As a critical measure for treating patients with end-stage organ failure, organ donation and transplantation has become an important benchmark reflecting a country’s comprehensive capacity in healthcare, modernization of governance and progress in social civilization. In 2024, the total number of organ transplant procedures worldwide exceeded 180 000, representing an annual growth rate of 2.4%. China ranked second globally with 24 000 transplant procedures, accounting for 13.8% of the global total. Meanwhile, driven by the growing burden of transplantation-related non-communicable diseases, the global demand for organ transplantation has reached an all-time high. At present, the global development of organ donation and transplantation features a landscape of coexisting strategic opportunities and risks and challenges. On the one hand, technological breakthroughs and institutional innovations have accelerated the rapid development of the field. On the other hand, issues such as uneven regional development, supply-demand imbalance, and lagging governance remain to be addressed. This study integrates multi-dimensional authoritative monitoring data, systematically summarizes twelve key characteristics of the global organ donation and transplantation sector, distills ten major developmental features and regional leading effects of China at the current stage, and elaborates on the practical connotation and contemporary value of the “Chinese Model”. The findings not only provide important references for countries to promote the sustainable development of the industry, narrow regional development gaps, and improve the equitable access to medical resources, but also offer comprehensive research support and scientific decision-making basis for China to consolidate its developmental advantages, refine Chinese solutions, and deeply participate in the construction of the global organ donation and transplantation governance system.

Currently, driven by rigid health demands, technological iteration and innovation, and the reshaping of the global development landscape, the global field of organ donation and transplantation presents a development trend featuring "continuous expansion of transplantation scale, diversified donor sources, multiple breakthroughs in core technologies, and sustained optimization of supporting policies". Meanwhile, it still faces profound challenges including prominent contradiction between supply and demand, unbalanced regional development, increasing governance difficulties, and lack of dynamic adaptation of ethical norms. Under the continuous initiative and promotion of the United Nations, the World Health Organization and relevant international academic groups, organ donation and transplantation have become an important issue for promoting the harmonious development of human society and improving global public health governance. At the present stage, the reshaping of the global development pattern and the impact of uncertainties in the international situation cannot be ignored, which not only brings challenges to transnational cooperation in the field of organ donation and transplantation, but also forces all countries to accelerate the construction of an independent, controllable, safe and efficient working system. Based on the development characteristics revealed by data insights, this paper further sorts out the innovative practical progress, policy evolution context and latest orientations of countries around the world in solving the development dilemmas of organ donation and transplantation in recent years, analyzes the core challenges and prospectively judges future policy trends. It not only provides experience reference for countries to carry out industrial governance, but also consolidates the decision-making foundation for China to build an independent knowledge system and a discourse system with Chinese characteristics, and deeply participate in the construction of the global governance system.

