired alveolar fluid clearance， manifesting as refractory hypoxemia and respiratory distress， with a poor clinical prognosis. Modern studies have revealed that mitochondrial dysfunction and glucose metabolic reprogramming in macrophages， characterized by hyperactivated glycolysis， drive pro-inflammatory polarization and represent a key mechanism leading to excessive inflammatory responses and disease progression in ALI. Therefore， targeting macrophage glycolysis may be a potential therapeutic strategy for ALI. The Plain Questions： Special Discussion on Channels and Vessels in Huangdi's Internal Classic states that "The spleen disseminates essence upward to the lungs". When the spleen fails in transport and transformation， the distribution of refined nutrients becomes disordered， resulting in the endogenous generation of turbid pathogens that obstruct the pulmonary collaterals， causing failure of lung dispersion and descent and leading to dyspneic reversal. This forms the dynamic pathological pattern of ''deficiency in the root with excess in the manifestation''， thereby proposing the core pathogenesis of ALI as ''spleen deficiency with transport dysfunction and turbid pathogens obstructing the lungs''. This process is intrinsically associated with the inflammatory cascade triggered by disordered macrophage glucose metabolism. Taking the theory of ''spleen failing to disperse essence'' as the entry point， the present study systematically elucidates the progressive pathological mechanism of "energy metabolism disorder-cytokine storm'' in ALI from the perspectives of the ''spleen deficiency-turbid obstruction'' pathogenesis and macrophage glycolysis-pro-inflammatory polarization. In addition， we summarize Chinese medicine compound formulas and monomeric components that ''restore spleen transport and eliminate turbid pathogens''， and explore their potential mechanisms in the treatment of ALI by regulating macrophage metabolic phenotypes to improve the state of ''spleen failing to disperse essence''. This provides a molecular basis for elucidating the ''spleen-lung'' energy metabolism dialogue， deepens understanding of the multi-target regulatory mechanisms of herbal prescriptions， and promotes the deep integration of classical theory with modern medicine.

Objective: To analyze the structural changes in whole blood and apheresis platelet donations in Chinese Society of Blood Transfusion (CSBT) sentinel units from 2021 to 2025, and to provide evidence for donor recruitment and blood service management. Methods: Aggregated data reported by sentinel sites were collected and stratified according to six indicators: age, sex, donation history, donation volume, donation site, and organization mode. Pearson χ test, Cramer′V coefficient, Cochran-Armitage trend test and simple linear regression were adopted for analysis. Results: A total of 16 256 973 whole blood donations and 1 576 546 apheresis platelet donations were included. Among whole-blood donations, the proportion of donors aged 18-22 years decreased from 27.30% to 10.60%. The proportion of male donors increased from 58.81% to 63.13%; the proportion of people aged 30 and above increased from 58.40% to 75.30%; the proportion of fixed locations rose from 28.37% to 36.57%; the proportion of social groups increased from 21.69% to 39.69%. The 400-mL donations decreased from 62.12% to 53.46%, while individually initiated voluntary donations remained above 50%. Apheresis platelet donations were predominantly from males, individuals aged 30-39 years, and repeat donors; 2-treatment-unit apheresis platelet donations increased from 67.19% to 74.93%, and individually initiated donations accounted for 92.97%-96.02%. Statistically significant overall annual compositional differences were observed for all six indicators (all P<0.001), whereas linear trends for some sub-categories were not statistically significant. Conclusion: In the participating CSBT sentinel units, among whole blood donations, the proportions of donors aged 18-22 years, university-organized group donations, and donations at blood mobiles decreased, whereas the proportions of organizational group donations and donations at fixed venues increased. The apheresis platelet donation cohort is relatively mature and is evolving toward a high-efficiency donation model. Individual voluntary donation remains the primary organization mode for both donation types. Strategies such as youth donor recruitment, optimized layout of fixed donation sites, and retention of repeat donors should be strengthened to improve the resilience of blood supply.

