To explore the advantages of traditional Chinese medicine （TCM） and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications （DMC）， refine key pathophysiological insights and treatment principles， and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine， hosted by the China Association of Chinese Medicine， was held in Beijing， 2024. Experts in TCM， Western medicine， and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis， diagnostic and treatment challenges， and mechanism research related to DMC， ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development， research prioritization， and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM， strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.

OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

ObjectiveTo establish a model that can quickly identify the aroma components in different parts of Nardostachys jatamansi， so as to provide a quality control basis for the market circulation and clinical use of N. jatamansi. MethodsHeadspace solid-phase microextraction-gas chromatography-mass spectrometry（HS-SPME-GC-MS） combined with Smart aroma database and National Institute of Standards and Technology（NIST） database were used to characterize the aroma components in different parts of N. jatamansi， and the aroma components were quantified according to relative response factor（RRF） and three internal standards， and the markers of aroma differences in different parts of N. jatamansi were identified by orthogonal partial least squares-discriminant analysis（OPLS-DA） and cluster thermal analysis based on variable importance in the projection（VIP） value >1 and P<0.01. The odor data of different parts of N. jatamansi were collected by Heracles Ⅱ Neo ultra-fast gas phase electronic nose， and the correlation between compound types of aroma components collected by the ultra-fast gas phase electronic nose and the detection results of HS-SPME-GC-MS was investigated by drawing odor fingerprints and odor response radargrams. Chromatographic peak information with distinguishing ability≥0.700 and peak area≥200 was selected as sensor data， and the rapid identification model of different parts of N. jatamansi was established by principal component analysis（PCA）， discriminant factor alysis（DFA）， soft independent modeling of class analogies（SIMCA） and statistical quality control analysis（SQCA）. ResultsThe HS-SPME-GC-MS results showed that there were 28 common components in the underground and aboveground parts of N. jatamansi， of which 22 could be quantified and 12 significantly different components were screened out. Among these 12 components， the contents of five components（ethyl isovalerate， 2-pentylfuran， benzyl alcohol， nonanal and glacial acetic acid，） in the aboveground part of N. jatamansi were significantly higher than those in the underground part（P<0.01）， the contents of β-ionone， patchouli alcohol， α-caryophyllene， linalyl butyrate， valencene， 1，8-cineole and p-cymene in the underground part of N. jatamansi were significantly higher than those in the aboveground part（P<0.01）. Heracles Ⅱ Neo electronic nose results showed that the PCA discrimination index of the underground and aboveground parts of N. jatamansi was 82， and the contribution rates of the principal component factors were 99.94% and 99.89% when 2 and 3 principal components were extracted， respectively. The contribution rate of the discriminant factor 1 of the DFA model constructed on the basis of PCA was 100%， the validation score of the SIMCA model for discrimination of the two parts was 99， and SQCA could clearly distinguish different parts of N. jatamansi. ConclusionHS-SPME-GC-MS can clarify the differential markers of underground and aboveground parts of N. jatamansi. The four analytical models provided by Heracles Ⅱ Neo electronic nose（PCA， DFA， SIMCA and SQCA） can realize the rapid identification of different parts of N. jatamansi. Combining the two results， it is speculated that terpenes and carboxylic acids may be the main factors contributing to the difference in aroma between the underground and aboveground parts of N. jatamansi.

