Non-alcoholic fatty liver disease （NAFLD） is one of the most prevalent forms of liver diseases globally. Its progression can lead to cirrhosis and end-stage liver disease， and there is currently a lack of effective pharmacological treatments. Adenosine monophosphate-activated protein kinase （AMPK）， as a regulatory hub for maintaining cellular energy homeostasis， can coordinate key cellular processes such as adipogenesis， glucose metabolism， and mitochondrial functions. Its activation exerts metabolic regulatory effects through pathways including inhibiting lipogenesis， enhancing mitochondrial β-oxidation， regulating inflammation and oxidative stress， and promoting autophagy. Accordingly， AMPK emerges as a potential target for the prevention and treatment of NAFLD. Traditional Chinese Medicine （TCM）， with low toxicity， high accessibility， and multi-component， multi-target synergistic effects， has demonstrated unique value in NAFLD treatment， particularly showing notable advantages in regulating the AMPK signaling pathway. Sichuan is known as the treasure house of TCM， and the active components of its authentic medicinal materials such as Coptidis Rhizoma not only reflect regional characteristics in AMPK signaling regulation but also form a multi-level metabolic regulatory network through crosstalk with pathways such as sirtuin 1 （SIRT1） and peroxisome proliferator-activated receptor α （PPARα）. They can achieve specific regulation by directly activating AMPK and modulating upstream and downstream targets， exerting prominent effects in ameliorating hepatic steatosis and inflammation. This study systematically reviews the research findings on TCM for the prevention and treatment of NAFLD over the past five years， elaborating the mechanisms by which TCM treats NAFLD through regulating the AMPK signaling pathway. It aims to provide new perspectives and references for clinical diagnosis and treatment， basic research， and drug development.

Tumor drug resistance is an important problem in the failure of chemotherapy and targeted drug therapy, which is a complex process involving chromatin remodeling. SWI/SNF is one of the most studied ATP-dependent chromatin remodeling complexes in tumorigenesis, which plays an important role in the coordination of chromatin structural stability, gene expression, and post-translation modification. However, its mechanism in tumor drug resistance has not been systematically combed. SWI/SNF can be divided into 3 types according to its subunit composition: BAF, PBAF, and ncBAF. These 3 subtypes all contain two mutually exclusive ATPase catalytic subunits (SMARCA2 or SMARCA4), core subunits (SMARCC1 and SMARCD1), and regulatory subunits (ARID1A, PBRM1, and ACTB, etc.), which can control gene expression by regulating chromatin structure. The change of SWI/SNF complex subunits is one of the important factors of tumor drug resistance and progress. SMARCA4 and ARID1A are the most widely studied subunits in tumor drug resistance. Low expression of SMARCA4 can lead to the deletion of the transcription inhibitor of the BCL2L1 gene in mantle cell lymphoma, which will result in transcription up-regulation and significant resistance to the combination therapy of ibrutinib and venetoclax. Low expression of SMARCA4 and high expression of SMARCA2 can activate the FGFR1-pERK1/2 signaling pathway in ovarian high-grade serous carcinoma cells, which induces the overexpression of anti-apoptosis gene BCL2 and results in carboplatin resistance. SMARCA4 deletion can up-regulate epithelial-mesenchymal transition (EMT) by activating YAP1 gene expression in triple-negative breast cancer. It can also reduce the expression of Ca²⁺ channel IP3R3 in ovarian and lung cancer, resulting in the transfer of Ca²⁺ needed to induce apoptosis from endoplasmic reticulum to mitochondria damage. Thus, these two tumors are resistant to cisplatin. It has been found that verteporfin can overcome the drug resistance induced by SMARCA4 deletion. However, this inhibitor has not been applied in clinical practice. Therefore, it is a promising research direction to develop SWI/SNF ATPase targeted drugs with high oral bioavailability to treat patients with tumor resistance induced by low expression or deletion of SMARCA4. ARID1A deletion can activate the expression of ANXA1 protein in HER2+ breast cancer cells or down-regulate the expression of progesterone receptor B protein in endometrial cancer cells. The drug resistance of these two tumor cells to trastuzumab or progesterone is induced by activating AKT pathway. ARID1A deletion in ovarian cancer can increase the expression of MRP2 protein and make it resistant to carboplatin and paclitaxel. ARID1A deletion also can up-regulate the phosphorylation levels of EGFR, ErbB2, and RAF1 oncogene proteins.The ErbB and VEGF pathway are activated and EMT is increased. As a result, lung adenocarcinoma is resistant to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Although great progress has been made in the research on the mechanism of SWI/SNF complex inducing tumor drug resistance, most of the research is still at the protein level. It is necessary to comprehensively and deeply explore the detailed mechanism of drug resistance from gene, transcription, protein, and metabolite levels by using multi-omics techniques, which can provide sufficient theoretical basis for the diagnosis and treatment of poor tumor prognosis caused by mutation or abnormal expression of SWI/SNF subunits in clinical practice.

