Based upon the underlying mechanism and pathological evidence of tissue injury of antibody-mediated rejection (AMR) , four etiological and symptomatic therapies were proposed for managing AMR, including etiological treatment of AMR including antibody-targeting, B cell or plasma cell-targeting therapies; strategies for preventing antibody-mediated endothelial damage: an inhibition of complement/antibody dependent cell-mediated pathways; anticoagulant & thrombolytic therapies for thrombotic microangiopathy secondary to endothelial damage ; anti-inflammatory therapies for acute/chronic vascular inflammation secondary to endothelial damage. Etiological treatment is essential for preventing and treating AMR while symptomatic measures, such as anticoagulant, thrombolytic and antiinflammatory therapies, are stressed. Finally the authors devised therapeutic strategies for AMR in 4 different patient groups of non-sensitized allograft recipients, sensitized allograft recipients, individuals with active AMR and those with chronic active AMR.

Pancreatic cancer is a common malignant tumor in the digestive tract, and the difficulty of early diagnosis and the lack of effective treatment means are the main reasons for the poor prognosis of pancreatic cancer. In recent years, multidisciplinary treatment (MDT) has become an important means to break through the bottleneck of diagnosis and treatment of pancreatic cancer and improve clinical prognosis. Besides providing patients with high-quality diagnosis and treatment services, this treatment model helps to improve the clinical diagnosis and treatment level of specialists and cultivate high-quality compound medical talents. It also highlights clinical research groups and high-quality case resource sharing, and promotes the clinical application of innovative drugs and new diagnostic and therapeutic technologies, which plays an essential role in increasing the core competence of hospitals. This paper reviews and summarizes the origin, status quo, and deficiencies of the MDT diagnosis and treatment model of pancreatic cancer in China, and examines the prospects for future development, with the aim to provide reference for domestic and foreign counterparts.

Objective:To establish and verify a diagnostic model for distinguishing multiple sclerosis (MS) from other neurological diseases with similar symptoms by usingcerebrospinal fluid oligoclonal band (CSF-OCB)combined with IgG intrathecal synthesis indicators and biochemical markers.Methods:Multiple sclerosis (MS) patients admitted to the Neurology Department of Beijing Tiantan Hospital affiliated with Capital Medical University from January 2014 to December 2022 were selected as the case group, while patients with similar neurological symptoms were selected as the control group. Using the case-control study design, a retrospective analysis was conducted on the detection of age, gender, oligoclonal bands in cerebrospinal fluid, IgG intrathecal synthesis indicators and biochemical indicators for all study subjects. The differential diagnosis model was determined by the multiple logistic regression analysis, and the receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficiency of the differential diagnosis model for neurological diseases with similar symptoms to MS and other conditions.Results:This study included 167 patients in the case group and 335 patients in the control group, of which 128 patients in the case group and 265 patients in the control group were used to construct the model, and 39 patients in the case group and 70 patients in the control group were used for model validation. The differential diagnostic model constructed by a multivariate logistic regression model was Y=0.871×CSF-OCB-0.051×CSFprotein-0.231×CSFchloride+1.183×gender-0.036×LDH+35.770. The model showed that the area under the curve, sensitivity and specificity were respectively 0.916, 87.3% and 87.6%. The Delong test results showed that the diagnostic efficacy of the model was significantly different from OCB, IgG intrathecal synthesis indicators, and OCB combined with IgG intrathecal synthesis indicators ( P<0.05). The new model validation showed that the actual diagnostic consistency rate for the MS group was 84.6%, while the actual diagnostic consistency rate for the control group was 90.0%. Conclusion:This study combines OCB, IgG intrathecal synthesis indicators, and biochemical indicators to establish a diagnostic prediction model for neurological diseases with similar clinical symptoms in MS. This model may have good differential diagnostic value and can better assist clinical diagnosis in the early stages of disease progression in MS patients.

Objective:To establish and verify a diagnostic model for distinguishing multiple sclerosis (MS) from other neurological diseases with similar symptoms by usingcerebrospinal fluid oligoclonal band (CSF-OCB)combined with IgG intrathecal synthesis indicators and biochemical markers.Methods:Multiple sclerosis (MS) patients admitted to the Neurology Department of Beijing Tiantan Hospital affiliated with Capital Medical University from January 2014 to December 2022 were selected as the case group, while patients with similar neurological symptoms were selected as the control group. Using the case-control study design, a retrospective analysis was conducted on the detection of age, gender, oligoclonal bands in cerebrospinal fluid, IgG intrathecal synthesis indicators and biochemical indicators for all study subjects. The differential diagnosis model was determined by the multiple logistic regression analysis, and the receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficiency of the differential diagnosis model for neurological diseases with similar symptoms to MS and other conditions.Results:This study included 167 patients in the case group and 335 patients in the control group, of which 128 patients in the case group and 265 patients in the control group were used to construct the model, and 39 patients in the case group and 70 patients in the control group were used for model validation. The differential diagnostic model constructed by a multivariate logistic regression model was Y=0.871×CSF-OCB-0.051×CSFprotein-0.231×CSFchloride+1.183×gender-0.036×LDH+35.770. The model showed that the area under the curve, sensitivity and specificity were respectively 0.916, 87.3% and 87.6%. The Delong test results showed that the diagnostic efficacy of the model was significantly different from OCB, IgG intrathecal synthesis indicators, and OCB combined with IgG intrathecal synthesis indicators ( P<0.05). The new model validation showed that the actual diagnostic consistency rate for the MS group was 84.6%, while the actual diagnostic consistency rate for the control group was 90.0%. Conclusion:This study combines OCB, IgG intrathecal synthesis indicators, and biochemical indicators to establish a diagnostic prediction model for neurological diseases with similar clinical symptoms in MS. This model may have good differential diagnostic value and can better assist clinical diagnosis in the early stages of disease progression in MS patients.

