Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Objective To evaluate the short-term efficacy of the VISULYZE software generated nomogram in assis-ting small incision lenticule extraction(SMILE)for the correction of myopia and astigmatism.Methods Non-randomized controlled trial.Patients who underwent SMILE surgery with the original nomogram,assisted by the same surgeon at the Laser Myopia Treatment Center of Xi'an NO.1 Hospital between February 2023 and January 2024,were included.A total of 52 patients(102 eyes)of myopic astigmatism with 3-month postoperative follow-up were collected.VISULYZE software was then used to generate a new nomogram.Subsequently,a total of 40 patients(70 eyes)with myopic with-the-rule astigmatism and a preoperative cylinder of ≤2.00 D,who underwent SMILE assisted by the new nomogram at the same center between August and November 2024,were enrolled.Among them,50 eyes had a target refraction of plano and were assigned to the experimental group.In addition,from the database of patients who underwent SMILE assisted by the origi-nal nomogram,42 patients(70 eyes)with myopic with-the-rule astigmatism and a cylinder of ≤2.00 D were screened,of which 51 eyes had a target refraction of plano,and these were assigned to the control group.The postoperative visual and refractive outcomes of both groups were compared at 3 months.Astigmatism results were analyzed using Alpins vector analysis.Results At 3 months postoperatively,among eyes with a target refraction of plano,50 eyes(98.0％)in the control group and all 50 eyes(100.0％)in the experimental group achieved an uncorrected distance visual acuity(UDVA)of ≥ 20/20.No eye in either group experienced a loss of more than one line in corrected distance visual acuity(CDVA)compared with the preoperative level.At 3 months postoperatively,63 eyes(90.0％)in the control group and 66 eyes(94.3％)in the experimental group had a spherical equivalent(SE)within-0.50 to 0.50 D.The postoperative cylinder was significantly lower in the experimental group than in the control group(P＜0.05).Vector analysis revealed that the ex-perimental group had smaller values for the difference vector,index of success,and absolute angle of error than the control group,with all differences being statistically significant(all P＜0.05).At 3 months postoperatively,43 eyes(61.4％)in the control group and 57 eyes(81.4％)in the experimental group had an angle of error within-5° to 5°.Conclusion The use of the VISULYZE software generated nomogram can optimize SMILE surgery design,offering good efficacy,safety,and predictability,and improving the precision of SMILE surgery for correcting myopia and astigmatism.

As a new type of rapid antidepres-sant,ketamine has provided a new approach for the treatment and research on the pathological mechanism of major depressive disorder.However,the addictive potential and neurotoxicity of ket-amine have become issues that cannot be ignored in clinical medication.This article briefly introduces the relevant research progress on ketamine addic-tion and neurotoxicity mechanisms at home and abroad,hoping to provide a reference for the ratio-nal development and utilization of ketamine.

Objective:To evaluate the clinical status of long-term oral anticoagulant management in patients with atrial fibrillation, and to analyze the obstacles and promoting factors in the implementation of evidence, so as to provide evidence for clinical transformation.Methods:This study was a cross-sectional study. Through the evidence-based nursing method, guided by the Ottawa Model, the review indicators and review methods were developed based on the best evidence. The clinical status review of 100 patients who met the inclusion criteria in the Department of Cardiology, Affiliated Hospital of Jiangsu University was conducted from August to November 2022 using a convenience sampling method, and based on the results of the review, an analysis of obstacles and promoting factors was carried out to develop a clinical response.Results:This study included 100 patients with atrial fibrillation, 60 males and 40 females, aged (70.14 ± 10.39) years. Totally 26 best items were included, and 24 review indicators were developed, among which only 4 indicators had a compliance rate of 100% , 2 indicators had a compliance rate of >60% , 5 indicators had a compliance rate of <60% , and 13 indicators had a compliance rate of 0. According to the results of the review, a comprehensive and systematic analysis was conducted from the three dimensions of system, practitioners, patients and family members. For each dimension, obstacles and promoting factors were analyzed in depth from evidence-based change, potential adopters and practical environment.Conclusions:There is a gap between the best evidence and clinical status of long-term oral anticoagulant management in patients with atrial fibrillation. In-depth analysis of obstacle factors, formulate countermeasures, and promote the efficient implementation of evidence in clinical practice.