Objective:To compare the efficacy of the detection kit based on MicroDrop microdroplet digital PCR platform that can identify mycoplasma pneumonia and common drug-resistance mutation,and throughout targeted next-generation sequencing(tNGS)in detecting common drug-resistance mutations of mycoplasma pneumonia.Methods:A total of 300 samples of clinical respiratory tract of pneumonia inpatients at Guangdong Provincial People's Hospital between 2023 and 2024 were collected.Both the detection kit for drug-resistance mutation of mycoplasma pneumoniae and the tNGS method were employed to detect drug-resistance mutation genes.For samples with inconsistent results,Sanger sequencing was used for verification.Results:For the 300 samples,the detection rates of positive mycoplasma pneumonia of the detection kit for drug-resistance mutation of mycoplasma pneumoniae and the tNGS method were respectively 87.00%and 78.67%,with a Kappa value of 0.711,indicating a relatively high level of agreement between the two methods.Among 25 samples with inconsistent results,Sanger sequencing was employed for validation.The results revealed that for samples with low-frequency gene mutations,the reagent kit maintained reliable detection capability,whereas tNGS exhibited missed detections.Thus,the reagent kit demonstrates superior performance in detecting low-frequency mutation samples.Conclusion:The detection rate of low-frequency mutation samples by the digital PCR-based mycoplasma pneumoniae drug-resistance mutation detection kit is higher than that of the tNGS method.This approach helps enhance the accuracy of detection results,providing a rapid and precise means of detecting drug-resistance genes for clinical diagnosis and treatment.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To compare the efficacy of the detection kit based on MicroDrop microdroplet digital PCR platform that can identify mycoplasma pneumonia and common drug-resistance mutation,and throughout targeted next-generation sequencing(tNGS)in detecting common drug-resistance mutations of mycoplasma pneumonia.Methods:A total of 300 samples of clinical respiratory tract of pneumonia inpatients at Guangdong Provincial People's Hospital between 2023 and 2024 were collected.Both the detection kit for drug-resistance mutation of mycoplasma pneumoniae and the tNGS method were employed to detect drug-resistance mutation genes.For samples with inconsistent results,Sanger sequencing was used for verification.Results:For the 300 samples,the detection rates of positive mycoplasma pneumonia of the detection kit for drug-resistance mutation of mycoplasma pneumoniae and the tNGS method were respectively 87.00%and 78.67%,with a Kappa value of 0.711,indicating a relatively high level of agreement between the two methods.Among 25 samples with inconsistent results,Sanger sequencing was employed for validation.The results revealed that for samples with low-frequency gene mutations,the reagent kit maintained reliable detection capability,whereas tNGS exhibited missed detections.Thus,the reagent kit demonstrates superior performance in detecting low-frequency mutation samples.Conclusion:The detection rate of low-frequency mutation samples by the digital PCR-based mycoplasma pneumoniae drug-resistance mutation detection kit is higher than that of the tNGS method.This approach helps enhance the accuracy of detection results,providing a rapid and precise means of detecting drug-resistance genes for clinical diagnosis and treatment.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Chemoresistance to 5-fluorouracil (5-FU) is a significant challenge in treating colorectal cancer (CRC). Novel combined regimens to thwart chemoresistance are therefore urgently needed. Herein, we demonstrated that the combination of Avenanthramide A (AVN A) and 5-FU has significant therapeutic advantages against CRC. Mechanistically, AVN A directly binds to the S198 site of the histone lysine demethylase KDM4C to promote its degradation, which subsequently fosters H3K9me3 occupancy on the MIR17HG promoter to block its transcription and derepress Bim expression. AVN A enhanced the therapeutic efficacy of 5-FU via impairing the KDM4C/MIR17HG/GSK-3β negative feedback loop. Importantly, the clinical correlation of the KDM4C/MIR17HG/Bim signaling axis with 5-FU response was validated in the refractory CRC patients. We provide evidence for the enhanced effectiveness of 5-FU when combined with AVN A in chemoresistant xenografts, CRC organoids, and Apc ^Min/+ mouse model. Additionally, AVN A mitigated the systemic adverse effects of 5-FU. Overall, our findings demonstrate that combinatorial therapy with AVN A and 5-FU represents an appealing opportunity and highlights KDM4C/MIR17HG/GSK-3β negative feedback loop which confers therapeutically exploitable vulnerability to chemo-refractory CRC patients.

