Objective To investigate the impact of intraoperative red blood cell (RBC) transfusion volume on the postoperative oxygenation index in lung transplant recipients. Methods This retrospective study analyzed the clinical data of patients who underwent lung transplantation at Wuxi People's Hospital Affiliated to Nanjing Medical University from 2021 to 2023. Patients were divided into a non-severe primary graft dysfunction (PGD) group and a severe PGD group based on whether their postoperative oxygenation index was>200 mm Hg at 0, 24, and 48 h. General patient data and intraoperative RBC transfusion volumes were compared between the two groups. A binary logistic regression model was constructed to explore the effect size (OR and its 95%CI) of RBC transfusion volume on postoperative oxygenation status at different time points (0, 24, and 48 h). The area under the receiver operating characteristic curve was calculated to evaluate the model's diagnostic performance. Results A total of 351 patients were included (260 males, 91 females), with ages ranging from 20 to 77 years. The OR for the effect of intraoperative RBC transfusion on poor oxygenation was 1.486 (95%CI 0.982 to 2.248, P=0.061) at 0 h postoperatively, 3.111 (95%CI 1.793 to 5.399, P<0.001) at 24 h, and 1.583 (95%CI 1.026 to 2.442, P=0.038) at 48 h. This indicated that as time progressed, the postoperative oxygenation status of lung transplant recipients was affected by the intraoperative transfusion volume. Furthermore, an RBC transfusion volume>975 mLhad a significant impact on patient oxygenation at 24 and 48 h postoperatively. Conclusion The volume of intraoperative RBC transfusion has a significant impact on the oxygenation status at 24 and 48 h postoperatively. Intraoperative RBC transfusion volume is associated with the occurrence of severe PGD after lung transplantation. Controlling the volume of RBC transfusion during lung transplantation may help reduce the incidence of severe PGD.

With the development of artificial intelligence， machine learning has shown great potential in the field of medical health. Machine learning conducts a comprehensive analysis of patient data including clinical features， blood tests， and imaging examinations and establishes corresponding mathematical models to achieve the diagnosis and treatment of diseases and the prediction of disease conditions， thereby guiding disease management. With reference to the latest research findings， this article reviews the application of machine learning in chronic hepatitis C and related research advances.

In 2025， Severe Liver Disease and Artificial Liver Group and Nutrition and Regeneration in End-Stage Liver Disease Group of Chinese Society of Hepatology， Chinese Medical Association， convened a panel of national experts to jointly develop China’s first guideline for the diagnosis and treatment of acute-on-chronic liver failure （ACLF）. Based on the latest research findings and clinical practice in China and globally， this guideline establishes a standardized definition of ACLF and provide recommendations for its diagnosis， treatment， and clinical management. This article gives an interpretation of the key points in the guideline， in order to provide a reference for standardized diagnosis and treatment of ACLF.

Juvenile idiopathic arthritis(JIA)is the most prevalent joint disease in childhood.The disease is defined as arthritis of unknown etiology,involving one or more joints,with onset before the age of 16 years and symptomatic duration of more than 6 weeks.Temporomandibular joint(TMJ)arthritis is a common manifestation of JIA,but it often develops insidiously.Failing to diag-nose and treat it promptly may lead to maxillofacial dysfunction and dentofacial deformity,and negatively affect the patient's quality of life.Therefore,early diagnosis and disease management of TMJ arthritis are crucial.This article reviews the occurrence of JIA-TMJ arthritis and its progress in clinical diagnosis and disease treatment in recent years,aiming to provide some reference for den-tists in the clinical diagnosis and treatment of JIA.

BACKGROUND:Previous studies have shown that paeoniflorin has an ameliorative effect on fibrosis in liver and kidney organs,especially in hepatic fibrosis.However,the protective effect of paeoniflorin on angiotensin Ⅱ-induced fibrosis in cardiac fibroblasts remains unclear.OBJECTIVE:To investigate the protective effects of paeoniflorin on angiotensin Ⅱ-induced extracellular matrix deposition in cardiac fibroblasts and molecular mechanisms.METHODS:Angiotensin Ⅱ(1 μmol/L)was added to primary isolated cultured SD rat mammary rat cardiac fibroblasts for 48 hours as the model group.The paeoniflorin low and high dose groups were pretreated with different doses of paeoniflorin(50 and 100 μmol/L)for 2 hours,and then treated with angiotensinⅡ for 48 hours.The SIRT1 inhibitor group was treated with SIRT1 inhibitor EX527 10 μmol/L for 2 hours,followed by paeoniflorin(100 μmol/L)for 2 hours,and then co-incubation with angiotensin Ⅱ for 48 hours.The cell viability was detected using the cell counting kit-8 method(CCK-8)assay.The cell migration ability was detected by Transwell.The level of intracellular reactive oxygen species was detected by DHA fluorescent probe.The level of oxidative stress markers was detected by relevant kits.Protein expression of fibrosis-related genes was detected by western blot assay.The mRNA expression levels of extracellular matrix and fibrosis-related genes were detected by qRT-PCR.RESULTS AND CONCLUSION:(1)Compared with the control group,the proliferation and migration of cardiac fibroblasts were significantly increased after angiotensin Ⅱ intervention;the intracellular content of reactive oxygen species and malondialdehyde content were elevated;the activities of superoxide dismutase and catalase were decreased,and the mRNA expression levels of α-smooth muscle actin,type Ⅰ collagen,type Ⅲ collagen,fibronectin,connective tissue growth factor,and matrix metalloproteinase 9 were increased.Compared with the model group,paeoniflorin could dose-dependently inhibit the above effect changes(P＜0.01).(2)Compared with the model group,paeoniflorin up-regulated the protein expression of SIRT1 in dose-dependent manner(P＜0.001).(3)Compared with the high-dose paeoniflorin group,the number of cell migration and the expression level of α-smooth muscle actin,type Ⅰ collagen,and typeⅢ collagen were significantly increased in the SIRT1-inhibitor group(P＜0.01).All the experimental results show that paeoniflorin effectively attenuates the angiotensin Ⅱ-induced changes in cardiac fibroblast fibrosis possibly through up-regulating the expression of SIRT1,dose-dependently inhibits cardiac fibroblast oxidative stress and extracellular matrix deposition,and has a protective effect on cardiac fibroblast fibrosis.

