Diabetic kidney disease（DKD） is a chronic kidney structural and functional disorder caused by diabetes. With the global prevalence of diabetes continuing to rise， DKD has gradually become a major cause of chronic kidney disease and end-stage renal disease（ESRD）， posing a serious threat to patients' quality of life and long-term health outcomes. Studies have shown that apoptosis plays a pivotal role in the development and progression of DKD， with its mechanisms involving abnormal activation of multiple signaling pathways such as Toll-like receptor 4（TLR4）/nuclear transcription factor-κB（NF-κB）/B-cell lymphoma-2（Bcl-2）/cysteinyl aspartate-specific proteinase（Caspase）-3， protein kinase R-like endoplasmic reticulum kinase（PERK）/eukaryotic initiation factor 2α（eIF2α）/activating transcript factor 4（ATF4）/CCAAT enhancer-binding protein homologous protein（CHOP）， phosphatidylinositol 3-kinase（PI3K）/protein kinase B（Akt）/glycogen synthase kinase-3β（GSK-3β）， Janus kinase 2（JAK2）/signal transducer and activator of transcription 3（STAT3）， adenosine monophosphate-activated protein kinase（AMPK）/mammalian target of rapamycin（mTOR） and silent information regulator 1（SIRT1）/tumor suppressor protein 53（p53）， thereby accelerating renal pathological damage in DKD. Extensive evidence-based medical studies have confirmed that traditional Chinese medicine（TCM）， leveraging its unique therapeutic advantages of multi-target， multi-component and multi-pathway approaches， has demonstrated remarkable efficacy and favorable safety profiles in treating DKD. Recent studies have demonstrated that active components of TCM can specifically target and modulate key effectors in apoptotic signaling pathways. Meanwhile， traditional compound formulations exert synergistic effects through multiple approaches such as replenishing deficiency and activating blood circulation， detoxifying and dredging collaterals， tonifying kidney essence， and removing stasis and purging turbidity， thereby comprehensively regulating critical pathological processes including endoplasmic reticulum stress and mitochondrial apoptosis pathways. This combined therapeutic approach of molecular targeting and holistic regulation provides novel strategies for delaying the progression of DKD. Based on this， this paper provides an in-depth analysis of key apoptotic signaling pathways and their regulatory mechanisms， while systematically summarizing recent research advances regarding the therapeutic effects of TCM active components， compound formulations， and proprietary Chinese medicines on DKD through modulation of these pathways， with particular emphasis on their underlying molecular mechanisms. These findings not only elucidate the modern scientific connotation and theoretical basis of TCM in treating DKD but also establish a solid theoretical and practical foundation for promoting the wider clinical application and further research of TCM in the field of DKD treatment.

Hepatic encephalopathy is a difficult and critical disease with rapid progression and limited treatment methods in the field of liver disease， and it is urgently needed to make breakthroughs in its pathogenesis. Selection of appropriate prevention and treatment strategies is of great importance in delaying disease progression and reducing the incidence and mortality rates. This article reviews the theory of “turbid toxin pathogenesis” and related prevention and treatment strategies for hepatic encephalopathy in traditional Chinese medicine/Zhuang medicine， proposes a new theory of “turbid toxin pathogenesis”， analyzes the scientific connotations of “turbid”， “toxin”， and the theory of “turbid toxin pathogenesis”， and constructs the “four-step” prevention and treatment strategies for hepatic encephalopathy， thereby establishing the new clinical prevention and treatment regimen for hepatic encephalopathy represented by “four prescriptions and two techniques” and clarifying the effect mechanism and biological basis of core prescriptions and techniques in the prevention and treatment of hepatic encephalopathy， in order to provide a reference for the prevention and treatment of hepatic encephalopathy.

The in-depth research of artificial intelligence in the medical field has greatly improved the workflow and diagnostic ability of diagnostic radiology.This article focuses on artificial intelligence technology in the field of interventional medicine,and enumerates its potential application scenarios,including improving image analysis capabilities to assist diagnosis and predict treatment response.It also describes the challenges that need to be overcome for practical application.Finally,with the continuous development of artificial intelligence in interventional medicine,artificial intelligence will further optimize the channels of interventional medicine and bring revolutionary changes to the clinical practice of interventional medicine.

