Clinical practice guidelines serve as a crucial bridge linking research evidence, clinical practice, and health policy decision-making. However, the guideline domain continues to face persistent challenges, including duplicate guideline development, variable methodological quality, lack of transparent reporting, insufficient implementation and translation, and delayed updates. Focusing solely on "how to develop a high-quality guideline" is no longer sufficient to meet the modern healthcare system's demands for timely, trustworthy, actionable, and dynamically updated recommendations. The emergence of the guideline ecosystem marks a shift in guideline research and practice from a linear development process toward a more systematic governance model. Rooted in the evidence ecosystem, the guideline ecosystem has its own distinct functional positioning, encompassing recommendation formulation, clinical implementation, and life-cycle updating. Looking ahead, China should leverage guideline registries, integrated quality assessment systems, implementation science, dynamic updating mechanisms, and artificial intelligence technologies to promote the transformation of its guideline system from scale expansion to an ecosystem-based model characterized by high quality and sustainability.

The patients with skeletal class Ⅱ malocclusion are often accompanied by structural and functional abnormalities of the upper airway,and obstructive sleep apnea hypopnea syndrome(OSAHS)may occur in severe cases.The morphologic and fluid dynamic changes of the upper airway in one patient with skeletal class Ⅱ malocclusion accompanied by OSAHS after maxillomandibular advancement(MMA)surgery were observed.The patient was a 27-year-old male with skeletal class Ⅱ malocclusion and moderate OSAHS.Combined orthodontic and orthognathic treatment was conducted,involving the anterior movement of the maxilla and mandible.After surgery,the patient's facial and intraoral features showed a satisfactory occlusion relationship with normal overbite,overjet and canine-molar relationships.There was also a significant improvement in the upper airway flow field.Two years after surgery,the cross-sectional area of the nasopharyngeal airway increased by 10.76％with a 55.36％reduction in pressure.The oropharyngeal airway showed a 108.25％increase in cross-sectional area with a 98.14％pressure reduction.The hypopharyngeal airway exhibited a 97.51％increase in cross-sectional area with a 351.03％pressure reduction.The laryngopharyngeal airway demonstrated a 27.54％increase in cross-sectional area with a 95.62％pressure reduction.The apnea-hypopnea index(AHI)decreased by 55.45％,achieving the treatment goal.Morphological measurements combined with fluid dynamic analysis can comprehensively evaluate the condition of the upper airway.The approximate value of the critical closing pressure(Pcrit)obtained from computational fluid dynamics(CFD)analysis may serve as a simple quantitative indicator for assessing the upper airway condition.

In order to further promote the standardization of the integrated traditional Chinese and western medicine treatment of atopic dermatitis(AD),the team of Professor Chen Dacan,who is honored as the Qihuang Scholar,developed the Clinical Practice Guidelines for Integrated Traditional Chinese and Western Medicine in Atopic Dermatitis(hereinafter referred to as Guidelines for AD).This paper detailed the process of development of Guidelines for AD,and analyzed the characteristics of Guidelines for AD,as well as the difficulties and countermeasures encountered during such a time.The development of Guidelines for AD follows the methodology of international guidelines for clinical trial.Experts specializing in various disciplines,such as traditional Chinese medicine,western medicine,integrated traditional Chinese and western medicine,and methodology,composed an expert group and a working group.On the basis of systematic literature research,the clinic experiences of frontline experts were well-summarized,and the draft of Guidelines for AD was formed after several meetings and discussions.In the process of developing Guidelines for AD,quite a number of problems were encountered,and the project team found the corresponding countermeasures after analyzing these problems.The countermeasures became the characteristics of Guidelines for AD:the integration of traditional Chinese medicine therapies and western medicine therapies,and the evaluation of the evidence of integrated traditional Chinese and western medicine solved the problem of traditional Chinese and western medicine diagnosis and treatment of AD lacking standardization;the adequately combination of the evidence with the experience of clinical practice solved the problems of the low overall level and the insufficiency of traditional Chinese medicine evidence for AD;the establishment of management goals and strategies for AD after taking the advantages of both traditional Chinese medicine and western medicine into account was in line with the international treatment and management concepts;the formulation of individualized traditional Chinese and western medicine therapy based on the integration of traditional Chinese medicine therapy and western medicine therapy met the clinical needs of patients with different characteristics of AD.The development process of Guidelines for AD and the analysis of problems and countermeasures during such a time will provide reference and reflection for the subsequent establishment of clinical guidelines for the integrated traditional Chinese and western medicine in other diseases.