Objective:This study aims to establish an early warning diagnosis model for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and to provide a simple, rapid, and accurate auxiliary diagnosis basis for clinical practice.Methods:The sample bank of subjects (patients admitted to the Eighth Medical Center of the PLA General Hospital from September 10, 2021, to July 25, 2023) was constructed, including the model establishment cohort [SCOPD group 49, 42 males and 7 females, (69.71±11.16) years old; AECOPD group 53, 49 males and 4 females, (72.60±10.19) years old] and the model validation cohort [SCOPD group 35, 28 males and 7 females, (69.97±10.40) years old; AECOPD group 35, 33 males and 2 females, (71.43±9.67) years old]. Fasting peripheral blood samples were collected, and the expression levels of IL-5, IL-17A, and IFN-α were detected by flow cytometry. Different expression levels were analyzed by Mann-Whitney U test. Binary logistic regression analysis was used to screen the related risk factors of COPD patients in acute exacerbation. The diagnostic efficacy of the model was evaluated by the receiver operating characteristic (ROC) curve.Results:The levels of IL-5 [1.64 (0.60, 2.86) pg/ml], IL-17A [1.42 (0.88, 2.29) pg/ml], and IFN-α [0.91 (0.59, 1.81) pg/ml] in the SCOPD group were significantly decreased compared with the AECOPD group IL-5 [4.68 (2.34, 9.40) pg/ml, Z=-5.033, P<0.001], IL-17A [2.33 (1.59, 4.62) pg/ml, Z=-3.919, P<0.001], IFN-α [2.83 (0.91, 3.75) pg/ml, Z=-4.127, P<0.01] in the cohort of model establishment. The results of binary logistic regression analysis between SCOPD and AECOPD groups showed that IL-5, IL-17A, and IFN-α were independent risk factors for acute exacerbation of patients with COPD ( P<0.05). And the regression equation is Y=-2.861+0.364×IL-5+0.385×IL-17A+0.445×IFN-α. The AUC value of IL-5, IL-17A, IFN-α and combined detection was 0.866 ( P<0.001). Compared to the SCOPD group and the AECOPD group in the cohort of model validation, the receiver operating characteristic (ROC) curve showed that the combined model of three (AUC=0.858, P<0.001) could be used to diagnose the AECOPD. And the Kappa value was 0.773( P<0.05). Conclusion:The combined detection of IL-5, IL-17A, and IFN-α has high diagnostic efficacy for patients with acute exacerbation of COPD. This method provides a new potential tool for the clinical diagnosis of AECOPD and has the value of further exploration and optimization, promotion, and application.

Purpose: Whether a dilated intrahepatic bile duct (IHBD) has any effect on the prognosis of choledochal cyst (CC) remains controversial. We aimed to summarize the clinical characteristics and prognosis of CC with IHBD dilatation. Methods: One hundred ninety-two children diagnosed with CC were identified, including 127 without IHBD dilatation (group A) and 65 with IHBD dilatation (group B). A retrospective analysis was performed to explore the clinical characteristics and prognosis of CC with IHBD dilatation based on clinical indices, symptoms, and complications. Results: Compared with group A, incidences of jaundice and fever were higher in group B (P = 0.010 and P = 0.033). Preoperative total bilirubin, direct bilirubin, and indirect bilirubin were increased in group B compared to group A (P = 0.005, P < 0.001, and P = 0.014), as were preoperative ALT, AST, γ-GT, and total bile acid (P = 0.006, P = 0.025, P < 0.001, and P = 0.024). The risk of liver fibrosis or cirrhosis was significantly increased for group B compared with group A (P = 0.012) and also occurred earlier in group B (P = 0.006). In the dilated IHBDs, 95.4% (62 of 65) recovered to normal, and more than half of dilated IHBDs (37 of 65) recovered to normal in 1 week. Conclusion Most IHBDs can recover to normal postoperatively in a short time, and proactive treatment is recommended for CC patients with IHBD dilatation for significant abnormal liver functions.

Hypersplenism is a common complication caused by liver cirrhosis and portal hypertension, and at present, splenectomy and partial splenic artery embolization (PSE) are the main methods for the treatment of hypersplenism. Splenectomy has a marked effect in the treatment of hypersplenism and can significantly improve the clinical symptoms of patients with hypersplenism. Compared with splenectomy, PSE causes partial splenic parenchymal infarction and thus achieve similar clinical efficacy as partial splenectomy while preserving the spleen and its function. Although PSE is an effective method for the treatment of hypersplenism, there are few reports on the effect of PSE on liver fibrosis, immunity, and liver regeneration in China and globally. This article summarizes the common causes of hypersplenism, the mechanism of PSE in the treatment of hypersplenism, the therapeutic effect of different embolization methods and materials, and the effect of PSE on liver fibrosis, immunity, and liver regeneration, so as to provide a theoretical basis and new ideas for the clinical treatment of hypersplenism.