Objective To evaluate the caregiving capacity of family caregivers of children with hirschsprung's disease(HD)and to establish an evidence base for developing family-empowered home care interventions.Methods An explanatory sequential mixed-method design was employed.A total of 308 family caregivers of HD patients admitted to the Pediatric Surgery Department of a tertiary children's hospital in Shanghai,were enrolled from July 2019 to July 2024.Quantitative data were collected in 2024 using a demographic questionnaire,the Zarit Caregiver Burden Interview and the Family Caregiver Task Inventory.Semi-structured interviews were conducted in August to December 2024 with 15 caregivers of children with HD with poor caregiving skills.Quantitative data were analyzed using nonparametric tests and multiple linear regression,and qualitative information was refined through Colaizzi's 7-step analysis of themes.Results In the end,281 valid questionnaires were recovered.The total caregiving competence was 12.00(6.00,20.00).Multivariate analysis identified significant predictors of caregiving competence,including children in the postoperative dilation period,frequency of enterocolitis episodes,place of residence monthly household income and burden of caregiving were the factors influencing the ability of family caregivers to take care of their children(P＜0.05).Qualitative analysis revealed 4 themes:persistent multidimensional adaptive challenges,disparity in clinical caregiving skills,systemic support limitations,and role multiplicity strain.Conclusion Family caregivers of children with HD face multidimensional stressors,necessitating a dynamic,family-centered support ecosystem.Strategic interventions should focus on enhancing clinical caregiving literacy while improving access to socioeconomic resources and establishing role-specific support networks.

Objective To evaluate the caregiving capacity of family caregivers of children with hirschsprung's disease(HD)and to establish an evidence base for developing family-empowered home care interventions.Methods An explanatory sequential mixed-method design was employed.A total of 308 family caregivers of HD patients admitted to the Pediatric Surgery Department of a tertiary children's hospital in Shanghai,were enrolled from July 2019 to July 2024.Quantitative data were collected in 2024 using a demographic questionnaire,the Zarit Caregiver Burden Interview and the Family Caregiver Task Inventory.Semi-structured interviews were conducted in August to December 2024 with 15 caregivers of children with HD with poor caregiving skills.Quantitative data were analyzed using nonparametric tests and multiple linear regression,and qualitative information was refined through Colaizzi's 7-step analysis of themes.Results In the end,281 valid questionnaires were recovered.The total caregiving competence was 12.00(6.00,20.00).Multivariate analysis identified significant predictors of caregiving competence,including children in the postoperative dilation period,frequency of enterocolitis episodes,place of residence monthly household income and burden of caregiving were the factors influencing the ability of family caregivers to take care of their children(P＜0.05).Qualitative analysis revealed 4 themes:persistent multidimensional adaptive challenges,disparity in clinical caregiving skills,systemic support limitations,and role multiplicity strain.Conclusion Family caregivers of children with HD face multidimensional stressors,necessitating a dynamic,family-centered support ecosystem.Strategic interventions should focus on enhancing clinical caregiving literacy while improving access to socioeconomic resources and establishing role-specific support networks.

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 evaluate the feasibility of the novel programmed death-ligand 1 (PD-L1)-targeted PET/CT molecular probe for evaluating PD-L1 expression and tumor heterogeneity in patients with non-small cell lung cancer (NSCLC).Methods:From October 2023 to October 2024, 30 patients (21 males, 9 females; age 69(58, 75) years) with newly diagnosed NSCLC at the First Affiliated Hospital of Xiamen University were prospectively enrolled. All patients underwent PET/CT imaging 1 h after intravenous administration of 68Ga-1, 4, 7-triazacyclononane-1, 4, 7-triacetic acid (NOTA)-DK224, and SUV max was calculated. Immunohistochemical staining on biopsy samples of patients were performed and the PD-L1 tumor proportion score (TPS) was calculated. The differences of SUV max between two groups were compared by using Mann-Whitney U test. Results:Of 30 patients, 31 biopsy specimens were obtained including 24 primary lesion biopsies, 1 lymph node lesion biopsy, and 6 metastatic lesion biopsies, with 16 TPS<1%, 9 1%≤TPS<50% and 6 TPS≥50%. PD-L1-positive tumors showed relatively high uptake of 68Ga-NOTA-DK224. The SUV max of TPS≥1% group was significantly higher than that of TPS<1% group (6.9(5.1, 7.7) vs 3.8(3.1, 4.2); Z=-4.47, P<0.001), and SUV max of TPS≥50% group was significantly higher than that of TPS<50% group (8.6(7.3, 12.4) vs 4.2(3.7, 5.3); Z=-3.65, P<0.001). Of 30 patients, 24 had multiple metastatic lesions with 212 lesions in total. The median fold difference was 2.3 (range: 1.4-6.0), and the median CV was 28.3% (range: 11.7%-61.6%). Conclusion:68Ga-NOTA-DK224 PET/CT is able to accurately and comprehensively reflect PD-L1 expression and tumor heterogeneity in primary and metastatic NSCLC.