Hepatolenticular degeneration, also known as Wilson disease (WD), is a type of copper metabolism disorder caused by an ATP7B gene variant, which is manifested by the abnormal accumulation of copper in the liver and other organs, resulting in multisystem damage. This article summarizes the latest research progress, with an emphasis on clinical characteristics, analysis of the optimization of diagnostic technology, and the clinical application of novel copper chelator therapy, as well as the development status and future prospects of gene therapy for WD. Future research should focus on the in-depth analysis of the mechanism, the application of multidimensional precision diagnosis technology, the development of individualized treatment plans, and the development of multicenter clinical trials in order to improve the comprehensive treatment effects and quality of life for patients with WD.

Objective:To evaluate the outcomes of stroke treatment in neurology and rehabilitation departments using the International Classification of Functioning, Disability and Health′s Rehabilitation Set (ICF-RS).Method:The functional status of stroke survivors before and after treatment in the neurology and rehabilitation departments was evaluated using the ICF-RS (30 items). Each patient′s functioning was graded (normal, mild, moderate or severe dysfunction) by an experienced clinical evaluator and also by the intelligent evaluation model in the ICF-RS app. Medical expenditure data during hospitalization were extracted from the hospital′s case records. Rank sum tests compared the functional changes in a patient before and after their rehabilitation. Kappa coefficients were computed to evaluate the consistency of the functional grades assigned by the evaluators and the app.Results:Before the rehabilitation treatment, all 30 items of the ICF-RS were abnormal for all of the patients from the neurology and rehabilitation departments. After their rehabilitation treatment, 25 items had improved significantly for the neurology patients and 8 had improved significantly for those from the rehabilitation department. After their rehabilitation treatment, the average functional improvement among the neurology patients was 25%. For the rehabilitation patients it was 13%. The total expenditure for every 1% improvement in function was Y977 for the neurology patients (including Y143 for rehabilitation) and Y1, 481 for the rehabilitation patients (including Y862 of actual rehabilitation). The proportions of rehabilitation expenditure were thus 14% and 58% respectively. The kappa coefficients quantifying overall consistency were both greater than 0.8.Conclusion:The national standard ICF-RS can be used to evaluate functional changes, rehabilitation efficacy and the composition of stroke patients′ medical expenditures in the early stage of neurology and the recovery period in the rehabilitation department. The consistency of the functional level evaluations between the app and human evaluators is good.

Objective Electrocardiogram(ECG)signal quality degrades when the level of activity is high and motion artifacts are severe.Poor quality signals may result in false alarms,poor patient monitoring,imprecise measurement,and misleading diagnosis.The quantitative assessment of ECG signal quality forms the basis of automatic ECG noise reduction and heart disease diagnosis.Methods The ECG signal quality index(SQI)was obtained by statistically analyzing the heartbeat similarity and the slope character,respectively,namely rSQI and kSQI.Results Using MIT-BIH Noise Stress Test Database to test,both rSQI and kSQI decreased when the Signal Noise Ratio(SNR)decreased,which revealed the ECG signal quality.Based on the quasiperiodic property,the waveform similarity,as a beat-to-beat index,is obtained by cross correlation between two ECG cycles with high precision but heavy computation.Slope-based method dispenses with QRS detection and is very simple and real-time,but its sensitivity is lower than similarity-based method and it only get statistical data.Conclusion Both morphology similarity and slope character algorithms could provide objective estimation of ECG quality.Slope-based method is an attractive measure due to its simplicity and mathematical convenience,while similarity-based method is more accurate and robust for ECG quality assessment.

Objective To explore the role in sleep staging from blood volume pulse(BVP)and triaxial acceleration(ACC)of body movement obtained by wristband.Methods The BVP and ACC obtained by Empatica E4 wristband were used from all 100 cases of sleep disorder subjects in the DREAMT public database.Two frequency domain characteristics(eS,LF/HF)and one time domain characteristic(vA)of the BVP baseline and the activity counts(CS)of the ACC were used for sleep-awakening classification based on random forest.Results The results of sleep-awakening classification of all 100 cases of sleep disorder subjects were obtained by leaving-one-out strategy.The accuracy is 79.8%and the Kappa coefficient is 0.56 by 4 features from BVP and ACC;the accuracy is 70.4%and the Kappa coefficient is 0.36 by 3 features of BVP;the accuracy is 75.1%and the Kappa coefficient is 0.47 based on activity counts.Conclusion The BVP and ACC obtained by the wristband can be used for the rough estimation of sleep and awakening for sleep disorder subjects,among which the importance of ACC is higher than that of BVP.

In 2025,Severe Liver Disease and Artificial Liver Group and Nutrition and Regeneration in End-Stage Liver Disease Group of Chinese Society of Hepatology,Chinese Medical Association,convened a panel of national experts to jointly develop China's first guideline for the diagnosis and treatment of acute-on-chronic liver failure(ACLF).Based on the latest research findings and clinical practice in China and globally,this guideline establishes a standardized definition of ACLF and provide recommendations for its diagnosis,treatment,and clinical management.This article gives an interpretation of the key points in the guideline,in order to provide a reference for standardized diagnosis and treatment of ACLF.