Objective Jejunal interposition is an important option for restoring gastrointestinal continuity in patients with complex esophageal cancer in whom the stomach is unavailable for reconstruction due to previous gastrectomy, tumor involvement, failed gastric conduit, or other constraints. Although the jejunum offers a caliber similar to the esophagus, a rich blood supply, and preserved peristaltic function, anatomical variations in mesenteric length and vascular arcades render long-segment and high-level reconstruction susceptible to excessive tension, mesenteric torsion, venous congestion, and inadequate distal perfusion. This consensus aims to provide standardized recommendations for the application of jejunal interposition in this specific patient population. Methods This consensus was developed in accordance with the WHO Handbook for Guideline Development and Chinese national guideline development standards, with reference to the Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) checklists. The project was registered on the international practice guidelines registry platform (PREPARE-2026CN1384). The working group systematically searched Chinese and English evidence addressing 12 clinical questions. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 system, with structured appraisal of risk of bias, inconsistency, indirectness, and imprecision. Recommendations were formulated through two rounds of Delphi surveys and a face-to-face consensus meeting, with an agreement threshold of ≥75%. Results The consensus generated 12 recommendations covering indications, selection between jejunum and colon, preoperative assessment, surgical approach and reconstruction route, pedicled jejunal interposition (PJI), supercharged pedicled jejunal interposition (SPJ), indocyanine green (ICG) perfusion assessment, perioperative nutrition, management of anastomotic leakage, long-term follow-up, and special treatment scenarios. Given that the available direct evidence is predominantly derived from single-center retrospective cohorts and case series, recommendations extrapolated from general esophagectomy or other gastrointestinal surgical evidence are deliberately phrased with caution. Conclusion Jejunal interposition is a safe and effective approach for digestive tract reconstruction in patients with complex esophageal cancer in whom the stomach is unavailable. This consensus emphasizes that clinical decision-making should be individualized based on the patient's prior treatment history, reconstruction height, vascular anatomy, technical availability, and institutional experience in the Chinese context.

ObjectivePremenstrual syndrome （PMS） is a cyclical psychosomatic disorder associated with neuroendocrine dysfunction and dysregulation of monoamine neurotransmitters. Yiqi Weixue prescription （YQWX）， with both medicinal and edible value， shows the potential in alleviating PMS， yet its multi-target synergistic mechanism remains unclear. This study aims to explore the multi-target synergistic mechanism of YQWX in alleviating premenstrual syndrome through transcriptomics. MethodsThe rat model of PMS was established by progesterone injection combined with restraint stress. A total of 49 female Wistar rats were randomized into a normal group， a solvent group， a model group， low-， medium-， and high-dose （359， 718， 1 436 mg·kg^-1， respectively） YQWX groups， and a positive control （Kuntai capsules， 540 mg·kg^-1） group. After two weeks of intervention， behavioral changes were assessed by open field， forced swimming， and sucrose preference tests. Serum levels of 5-hydroxytryptamine （5-HT）， norepinephrine （NE）， and brain-derived neurotrophic factor （BDNF）， as well as serum levels of interleukin-6 （IL-6） and interleukin-1β （IL-1β）， were measured by enzyme-linked immunosorbent assay （ELISA）. Hippocampal RNA was extracted for transcriptomic sequencing， followed by screening of differentially expressed genes （DEGs）， and then Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analyses were performed. The expression of key genes was validated by quantitative Real‑time polymerase chain reaction （Real-time PCR）， ELISA， and immunohistochemical （IHC） staining. ResultsCompared with the solvent group， the model group showed decreases in total movement distance， active time， rearing frequency， central zone duration， and grid line crossings in the open field test （P<0.01）， increases in peripheral zone duration and immobility time in the forced swimming test （P<0.01）， a reduced sucrose preference rate （P<0.01）， declined serum levels of 5-HT， NE， and BDNF （P<0.01）， and elevated serum levels of IL-6 and IL-1β （P<0.01）. Compared with the model group， the medium and high-dose YQWX groups exhibited significant improvements in the above behavioral parameters （P<0.05， P<0.01）. The medium-dose YQWX group showed restoration of 5-HT and BDNF levels （P<0.05）， and the high-dose YQWX group showed restoration of NE levels （P<0.01）. All YQWX groups reduced serum IL-6 and IL-1β levels （P<0.01）. Transcriptome sequencing identified 513 DEGs in the model group compared with the solvent group and 512 DEGs in the YQWX group compared with the model group. Enrichment analyses pointed out key pathways related to platelet activation， complement， coagulation cascade， inflammation， and neuroendocrine regulation. Experimental validation demonstrated that YQWX upregulated the mRNA and protein levels of F9 in the liver tissue （P<0.01）. Medium- and high-dose YQWX upregulated the mRNA level of PLCD3 in the hippocampus and uterus （P<0.05， P<0.01）， as well as protein levels of CAMK2G and SNCAIP in the hippocampus （P<0.01）. ConclusionYQWX synergistically alleviates behavioral and neurobiochemical abnormalities in PMS rats by regulating key genes， providing a molecular basis for its traditional effects of replenishing Qi， nourishing blood， and harmonizing the liver and spleen.

