This paper systematically elaborates on the key points of diagnosis and differential diagnosis of salivary gland tumors characterized by a substantial amount of extracellular mucus as a main or prominent feature, and clarifies the core differential features. The term "mucus-rich" specifically denotes that mucus is a major component of the tumor, rather than a focal or minor one. This phenomenon is associated with distinct histogenetic mechanisms: it may result from specific genetic mutations (e.g., AKT1 E17K in mucinous adenocarcinoma) that drive ductal epithelial differentiation into mucus-secreting cells, or from myoepithelial cells secreting glycosaminoglycans that form a myxoid stroma. Salivary gland tumors with abundant extracellular mucus include mucinous cystadenoma, sialadenoma papilliferum-like intraductal papillary tumors, mucinous myoepithelioma, pleomorphic adenoma with mucin-rich stroma, mucinous adenocarcinoma, low-grade mucoepidermoid carcinoma, mucin-rich salivary duct carcinoma and intestinal-type adenocarcinoma. The diagnosis of these tumors is complicated by the dual nature of extracellular mucus: while it is a defining feature of some entities, it can also obscure key diagnostic architectural features in others, leading to histological overlap and inconspicuous diagnostic areas. Given the frequent histological morphological overlap among these tumors, immunohistochemical findings and molecular characteristics have emerged as crucial differential diagnostic criteria. Core differential diagnostic points include the following: histologically, there must be meticulous identification of typical structures obscured by mucin (such as squamoid cells in mucoepidermoid carcinoma and apocrine features in salivary duct carcinoma); in immunohistochemical staining, CK20 is useful for distinguishing intestinal-type adenocarcinoma (positive) from mucinous adenocarcinoma (negative), while androgen receptor aids in differentiating salivary duct carcinoma (positive) from mucoepidermoid carcinoma (negative); and molecular testing plays a critical role in definitive diagnosis (e.g., the AKT1 E17K mutation for mucinous adenocarcinoma, MAML2 rearrangement for mucoepidermoid carcinoma, and MEF2C::SS18 fusion for microsecretory adenocarcinoma). This paper systematically summarizes the core pathological features and differential diagnostic points of mucin-rich salivary gland tumors, aiming to provide a practical reference for clinical pathological diagnosis.

Bronchiolar adenoma (BA) is a rare type of lung tumor characterized by bilayered epithelial cells having a continuous basal layer and a luminal layer. It resembles mucinous adenocarcinoma (MA) on frozen section, with difficulty in distinguishing the basal layer. Immunohistochemistry is the best choice for verifying the diagnosis. This study aimed to comprehensively characterize three cases of BA-combined carcinoma using clinical, histopathological, and genetic features. BA and carcinoma sections were subjected to next-generation sequencing, respectively. It was hypothesized that while different mutation forms matched different regions, BA and lung adenocarcinoma shared the same gene mutation when they co-occurred in the same location. BA with extensive carcinoma is extremely rare and presents diagnostic challenges due to its overlap with conditions such as MA. Because of its distinctive morphological characteristics, BA may be regarded as a low-grade malignancy, particularly during a confusing evaluation. A multifaceted examination of clinical, radiological, immunohistochemical, and genetic data is necessary for an accurate diagnosis.

Objective In order to understand the current resistance status of Aedes albopictus(Ae. albopictus) adult population to commonly used insecticides and the resistance dynamics development in Zhejiang Province and provide a theoretical basis for the scientific and rational use of hygienic insecticides. Methods Resistance determination was carried out using the diagnostic dose method(GB/T 26347-2010)recommended by WHO in the adult mosquito contact cylinder method to monitor the resistance of Ae. albopictus field populations in 11 cities and districts in Zhejiang Province in 2024. Results The monitoring result showed that adult Ae. albopictus in 11 areas were resistant or suspected resistant populations to both cis-cypermethrin and permethrin; suspected and resistant populations to the organophosphate insecticide malathion were as high as 81.82%; while suspected resistance to the carbamate insecticide residual carbofuran accounted for 45.45%, and the rest of the monitoring sites were sensitive to it. Conclusions The result suggest that the generalized resistance of Ae. albopictus populations to pyrethroids and organophosphorus insecticides in the field in Zhejiang Province needs to be highly emphasized. In future mosquito vector and mosquito-borne disease control, insecticides should be selected based on the resistance monitoring information, while following scientific guidelines for insecticide use.