The coil adverse events in the U.S.Food and Drug Administration Manufacturer and User Facility Device Experience(MAUDE)database from January 2021 to June 2024 were analyzed retrospectively.The risks of coils during the clinical application and their causes were explored with hospital survey and expert demonstration in Shandong Province.Some improving measures were put forward for the safe use of coils,including implementing the main responsibility of the registrant,enhancing the professional skills of the using institutions and strengthening the supervision of the supervisory authorities.[Chinese Medical Equipment Journal,2025,46(6):83-87]

This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

ObjectiveTo investigate the effects of Pinelliae Rhizoma Praeparatum （PRP） on lung tissue， gut microbiota， and short-chain fatty acid （SCFA） metabolism in a model of mice with cold fluid retention in the lung and explore its mechanism of action in resolving dampness and phlegm based on the interconnection between the lung and large intestine. MethodsFifty female ICR mice were randomly divided into a normal group， model group， positive control group （Xiaoqinglong granules， 6.5 g·kg^-1）， and high-dose and low-dose PRP decoction groups （3.0， 1.5 g·kg^-1）， with 10 mice in each group. A model of mice with cold fluid retention in the lung was established using ovalbumin （OVA） sensitization combined with cold-water immersion. Drug interventions were conducted from day 18 to day 33 for 15 consecutive days. The airway resistance value of the mice was measured using a non-invasive pulmonary function analyzer. Phlegm-resolving effects were evaluated via a microplate reader. Eosinophil and neutrophil counts in bronchoalveolar lavage fluid （BALF） were analyzed using an automated hematology analyzer. Serum levels of total immunoglobulin E （IgE）， interferon-γ （IFN-γ）， interleukin-4 （IL-4）， and BALF levels of interleukin-6 （IL-6） and interleukin-8 （IL-8） were quantified by enzyme-linked immunosorbent assay （ELISA）. Lung histopathology was assessed using hematoxylin-eosin （HE） staining. Immunohistochemistry （IHC） was employed to detect mucin 5AC （MUC5AC） and aquaporin 5 （AQP5） protein expression in lung tissue. Gut microbiota composition was analyzed via agarose gel electrophoresis， and fecal SCFA levels were measured by gas chromatography-mass spectrometry （GC-MS）. ResultsCompared with the normal group， the model group exhibited significantly increased airway resistance value （RI） （P<0.05）， elevated eosinophil and neutrophil counts and IL-6 and IL-8 levels in BALF （P<0.05）， increased serum IgE and IL-4 levels （P<0.05）， with reduced IFN-γ levels （P<0.05）. It also showed thickened bronchial walls， widened alveolar septa， narrowed lumens， and mucus plugs in lung tissue， upregulated MUC5AC protein expression and downregulated AQP5 protein expression （P<0.05）， decreased relative abundance of beneficial gut microbiota （Firmicutes， Clostridia， Clostridiales， Lactobacillaceae， and Lactobacillus）， and increased abundance of harmful microbiota （Bacteroidetes， Bacteroidia， Bacteroidales， Muribaculaceae， and Muribaculum）. In addition， the model group presented reduced fecal SCFA levels （acetate， propionate， and butyrate） （P<0.05）. After the intervention of PRP decoction， compared to the model group， all drug administration groups showed decreased RI （P<0.05）， increased phenol red excretion， declined eosinophil and neutrophil counts and IL-6， IL-8， IgE， and IL-4 levels （P<0.05）， and improved IFN-γ levels （P<0.05） and lung pathology improved. The MUC5AC protein expression decreased （P<0.05）， and the AQP5 protein expression increased （P<0.05）. The disorder of gut microbiota was improved， and the diversity of gut microbiota was restored， with a significantly increased relative abundance ratio of beneficial microbiota （P<0.05） and a significantly reduced relative abundance ratio of harmful microbiota （P<0.05）. The SCFA levels （acetate， propionate， and butyrate） increased （P<0.05）. The efficacy indicators of serum inflammatory factors （IgE， IL-4， and IFN-γ）， phlegm-resolving effect， airway resistance， total pathological score， and the protein expression of MUC5AC and AQP5 were correlated with gut microbiota and SCFAs. ConclusionPRP decoction alleviates cold-phlegm syndrome by modulating the gut-lung axis， promoting beneficial gut microbiota， enhancing SCFA production， restoring the balance of gut microbiota， and suppressing respiratory inflammation. This study provides novel insights into the TCM theory of interconnection between the lung and large intestine.