Objective: To investigate the correlation between maternal parity and ABO hemolytic disease of the fetus and newborn (ABO-HDFN). Methods: A total of 244 neonates diagnosed with ABO-HDFN who were admitted to the neonatology department of of our hospital from January 2021 to December 2024 were selected as the research subjects. According to maternal parity, the neonates were divided into the first- (n=139), second- (n=79), and third-parity group (n=26). Statistical analyses were performed on the maternal IgG anti-A (B) antibody titer, results of the three hemolysis tests, hemolysis-related indicators, and treatment regimens among the three groups. Binary logistic multivariate regression analysis was applied to identify the risk factors for intravenous immunoglobulin (IVIG) therapy in neonates. Results: The proportions of mothers with IgG anti-A (B) titers <64 and ≥64 in each group were as follows: first parity group: 86.33% vs 13.67%; second parity group: 70.89% vs 29.11%; third parity group: 53.85% vs 46.15%. Compared with the first parity group, both the second and third parity group showed statistically significant differences (P =0.005, P <0.001), while no statistically significant difference was observed between the second and the third parity group (P =0.110). The positive rates of direct Coombs test in the first, second and third parity groups were 19.42%, 34.18% and 42.31%, respectively. Compared with the first parity group, the second and third parity group showed statistically significant differences (P =0.015, P =0.011), whereas the difference between the second and third parity group was not statistically significant (P =0.454). The absolute values of reticulocytes (RET#) (×10 /L) in the first, second and third parity groups were 197.02±66.16, 225.69±67.42 and 227.74±64.03, the reticulocyte percentages (RET%) were 4.80±1.83, 5.81±2.07 and 5.90±1.84, and the immature reticulocyte fractions (IRF%) were 38.35±8.06, 40.76±6.63 and 43.25±5.86, respectively. There were statistically significant differences in RET# and RET% between the first and second parity group (RET#: P =0.002; RET%: P <0.001), but no statistically significant difference in IRF% (P =0.022). There were statistically significant differences in RET% and IRF% between the first and third parity group (RET%: P =0.008; IRF%: P =0.002), while no statistically significant difference was found in RET# (P =0.031). No statistically significant differences were observed between the second and the third parity group (RET#: P =0.891, RET%: P =0.825, IRF%: P =0.139). The proportions of neonatal patients with normal hemoglobin (HGB) levels (>144 g/L), mild anemia (120-144 g/L) and moderate anemia (90-120 g/L) were 72.66%, 25.90% and 1.44% in the first parity group; 51.90%, 35.44% and 12.66% in the second parity group; and 46.15%, 38.46% and 15.38% in the third parity group. Compared with the first parity group, the second and third parity group showed statistically significant differences (P =0.001, P =0.009). However, there was no statistically significant difference between the second and third parity group (P =0.594). The proportions of neonatal patients receiving phototherapy alone and phototherapy combined with IVIG treatment in the three groups were as follows: first parity group: 84.17% and 15.83%; second parity group: 63.29% and 36.71%; third parity group: 61.54% and 38.46%. Compared with the first parity group, the second and third parity group showed statistically significant differences (P <0.001, P =0.007), while no statistically significant difference was detected between the second and third parity group (P =0.873). Conclusion: When the maternal parity is ≥ 2, the titers of maternal IgG anti-A (B) antibody increase, and the neonates present with elevated positive rate of direct Coombs test and reticulocyte count, along with changes in the degree of anemia and clinical treatment strategies. Positive direct Coombs test and low 24-hour hemoglobin level are the risk factors for clinical administration of IVIG therapy.

The patient, a 10-year-old and 4-month-old boy, was admitted to the hospital "with a history of 19 days since tonsil surgery and 11 days of recurrent hematemesis". 19 days ago, bilateral endoscopic tonsil + adenoid plasma melting and bilateral tonsil fossa inferior pole suture were performed in the outer hospital, and recurrent hematemesis occurred 11 days ago, accompanied by transient fatigue and abdominal pain, diagnosis: ①Hematemesis to be investigated: postoperative tonsil bleeding? Upper gastrointestinal bleeding?②Acute moderate hemorrhagic anemia. On the first and third days of admission, the child had two sudden episodes of massive hematemesis, both of which were more than 1 000 mL, with pale lips, fatigue, and hemorrhagic shock. Bleeding was rapid and can terminate spontaneously, and emergency physical examination does not reveal a clear point of bleeding. Bilateral inferior pole sutures in the tonsillar fossa are in place. There were no obvious abnormalities in the emergency digestive endoscopy, no obvious bleeding points were detected in the tonsils and adenoids surgical area, and no obvious abnormalities were found in the neck CT angiography（CTA）. Emergency DSA-guided percutaneous selective external carotid artery intervention was performed, during which about 5 mm contrast agent overflowed at the origin of the facial artery, and a coil was implanted. The child had no active bleeding after the operation, and his life was as usual at 2 months of follow-up.
Humans ; Male ; Child ; Tonsillectomy/adverse effects* ; Postoperative Hemorrhage/therapy* ; Palatine Tonsil/surgery* ; Recurrence

Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

Protein arginine methyltransferase 5 (PRMT5) acts as an oncogene in liver cancer, yet its roles and in-depth molecular mechanisms within the liver cancer immune microenvironment remain mostly undefined. Here, we demonstrated that disruption of tumor-intrinsic PRMT5 enhances CD8⁺ T-cell-mediated antitumor immunity both in vivo and in vitro. Further experiments verified that this effect is achieved through downregulation of the inhibitory immune checkpoint molecule, fibrinogen-like protein 1 (FGL1). Mechanistically, PRMT5 catalyzed symmetric dimethylation of transcription factor 12 (TCF12) at arginine 554 (R554), prompting the binding of TCF12 to FGL1 promoter region, which transcriptionally activated FGL1 in tumor cells. Methylation deficiency at TCF12-R554 residue downregulated FGL1 expression, which promoted CD8⁺ T-cell-mediated antitumor immunity. Notably, combining the PRMT5 methyltransferase inhibitor GSK591 with PD-L1 blockade efficiently inhibited liver cancer growth and improved overall survival in mice. Collectively, our findings reveal the immunosuppressive role and mechanism of PRMT5 in liver cancer and highlight that targeting PRMT5 could boost checkpoint immunotherapy efficacy.