Background and aims Hepatocellular carcinoma (HCC) cells are metabolically reprogrammed for excessive uptake and metabolism of many nutrients. The tumor suppressive microRNA-148a-3p (miR-148a-3p) is downregulated in HCC, whereas its function in regulating HCC cell metabolism remains obscure. Herein we aimed to delineate the role of miR-148a-3p in HCC cell metabolism by using novel bioengineered miR-148a-3p (BioRNALeu/miR-148a-3p) agent produced in vivo. Methods BioRNALeu/miR-148a-3p was designed by using human leucyl transfer RNA fused hsa-pre-miR-34a carrier, overexpressed in Escherichia coli (E. coli), and purified to high homogeneity. After transfection into HCC cells, the released miR-148a-3p levels were assessed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Cell proliferation was determined by CellTiter-Glo assays. Targets were validated by dual-luciferase reporter assays, immunoblotting, and immunofluorescence confocal imaging. Glycolysis capacity was evaluated by Seahorse XF assays, and glucose, lactate, and amino acid levels were quantified by liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods. Results BioRNALeu/miR-148a-3p was efficiently processed into target miR-148a-3p in HCC cells to effectively inhibit cell proliferation in a dose- and time-dependent manner. Mechanistically, miR-148a-3p suppressed the protein levels of glucose transporter GLUT1/SLC2A1 and L-type amino acid transporter LAT1/SLC7A5 via acting on their 3′-untranslated regions, as well as amino acid transporter ASCT2/SLC1A5. These, in turn, led to a reduction of glucose uptake, lactate production, and glycolytic flux in HCC cells, and alteration of intracellular amino acid metabolome including glutamine, leucine, phenylalanine, tyrosine, and methionine. Conclusions Reintroduction of miR-148a-3p into HCC cells modulates glucose and amino acid metabolism via regulating multiple SLC transporters, thereby suppressing HCC cell viability. These findings highlight the role of miR-148a-3p in HCC cell metabolism and potential of bioengineered miRNA molecules for functional studies and therapeutic development.

Objective:Conduct an in-depth investigation into the current status and development needs of infectious disease clinical testing at medical institutions at all levels across the country.Methods:A cross-sectional survey was carried out from January 5, 2023, to June 1, 2023, using a web-based questionnaire distributed to healthcare organizations at all levels nationwide. A total of 3 462 questionnaires were collected, and after quality control and a no-return random sampling process, 2 778 questionnaires were included in the analysis. The research covered basic information about medical institutions, the current emergency response capacity of infectious disease laboratories, the status of the implementation of statutory infectious diseases, the demand for infectious disease testing programs, and the reasons for any lack of implementation. Additionally, the study further analyzed the participation rates of medical institutions at all levels, laboratory accreditation, the presence of infectious disease testing departments, and the testing rates for major infectious diseases.Results:Among the 2 778 questionnaires, the proportions of tertiary, secondary, and primary hospitals were 39.13% (1 087/2 778), 53.20% (1 478/2 778) and 4.46% (124/2 778), respectively. The proportion of specialized infectious disease medical institutions was 8.89% (247/2 778). The proportion of medical institutions with laboratory accreditation was 12.92% (359/2 778). The proportion of clinical laboratory performing infectious disease testing was 98.56% (2 738/2 778). Among the infectious disease pathogens included in the analysis, the implementation rates of testing related to hepatitis B virus, hepatitis C virus, 2019-nCoV, human immunodeficiency virus, and syphilis spirochete were 97.62% (2 712/2 778), 94.85% (2 635/2 778), 93.27% (2 591/2 778), 96.33% (2 676/2 778) and 96.22% (2 673/2 778), respectively. In the research on the demand for clinical infectious disease pathogen testing, the demand for testing of Brucella spp. bacteria and Mycobacterium tuberculosis was 25.50% (90/353) and 8.22% (29/353), respectively. The main factors that did not meet the demand for clinical infectious disease testing were the lack of space in the laboratory to carry out the tests, insufficient manpower, and the absence of a fee schedule, accounting for 44.10% (1 225/2 778), 42.55% (1 182/2 778) and 36.00% (1 000/2 778), respectively.Conclusions:Clinical testing for infectious diseases in our country is mainly carried out in the laboratories of tertiary and secondary medical institutions, which can adequately meet the laboratory testing needs for common infectious diseases. However, there are situations such as limited infectious disease testing projects and insufficient spatial, human, and material resources. Improvements in laboratory construction and methodology can be made according to the actual conditions of each region.

