Objective To explore and analyze the related factors of kinesiophobia in elderly patients with coronary heart disease (CHD) during cardiac rehabilitation exercise period, and to evaluate the effect of cognitive behavior therapy on improving kinesiophobia and promoting rehabilitation. Methods A total of 352 elderly patients with CHD admitted to the hospital were included from October 2023 to October 2024. Tampa Scale for Kinesiophobia-11 (TSK-11) was adopted to evaluate the kinesiophobia status. Patients with kinesiophobia were randomly grouped. Routine intervention (routine group, n=82) and cognitive behavior intervention (study group, n=82) were implemented respectively. The intervention effects were observed in both groups. Results Among the 352 patients, 46.59 % (164/352 ) of elderly patients with coronary heart disease had different degrees of kinesiophobia. The proportions of female, divorced/widowed, revascularization and family relationship disharmony and scores of Patient Health Questionnaire (PHQ9) and Generalized Anxiety Disorder Scale (GAD7) in patients with kinesiophobia were higher than those in patients without kinesiophobia (P<0.05) while the scores of General Self-Efficacy Scale (GSES) and Social Support Rating Scale (SSRS) were lower compared with those in patients without kinesiophobia (P<0.05). Logistic regression analysis found that female, divorced/widowed, family relationship disharmony, revascularization and scores of PHQ9, TSK-11, GAD7, GSES and SSRS were related to kinesiophobia (P<0.05). After intervention, the scores of TSK-11, PHQ9 and GAD7 in the study group were lower while the scores of GSES and SSRS, 6 min walking test distance, and cardiopulmonary exercise test peak oxygen uptake and anaerobic threshold were higher compared to the routine group (P<0.05). Conclusion The kinesiophobia in elderly patients with CHD during cardiac rehabilitation is related to gender, revascularization and psychosocial factors. Clinically, cognitive behavior intervention should be provided according to the situation and guided to carry out rehabilitation exercise regularly so as to promote improvement of cardiopulmonary function.

In August 2023， the European Society for Organ Transplantation （ESOT） published the ESOT Consensus Statement on Biomarkers in Liver Transplantation online. The consensus statement focuses on biomarkers in liver transplantation， clinical applicability， and future needs and explores the role of new biomarkers in predicting liver transplantation outcomes by reviewing the literature on primary disease recurrence， development of chronic kidney disease （CKD）， and safe weaning of immunosuppression. This consensus statement conducts studies from the four aspects of recurrent liver disease after liver transplantation， recurrent hepatocellular carcinoma， weaning of immunosuppression， and CKD progression， emphasizes the importance of biomarkers in predicting or detecting disease recurrence， and proposes that large-scale prospective studies are still needed to improve the quality of evidence. The author’s team gives an excerpt of the consensus statement and systematically introduces the four aspects of the consensus statement and related discussions and conclusions， in order to provide more evidence-based medical evidence for identifying and exploring new biomarkers for liver transplantation.

ObjectiveTo investigate the attenuating effect of Dioscoreae Bulbiferae Rhizoma（DBR） processed with Phaseoli Radiati Semen（PRS） juice， and explore the attenuating mechanism based on ferroptosis of the main toxic target organ. MethodSixty male ICR mice were randomly divided into blank group， DBR group， water roasted DBR group（hereinafter referred to as water group）， PRS juice-roasted DBR group 1（DBR-PRS 10∶1， stuffy moistening for 40 min， stir-fried at 130 ℃ for 18 min， hereinafter referred to as group 1）， PRS juice-roasted DBR group 2（DBR-PRS 10∶1， stuffy moistening for 80 min， stir-fried at 100 ℃ for 14 min， hereinafter referred to as group 2）， PRS juice-roasted DBR group 3（DBR-PRS=20∶3， stuffy moistening for 40 min， stir-fried at 160 ℃ for 14 min， hereinafter referred to as group 3）. The raw and processed groups of DBR were gavaged with their corresponding 95% ethanol extract at a dose of 3 g·kg^-1·d^-1， while the blank group was gavaged with an equal volume of 0.5% sodium carboxymethyl cellulose， once a day for 14 consecutive days. Hematoxylin-eosin（HE） staining was used to observe the histopathological changes of mouse liver. Alanine aminotransferase（ALT） and aspartate aminotransferase（AST） levels in serum， as well as malondialdehyde（MDA）， ferrous ions（Fe²⁺）， reduced glutathione（GSH） and superoxide dismutase（SOD） levels in liver tissue were detected by the biochemical detection. Western blot was used to detect the expression of iron key proteins such as ferritin heavy chain 1（FTH1） and glutathione peroxidase 4（GPX4）. ResultHE staining results showed that the liver tissue structure of the blank group was clear， the morphology of hepatocytes was normal， the cytoplasms of hepatocytes in the DBR group and water group were loose and vacuolar， with obvious pathological damages， and the pathologic damages of mice in the group 1-3 were significantly improved. Compared with the blank group， the levels of ALT， AST， MDA and Fe²⁺ in mice from the DBR group were significantly increased（P<0.01）， while GSH and SOD levels were significantly reduced（P<0.01）， and the protein expression levels of FTH1 and GPX4 were significantly decreased（P<0.01）. Compared with the DBR group， the ALT， AST，MDA and Fe²⁺ levels of mice in the group 1-3 were significantly reduced（P<0.05， P<0.01）， the GSH and SOD levels and the protein expression levels of FTH1 and GPX4 were significantly increased（P<0.01）. Compared with the water group， the AST and MDA levels of mice in the group 1-3 were significantly reduced（P<0.05， P<0.01）， the SOD level significantly increased（P<0.05， P<0.01）， the FTH1 protein expression significantly increased（P<0.01）， and the serum ALT level of mice in the group 2-3 significantly reduce（P<0.01）， Fe²⁺ level significantly reduced（P<0.01）， GSH level significantly increased（P<0.05， P<0.01）， and GPX4 protein expression significantly increased（P<0.05， P<0.01）. Among the group 1-3， the group 3 had the best detoxification effect. ConclutionProcessing with PRS juice can reduce the liver injury induced by DBR， and the mechanism may be related to the inhibition of ferroptosis in the liver.

