In December 2025， American Gastroenterological Association released the expert review of clinical practice update on the management of ascites， volume overload， and hyponatremia in cirrhosis. The expert review proposes 13 best practice recommendations based on available evidence. This article gives an excerpt of the main recommendations from the expert review.

ObjectiveTo observe the clinical efficacy and safety of Tianmeng Lingjiao Formula（天礞羚角方， TLF） as an adjunctive therapy for paroxysmal atrial fibrillation （PAF） with phlegm-heat harassing the interior syndrome. MethodsNinety patients with PAF and phlegm-heat harassing the interior syndrome were enrolled and randomly assigned in a 2∶1 ratio to test group （60 cases） and control group （30 cases）. The control group received conventional western medicine， while the test group received TLF in addition to the conventional treatment， with one dose administered daily. The treatment course for both groups was 4 weeks. The efficacy of traditional Chinese medicine （TCM） syndrome and the rate of atrial fibrillation （AF） conversion were compared between groups. Assessments included AF burden， frequency and duration of AF episodes， TCM syndrome scores， and European Heart Rhythm Association （EHRA） AF symptom classification before and after treatment. Safety indicators such as blood routine， urine routine， stool routine， liver function， kidney function， and electrolytes were also monitored. Adverse events were recorded. ResultsA total of 82 patients completed the study （54 in the test group and 28 in the control group）. After treatment， AF burden， the frequency and duration of AF episodes， and TCM syndrome scores were significantly reduced in both groups， and the test group showed lower indicators than the control group （P＜0.01 or P＜0.05）. The AF conversion rate was 25.93% （14/54） in the test group， significantly higher than 3.57% （1/28） in the control group （P＜0.05）. The total effective rate for TCM syndrome efficacy was 83.33% （45/54） in the test group， which was significantly higher than 67.86% （19/28） in the control group （P＜0.05）. After treatment， the EHRA atrial fibrillation symptom severity in the test group showed significant improvement， and the improvement in atrial fibrillation symptoms was superior to that in the control group （P＜0.01or P＜0.05）. No significant abnormalities were observed in safety indicators， and no adverse events occurred during the trial. ConclusionTLF as an adjunctive therapy can reduce AF burden， enhance the conversion rate of AF， decrease the frequency and duration of episodes， and improve clinical symptoms in patients with paroxysmal atrial fibrillation presenting with phlegm-heat harassing the interior syndrome， with a favorable safety profile.

Objective:To investigate the rate-limiting steps of hand-assisted laparoscopic donor nephrectomy, analyze the relevant factors affecting surgical difficulty, and subsequently construct a mathematical model to predict the difficulty of the procedure preoperatively.Methods:A retrospective study was conducted on 100 kidney donors who underwent hand-assisted laparoscopic donor nephrectomy performed by the same surgeon at Beijing Friendship Hospital, Capital Medical University from January 2021 to January 2024. Preoperative demographic data, imaging findings, general condition, donor kidney size, and postoperative complications were collected and analyzed. The surgeon′s subjective rating (1-3 points) was used as a quantitative measure of surgical difficulty. ANOVA and Chi-square tests were employed to explore the differences in postoperative complications, recovery, operative time, and intraoperative blood loss among groups with varying levels of difficulty. The main procedure was divided into four steps (excluding abdominal closure): Trocar placement, renal hilar dissection, perinephric dissection, and kidney retrieval. The time for each step and the total operative time were recorded. Pearson correlation test was used to analyze the relationship between each step and the total operative time, and ANOVA test was used to assess the time differences between steps and to determine if the time for the same step varied across different difficulty subgroups, thereby identifying the rate-limiting step of hand-assisted laparoscopic donor nephrectomy. In terms of the risk factors influencing the difficulty of surgery, Pearson and Spearman correlation tests were used to investigate the relationship between preoperative donor data and surgical difficulty scores, and a predictive model was constructed using multiple linear regression. Finally, the model was internally and externally validated to confirm its accuracy and effectiveness.Results:As the surgical difficulty increased (groups 1, 2, and 3), the postoperative drainage tube duration was correspondingly prolonged [(5.92±1.48) d, (8.00±1.75) d, and (11.88±4.45) d, respectively, P<0.05], and the severity of postoperative complications also significantly increased (the incidence of Clavien-Dindo grade ≥2 was 5.66%, 31.82% and 64.00%, respectively, P<0.01). In the analysis of rate-limiting steps, the time taken for all steps, except for Trocar placement, showed significant differences among the difficulty subgroups ( P<0.001). However, the average time for renal hilar dissection was (19.82±5.65) min, which was significantly longer than the other steps ( P<0.001). Therefore, renal hilar dissection was identified as the rate-limiting step of hand-assisted laparoscopic donor nephrectomy. In terms of the influencing factors of surgical difficulty, donor obesity, kidney width, abdominal anteroposterior sagittal diameter, number of renal arteries, distance from renal artery bifurcation to the abdominal aorta, degree of renal artery calcification, and mayo adhesive probability (MAP) score were all correlated with the surgical difficulty score ( P<0.05). However, multiple linear regression analysis revealed that only the number of renal arteries and the MAP score were the independent risk factors for higher surgical difficulty of hand-assisted laparoscopic donor nephrectomy. The predictive equation was: surgical difficulty=0.649×number of renal arteries+ 0.770×MAP score. Both internal and external validation confirmed the model's good accuracy. Conclusions:This study established a reliable and objective predictive model for the difficulty of hand-assisted laparoscopic donor nephrectomy based on the number of renal arteries and the MAP score. Renal hilar dissection was identified as the rate-limiting step of the procedure. This provides a reference for selecting an appropriate surgeon based on the predicted surgical difficulty.