Objective To explore the role of plasma exosome microRNA-622(miR-622)in cachexia of hep-atocellular carcinoma(HCC).Methods Select preoperative blood samples from 40 patients with stage Ⅲ-ⅣHCC and 33 patients with non HCC liver benign diseases collected at Huashan Hospital,Fudan University from 2021 to 2024 as the research subjects.Exosomes were isolated from the plasma of patients,human HCC cell lines(HepG2,Hep3B,PLC,Huh7),and the culture supernatants of primary human hepatocytes(PHH)by differential centrifugation.The relative expression level of miR-622 was detected by real-time fluorescence quantitative polymerase chain reaction.The level of lipolysis was assessed by determining the concentration of glycerol and fatty acids in adipocyte culture medium.Results Plasma exosome miR-622 levels in HCC pa-tients were positively correlated with subcutaneous adipose index and visceral adipose index(r=0.516,0.539,P＜0.05).HCC cell conditional medium was able to significantly increase the lipolysis level of adipo-cytes.The relative expression levels of miR-622 in exosomes from HCC cells(HepG2,Hep3B,PLC,Huh7)were significantly lower than those in exosomes from PHH,with values of 0.13±0.04,0.28±0.08,0.23±0.07,and 0.24±0.04,respectively,compared to 1.00±0.18 in PHH exosomes.Further studies revealed that plasma exosome of HCC patients treatment was able to lead to a decrease in the relative expression level of miR-622 in adipocytes,as well as an enhancement of lipolysis.Conclusion The expression of plasma exosomal miR-622 is downregulated in HCC patients.HCC cells can deliver miR-622 to adipocytes via exosomes to reg-ulate lipolysis.Plasma exosomal miR-622 may serve as a potential biomarker for predicting HCC cachexia and a therapeutic target.

Sacroiliac complex injuries are commonly seen in high-energy pelvic fractures. The injuries make a big difference in treatment patterns due to the diverse injury types, posing considerable challenges in formulating optimal treatment strategies, and hence are persistent clinical difficulties in orthopedic trauma. The clinical management of sacroiliac complex injuries presents several key challenges such as a non-negligible rate of missed diagnoses in associated vascular and visceral injuries, absence of standardized protocols for surgical approaches and reduction-fixation strategies across different injury patterns, and ongoing controversies regarding surgical indications and optimal timing for patients combined with concomitant lumbosacral plexus injuries. Currently, no systematic clinical guidelines are available for the diagnosis and treatment of sacroiliac complex injuries both domestically and internationally. To this end, the Pelvic and Acetabular Surgery Group, Orthopedic Branch, China International Exchange and Promotive Association for Medical and Health Care and Orthopedic Physician Branch, Chinese Medical Doctor Association organized a panel of domestic experts in the field to develop the Clinical guideline for the diagnosis and treatment of sacroiliac complex injuries ( version 2025), based on evidence-based medicine and adhering to the principles of scientific rigor, clinical applicability, and innovation. These guidelines provided 11 recommendations covering diagnosis, therapeutic principles and techniques, management protocols for lumbosacral plexus injuries, outcome evaluation, and postoperative rehabilitation pathways, etc., aiming to standardize the clinical management of sacroiliac complex injuries.