Objective To assess the intervention effect of nicotinamide mononucleotide (NMN) on the mouse model of hematotoxicity induced by subacute benzene exposure. Methods Benzene exposure and NMN intervention were adopted in a 2×2 factorial design, as benzene exposure and non-exposure, and NMN intervention and non-intervention. Male specific pathogen-free C57BL/6J mice were randomly assigned to negative control group, NMN control group, simple benzene exposure group and NMN intervention group, with 12 mice in each group. Benzene exposure of mice in simple benzene exposure group and NMN intervention group was conducted by dynamic inhalation of benzene at a concentration of 325 mg/m³ for six hours per day, five days per week for four weeks (28 days). Mice in the negative control and NMN control group inhaled clean air. During benzene exposure, mice in the NMN control group and NMN intervention group received NMN in drinking water at a dose of 300 mg/kg body weight. Peripheral blood samples of mice were collected for complete blood count analysis and calculation of composite inflammatory indices after 28 days. Results Interaction analysis showed that the counts of peripheral white blood cell, neutrophil, lymphocyte, and platelet of mice in the simple benzene exposure group were lower than those in the negative control group (all P<0.05). Neutrophil and platelet counts in the NMN intervention group were higher than those in the simple benzene exposure group (all P<0.05). The results of main effect analysis showed that the monocyte count of peripheral blood, systemic inflammatory index, systemic inflammatory response index, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio of mice in the benzene exposure group increased (all P<0.05), and the basophil count and lymphocyte/monocyte ratio decreased (all P<0.05), compared with the control group. Conclusion Oral NMN alleviates subacute benzene-induced decreases in peripheral neutrophil and platelet counts in mice. This protective effect may be related to the targeted intervention of NMN on mitochondrial energy metabolism disorder and oxidative damage induced by benzene exposure in male mice.

Atopic dermatitis （AD） is a common pruritic and chronic inflammatory dermatosis in clinical practice and is one of the diseases responding specifically to traditional Chinese medicine （TCM）. With the launch of biological agents and small molecule drugs and the development and implementation of guidelines of diagnosis and treatment， clinical pathways of treatment of moderate to severe AD， and consensus on the whole-process management of AD， the clinical efficacy of moderate to severe AD has been significantly improved. However， there are still many unmet clinical needs that require more effective methods to meet. In response to the Opinions of the CPC Central Committee and the State Council on Facilitating the Inheritance， Innovation， and Development of Traditional Chinese Medicine and the spirit of the National Conference on TCM， the China Association of Chinese Medicine organized more than 20 experts in TCM dermatology， Western medicine dermatology， interdisciplinary fields， and industries to discuss the difficulties and advantages of TCM in the treatment of AD. TCM treatment for AD can not only improve rash and relieve itching but also solve many concomitant syndromes. The abundant external treatment methods of TCM have advantages for different special populations and rash characteristics. The concept of treating disease before its onset in TCM is in line with the chronic disease management mode of prevention and treatment of atopic march and prevention of recurrence. In addition， TCM therapy can reduce the use of topical glucocorticoids and has good safety. Regarding the comorbidity of AD， equal emphasis on TCM and Western medicine and multidisciplinary joint treatment should be advocated to achieve maximum benefit for patients. The exchange of TCM and Western medicine has clarified the positioning and advantages of TCM intervention in AD， providing guidance for clinical and scientific research.

Objective To observe the effect of mild moxibustion at"Qihai","Guanyuan"and"Zhongji"on GnRH and its receptor in rats with gynecological cold coagulation and blood stasis syndrome(CCBS);To explore the mechanism of moxibustion on reproductive function of gynecological CCBS.Methods Totally 48 female SD rats were randomly divided into blank group,model group,moxibustion group,inhibitor group,inhibitor+moxibustion group and angonist group,with 8 rats in each group.The gynecological CCBS model was prepared by ice bath and adrenalin injection.GnRHant or GnRHa injection and mild moxibustion intervention were given to each treatment group.The score of CCBS symptoms and the amount of microcirculation blood perfusion in uterus were detected,the morphology of ovarian tissue and uterine tissue were observed by HE staining,serum reproductive hormones(GnRH,FSH,LH)and neurotransmitters(DA,GABA)contents were detected by ELISA,the expressions of GnRHR,FSHR and LHR mRNA and protein in ovarian and uterine tissue were detected by immunohistochemistry,RT-qPCR and Western blot.Results Compared with the blank group,the symptom score of CCBS in model group was significantly increased,the amount of microcirculation blood perfusion in uterus was decreased,the ovarian follicles were decreased,and the endometrial epithelium was thinner and the structure was chaotic,the contents of serum GnRH,FSH,LH,GABA decreased,DA content increased;the mRNA and protein expressions of GnRHR,FSHR and LHR in ovarian tissue decreased(P<0.01).Compared with the model group,the symptom score of CCBS in each intervention group were significantly decreased,the amount of microcirculation blood perfusion in uterus increased,ovarian follicles increased,endometrium thickened and glands increased,the contents of serum GnRH,FSH,LH,GABA increased,DA content decreased;the mRNA and protein expressions of GnRHR,FSHR and LHR were increased(P<0.05,P<0.01).Conclusion Moxibustion can regulate GnRH and its receptor and improve HPO axis function by regulating neurotransmitters,so as to improve the general state and reproductive function of gynecological CCBS model rats.