Objective Under the background of national centralized procurement,to understand the problems and needs faced by nurses in the drug identification process,and to provide a basis for formulating targeted intervention measures.Methods Nurses from a tertiary hospital in Hubei province were selected as interviewees using purposive sampling from June to September in 2024.Semi-structured interviews method were conducted with the respondents on a one-on-one basis,and the interview data were analyzed using Colaizzi's phenomenological analysis method.Results The experience of nurses in drug identification could be summarized into two themes:increased risk of drug identification errors,and bearing complex psychological burdens.The demands of nurses for drug identification could be summarized into three themes:enhancing the ability of safe identification;innovation-driven drug identification management;and optimizing the environment for medication safety.Conclusion Under the background of centralized procurement,the update pace of clinically used drugs has accelerated,which has increased the difficulty for nurses in identifying drugs,and there is a negative psychological experience during the drug identification.Nursing managers should pay attention to the experiences and needs of nurses,and start from multiple dimensions such as theoretical knowledge training,improvement of professional ethics,innovation driven drug identification and management,and optimization of drug safety environment,to help clinical nurses obtain positive experiences in drug identification,reduce the risk of drug identification errors,and enhance the safety guarantee of drug identification.

To summarize the research progress and to discuss current drug supplement status of radiation preventive and curative drugs,which would provide fresh thoughts for nuclear emergency rescue and therapy.Classification of clinically available and under-development radiation prevention and treatment drugs has been presented in terms of symptomatic and causative prevention and treatment drugs.We analyzed the necessity and challenges of establishing a supply system for radiation prevention and treatment and put forward counter measures and thinking prospects.Clinical stockpile of symptomatic drugs is relatively sufficient.Allopathic drugs are widely developed,however,the barriers between research and clinical translation and the inadequate market supply system pose greater demands and challenges to the provision of hospital radiation allopathic drugs.

