ObjectiveThis paper aims to investigate the distribution patterns of traditional Chinese medicine syndromes in patients with chronic hepatitis B （CHB） comorbid with metabolically associated fatty liver disease （MAFLD） and analyze their correlation with clinical characteristics and the progression of liver fibrosis. MethodsA cross-sectional study method was employed， and 506 patients with CHB comorbid with MAFLD who attended the Hepatology Outpatient Department of Public Health Clinical Center of Chengdu from June 2024 to December 2024 were enrolled. General information， traditional Chinese medicine syndromes information， laboratory indicators， and imaging examination results were collected using case report forms （CRF）. Tongue images of patients were acquired using a tongue diagnosis instrument， and tongue feature parameters were extracted using computer image processing technology. Frequency analysis， factor analysis， and cluster analysis， and other methods were used to explore syndrome categories and distribution patterns. Non-parametric tests were used to compare the differences in clinical characteristics among different syndromes. Univariate and multivariate logistic regression analyses were performed to investigate the correlation between traditional Chinese medicine syndromes and the progression of liver fibrosis. ResultsThe main traditional Chinese medicine syndromes in patients with CHB comorbid with MAFLD were mainly dominated by damp-heat accumulation syndrome， liver stagnation and spleen deficiency syndrome， and phlegm-blood stasis syndrome， with damp-heat accumulation syndrome accounting for the highest proportion （41.89%）. Compared with those without damp-heat accumulation syndrome， patients with damp-heat accumulation syndrome had significantly lower tongue proper H value， tongue coating H value， and tongue coating a^* value （P<0.05）， significantly higher tongue coating b^* value （P<0.05）， significantly increased levels of white blood cell （WBC）， red blood cell （RBC）， hemoglobin （HGB）， and glucose （GLU）， increased CAP values （P<0.05）， a higher proportion of males （P<0.05）， and a younger age （P<0.05）. Univariate and multivariate logistic regression analyses show that age， hepatitis B surface antigen （HBsAg）， diabetes， and damp-heat accumulation syndrome are independent risk factors for liver fibrosis （P<0.05）， and that damp-heat accumulation syndrome is predominantly distributed in liver fibrosis stage F0-F1. ConclusionDamp-heat accumulation syndrome is a typical syndrome in patients with CHB comorbid with MAFLD， which is significantly associated with enhanced inflammatory response， metabolic disorders， and early liver fibrosis， and is a key link in disease progression. Clinical attention and early intervention are needed.

Attention-deficit/hyperactivity disorder(ADHD)is a common behavioral disorder in children and has significant non-specific symptoms.The specific pathogenesis of ADHD remains unclear.Chinese medicine has a unique advantage in treating this disease.The"qi cycle in round"theory is a unique diagnosis and treatment system constructed by Huang Yuanyu,a Qing Dynasty physician,through systematic integration and innovative development of the theoretical framework of traditional Chinese medicine,which is widely used in clinical practice.Based on the"qi cycle in round"theory,the pathogenesis of ADHD in children was discussed,and the abnormal middle qi was proposed as the root cause of the disease,with hyperactivity of the liver,lung depletion,and fire as the key contributing factors.Guided by the"qi cycle in round"theory in the treatment of ADHD in children,the approach focuses on restoring and balancing central qi.It emphasized the understanding of the overall changes in the spleen,stomach,lungs,liver,heart,kidney,and other viscera,along with the movement of qi.Treatment focuses on methods such as lifting clear yang,reducing stomach turbidity,softening the liver and quenching the wind,suppressing the lungs and reducing the inversion,and reducing the fire and returning to the yuan.These interventions aim to promote the smooth circulation of the qi circulation from multiple perspectives,thereby facilitating recovery.

In the era of intelligence and individualization, gastric cancer surgery is under-going multidimensional advancements. The authors focus on the cutting-edge progress and future challenges of artificial intelligence (AI) in the diagnosis and decision-making, treatment and drug development, as well as postoperative rehabilitation in gastric cancer surgery. In terms of diagnosis, AI integrates imaging, liquid biopsy, pathology, and multimodal technologies to enhance diagnostic comprehensiveness and accuracy. Regarding decision-making, AI assists in formulating personalized treatment plans, conducting risk assessments, and predicting prognoses. In the treatment domain, AI facilitates the advancement of individualized surgical approaches, supports postoperative follow-up, and aids in physician education and training. In drug development, the introduction of virtual cell models and AlphaFold has improved the efficiency and accuracy of mechanistic and clinical research. For postoperative rehabilitation guidance, AI provides personalized recommendations to optimize treatment outcomes.AI holds great promise in gastric cancer surgery across diagnosis and decision-making, treatment and drug development, and postoperative rehabilitation. However, current AI technologies face challenges such as data sharing and privacy protection, multicenter research and model generalization, human-machine collaboration, interpretability, ethical considerations, sustaina-bility, and widespread adoption. Addressing these challenges will require collective efforts to fully leverage AI′s advantages in gastric cancer diagnosis and treatment.