Objective To observe the value of non-parallel transmission(non-PTX)reduced field-of-view(rFOV)echo planar imaging(EPI)sequence applied in diffusion weighted imaging(DWI)for displaying prostate lesions.Methods Conventional EPI-DWI and non-PTX rFOV-EPI-DWI were prospectively acquired in 30 patients with prostate lesions,including 22 cases of prostatic hyperplasia and 8 cases of prostate cancer.Subjective scoring of imaging quality,as well as objective evaluation on indexes including signal-to-noise ratio(SNR),contrast ratio(CR),contrast-to-noise ratio(CNR)and lesions'apparent diffusion coefficient(ADC)values were performed and compared between two kinds of DWI.Results The subjective score of non-PTX rFOV-EPI-DWI was higher than that of conventional EPI-DWI(P＜0.001).SNR,CR,CNR of non-PTX rFOV-EPI-DWI and lesions'ADC values measured on non-PTX rFOV-EPI-DWI were all higher than those of conventional EPI-DWI(all P＜0.05).Conclusion non-PTX rFOV-EPI DWI could display prostate lesions better than conventional EPI-DWI.

Objective:To investigate the pregnancy outcomes and cumulative live birth rate (CLBR) after in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) in patients with high basal follicle-stimulating hormone (bFSH) levels. Methods:This retrospective cohort study included clinical data from patients who underwent IVF/ICSI-ET treatment at the Reproductive Medical Center of Peking University Third Hospital from January 2018 to December 2022. Patients were divided into three groups based on the highest bFSH level during all cycles of treatment: group A (15 U/L≤bFSH<25 U/L), group B (25 U/L≤bFSH<40 U/L), and group C (bFSH≥40 U/L). After propensity score matching (PSM) based on the female body mass index, the baseline data, embryology laboratory outcomes, and assisted reproductive outcomes such as clinical pregnancy rate among the three groups of patients were compared. Binary logistic regression analysis was used to explore the impact of various factors on live birth, and the trend of CLBR across multiple cycles was also studied.Results:After PSM, 340 cycles were included in group A, 340 cycles were included in group B, 127 cycles were included in group C. There were statistically significant differences among the three groups in antral follicle count, bFSH, basal progesterone, basal luteinizing hormone, and anti-Müllerian hormone levels ( P=0.004, P<0.001, P<0.001, P<0.001, P<0.001). In the analysis of controlled ovarian stimulation (COS) protocols, groups A and B mainly used conventional COS protocol, while group C primarily used mild stimulation protocol. The duration and dosage of gonadotropin used were the highest in group A [10 (7, 12) d, 2 728 (1 650, 3 725) U], with statistically significant differences among the three groups (all P<0.001). On the day of human chorionic gonadotropin injection, there were statistically significant differences in estradiol and progesterone levels among the three groups ( P=0.022 and P=0.048, respectively). The cancellation rate of cycles did not differ significantly among the three groups ( P>0.05), while the number of oocytes retrieved ( P<0.001) and the rate of cycles with no transferable embryos ( P=0.034) showed statistically significant differences. The type of embryos transferred in all three groups was mainly cleavage-stage embryos, and there were statistically significant differences in the rate of two pronuclei and high-quality embryos among the groups ( P=0.003 and P=0.006, respectively). The rate of high-quality embryos decreased with increasing bFSH levels, and comparisons between group A and group B, as well as group A and group C, showed statistically significant differences (all P<0.016 7). The biochemical pregnancy rate and the clinical pregnancy rate in fresh cycles differed significantly among the three groups ( P=0.025 and P=0.010, respectively), while the live birth rate per initiated cycle showed marginal significance ( P=0.058). However, the miscarriage rate and the live birth rate per transfer cycle did not differ significantly among the groups (all P>0.05). Binary logistic regression analysis revealed that bFSH ( OR=0.955, 95% CI: 0.912-1.000, P=0.050) and the number of oocytes retrieved ( OR=1.104, 95% CI: 1.009-1.207, P=0.031) were independent predictors of live birth. Analysis of CLBR curves across multiple oocyte retrieval cycles showed that CLBR gradually increased with the number of oocyte retrievals and stabilized at 14.32% after the fifth retrieval. Conclusion:High bFSH levels reduce the live birth rate per initiated cycle but do not affect the live birth rate per transfer cycle. Increasing age and a low number of oocytes retrieved can both decrease the live birth rate. Multiple oocyte retrieval and transfer cycles can improve CLBR in patients with high bFSH level to some extent, but it tends to stabilize after the fifth cycle.