Objective:To investigate the management effectiveness of the integrated service mode of community cerebrovascular disease specialty and general practice team on stroke management.Methods:This was a randomized controlled trial. Patients with non-acute stroke who visited Fangzhuang Community Health Service Center in Fengtai District, Beijing between September 2022 and January 2023 were enrolled and randomly assigned to an integrated specialist-primary care group and a control group using a random number table method. Baseline clinical data were collected. Patients in the integrated specialist-primary care group received a collaborative care model combining stroke specialty services and primary care teams, while the control group received routine care. Neurological status, mental status, medical adherence, cognitive function, and psychological status were assessed using standardized scales at baseline, followed by evaluations every 3 months for 1 year, totaling 5 assessments.Results:A total of 142 non-acute stroke patients were included, with 71 in the specialist-primary care integrated service group, aged (69.5±7.6) years, including 43 males (60.56%), and 71 in the control group, aged (68.8±8.5) years, including 38 males (53.52%). There were no statistically significant differences in baseline clinical characteristics such as age, sex, and body mass index between the two groups (all P>0.05). Prior to the intervention, there were no statistically significant differences in the Mini-Mental State Examination scores between the two groups ( P>0.05). However, at 3, 6, 9, and 12 months post-intervention, the scores of the specialist-primary care integrated service group were significantly higher than those of the control group (all P<0.05). Before the intervention, there were no statistically significant differences between the two groups in the scores on Generalized Anxiety Disorder Scale and Patient Health Questionnaire Depression Scale (all P>0.05). At 6, 9, and 12 months post-intervention, the scores on these two scales for the specialist-primary care integrated service group were significantly lower than those of the control group (all P<0.05). There were no statistically significant differences in adherence behavior scores between the two groups before the intervention ( P>0.05), but at 6, 9, and 12 months post-intervention, the adherence behavior scores of the specialist-primary care integrated service group were significantly higher than those of the control group (all P<0.05). Conclusions:The integrated service mode of cerebrovascular disease specialists and general practice teams can effectively improve cognitive function, anxiety, depression, and compliance behavior, and is more conducive to the recovery of stroke patients in the community, which has popularization value.

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 evaluate the feasibility of the novel programmed death-ligand 1 (PD-L1)-targeted PET/CT molecular probe for evaluating PD-L1 expression and tumor heterogeneity in patients with non-small cell lung cancer (NSCLC).Methods:From October 2023 to October 2024, 30 patients (21 males, 9 females; age 69(58, 75) years) with newly diagnosed NSCLC at the First Affiliated Hospital of Xiamen University were prospectively enrolled. All patients underwent PET/CT imaging 1 h after intravenous administration of 68Ga-1, 4, 7-triazacyclononane-1, 4, 7-triacetic acid (NOTA)-DK224, and SUV max was calculated. Immunohistochemical staining on biopsy samples of patients were performed and the PD-L1 tumor proportion score (TPS) was calculated. The differences of SUV max between two groups were compared by using Mann-Whitney U test. Results:Of 30 patients, 31 biopsy specimens were obtained including 24 primary lesion biopsies, 1 lymph node lesion biopsy, and 6 metastatic lesion biopsies, with 16 TPS<1%, 9 1%≤TPS<50% and 6 TPS≥50%. PD-L1-positive tumors showed relatively high uptake of 68Ga-NOTA-DK224. The SUV max of TPS≥1% group was significantly higher than that of TPS<1% group (6.9(5.1, 7.7) vs 3.8(3.1, 4.2); Z=-4.47, P<0.001), and SUV max of TPS≥50% group was significantly higher than that of TPS<50% group (8.6(7.3, 12.4) vs 4.2(3.7, 5.3); Z=-3.65, P<0.001). Of 30 patients, 24 had multiple metastatic lesions with 212 lesions in total. The median fold difference was 2.3 (range: 1.4-6.0), and the median CV was 28.3% (range: 11.7%-61.6%). Conclusion:68Ga-NOTA-DK224 PET/CT is able to accurately and comprehensively reflect PD-L1 expression and tumor heterogeneity in primary and metastatic NSCLC.