Objective: To investigate the status of heat illness, knowledge awareness and adaptive behaviors of heat wave knowledge among food delivery riders, so as to provide a basis for optimizing heat wave response measures for food delivery riders. Methods: In November 2022, food delivery riders from a large food delivery platform in Ningbo City, Zhejiang Province were selected as survey subjects using a cluster sampling method. A self-designed electronic questionnaire was used to select demographic information, work status, lifestyle behaviors and disease history, heat illness status, knowledge awareness and adaptive behaviors of heatwave. Results: A total of 911 questionnaires were distributed, and 830 valid questionnaires were recovered, resulting in a valid response rate of 91.11%. Among the respondents, 796 (95.90%) were male, and 818 (98.55%) worked full-time. The mean age was (27.75±8.00) years. A total of 470 respondents (56.63%) had a work tenure of less than 1 year. The primary working hours were 8-<12 hours, with 504 people accounting for 60.72%. There were 108 cases of heatstroke, with an occurrence rate of 13.01%. And 286 people reported heat-related symptoms, with an occurrence rate of 34.46%. The overall awareness rate of heat wave knowledge was 73.22%, while the awareness rate of heat warning signal classification was relatively low at 9.04%. The heat wave cognition score was (5.86±1.31) points. There were statistically significant differences in heat wave cognition scores among food delivery riders of different ages, educational levels, family annual income, work tenures, and work durations (all P<0.05). Regarding positive adaptive behaviors, the number of riders paying attention to weather forecasts and actively learning about preventive measures was higher (734 people each, accounting for 88.43%). Regarding negative adaptive behaviors, the number of riders who often drank ice-cold beverages was higher (509 people, accounting for 61.33%). The heat wave adaptive behavior score was (6.88±1.77) points. There were statistically significant differences in adaptive behavior scores among riders with different educational levels, family annual income, work tenures, and smoking frequency (all P<0.05). Conclusions The occurrence rates of heatstroke and heat-related symptoms among food delivery riders are relatively high. The knowledge awareness and adaptive behaviors regarding heat wave are at a moderate level. It is suggested to strengthen health education, reinforce risk cognition of heat wave, and promote positive adaptive behaviors among food delivery riders.

Objective: Blood safety surveillance is a critical measure for the objective assessment of blood quality and enhancing transfusion safety. This study aims to comprehensively understand the current status of blood safety surveillance and management in blood collection and supply institutions in Sichuan Province, systematically analyze existing problems and vulnerabilities, and provide a basis for optimizing management strategies and improving capabilities to ensure blood safety. Methods: The Blood Safety Surveillance questionnaire was designed, covering adverse donor reaction reporting, management of adverse events, and transfusion adverse reaction feedback. An online survey was conducted via Questionnaire Star platform among 21 blood collection and supply institutions in the province, gathering information on management systems, process implementation, and utilization of monitoring data. The collected data were organized and statistically analyzed using Excel. Results: The questionnaire response rate and validity rate were both 100%. Blood collection and supply institutions in Sichuan Province have generally established a blood safety surveillance system and achieved positive outcomes. Regarding adverse events in blood collection and supply, 95.24% (20 institutions) have established reporting procedures, and 66.67% (14) collect information through multiple channels such as internal reports, external reports, and statistical trend feedback. A total of 90.48% (19) institutions regularly summarize and analyze adverse event data, and 85.71% (18) produce reports with improvement recommendations based on this analysis.71.43% (15) institutions implement reward and penalty measures, and 71.43% (15) report underreporting or omission due to accountability or performance concerns. In terms of monitoring adverse blood donation reactions, all blood collection and supply institutions have established full-process management systems.76.19% (16) collect data through multiple approaches, including on-site donation records, voluntary donor reports, and donor follow-ups. Adverse reactions were followed up in 95.24% (20) of institutions with 65% (13) completing follow-ups within 24 hours.80.95% (17) have established investigation procedures, while 66.67% (14) believe underreporting or omission still occurs. All blood collection and supply institutions regularly compile statistics on adverse donation reactions. Of these, 85.71% (18) institutions providing feedback to management departments and 90.48% (19) analyzing the data and making recommendations.76.19% (16) institutions use monitoring data for return donor management and targeted care, and 71.43% (15 stations) incorporate it into management reviews. Regarding adverse transfusion reactions, 95.24% (20) institutions have established and implemented procedures for isolating, recalling, and tracing of problematic blood units. However, only 42.86% (9) have established feedback mechanisms of adverse transfusion reaction with hospitals, and only 19.05% (4) support direct reporting via information systems.47.62% (10) institutions regularly analyze adverse transfusion reaction data, and 19.05% (4) provide feedback and recommendations to relevant hospitals. All blood collection and supply institutions reported challenges in collecting hospital feedback, citing complexities in data collection and reporting processes. Conclusion: Blood safety surveillance systems have been preliminarily established in Sichuan Province. However, further strengthening is still required, including conducting in-depth data analysis and utilization, standardizing the configuration of emergency medications and equipment, and improving feedback mechanisms for adverse transfusion reactions. To improve the overall level of blood safety management, it is recommended to strengthen closed-loop data management, improve feedback mechanisms between blood collection and supply institutions and hospitals, foster a non-punitive reporting culture, and systematically advance the regionalization and standardization of the monitoring system. These efforts will contribute to sustainably improving the overall effectiveness and sustainability of blood safety management.