Objective:To investigate the outcomes of natural cycle (NC) and modified natural cycle (MNC) assisted reproductive technology (ART) in patients with diminished ovarian reserve (DOR), and to provide a scientific basis for individualized treatment strategies for DOR patients.Methods:A retrospective cohort analysis was performed on the clinical data of DOR patients who underwent ART at the Center for Reproductive Medicine of the Department of Obstetrics and Gynecology, Peking University Third Hospital from January 1, 2015 to December 31, 2023. Patients were divided into the NC group ( n=801) and the MNC group ( n=385) based on their treatment protocol. The primary outcomes were cycle cancellation rate and oocyte retrieval rate. Secondary outcomes included clinical pregnancy rate and live birth rate per fresh embryo transfer cycle and frozen-thawed embryo transfer cycle, cumulative pregnancy rate and cumulative live birth rate per started cycle and per transfer cycle, as well as laboratory parameters such as the number of retrieved oocytes, the number of two pronuclei (2PN) fertilized oocytes, the number of transferable embryos, and transferable embryo formation rate. Further, multivariate logistic regression was used to analyze the impact of the treatment protocol on pregnancy and live birth outcomes. Results:There were no statistically significant differences between the NC and MNC groups in terms of general characteristics such as age, body mass index, and baseline hormone levels (all P>0.05). The cycle cancellation rate was significantly higher in the NC group [19.10% (153/801)] than in the MNC group [10.65% (41/385), P<0.001], and the oocyte retrieval rate was significantly lower in the NC group [66.31% (431/650)] than in the MNC group [74.86% (259/346), P=0.005]. The number of retrieved oocytes [1 (0,1)], the number of 2PN fertilized oocytes [1 (0,1)], and the number of transferable embryos [0 (0, 1)] were also significantly lower in the NC group than in the MNC group [1 (1, 2), P<0.001; 1 (1, 1), P<0.001; 0 (0, 1), P<0.001]. However, there were no statistically significant differences in 2PN fertilization rate and transferable embryo formation rate between the NC and MNC groups (all P>0.05). In both fresh embryo transfer cycles and frozen-thawed embryo transfer cycles, there were no statistically significant differences in clinical pregnancy rate and live birth rate between the NC and MNC groups (all P>0.05). The cumulative pregnancy rate per started cycle and transfer cycle, the cumulative live birth rate per started cycle and per transfer cycle were also not significantly different between the NC and MNC groups (all P>0.05). Multivariate logistic analysis showed no significant association between NC and clinical pregnancy or live birth compared with MNC. Conclusion:While MNC to some extent reduced the cycle cancellation rate and improved oocyte retrieval rates compared with NC, it did not ultimately improve pregnancy outcomes in DOR patients.

Objective To explore the influencing factors of readmission within 90 days in frail patients with chronic obstructive pulmonary disease(COPD),construct an early warning model and evaluate its discrimination and effectiveness.Methods A total of 831 COPD patients with frailty were included and divided into the readmission group(290 cases)and the control group(541 cases)based on whether they were readmitted within 90 days after discharge.The electronic medical record data were collected and compared between the two groups of patients.Multivariate Logistic regression analysis was used to screen independent influencing factors for readmission within 90 days in COPD weak patients.A predictive model was established.The column chart was drawn.The discriminability of the predictive model was evaluated through receiver operating characteristic(ROC)curves.The clinical practicality and the predictive model calibration were evaluated through decision curves and calibration curves.Results The body mass index(BMI)of the readmission group was lower than that of the non readmission group,and the proportion of acute exacerbation of COPD hospitalizations≥2 times in the past year,the Edmonton frailty scale(REFS)score and the Chalson comorbidity index(CCI)were higher in the readmission group than those of the non readmission group(P＜0.05).Multivariate Logistic regression analysis showed that BMI(OR=0.721,95%CI:0.636-0.818),the number of acute exacerbations of COPD hospitalizations in the past year(OR=3.040,95%CI:1.944-4.753),REFS score(OR=1.726,95%CI:1.486-2.005)and CCI score(OR=3.917,95%CI:3.079-4.983)were all independent influencing factors for readmission within 90 days in COPD frail patients(P＜0.05).Based on the results of multiple factor Logistic regression analysis,the column chart warning model was constructed.The AUC value of the ROC curve was 0.847(95%CI:0.820-0.874),the specificity was 87.20%and the sensitivity was 64.50%.The calibration curve of the predictive model was close to the diagonal,and the calibrationa degree was good.The decision curve suggested that the prediction model had clinical practicality.Conclusion The early warning model constructed based on the influencing factors of readmission hospitalization within 90 days in weak patients with COPD has good predictive effect and clinical practicability.