Objective To investigate the safety and efficacy of Remimazolam combined with nalbuphine in painless endoscopic mucosal resection(EMR)of colorectal polyps.Methods A total of 100 patients who undergo painless colorectal polyp EMR were randomly divided into nalbuphine combined with remimazolam(NR)and nalbuphine combined with propofol(NP),with 50 patients in each group.The mean arterial pressure,heart rate and oxygen saturation were recorded after entry(T0),1min after administration(T1),1min at the beginning of surgery(T2),3min(T3),5min(T4),and at the end of surgery(T5).The frequency of application of vasoactive drugs,their operation time,consciousness vanishing time,recovery time,the times of supplementary sedation,dosage of incidence of nalbuphine,adverse reactions,The satisfaction of doctors and patients were compared.Results The mean arterial pressure of T1,T2,T3,T4 and T5 in the NR group was higher than that in the NP group(P<0.05),and the heart rate of T1 in the NR group was higher than that in the NP group(P<0.05).The incidence of respiratory depression,hypotension,injection pain,the recovery time and the frequency of application of vasoactive drugs in the NR group was lower than that in the NP group(P<0.05).The satisfaction of doctors in the NR group was higher than that in the NP group(P<0.05).There was no significant difference between the two groups in the operation time,oxygen saturation,the times of supplementary sedation,the dosage of incidence of nalbuphineincidence of dizziness,nausea and vomiting,and other adverse reactions(P>0.05).Conclusion Nalbuphine combined with remimazolam can be used safely in the EMR,has few perioperative adverse effects,and is a good choice for painless EMR.

Pharmacoeconomic evaluation is the essential supporting information for the inclusion of rare disease drugs into medical insurance in China. The accurate measurement of the health state utility of rare diseas is of practical significance to the development of rare disease pharmacoeconomic evaluation. Based on the review of pharmacoeconomic evaluation requirements for rare diseases in some countries/regions, we systematically retrieved the published studies on the measurement of health state utility for 121 rare diseases in China and other countries and regions. We identified 17 591 papers in the initial review, and later selected 230 after screening. We also made a comprehensive analysis of the quality of literature, evaluation content and use of tools for measuring health state utility in rare diseases in China. Finally, we analyzed the challenges in measurement in terms of population, instruments use, and application of results and made recommendations based on analysis, hoping to provide reference for the development of rare disease health state utility measurement studies in China.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Objective To explore whether remote ischemic preconditioning(RIPC)can prolong the time of ultra-intense exercise(110%VO2max)by increasing the maximum cumulative oxygen deficit(MA-OD),and the specific ways of energy supply of the anaerobic metabolic system.Methods Twenty-four racquet athletes(22.2±2.0 years;174±9 cm;67.1±12.4 kg)completed three supramaximal intensi-ty tests on a treadmill at 110%VO2max intensity to exhaustion separated with Control,Placebo and RIPC interventions.RIPC was induced on the limbs on both sides(5×5 min alternating bilateral occlu-sion 220 and 60 mmHg for Placebo and RIPC interventions,respectively).Moreover,all groups under-went a fourth test with incremental load,and a fifth test with constant load at 40%,50%,60%,70%and 80%VO2max.Results The time to exhaustion and the MAOD of the RIPC group were both greater than those in the Placebo and Control groups(P<0.05).However,no significant differences were found in the average alternative maximal accumulated oxygen deficit(MAODALT),lactic anaerobic metabolism,alactic anaerobic metabolism and parameters of excess post-exercise oxygen consump-tion dynamic curve of the three groups(P>0.05).Meanwhile,in the RIPC group,the average MAOD was significantly higher than MAODALT(P<0.05).Pearson correlation analysis showed a significant rela-tionship between the improvement of MAOD and an increase in exhaustion time after RIPC interven-tion.Conclusion RIPC can improve supramaximal exercise performance of racquet athletes by enhanc-ing their MAOD,and the enhancement of glycolysis energy supply and lactic acid elimination is a po-tential intermediary of the improvement of sports performance.