Objective: To investigate the association between high normal blood pressure, hypertension and microalbuminuria (MAU), so as to provide the basis for early screening and prevention of renal injury caused by hypertension. Methods: A multi-stage cluster random sampling method was used to select permanent residents aged 18 to 75 years from six provinces including Hebei, Hunan, Sichuan, Heilongjiang, Qinghai and Jiangxi from September to October 2021. Basic information and lifestyle behaviors were collected through questionnaires. Indices including height, weight and blood pressure were measured. Urinary microalbumin and creatinine were measured in 24-hour urine samples. The associations between high normal blood pressure, hypertension, and MAU were analyzed by using a multivariable logistic regression model. Results: A total of 1 982 residents were surveyed, with 996 residents aged <50 years (50.25%) and 986 residents aged ≥50 years (49.75%). There were 958 males (48.34%) and 1 024 females (51.66%). Normal blood pressure was observed in 653 residents (32.95%), high normal blood pressure in 748 (37.74%) and hypertension in 581 (29.31%). MAU was detected in 164 participants, with a detection rate of 8.27%. The detection rates of MAU among residents with normal blood pressure, high normal blood pressure, and hypertension were 2.14%, 8.16% and 15.32%, respectively, and the difference was statistically significant (P<0.05). Multivariable logistic regression analysis showed that after adjusting for gender, age, educational level, smoking, alcohol consumption, regular exercise and body mass index, the residents with high normal blood pressure (OR=3.535, 95%CI: 1.898-6.585) and hypertension (OR=7.232, 95%CI: 3.808-13.732) had higher risks of MAU compared to those with normal blood pressure; the residents with hypertension (OR=1.914, 95%CI: 1.340-2.735) had a higher risk of MAU compared to those with high normal blood pressure. Conclusions High normal blood pressure and hypertension are associated with an increased risk of MAU.

Objective To reform the teaching content of acupuncture and moxibustion for undergraduate of Nursing College and to evaluate the effectiveness of the teaching reform,so to provide constructive information for optimizing the curriculum.Methods To revise the teaching content of Traditional Chinese Medicine(TCM)acu-puncture course based on the results of previous questionnaires,including reducing boring theoretical knowledge,increasing commonly used acupuncture techniques and clinical case analysis,organizing all undergraduates atten-ding the TCM teaching in the Nursing College of Peking Union Medical College to fill out the"Acupuncture Course Content Questionnaire"in 2023.The content covers four aspects:students'basic cognition of acupuncture and moxibustion before the course,students' learning feedback,students'learning effectiveness after the course and students' suggestions for further optimization of acupuncture and moxibustion course.Results Totally 149 students participated in the questionnaire survey and 73.15%of them were interested in the acupuncture course.There were 62.42%of the students thought that the most difficult part of the course was the"Acupuncture Points",and 71.81%of them complained the most constraining factor to the learning effectiveness was the diffi-culty of memorizing the meridians and acupoints.The most interesting part of the course was"Overview of Acu-puncture Treatment and Acupuncture Treatment of Common Diseases",which accounted for 44.3%of the students.Through the study,88.59%of the students were willing to recommend acupuncture treatment to pa-tients with indications.Students' suggestions for improvement of the acupuncture course was increase of classroom practice or learning by observation of operation videos.Conclusions The reformed acupuncture course highlights the practicability,improves the learning interest and subjective initiative,but the training of practice skill still needs to be strengthened.