Objective: Data on syncopal donation-related vasovagal reaction (DRVR) collected from 74 blood centers between 2020 and 2023 was statistically analyzed to provide a reference for developing preventive strategies against syncopal DRVR. Methods: Data on blood donation adverse reactions and basic information of donors from 2020 to 2023 were collected through the information management system at monitoring sentinel sites. Statistical analysis was performed on the following aspects of syncopal DRVR: characteristics of donors who experienced syncope, reported incidence, triggers, duration, presence and occurrence time of syncope-related trauma, clinical management including outpatient and inpatient treatment, and severity grading. Results: From 2020 to 2023, 45 966 donation-related adverse reactions were recorded. Of these, 1 665 (3.72%) cases were syncopal DRVR. The incidence of syncopal DRVR decreased with age, being the highest in the 18-22 age group. Incidence was significantly higher in female donors than male donors, in first-time donors than repeat donors, and in university and individual donors than group donors (all P<0.05). There was no statistically significant difference among different blood donation locations (P>0.05). The top three triggers were tension, fatigue, and needle phobia or fear of blood. Among syncopal DRVR cases, 60.36% occurred during blood collection, 87.63% lasted for less than 60 seconds, and 5.05% were accompanied by trauma. Notably, 57.14% of these traumas occurred after donor had left the blood collection site. Syncope severity was graded based on required treatment: grade 1 (fully recovered without treatment, 95.50%); grade 2 (recovered after outpatient treatment, 4.02%); and grade 3 (recovered after inpatient treatment, 0.48%). Conclusion: By analyzing the data of syncopal DRVR cases, it is possible to provide a reference for formulating blood donor safety policies.

Objective To investigate the clinical advantages and safety of an acupoint auto-positioning moxibustion robot combined with massage techniques in the treatment of lumbar disc herniation.Methods Totally 114 patients with lumbar disc herniation treated between June 2021 and December 2023 at Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,the Outpatient Department of Rehabilitation Medicine,Changhai Hospital and Shanghai Third Rehabilitation Hospital were divided into control group and experimental group with random number table method,with 57 cases in each group.The control group received conventional moxibustion combined with massage techniques,while the experimental group was treated using an acupoint auto-positioning moxibustion robot combined with massage techniques.Both groups underwent treatment once every three days,totaling 10 sessions over one month.Clinical efficacy was observed between the two groups by comparing pre-treatment and post-treatment(after 3,6 and 10 sessions)scores on the visual analogue scale(VAS)for pain,the Japanese Orthopaedic Association(JOA)lower back pain score,and lumbar range of motion(LROM).Adverse reactions during the intervention were recorded.Satisfaction with the moxibustion robot in the experimental group was assessed using a Likert scale.Additionally,20 healthy subjects were recruited to evaluate the accuracy of the robot's acupoint auto-positioning function.Results The overall effective rate was 91.23%(52/57)in the experimental group and 94.74%(54/57)in the control group,without statistical significance between the two groups(P>0.05).Compared to pre-treatment,both groups showed significant improvements in VAS scores,JOA scores and LROM across all measured directions after 3,6,and 10 treatment sessions(P<0.001).In the Likert scale assessment,86.96%of subjects agreed that the device was convenient to use,87.72%agreed that the device was safer than conventional moxibustion therapy,and 94.74%were willing to recommend the device to other patients.The accuracy evaluation of the acupoint auto-positioning moxibustion robot demonstrated that the average deviation between robot-positioned acupoints and standard acupoints was(1.68±0.46)mm,achieving a positioning accuracy rate exceeding 95%.No adverse reactions were reported during the intervention.Conclusion The combination of an acupoint auto-positioning moxibustion robot with massage techniques is as effective as conventional moxibustion combined with massage techniques in improving clinical symptoms,alleviating pains,enhancing lumbar function and increasing lumbar mobility in patients with lumbar disc herniation.Participants have exhibited a high willingness to use the device,and the robot achieved a high accuracy rate in acupoint positioning.