Objective:To evaluate the accuracy and practicability of hepatocellular carcinoma prediction score (PAGE-B) and modified hepatocellular carcinoma prediction score (mPAGE-B) in predicting the development of hepatocellular carcinoma in patients with hepatitis B virus (HBV)-associated liver cirrhosis and received nucleos(t)ide analogue (NA) treatment.Methods:From June 2009 to December 2014, at Department of Hepatology, the First Affiliated Hospital of Fujian Medical University, the clinical data of 707 patients with HBV-associated liver cirrhosis and received NA treatment were retrospectively collected, and the patients were followed up. The risk factors of development of hepatocellular carcinoma were analyzed. PAGE-B (including platelet count, age, gender), mPAGE-B (including platelet count, age, gender and albumin), Child-Turcotte-Pugh (CTP) score and aspartate aminotransferase to platelet ratio index (APRI) were compared in area under receiver operator characteristic curve (AUROC) for predicting the occurrence of hepatocellular carcinoma within 5 years. Risk stratification analysis was carried out for mPAGE-B and PAGE-B. Multivariate Cox regression analysis, receiver operator characteristic curve, Mann-Whitney U test and Kaplan-Meier method were used for statistical analysis. Results:The age of 707 patients was (46.7±12.2) years old, including 567 males (80.2%) and 140 females (19.8%). The positive rate of hepatitis B e antigen was 56.4% (399/707). The scores of PAGE-B, mPAGE-B, CTP and APRI were 15.90±4.24, 12.39±3.58, 6.88±2.15 and 1.80 (0.85, 3.79), respectively. The overall follow up time was (38.14±20.97) months and the incidence of hepatocellular carcinoma was 8.1% (57/707). The results of multivariate Cox regression analysis showed that advanced age, low platelet count and quantitative reduction of HBV DNA were independent risk factors of development of hepatocellular carcinoma (Wald=20.44, 5.64 and 9.25; HR(95% confidence interval (95% CI) 1.056(1.031 to 1.081), 0.994(0.989 to 0.999) and 0.769(0.649 to 0.911); P<0.001, =0.018 and 0.002). The AUROCs (95% CI) of PAGE-B, mPAGE-B, CTP score and APRI for predicting the occurrence of hepatocellular carcinoma within 5 years were 0.708 (0.639 to 0.778), 0.724 (0.657 to 0.778), 0.576 (0.500 to 0.652) and 0.516 (0.443 to 0.589), respectively. There were no statistically significant differences in AUROCs for predicting the occurrence of hepatocellular carcinoma within 5 years between mPAGE-B and PAGE-B, between APRI and CTP score (both P>0.05). The AUROC for predicting the occurrence of hepatocellular carcinoma within 5 years of CTP score was less than those of PAGE-B and mPAGE-B, and the differences were statistically significant ( Z=3.00 and 3.79; P=0.003, <0.001). The AUROC for predicting the occurrence of hepatocellular carcinoma within 5 years of APRI was less than those of PAGE-B and mPAGE-B, and the differences were statistically significant ( Z=4.75 and 5.46, both P<0.001). There were 51 cases (7.2%), 394 cases (55.7%) and 262 cases (37.1%) in the low-risk (<10) group, medium-risk (10 to 17) group and high-risk (>17) group as assessed by PAGE-B. The incidence of hepatocellular carcinoma was 0(0/51), 4.8% (19/394) and 14.5% (38/262), respectively the annual average incidence of hepatocellular carcinoma was 0, 1.6% and 5.5%, respectively, the 5-year cumulative incidence of hepatocellular carcinoma was 0, 7.3% and 31.3%, respectively. The 5-year cumulative incidence of hepatocellular carcinoma of high-risk group was higher than those of medium-risk group and low-risk group (log-rank test=19.27, P<0.001). There were 97 cases (13.7%), 246 cases (34.8%) and 364 cases (51.5%) in the low-risk group (<9), medium-risk group (9 to 12) and high-risk group (>12) as assessed by mPAGE-B. The incidence of hepatocellular carcinoma was 2.1% (2/97), 3.7% (9/246) and 12.6%(46/364), the annual average incidence of hepatocellular carcinoma was 0.6%, 1.1% and 4.7%, respectively, the 5-year cumulative incidence of hepatocellular carcinoma was 2.4%, 5.1% and 26.7%, respectively. The 5-year cumulative incidence of hepatocellular carcinoma of high-risk group was higher than those of medium-risk group and low-risk group (log-rank test value=18.64, P<0.001). Conclusions:Both PAGE-B and mPAGE-B can predict the occurrence of hepatocellular carcinoma within 5 years in patients with HBV-associated liver cirrhosis treated with antiviral therapy, identify liver cirrhotic patients at high risk of development of hepatocellular carcinoma and guide clinicans to use more efficient screening strategies.