Osteoporosis and cardiovascular calcification,two major age-related chronic diseases that China is confronting today,pose serious threats to public health.Previous studies have reported overlapping connections in the pathological processes and molecular mechanisms of these two diseases,particularly concerning inflammation,oxidative stress,and dysregulation of mineral metabolism,and that these two diseases tend to share common pathogenic factors.However,research exploring the comorbidity mechanisms of the two diseases remains limited in both depth and scope,largely due to the lack of widely accepted comorbidity animal models.Herein,we analyzed the latest research findings on the comorbidity mechanisms of vascular calcification and osteoporosis,focusing on summarizing the animal disease models currently in extensive use and the relevant evaluation criteria.We aim to provide new references for comorbidity research models and offer scientific evidence for future studies on pathological mechanisms and the development of new therapeutic strategies.

Objective To systematically characterizes the temporal changes in urokinase-type plasminogen activator(uPA)over the course of neoplastic progression using a mouse oral squamous cell carcinoma(OSCC)model induced by 4-nitroquinoline-1-oxide(4-NQO).Methods A total of 65 wild-type C57BL/6 mice of 5 weeks old were randomly assigned to two groups,a 4-NQO group(n=50),which received daily administration of 100 μg/mL 4-NQO in drinking water,and a control group(n=15),which received sterile water.At 12,16,20,22,and 24 weeks,10 mice from the 4-NQO group and 3 from the control group were randomly selected,weighed,and sacrificed.Tongue tissues were collected for hematoxylin-eosin(HE)staining to preliminarily assess OSCC development,and for immunofluorescence staining and quantitative real-time PCR to evaluate dynamic uPA expression in tongue tissues during OSCC progression.Results After 16 weeks of exposure,4-NQO-treated mice exhibited significantly lower body mass compared with that of the controls(P<0.05)and the weight loss became increasingly more pronounced over time.Histopathological changes in tongue tissues progressed in a clearly time-dependent manner—hyperplasia and mild dysplasia emerged at week 12,while moderate-to-severe dysplasia and carcinoma were observed by week 22,yielding a tumorigenic rate of 25%,which escalated to 70%by week 24.Immunofluorescence and qPCR analyses demonstrated a pronounced,progressive up-regulation of uPA expression in lesional tissues as OSCC progressed(P<0.000 1).Conclusion This study not only confirmed the uniqueness of the 4-NQO model in OSCC research,but also revealed the changes in uPA during tumor invasion.These findings provide a theoretical foundation for the development of early diagnosis and precision treatment strategies,holding significant potential clinical value and research importance for improving patient prognosis.