Objective:Conduct an in-depth investigation into the current status and development needs of infectious disease clinical testing at medical institutions at all levels across the country.Methods:A cross-sectional survey was carried out from January 5, 2023, to June 1, 2023, using a web-based questionnaire distributed to healthcare organizations at all levels nationwide. A total of 3 462 questionnaires were collected, and after quality control and a no-return random sampling process, 2 778 questionnaires were included in the analysis. The research covered basic information about medical institutions, the current emergency response capacity of infectious disease laboratories, the status of the implementation of statutory infectious diseases, the demand for infectious disease testing programs, and the reasons for any lack of implementation. Additionally, the study further analyzed the participation rates of medical institutions at all levels, laboratory accreditation, the presence of infectious disease testing departments, and the testing rates for major infectious diseases.Results:Among the 2 778 questionnaires, the proportions of tertiary, secondary, and primary hospitals were 39.13% (1 087/2 778), 53.20% (1 478/2 778) and 4.46% (124/2 778), respectively. The proportion of specialized infectious disease medical institutions was 8.89% (247/2 778). The proportion of medical institutions with laboratory accreditation was 12.92% (359/2 778). The proportion of clinical laboratory performing infectious disease testing was 98.56% (2 738/2 778). Among the infectious disease pathogens included in the analysis, the implementation rates of testing related to hepatitis B virus, hepatitis C virus, 2019-nCoV, human immunodeficiency virus, and syphilis spirochete were 97.62% (2 712/2 778), 94.85% (2 635/2 778), 93.27% (2 591/2 778), 96.33% (2 676/2 778) and 96.22% (2 673/2 778), respectively. In the research on the demand for clinical infectious disease pathogen testing, the demand for testing of Brucella spp. bacteria and Mycobacterium tuberculosis was 25.50% (90/353) and 8.22% (29/353), respectively. The main factors that did not meet the demand for clinical infectious disease testing were the lack of space in the laboratory to carry out the tests, insufficient manpower, and the absence of a fee schedule, accounting for 44.10% (1 225/2 778), 42.55% (1 182/2 778) and 36.00% (1 000/2 778), respectively.Conclusions:Clinical testing for infectious diseases in our country is mainly carried out in the laboratories of tertiary and secondary medical institutions, which can adequately meet the laboratory testing needs for common infectious diseases. However, there are situations such as limited infectious disease testing projects and insufficient spatial, human, and material resources. Improvements in laboratory construction and methodology can be made according to the actual conditions of each region.

Objective:To develop a convolutional neural network model of whole slide imaging of cerebrospinal fluid cells for rapid and accurate identification and classification of tumor cells in cerebrospinal fluid.Methods:A total of 8 692 cerebrospinal fluid cytology smears from Huashan Hospital Affiliated to Fudan University from January 2nd, 2019, to December 27th, 2024. As randomly assigned, the training set included 4 941 benign and 1 745 malignant samples, while the validation set comprised of 1 368 benign and 638 malignant samples. Whole-slide digital images were acquired using a cytopathology scanner, cells (clusters) were annotated for classification, and a deep learning model was constructed via tiled image patches for cell detection and classification. Model performance was evaluated using accuracy, sensitivity, specificity, and other indicators. The classification efficiency of manual microscopy was compared.Results:The model achieved a mean precision of 96.75% for cerebrospinal fluid cell classification. For malignant tumor cells, the classification accuracy was 96.61% (mAP=98.36%, AUC=0.97). Subtype classification accuracies for epithelial/epithelioid tumors and small round cell tumors were 97.13% (AUC=0.98) and 95.58% (AUC=0.93), respectively. Compared with manual microscopy, which took (9.70±0.82) minutes for classifying 200 cells, (18.27±1.21) minutes for 500 cells, and often exceeded 60 minutes or infeasible for full slides, the AI model took (3.46±0.49) seconds for 200 cells, (6.76±0.82) seconds for 500 cells, and a median of 48.57 seconds for full slides ( P<0.001), representing an efficiency improvement of approximately 161-170 times, significantly enhancing diagnostic efficiency. Conclusion:This fully automated hierarchical deep learning model enables efficient and accurate tumor cell identification and classification in CSF, providing an effective auxiliary tool for the rapid diagnosis of meningeal carcinomatosis.

Classical Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) comprise a group of clonal disorders originating from hematopoietic stem cells, commonly characterized by thrombotic events, extramedullary hematopoiesis, and a propensity for malignant progression to myelofibrosis or acute leukemia. With the inclusion in the core diagnostic criteria, molecular biomarkers has exhibited applicational valus in multiple levels in the aspects of personalized therapy to subtype MPN, interpret phenotypic heterogeneity, and predict clinical outcomes. Molecular biomarkers are currently being applied in disease diagnosis, progression prediction, therapeutic strategy refinement, precision monitoring, familial MPN screening, and the development of emerging detection technologies, advancing the shift from fundamental MPN research to individualized clinical management.