Objective To investigate the predictive performance of serum soluble CD40 ligand(sCD40L),interleukin-17(IL-17)and neutrophil extracellular traps(NETs)in combination for intracranial aneurysm rupture.Methods A total of 120 patients with intracranial aneurysms admitted from January 2022 to January 2025 were selected and divided into low-risk group and medium-high-risk group according to different rupture risks.After propensity score matching with 1:1 ratio and caliper matching(caliper=0.02),there were 60 patients in each group.The general data and serum levels of sCD40 L,IL-17 and NETs were compared between the two groups.Multivariate logistic regression analysis was used to analyze the risk factors of intracranial aneurysm rupture.The linear relationship between serum sCD40 L,IL-17,NETs and the risk of intracranial aneurysm rupture was analyzed by smoothing curve fitting.The receiver operating characteristic(ROC)curve,clinical impact curve(CIC)and clinical decision curve analysis(DCA)were used to evaluate the predictive performance of serum sCD40L,IL-17 and NETs for intracranial aneurysm rupture.Results The irregular shape of aneurysms,the proportion of the longest diameter of aneurysms≥7 mm and the levels of serum sCD40L,IL-17 and NETs in the low-risk group were lower than those in the medium-high-risk group(P<0.01).The shape of aneurysm,the longest diameter of aneurysm,sCD40L,IL-17 and NETs were the independent risk factors for intracranial aneurysm rupture(P<0.05).After adjusting for other covariates,serum sCD40L,IL-17 and NETs were positively correlated with the risk of intracranial aneurysm rupture(P<0.05).The ROC curve showed that the area under the curve of serum sCD40L,IL-17 and NETs in combination for predicting the risk of intracranial aneurysm rupture was the largest.The DCA and CIC showed that both the net benefit of the combined prediction model of serum sCD40L,IL-17 and NETs in predicting the risk of intracranial aneurysm rupture and the coincidence rate with the actual situation were relatively high.Conclusion The elevated levels of serum sCD40L,IL-17,and NETs in patients with intracranial aneurysms are associated with their rupture risk.The combination of the three indicators has a high predictive performance for the risk of intracranial aneurysm rupture.

The integration of artificial intelligence (AI) into human assisted reproductive technology (ART) represents one of the most promising advancements in modern medicine. ART, which include in vitro fertilization, intracytoplasmic sperm injection, preimplantation genetic testing and embryo freezing, have traditionally relied on the expertise of clinicians and embryologists. The inherent subjectivity and complexity of these processes, coupled with the ever-increasing demand for higher success rates, have prompted researchers and clinicians to explore AI-driven solutions. AI, with its capacity to process vast amounts of data, recognize patterns, and make predictive analyses, offers the potential to revolutionize every aspect of human reproduction, from initial diagnosis and treatment planning to embryo selection and pregnancy monitoring. This summary explores the current landscape of AI applications in ART, reviewing key advancements, challenges, and future prospects.

The wide application of assisted reproductive technology (ART) has brought the hope of fertility to infertile couples worldwide. However, with the gradual popularization of ART, the long-term health status of ART children has attracted extensive attention from society. Adolescence is a critical developmental period for individuals to transition from childhood to adulthood, with significant physical and psychological changes, so the health status of ART offspring during this period has a profound impact on their overall future health. This article reviews the existing studies, focusing on the effects of ART on multiple aspects of adolescent health, especially growth and development, cardiovascular health, endocrine function, fertility, cancer risk, atopic diseases, mental health, epigenetic changes and other aspects. The possible mechanisms leading to these health problems, including genetic factors, environmental exposures, and the long-term effects of early life interventions, were explored. Future research should continue to explore the long-term effects of ART on the health of offspring and further clarify the mechanisms of these effects, so as to provide a scientific basis for the development of effective prevention and intervention measures.

Objective:To investigate the awareness levels of doctors from various departments regarding fertility preservation to provide reference and suggestions for further improving awareness and promoting multidisciplinary development in fertility preservation.Methods:From November to December 2023, the China Alliance of Fertility Preservation initiated this survey covering 88 hospitals in 23 cities across 20 provinces in China. The survey focused on the degree of understanding of basic concepts, technological perceptions, treatment concepts, and related challenges regarding fertility preservation. Descriptive statistics and Fisher's exact test were used to analyze the difference in awareness levels across various departments.Results:There was a significant difference in the awareness of fertility preservation guidelines among physicians from different departments ( P<0.001). Reproductive center physicians had the highest level of understanding [68.3% (41/60)]. Doctors in the reproductive centers had a higher awareness rate of the five fertility preservation techniques (ovarian tissue cryopreservation, oocyte cryopreservation, sperm cryopreservation, testicular tissue cryopreservation, and embryo cryopreservation) than that in other departments (all P<0.05). Regarding treatment concepts, more reproductive center physicians believed that psychological counselling about fertility preservation before oncological treatment was necessary ( P=0.016). Hematologists had more worries and concerns about fertility preservation treatment. Additionally, 96.7% (58/60) of reproductive center physicians expressed the need to establish effective referral mechanisms within the same city, province, or across provinces. However, 55.6% (35/63) of oncologists, 64.6% (31/48) of hematologists, and 77.8% (7/9) of pediatricians considered treating primary tumors far more important than fertility preservation. Conclusion:Doctors from different departments have varying levels of understanding regarding fertility preservation. It is necessary to strengthen the dissemination and training of fertility preservation knowledge among physicians from various departments, as well as to promote a multidisciplinary treatment model to improve efficiency, to establish a comprehensive referral mechanism to improve patients' opportunities for fertility preservation.