Objective To evaluate the effects of Yiqi Huayu Jiedu Decoction combined with chemotherapy on disease-free survival rate and disease-free survival(DFS)of patients with stage Ⅱ and Ⅲ postoperative gastric cancer.Methods Totally 102 patients with stage Ⅱ and Ⅲ postoperative gastric cancer treated by Affiliated Hospital of Nanjing University of Chinese Medicine and Nanjing Drum Tower Hospital were selected.The patients were divided into control group(52 cases)and test group(50 cases)with block random method.The control group received conventional postoperative adjuvant chemotherapy for 4-6 cycles.The test group was treated with Chinese materia medica for 6 months on the basis of chemotherapy.Continue follow-up until the patients had recurrence,metastasis or death.DFS was analyzed by Kaplan-Meier method,and the average DFS of the two groups was estimated.Log Rank test was used to test the significance of differences in survival distribution between groups.Univariate and multivariate analyses of variables affecting prognosis were conducted using the Cox regression model.Adverse reactions of both groups were monitored.Results The recurrence and metastasis rate of the test group was 12.0%(6/50),while that of the control group was 34.6%(18/52),which was lower in the test group than in the control group(P<0.05).The 1-year and 2-year DFS rates and DFS of the control group were 86.5%,72.2%and 25.8 months respectively,while those of the test group were 95.6%,84.1%and 33.9 months respectively,with statistical significance(P=0.012).Cox-regression analysis suggested:The independent factors influencing the disease-free survival time of patients with gastric cancer were the test group(P=0.022),surgical methods of subtotal gastrectomy(P=0.038)and clinical stages Ⅱ(P=0.040).No adverse reactions related to Chinese materia medica were reported in the two groups.Conclusion Yiqi Huayu Jiedu Decoction combined with chemotherapy can improve the 1-year and 2-year DFS rate,prolong DFS,reduce the recurrence and metastasis rate,and improve the prognosis.

Objective:To evaluate the feasibility of using the domestic ArcherQA system for fast and simplified independent verification of CyberKnife (CK) stereotactic radiotherapy (SRT) plans.Methods:SRT plans of 57 patients treated with CK at Tianjin Medical University Cancer Institute and Hospital from August 2021 to August 2022 were retrospectively analyzed, including 15 intracranial, 30 pulmonary, and 12 abdominal tumors cases. Point-dose and planar-dose verifications were performed using an ionization chamber and radiochromic films embedded in a homogeneous phantom, and the results were compared with those calculated by the treatment planning system (TPS). The localization CT images and corresponding SRT plans were imported into the ArcherQA system for independent dose verification and analysis. The correlation between ArcherQA results and phantom measurements was analyzed, with comparisons of target mean dose differences and γ pass rates.Results:Phantom measurement results showed, the measured point-dose differences for intracranial, lung, and abdominal plans were -0.94% ± 3.22%, 1.92% ± 2.05%, and 2.12% ± 0.77%, respectively. The mean dose differences in target dose calculation between ArcherQA and TPS: intracranial in the gross tumor volume (GTV) regions were 0.34% ± 2.21%, lung tumor GTV were -2.47% ± 2.46%, and abdominal tumor GTV were 0.80% ± 2.61%, respectively. Among them, the abdominal GTV region showed the highest correlation between ArcherQA and measured results ( r=0.78). The average two-dimensional γ pass rates (2 mm/2%, threshold=10%) measured using phantom films were 95.92% ± 2.35% for intracranial, 95.70% ± 2.74% for lung, and 96.74% ± 3.41% for abdominal tumors plans, respectively. The three-dimensional ArcherQA results showed comparable γ pass rates (1 mm/2%, threshold=10%) for lung and abdominal GTV and PTV regions, with similar medians and data dispersion to film measurements. Conclusions:The ArcherQA system enables rapid and efficient independent dose verification of CK SRT plans without the need for additional hardware. The verification results show good correlation with phantom measurements, supporting its potential as an auxiliary quality assurance tool in clinical CK SRT implementation.