Objective:To construct a risk evaluation system for safe operation of medical equipment of the department of pediatric internal medicine on the basis of comprehensive weight,so as to reduce the risk of operating equipment.Methods:The risk evaluation model of managing medical equipment was constructed by using Delphi method,and the evaluation indicators were weighted by analytic hierarchy process(AHP)and entropy weight method,and then,the safety management for equipment was conducted after the relative weights of indicators at each level were determined.A total of 100 used medical equipment in the department of pediatric internal medicine of Yuncheng Central Hospital of Shanxi Province from January 2022 to December 2023 were selected,and they were managed respectively by conventional management mode(50 equipment)and the management mode with risk evaluation system for safe operation of medical equipment(50 equipment).The quality of equipment operation,safety of clinical use and risk control rate of equipment alarm between the two management modes were compared,as well as the recognition scores of the engineers of equipment,doctors,paramedics and managers of relative department,who used and managed equipment,for the two management modes.Results:The average values of maintenance implementation rate,quality inspection qualification rate,disinfection qualification rate and effective response rate of problems of equipment of using the management mode with risk evaluation system were respectively(93.65±3.65)%,(91.45±3.25)%,(93.14±3.69)%and(94.26±3.14)%,which were all higher than these of conventional management mode,and the differences were statistically significant(t=18.599,12.376,11.746,16.006,P＜0.05).The ratios of device-associated infection,stress injury and body fluid extravasation of risk events were respectively 4%(2/50),6%(3/50)and 6%(3/50),which were lower than those of conventional management mode,and the differences were statistically significant(x2=10.714,8.576,9.756,P＜0.05).The recognition scores of the engineers of equipment,doctors,paramedics and managers of relative department for the equipment management of adopting the management mode with risk evaluation system were respectively(92.14±4.01),(93.54±4.63),(93.65±3.36)and(91.57±3.98)points,which were all higher than these of adopting conventional management mode,and the differences were statistically significant(t=15.798,13.331,15.545,13.940,P＜0.05).The average value of qualified rate of threshold value of equipment alarm,and that of operation and maintenance of equipment of adopting the management mode with risk evaluation system were respectively(98.25±3.54)%and(97.36±4.65)%,which were higher than those of the conventional management mode,and the average value of alarm silence rate of the management mode with risk evaluation system was(2.36±1.54)%,which was lower than that of conventional management mode,and the differences were statistically significant(t=11.207,8.813,10.717,P＜0.05).Conclusion:The application of the risk evaluation system for safe operation of medical equipment of the department of pediatrics on the basis of comprehensive weight in the management for equipment can enhance the safety of operating equipment,and reduce the risk of using equipment,and improve the quality of managing equipment.