ObjectiveTo investigate the effects of Pinelliae Rhizoma Praeparatum （PRP） on lung tissue， gut microbiota， and short-chain fatty acid （SCFA） metabolism in a model of mice with cold fluid retention in the lung and explore its mechanism of action in resolving dampness and phlegm based on the interconnection between the lung and large intestine. MethodsFifty female ICR mice were randomly divided into a normal group， model group， positive control group （Xiaoqinglong granules， 6.5 g·kg^-1）， and high-dose and low-dose PRP decoction groups （3.0， 1.5 g·kg^-1）， with 10 mice in each group. A model of mice with cold fluid retention in the lung was established using ovalbumin （OVA） sensitization combined with cold-water immersion. Drug interventions were conducted from day 18 to day 33 for 15 consecutive days. The airway resistance value of the mice was measured using a non-invasive pulmonary function analyzer. Phlegm-resolving effects were evaluated via a microplate reader. Eosinophil and neutrophil counts in bronchoalveolar lavage fluid （BALF） were analyzed using an automated hematology analyzer. Serum levels of total immunoglobulin E （IgE）， interferon-γ （IFN-γ）， interleukin-4 （IL-4）， and BALF levels of interleukin-6 （IL-6） and interleukin-8 （IL-8） were quantified by enzyme-linked immunosorbent assay （ELISA）. Lung histopathology was assessed using hematoxylin-eosin （HE） staining. Immunohistochemistry （IHC） was employed to detect mucin 5AC （MUC5AC） and aquaporin 5 （AQP5） protein expression in lung tissue. Gut microbiota composition was analyzed via agarose gel electrophoresis， and fecal SCFA levels were measured by gas chromatography-mass spectrometry （GC-MS）. ResultsCompared with the normal group， the model group exhibited significantly increased airway resistance value （RI） （P<0.05）， elevated eosinophil and neutrophil counts and IL-6 and IL-8 levels in BALF （P<0.05）， increased serum IgE and IL-4 levels （P<0.05）， with reduced IFN-γ levels （P<0.05）. It also showed thickened bronchial walls， widened alveolar septa， narrowed lumens， and mucus plugs in lung tissue， upregulated MUC5AC protein expression and downregulated AQP5 protein expression （P<0.05）， decreased relative abundance of beneficial gut microbiota （Firmicutes， Clostridia， Clostridiales， Lactobacillaceae， and Lactobacillus）， and increased abundance of harmful microbiota （Bacteroidetes， Bacteroidia， Bacteroidales， Muribaculaceae， and Muribaculum）. In addition， the model group presented reduced fecal SCFA levels （acetate， propionate， and butyrate） （P<0.05）. After the intervention of PRP decoction， compared to the model group， all drug administration groups showed decreased RI （P<0.05）， increased phenol red excretion， declined eosinophil and neutrophil counts and IL-6， IL-8， IgE， and IL-4 levels （P<0.05）， and improved IFN-γ levels （P<0.05） and lung pathology improved. The MUC5AC protein expression decreased （P<0.05）， and the AQP5 protein expression increased （P<0.05）. The disorder of gut microbiota was improved， and the diversity of gut microbiota was restored， with a significantly increased relative abundance ratio of beneficial microbiota （P<0.05） and a significantly reduced relative abundance ratio of harmful microbiota （P<0.05）. The SCFA levels （acetate， propionate， and butyrate） increased （P<0.05）. The efficacy indicators of serum inflammatory factors （IgE， IL-4， and IFN-γ）， phlegm-resolving effect， airway resistance， total pathological score， and the protein expression of MUC5AC and AQP5 were correlated with gut microbiota and SCFAs. ConclusionPRP decoction alleviates cold-phlegm syndrome by modulating the gut-lung axis， promoting beneficial gut microbiota， enhancing SCFA production， restoring the balance of gut microbiota， and suppressing respiratory inflammation. This study provides novel insights into the TCM theory of interconnection between the lung and large intestine.