Objective:To investigate the clinical and neonatal outcomes of nonobstructive azoospermia (NOA) patients undergoing a second microdissection testicular sperm extraction (microTESE) combined with intracytoplasmic sperm injection (ICSI).Methods:A retrospective self-controll study and a cohort study were conducted in 29 NOA patients who underwent the second microTESE-ICSI treatments at the Assisted Reproduction Center of Northwest Women's and Children's Hospital between October 2013 and December 2024, with successful sperm retrieval in the first microTESE for all included patients. The sperm retrieval rate (SRR), the two-pronuclei (2PN) rate, the high-quality embryo rate, the transferable embryo rate, the blastocyst formation rate, the pregnancy and neonatal outcomes between the two microTESE-ICSI cycles were analyzed. According to whether sperm was detected during the second microTESE, the patients were divided into detected sperm group ( n=22) and without detected sperm group ( n=7). The surgical interval, preoperative hormone levels, testicular volume, and patient pathological type were compared between the two groups. Patients who had achieved at least one biochemical pregnancy in the first cycle were classified as the pregnancy group, while those who had not achieved a biochemical pregnancy were classified as the non-pregnancy group, and the pregnancy outcomes of patients during the second microTESE-ICSI treatment were compared between the two groups. Previous surgical recordings were also analyzed. Results:The SRR of the second microTESE was 75.9% (22/29). There were no statistically significant differencs in surgical interval, preoperative hormones level, testicular volume, and patient pathological type between detected sperm group and without detected group during the second examination (all P>0.05). SRR showed no difference between idiopathic and non-idiopathic NOA ( P>0.05). 2PN rate, high-quality embryo rate, transferable embryo rate, blastocyst formation rate did not differ statistically between the two cycles (all P>0.05). Among patients completing follow-up in the second microTESE-ICSI cycle, cumulative pregnancy and live birth rates after all embryos transfer were 52.4% (11/21) and 42.9% (9/21), respectively. Further analysis revealed that patients in pregnancy group [75.0% (6/8)] had significantly higher cumulative live birth rate than that in non-pregnancy group [23.1% (3/13), P=0.032] in the second cycle. No birth defects were observed in neonates. Surgical video review suggested that excessive microdissection and low-magnification electrocautery hemostasis might increase intratesticular scarring. Conclusion:For NOA patients with failed initial microTESE-ICSI, the second treatment can effectively retrieve sperm and achieve favorable pregnancy and neonatal outcomes. Patients with prior biochemical pregnancy may benefit from higher live birth rate in subsequent cycles.

Since the birth of the first "test-tube baby" in Chinese mainland in 1988, assisted reproductive technology (ART) in China has matured significantly. The number of ART cycles has surpassed one million, and the number of assisted reproductive institutions and practitioners has attained a significant scale, contributing to the establishment of a fertility-friendly society. However, due to the complexity of the ART process, the diversity of personnel backgrounds, and the profound impact of any error that may occur, there is an urgent need to establish an efficient and effective safety management model for error prevention. This paper aims to outline the key processes and steps involved in the implementation of ART, explore control measures for these critical processes, and delve into error prevention strategies for gamete and embryo laboratories through the creation and utilization of a "gamete safety checklist".