Gastric cancer remains a highly prevalent malignancy worldwide, with surgical resection currently constituting the cornerstone of treatment aimed at improving long-term patient survival. Owing to their notable advantages, including reduced surgical trauma and accelerated postoperative recovery, minimally invasive procedures are progressively supplanting conventional open surgery and have become the mainstream approach in gastric cancer management. Concurrently, the rapid advancement of artificial intelligence (AI) technologies has enabled real-time intraoperative monitoring of surgical scenes, thereby furnishing novel technical support for adjunctive decision-making, surgical navigation, and skill assessment during gastrectomy. This article provides a systematic review of the current status of AI applications in minimally invasive gastric cancer surgery, with a particular focus on research progress pertaining to instrument recognition, surgical phase identification, delineation of normal anatomical structures, detection of metastatic foci, and early warning of intraoperative adverse events. Furthermore, we discuss the potential value of AI in enhancing surgical efficiency, ensuring patient safety, and optimizing surgical education. On this basis, we further analyze the principal challenges and inherent risks confronting current AI systems, with the aim of informing future technological innovation and facilitating clinical translation.

On June 27， 2026， the Asian Pacific Association for the Study of the Liver （APASL） released updated management guidelines for chronic HBV infection， which systematically elaborates on screening， vaccination， antiviral treatment， and hepatocellular carcinoma surveillance and other aspects in 13 key areas， and provides comprehensive recommendations. This article summarizes and makes an excerpt of the key recommendations from the updated guidelines.

ObjectiveTo identify key ligand-receptor axes that may improve immunotherapeutic strategies for hepatocellular carcinoma with portal vein tumor thrombus （PVTT）. MethodsSingle-cell RNA sequencing （scRNA-seq） data from normal tissues （Norm） and PVTT cells were downloaded from the gene expression omnibus （GEO） database， integrated， and annotated. CellChat was used to infer intercellular communication and compare pathway activities to screen significantly differential candidate ligand-receptor axes. Multiplex immunofluorescence （mIF） was then performed to evaluate the spatial distribution of signals related to candidate axes at the tissue level. The expression of key ligands and receptors was validated by qPCR and flow cytometry in peripheral blood-derived CD8⁺ T cells and the human hepatic stellate cell line LX-2. Functional effects were further assessed in vitro using recombinant proteins and antagonists or neutralizing blockers. ResultsThe analysis revealed strong bidirectional communication between CD8⁺ T cells and activated hepatic stellate cells （aHSCs） in PVTT. The SPP1-CD44 axis was the most prominent in the direction from CD8⁺ T cells to aHSCs， whereas the MIF-（CD74+ CD44） axis was strongly supported in the opposite direction. These axes were consistently supported by bioinformatic screening， tissue spatial analysis， and cellular or functional validation. ConclusionThe SPP1-CD44 and the MIF-（CD74+ CD44） axes may collectively shape the immunosuppressive tumor microenvironment （ITME） of PVTT through stromal activation and T-cell functional reprogramming， suggesting potential targets for improving immunotherapeutic responsiveness in patients with PVTT.