Glycosylation plays an important role in tumorigenesis and development. Mucoprotein-1 (MUC1), a transmembrane glycoprotein, is overexpressed in a variety of malignant tumors. The biochemical characteristics of tumor-specific short chain O-glycosylation (such as Tn/sialyl Tn (STn) antigens) are significantly different from those of normal tissue MUC1, which provides a molecular basis for precision diagnosis and treatment of tumors. This article systematically reviews the molecular design, clinical transformation progress and technical bottleneck of three types of probes targeting MUC1 glycosylation epitopes in tumors, including aptamers, peptides and monoclonal antibodies, focusing on their tumor uptake efficiency, targeting specificity and the potential of diagnosis and treatment integration, so as to provide theoretical basis for optimizing the clinical transformation path of MUC1 targeting probes.

Objective:To analyze the clinical characteristics and gene mutations of 4 patients with the male phenotype of 17α-hydroxylase /17, 20-lyase deficiency(17-OHD), in order to improve the recognition and appropriate management of atypical cases.Methods:A retrospective analysis was performed on the clinical features, biochemical findings, and gene mutations of 4 patients with the male phenotype of 17-OHD treated in our hospital between 2018 and 2023.Results:The social gender of all 4 patients with 17-OHD was male. None of the 4 patients had hypertension or hypokalemia, but all had micropenis and gynecomastia. Two patients had adrenal hyperplasia, while adrenal morphology was normal in the other two. One patient had decreased bone mass. There were typical changes in the steroid synthesis-related hormone spectrum: progesterone was significantly elevated in all 4 patients, 17-hydroxyprogesterone was not markedly abnormal, cortisol, dehydroepiandrosterone sulfate(DHEAS) and estradiol levels were low, and testosterone levels were also low.Conclusion:17-OHD is a rare type of congenital adrenal hyperplasia, with the male phenotype being even rarer. Early symptoms are often atypical, resulting in high rates of misdiagnosis and missed diagnosis. Patients without hypertension and hypokalemia are particularly prone to diagnostic confusion. Male patients with unexplained progesterone elevation, poor secondary sexual development, and gynecomastia should undergo timely steroid hormone profiling and genetic testing to avoid misdiagnosis and missed diagnosis.

Objective:To compare postoperative inflammatory markers and surgical outcomes between open reduction and internal fixation versus double reverse traction closed reduction and percutaneous internal fixation for tibial plateau fractures.Methods:A retrospective analysis was conducted of the data of 229 patients with tibial plateau fracture who had been admitted to Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University from January 2023 to December 2023. There were 155 males and 74 females with an age of (48.7±10.9) years. According to the surgical methods, the patients were divided into 2 groups. A conventional group of 87 cases were treated by open reduction and internal fixation while a minimally invasive group of 142 cases treated with double reverse traction closed reduction and percutaneous internal fixation. The 2 groups were compared in terms of hematological indexes [white blood cell count (WBC), neutrophil count (NEUT), lymphocyte count (LYM), monocyte count (Mono), platelet count (PLT), and albumin (ALB)] and composite inflammatory indexes [neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI)] before operation and on the first day after operation, intraoperative blood loss, operation time, fracture healing time, Hospital for Special Surgery (HSS) knee score and incidence of thrombosis.Results:There were no significant differences in baseline characteristics or treatment variables between the 2 groups, indicating comparability ( P > 0.05). All the 229 patients were followed up for (16.5±2.8) months. In each group, comparisons between preoperation and postoperation showed that LYM and ALB significantly decreased while WBC, NEUT, Mono, PLT, NLR, PLR, SII and SIRI significantly increased on the first day after operation ( P < 0.05). Preoperatively, there were no significant differences between the 2 groups in terms of hematological or composite inflammatory indexes ( P > 0.05). On the first day after operation, there was no significant difference in WBC, NEUT, LYM, ALB or NLR between the 2 groups ( P > 0.05), but Mono, PLT, PLR, SII and SIRI in the minimally invasive group were significantly lower than those in the conventional group ( P < 0.05). The intraoperative blood loss, operation time, fracture healing time, HSS knee score and incidence of thrombosis in the minimally invasive group were significantly better than those in the conventional group ( P < 0.05). Conclusion:In the treatment of tibial plateau fractures, compared with conventional open reduction and internal fixation, double reverse traction closed reduction and percutaneous internal fixation shows obvious advantages in reducing inflammatory indicators and leads to better surgical outcomes.