Objective To explore the mechanism of Kangliu Zengxiao Jiandu Prescription(KLJD)in enhancing the efficacy of cisplatin chemotherapy in non-small cell lung cancer(NSCLC)through network pharmacology and in vivo/in vitro experiments.Methods Components of KLJD were screened via the TCMSP database to identify active components and potential targets.Lung cancer-related genes were obtained from the GeneCards and OMIM databases.GO and KEGG pathway enrichment analysis was performed on drug-disease intersection targets using the Metascape database;molecular docking was performed between core target proteins and main active components.A Lewis lung cancer mouse model was established,and intervened with KLJD and cisplatin.Organ indexes and tumor inhibition rate were counted,and Western blot and RT-PCR were used to detect the expressions of key pathway target proteins and mRNA;A549 and H1299 cells were intervened with KLJD,and Western blot was used to detect key target protein expressions.Results Network pharmacology identified 74 active components and 20 key targets of KLJD,primarily involved in biological processes such as cell proliferation and inflammatory response,and pathways in cancer and PI3K/AKT signaling pathway;molecular docking revealed stable binding between EGFR and major compounds.Animal experiments demonstrated that,compared with the model group,the KLJD group showed significantly higher tumor inhibition rate(P<0.01)and downregulation of EGFR,AKT and PI3K protein and mRNA expression in tumor tissues(P<0.05).Compared with the cisplatin group,the combination group exhibited significantly enhanced tumor inhibition rate(P<0.01),elevated thymic and splenic indices(P<0.01),and decreased EGFR,PI3K and AKT protein and mRNA expressions(P<0.01).Cell experiments showed that KLJD concentration-dependently inhibited A549 and H1299 cell proliferation(IC50:14.72 mg/mL and 14.68 mg/mL,respectively).Combined with cisplatin,KLJD synergistically down-regulated EGFR PI3K and AKT protein expressions(P<0.01).Conclusion KLJD effectively enhances cisplatin's chemotherapeutic efficacy in NSCLC by inhibiting the EGFR/PI3K/AKT pathway while improving immune organ function.Its mechanism likely involves multi-target regulation,including suppression of tumor proliferation,promotion of apoptosis,and modulation of the immune microenvironment.

Objective:To explore the clinical characteristics and genetic variants underlying Hereditary coagulation factor Ⅴ (FⅤ) deficiency in two Chinese pedigrees.Methods:Seventeen individuals from three generations of the two pedigrees affected with FⅤ deficiency whom had visited Taizhou Hospital of Zhejiang Province respectively in March and June 2024 were recruited as study subjects. One hundred healthy individuals undergoing physical examinations have served as the controls. Relevant coagulation parameters were measured. Thrombin generation was assessed using the calibrated automated thrombogram (CAT) assay. All exons and flanking regions of the F5 gene were amplified by PCR and directly sequenced. Candidate variants were analyzed for evolutionary conservation and potential pathogenicity, and their effects on protein structure were predicted. This study was approved by the Medical Ethics Committee of Taizhou Hospital of Zhejiang Province (Ethics No.: 20230722). Results:The FⅤ activity (FⅤ: C) and antigen levels (FⅤ: Ag) of both probands showed concurrent decrease. By thrombin generation assay, both the lag time ratio and time to peak ratio were significantly increased. Genetic analysis revealed that proband A carried compound heterozygous missense variants c. 911G>A (p.Gly304Glu) and c. 1238T>C (p.Met413Thr), whilst Proband B carried compound heterozygous missense variants c. 1258G>T (p.Gly420Cys) and c. 1538G>A (p.Arg513Lys) of the F5 gene. Conservation analysis revealed that the amino acid residues p. Gly304, p. Gly420, and p. Arg513 are highly conserved across various species. Online bioinformatics tools predicted that both the p. Gly304Glu and p. Gly420Cys variants are pathogenic. Protein modeling demonstrated that all four variants can result in alterations of protein structure or disruption of hydrogen bonding. Conclusion:FⅤ deficiency in these two pedigrees can be attributed to the compound heterozygous variants p. Gly304Glu/p.Met413Thr and p. Gly420Cys/p.Arg513Lys of the F5 gene.

Drynaria fortunei,commonly known as"bone setting herb",has been widely included in various traditional Chinese herb-al classics for treating bone injuries.It is used medicinally from its rhizome,which has a bitter taste and warm property.It is known to nourish the kidneys,strengthen bones,and alleviate pain from injuries.The chemical constituents mainly include flavonoids,phenylpro-panoids,triterpenoids,phenolic acids,lignans,and sterols.Modern medical research indicates that Drynaria fortunei has anti-osteoporo-sis effects,promotes fracture healing,has anti-inflammatory properties,and benefits dental health.This article reviews the historical use of Drynaria fortunei and recent research on its chemical composition and pharmacological effects,summarizing some of the mechanisms of action.The aim is to provide a reference for further research on this medicinal herb.