Objective To evaluate the short-term efficacy of the VISULYZE software generated nomogram in assis-ting small incision lenticule extraction(SMILE)for the correction of myopia and astigmatism.Methods Non-randomized controlled trial.Patients who underwent SMILE surgery with the original nomogram,assisted by the same surgeon at the Laser Myopia Treatment Center of Xi'an NO.1 Hospital between February 2023 and January 2024,were included.A total of 52 patients(102 eyes)of myopic astigmatism with 3-month postoperative follow-up were collected.VISULYZE software was then used to generate a new nomogram.Subsequently,a total of 40 patients(70 eyes)with myopic with-the-rule astigmatism and a preoperative cylinder of ≤2.00 D,who underwent SMILE assisted by the new nomogram at the same center between August and November 2024,were enrolled.Among them,50 eyes had a target refraction of plano and were assigned to the experimental group.In addition,from the database of patients who underwent SMILE assisted by the origi-nal nomogram,42 patients(70 eyes)with myopic with-the-rule astigmatism and a cylinder of ≤2.00 D were screened,of which 51 eyes had a target refraction of plano,and these were assigned to the control group.The postoperative visual and refractive outcomes of both groups were compared at 3 months.Astigmatism results were analyzed using Alpins vector analysis.Results At 3 months postoperatively,among eyes with a target refraction of plano,50 eyes(98.0％)in the control group and all 50 eyes(100.0％)in the experimental group achieved an uncorrected distance visual acuity(UDVA)of ≥ 20/20.No eye in either group experienced a loss of more than one line in corrected distance visual acuity(CDVA)compared with the preoperative level.At 3 months postoperatively,63 eyes(90.0％)in the control group and 66 eyes(94.3％)in the experimental group had a spherical equivalent(SE)within-0.50 to 0.50 D.The postoperative cylinder was significantly lower in the experimental group than in the control group(P＜0.05).Vector analysis revealed that the ex-perimental group had smaller values for the difference vector,index of success,and absolute angle of error than the control group,with all differences being statistically significant(all P＜0.05).At 3 months postoperatively,43 eyes(61.4％)in the control group and 57 eyes(81.4％)in the experimental group had an angle of error within-5° to 5°.Conclusion The use of the VISULYZE software generated nomogram can optimize SMILE surgery design,offering good efficacy,safety,and predictability,and improving the precision of SMILE surgery for correcting myopia and astigmatism.

Professor Zou Yunxiang proposed the"kidney essence theory"in 1955,which believes that the kidney,as an important excretory organ in the human body,participates in the body's metabolism,and the basis for producing this effect is the essence of the kidney.Subsequently,the Zou nephrology team established the core medical technique of"tonifying the kidney element"based on this foundation,constructed a system of syndrome differentiation and treatment for chronic kidney disease,proposed the traditional Chinese medicine names,causes,and mechanisms of chronic kidney disease,as well as four major methods for diagnosing and treating chronic kidney disease,and developed representative drugs representing the core medical technique of"tonifying the kidney element"-Huang-zhi Yishen Capsules and Shenwu Yishen Tablets.In addition,the Zou nephrology team has extensively applied and promoted the core medical technique of"tonifying the kidney element".