The apprenticeship education of Traditional Chinese medicine(TCM)is an important pathway for the cultivation of talents in TCM education.The combination of institutional education and apprenticeship education is considered to be the most suitable educational model that aligns with the inherent characteristics of TCM education.The current status of TCM education in western medical institutions and the main challenges include the difficulty in transitioning between western and Chinese medical reasoning and limited clinical internship hours for TCM.The strengths and features of TCM apprenticeship education lie in cultural heritage,classical teachings,mentorship,practice orientation and personalized education.Therefore,integration of TCM apprenticeship education and clinical internships for western medical students represents a new educational model for medical undergraduates.

Liver regenerative medicine can use functional liver cells to repair or replace damaged liver tissue and it is expected to be rapidly developed as an alternative treatment to liver transplantation. However, regenerative medicine requires cells with stable proliferation ability and liver cell characteristics. Liver organoids are derived from adult stem cells or pluripotent stem cells. They can be proliferated in large quantities and cultured for a long time in vitro, meanwhile maintain genetic stability, and simulate the structural and functional characteristics of organs in the body, providing a new strategy for liver regeneration. This article reviews liver organoids and their research progress in liver regenerative medicine, and discusses their application potential and existing limitations.

Objective:To compare the effects of different test meals on postprandial triglycerides and to optimize the standard meal composition and the blood sampling protocol for the oral fat tolerance test.Methods:This study is a prospective, open-label, randomized, cross-over trial. In March 2023, 36 volunteers were recruited in Hebei General Hospital. They underwent a health examination and oral glucose tolerance test. Twenty-six healthy volunteers(11 males and 15 females) were included in this study, with an average age of(39.08±4.56) years. Each volunteer received 75 g protein meal, 75 g fat meal, 700 kcal fixed-calorie high-fat mixed meal, and a high-fat mixed meal with energy adjusted based on 10 kcal/kg body weight. A one-week washout period of regular diet was applied before each trial. Blood was collected at fasting status and 1, 2, 3, 4, 5, and 6 hours after a meal to detect serum triglycerides, total cholesterol, low density lipoprotein-cholesterol(LDL-C), high density lipoprotein-cholesterol(HDL-C), glucose, and insulin. The variations of postprandial metabolic indicators over time following the consumption of different test meals were analyzed. The disparities in postprandial metabolic responses between the two types of mixed meals were compared.Results:The protein meal, fat meal, fixed-calorie high-fat mixed meal, and adjusted-calorie high-fat mixed meal resulted in postprandial triglyceride increases of 22.45%, 115.40%, 77.14%, and 63.63%, and insulin increase of 560.43%, 85.69%, 554.18%, and 598.97%, respectively, and with reductions in total cholesterol, LDL-C, and HDL-C ranging from 5.64%-21.81%, respectively. The blood glucose changed slightly. Changes in metabolic indicators mainly occured within 4 hours. The comparison of the characteristics of postprandial triglycerides between the two high-fat mixed meals showed no statistically significant differences( P>0.05). Conclusion:A standardize protocol with a 700 kcal fixed-calorie high-fat mixed meal as test meal, and blood lipid levels measured at fasting and at 1, 2, 3, and 4 hours after consumption, can serve as an optimized approach for oral fat tolerance test.

Osteoporosis and knee osteoarthritis often co-occur and are closely related in terms of epidemiology， clinical symptoms， pathogenesis and other aspects. Therefore， it is necessary to manage the co-morbidity and treat the two as a whole. Based on the overall relationship between wei （痿） and bi （痹） in TCM， it is believed that osteoporosis and knee osteoarthritis have marrow loss and bone atrophy as the core pathogenesis of co-morbidity， and microfractures as the central pathological link. The overall treatment is rooted in boosting kidney， supplementing marrow and strengthening the bones. According to the pathological manifestations of microfractures in the process of co-morbidity， and the different deficiency and excess characteristics of wei and bi， it can be divided into three types， "wei emerging with mild bi"， "wei and bi progressing simultaneously"， and "emphasis on both wei and bi"， for treatment. In terms of "wei emerging with mild bi"， that is the early stage of osteoporosis， the traditional Daoyin （导引） is the main therapy. For "wei and bi progressing simultaneously"， it can be divided into three stages further， including the onset stage， remission stage， and recovery stage of knee pain， treated with Taohong Siwu Decoction （桃红四物汤）， Bushen Huoxue Formula （补肾活血方） and self-made Bushen Qianggu Formula （补肾强骨方） as the main formula respectively. For "emphasis on both wei and bi"， the proven formula， Qianggu Zhitong Formula （强骨止痛方）， is taken as the main prescription.