Objective:To investigate the efficacy and safety of endovascular treatment (EVT) in young patients with symptomatic intracranial atherosclerotic stenosis (sICAS).Methods:Young patients with sICAS admitted to the Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University, Medical School from January 2020 to July 2024 were included retrospectively. According to the therapeutic modalities, they were divided into a best medical treatment (BMT) group and an EVT group. The efficacy outcome was any stroke recurrence or death within 30 days and 1 year. The safety outcome was symptomatic intracranial hemorrhage (sICH) within 30 days and restenosis within 1 year.Results:A total of 113 patients were enrolled, including 85 males (75.2%), with a median age of 43 (interquartile range, 37-48) years; 44 patients (38.9%) received EVT, and 69 (61.1%) received BMT. Among the 44 patients who underwent EVT, 8 (18.2%) underwent balloon angioplasty and 36 (81.8%) underwent stenting. There was no significant difference in the incidence of stroke recurrence or death within 30 days (2.9% vs. 2.3%) and sICH incidence (0% vs. 2.3%) between the BMT group and the EVT group. However, the 1-year stroke recurrence or death rate in the EVT group was significantly lower than that in the BMT group (18.8% vs. 4.5%; P=0.029). Cox proportional hazards regression analysis showed that EVT was independently associated with a lower incidence of stroke recurrence or death within 1 year (hazard ratio 0.225, 95% confidence interval 0.051-0.996; P<0.05). The median age of the balloon angioplasty group was significantly lower than that of the stenting group (33.5 years vs. 46 years; P=0.007), while there were no significant differences in other demographic and baseline data. There was no significant difference in all efficacy and safety outcome between the balloon angioplasty group and the stenting group. Conclusions:For young patients with sICAS who have an unsatisfactory response to drug treatment, EVT can reduce the risk of stroke recurrence or death within 1 year without increasing the risk of sICH. The safety and efficacy of balloon angioplasty and stenting are similar.

Objective:To estimate the economic burden of 14 chronic diseases among middle-aged and elderly people in China.Methods:This cross-sectional study was based on longitudinal data from five waves (2011 to 2020) of the China Health and Retirement Longitudinal Study (CHARLS). Participants aged 45 and over who had been diagnosed with exactly one target chronic disease were included in the study. The 14 chronic diseases included: hypertension, dyslipidemia, diabetes or elevated blood glucose, malignant tumors, chronic pulmonary diseases, liver diseases, heart diseases, stroke, kidney diseases, digestive system diseases, emotional and mental diseases, memory-related diseases, arthritis or rheumatic diseases, and asthma. The economic burden of disease was measured in terms of both direct and indirect economic burden, with the results adjusted using a healthcare-specific Consumer Price Index (CPI). The direct economic burden included direct medical and non-medical burden. The human capital method was employed to calculate the indirect economic burden. A generalized linear mixed model (GLMM) was conducted to compare the differences in the economic burden between urban and rural areas, with provinces and prefecture-level cities set as random effects and residence (urban or rural areas) as fixed effects to control for the effects of geographic hierarchical structure. Gender, age and educational attainment were also included as covariates to control for confounding factors. The model′s robustness was assessed by comparing the significance of urban-rural differences before and after adding the covariates.Results:The median annual economic burden of the 14 chronic diseases among the middle-aged and elderly population in China ranged from 7 565 to 17 174 CNY, of which the direct economic burden ranged from 6 909 to 16 565 CNY, and the indirect burden ranged from 284 to 1 276 CNY. The direct economic burden was primarily driven by direct medical burden (83.67% to 95.01% of direct economic burden). Out-of-pocket expenses for outpatient medical burden ranged from 50% to 100%, while those for inpatient ranged from 36.30% to 61.29%. GLMM analysis revealed no statistically significant difference in the overall economic burden between urban and rural areas across diseases. However, the burden of inpatient medical burden for arthritis or rheumatism was higher in urban areas than in rural areas (5 338 vs. 3 898 CNY; LR=6.04, P=0.014). Similarly, the burden of self-treatment for hypertension was also higher in urban areas than in rural areas (324 vs. 238 CNY; LR=8.30, P=0.004). The outpatient non-medical burden for diabetes or elevated blood glucose (59 vs. 149 CNY; LR=5.99, P=0.014), stroke (0 vs. 307 CNY; LR=4.55, P=0.033), and digestive system diseases (45 vs. 107 CNY; LR=9.58, P=0.002) was lower in urban areas than rural. Conclusions:Chronic diseases cause heavy economic burden on middle-aged and elderly people in both urban and rural areas of China, with direct economic burden accounting for the majority of expenditure. The outpatient medical burden accounts for a higher proportion of out-of-pocket expenses than the inpatient.

Objective To optimize the processing technology of Curculigo orchioides Gaertn.Methods On the basis of single factor experiment,the ratio of material to liquid,frying temperature and frying time were taken as the influencing factors,and the comprehensive scores of appearance traits,curculigoside,orcinol glucoside and orcinol gentiobioside were taken as the evaluation indexes.The optimal processing technology was optimized by Box-Behnken response surface method combined with analytic hierarchy process,and the process verification was carried out.Results The optimal process was as follows:the raw C.orchioides pieces were mixed with the same amount of Evodia rutaecarpa juice,placed in a closed container,moistened until the juice was completely absorbed,stir-fried at 130 ℃ for 6 min,taken out and dried at 60 ℃.For each 100 kg of Curculigo,10 kg of Evodia rutaecarpa was used.Evodia rutaecarpa juice preparation method:10 kg of Evodia rutaecarpa was soaked in 12 times the amount of water for 60 min,decocted for 50 min,extracted for 3 times,combined with the filtrate,and concentrated to 100 kg to obtain Evodia rutaecarpa juice.Conclusion The optimal processing technology of Curculigo orchioides Gaertn.is stable and feasible.

Objective:To understand the current status and influencing factors for science and technology ethics awareness among medical postgraduates, explore scientific cultivation path, and provide empirical evidence for higher medical colleges to carry out science and technology ethics education.Methods:The study adopted a cluster sampling method and designed a questionnaire. A total of 2 095 medical postgraduates from Hebei Medical University participated in the survey from June to December 2023. SPSS 24.0 was used for non-parametric tests, and the ordered logistic regression analysis was used to explore the influencing factors.Results:A total of 1 992 valid questionnaires were collected, with a valid response rate of 95.08% (1 922/2 095). The qualified rate of science and technology ethics awareness among medical postgraduates was 90.76% (1 808/1 992), with 48.24% (961/1 992) of students falling into the good interval and 16.21% (323/1 992) falling into the excellent interval. The regression analysis showed that sex, academic category, students' attention to science and technology ethical issues, and understanding of ethical principles were significant influencing factors for medical postgraduates' science and technology ethics awareness ( P<0.05). Conclusions:The science and technology ethics awareness of medical postgraduates is at a medium level. Higher medical colleges should start from the needs and adhere to the direction of lifelong education to build a multi-subject, all-round, and all-process cultivation path. They can help students cultivate ethical awareness by improving the educational system, building a scientific teaching system, and creating a social education atmosphere. They can also help students internalize ethical norms and externalize them in their behaviors, and ensure that they can maintain ethical sensitivity in scientific and technological activities, thereby cultivating high-quality new medical and health professionals who can anticipate scientific and technological risks and assume ethical responsibilities.

Objective To explore time-related changes in renal function,renal injury biomarkers,and renal pathology in rats entering a low-pressure and low-oxygen(LPLO)environment simulating moving from the plains to a plateau.Methods Thirty male Sprague-Dawley rats were divided randomly into five groups(n=6 rats per group).Rats in the Control group were placed outside the chamber under normal pressure and oxygen conditions.Rats in the experimental groups were placed in an LPLO chamber to simulate a plateau environment at 5000 m above sea level,and were maintained in the chamber for 3,7,14,and 28 days,respectively.Serum levels of creatinine(CRE),cystatin C(CysC),neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule-1(KIM-1),and interleukin-18(IL-18)were measured as biomarkers of renal injury.Pathological changes in the kidney were observed by hematoxylin and eosin and periodic acid-Schiff staining,with quantitative assessment of the following parameters:average glomerular diameter,peritubular capillary(PTC)density per tubule,tubular injury score,and outer medulla(OM)congestion score.Results NGAL,KIM-1,CysC,and CRE were significantly increased in the experimental compared with the Control group(all P＜0.05).The average glomerulus diameter was significantly reduced in the LPLO 3 d group and significantly increased in the LPLO 14 d group(both P＜0.05).The peritubular capillary(PTC)/tubule ratio was significantly decreased.The renal tubular injury and OM congestion scores were significantly increased(both P＜0.05).Regression analysis showed that PTC/tubule was linearly negatively correlated with the LPLO duration,while CRE,CysC,and pathological indicators(mean glomerular diameter,OM congestion score,renal tubular injury score)were curvilinearly correlated with the duration of LPLO(all P＜0.05).Variables with a curvilinear correlation were analyzed using restricted cubic splines(RCS).Each curve exhibited an inverted-L shape,with inflection points on day 7,indicating that the rate of increase of all indicators was highest within the first 7 days of LPLO,and the rate of increase then slowed from 7 days to 28 days.Conclusions A simulated move from a plains to a plateau environment was associated with significant structural and functional renal damage,but the kidneys then showed a self-adaptive adjustment process towards the plateau environment.