Objective To investigate the value of continuous monitoring of indocyanine green retention rate at 15 minutes(ICG-R15)combined with standard residual liver volume(SRLV)in predicting hepatic insufficiency after partial hepatectomy.Methods Clinical data and SRLV data were collected from 70 patients with hepatocellular carcinoma who were admitted to Department of Hepatobiliary Surgery,Tianjin First Central Hospital,from November 2016 to May 2017.According to the presence or absence of hepatic insufficiency after surgery,the patients were divided into good liver function group with 56 patients and hepatic insufficiency group with 14 patients.Based on preoperative liver function evaluation and contrast-enhanced CT scans,resected liver volume and residual liver volume were calculated,and three-dimensional reconstruction of the liver was performed.Intraoperative ultrasound localization was performed to determine the surgical regimen,and selective hepatic inflow occlusion or intermittent hepatic portal occlusion was selected based on intraoperative conditions.CUSA combined with BIPOLAR drip electric coagulation forceps were used for the partition of liver parenchyma.SRLV was calculated,and ICG-R15 was monitored continuously.The independent-samples t test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups;the area under the ROC curve(AUC)was used to investigate the accuracy in predicting hepatic insufficiency after surgery.A multivariate Logistic regression analysis was used to establish a predictive model for postoperative hepatic insufficiency,and diagnostic criteria were developed for SLRV combined with postoperative ICG-R15 dynamic monitoring in the diagnosis of postoperative hepatic insufficiency.Results There were significant differences between the two groups in ICG-R15 before surgery,immediately after surgery,and on days 3 and 5 after surgery,as well as significant differences in SRLV and Child class(all P＜0.05).The incidence rate of postoperative hepatic insufficiency increased with the increase in ICG-R15 before surgery,immediately after surgery,and on days 3 and 5 after surgery(all P＜0.001).Further comparison between two groups showed that there was a significant difference in the incidence rate of hepatic insufficiency between the ICG-R15＞20%group and the other two groups before surgery,immediately after surgery,and on days 3 and 5 after surgery(all P＜0.001),and there was a significant difference in the incidence rate of hepatic insufficiency between the ICG-R15＜10%group and the 10%≤ICG-R15≤20%group immediately after surgery(P＜0.001).ICG-R15 before surgery,ICG-R15 immediately after surgery,ICG-R15 on day 3 after surgery,and ICG-R15 on day 5 after surgery had an AUC of 0.790,0.857,0.855,and 0.870,respectively,in predicting postoperative hepatic insufficiency,and ICG-R15 immediately after surgery and on days 3 and 5 after surgery had a significantly larger AUC than ICG-R15 before surgery(all P＜0.05).The multivariate analysis showed that increases in SRLV and postoperative ICG-R15 dynamic monitoring(immediately after surgery and on days 3 and 5 after surgery)were independent risk factors for postoperative hepatic insufficiency,while increased body mass index before surgery was an independent protective factor(all P＜0.05).A multivariate Logistic regression predictive model was established and was used to predict hepatic insufficiency after surgery(immediately after surgery and on days 3 and 5 after surgery),and the ROC curve analysis showed that the model had an AUC of 0.963,0.967,and 0.967,respectively,in predicting hepatic insufficiency immediately after surgery and on days 3 and 5 after surgery(all P＜0.01).Diagnostic criteria were developed for SLRV combined with postoperative ICG-R15 dynamic monitoring in the diagnosis of postoperative hepatic insufficiency,i.e.,SLRV＞1 240 mL/m2,ICG-R15＞20%immediately after surgery,or ICG-R15＞25%on day 3 or 5 after surgery,and postoperative hepatic insufficiency could be diagnosed if a patient met any one criterion.These diagnostic criteria had a sensitivity of 100%,a specificity of 60.71%,and a conformity degree of 68.57%.Conclusion Continuous monitoring of ICG-R15 before and after surgery is of guiding significance for predicting postoperative hepatic insufficiency,and ICG-R15 on day 5 after surgery has the highest accuracy.SRLV combined with postoperative ICG-R15 dynamic monitoring can effectively predict the onset of hepatic insufficiency after hepatectomy and can guide clinicians to predict the onset of postoperative hepatic insufficiency in patients with liver cancer and perform clinical intervention as soon as possible.