Lung transplantation is the only effective treatment for end-stage lung diseases.However,its long-term prognosis is affected by early and late complications,such as primary graft dysfunction,antibody-mediated rejection,and chronic lung allograft dysfunction.In recent years,the central role of the complement system in these pathological processes has gradually gained attention.As a novel immunomodulatory strategy,complement inhibitors are still in the exploratory phase in lung transplantation.Therefore,this article reviews the pathological mechanisms of the complement system in primary graft dysfunction,antibody-mediated rejection,and chronic lung allograft dysfunction.Combined with existing clinical cases,it analyzes the potential role and limitations of complement inhibitors in improving lung allograft function and proposes future research directions and suggestions.The aim is to provide a reference for the precise intervention of lung transplant complications and the improvement of lung transplant outcomes.

Objective:To investigate the influence of ultrasonic monitoring of bladder filling levels on setup errors before fractionated radiotherapy for cervical cancer patients through a comparative analysis, and its effectiveness in improving clinical target volume (CTV) margins.Methods:A retrospective study was conducted on 1 284 error data of setup via cone beam CT (CBCT) and 6D setup error correction system from 172 cervical cancer patients treated in the Radiotherapy Department of Peking University Cancer Hospital from January 2019 to October 2023. These patients were classified into two groups: 87 (659 times of setup) with ultrasonic monitoring of bladder filling levels and 85 (625 times of setup) without ultrasonic monitoring. The setup errors, error distributions, and numbers of abnormal setups between the two groups were compared in the lateral (Lat), longitudinal (Lng), vertical (Vrt), pitch (Pitch), roll (Roll), and rotational (Rtn) dimensions. Moreover, the CTV to planning target volume(PTV) margin values in the three-dimensional direction were calculated for both groups to assess the clinical value of ultrasonic monitoring of bladder filling levels before fractionated radiotherapy.Results:Compared to the group without ultrasonic monitoring, the group with ultrasonic monitoring exhibited lower median values of setup errors in all six-dimensional directions and smaller upper and lower interquartile ranges ( Z = -10.86 to -6.34, P<0.05). The group with ultrasonic monitoring manifested more concentrated setup errors in various directions and statistically significantly reduced numbers of abnormal setups ( χ2=15.33, P<0.05). Moreover, CTV-PTV margins of the group with ultrasonic monitoring displayed reduced CTV-PTV margin values by 0.55, 1.52, and 1.26 mm in the Vrt, Lng, and Lat directions, respectively. Conclusions:Pre-radiotherapy ultrasonic monitoring of bladder filling levels in cervical cancer patients can significantly improve the repeatability of setup, thus notably reducing the incidence of abnormal setups. Theoretically, it can narrow the range from the CTV to the PTV, thereby minimizing radiation exposure to healthy tissues and ultimately enhancing radiotherapy precision for cervical cancer and reducing radiation damage.

Objective To investigate the effects and mechanism of Dahuang Lingxian Prescription on bile duct reaction of cholestatic liver fibrosis rats caused by bile duct ligation.Methods A total of 40 SD rats were randomly divided into blank group,model group,ursodeoxycholic acid group and Dahuang Lingxian Prescription group,with 10 rats in each group.Except for the blank group,the remaining groups of rats underwent bile duct ligation surgery to establish a cholestatic liver fibrosis model.After surgery,the ursodeoxycholic acid group was given ursodeoxycholic acid solution by gavage,Dahuang Lingxian Prescription group was given Dahuang Lingxian Prescription solution by gavage,and the blank group and model group were given equal volume of normal saline by gavage,once a day for 3 consecutive weeks.The activities of serum AST,ALT,ALP,GGT and the contents of TBIL,TBA were tetected,the morphology of liver tissue was observed by HE staining,and the liver fibrosis was observed by Masson staining,immunohistochromic staining and Western blot were used to detect the expressions of CK19,CK7,EpCAM and SOX9 proteins.Results Compared with the blank group,the liver surface of the model group rats was rough,with a harder texture and obvious graininess,HE staining showed damage to the liver lobule structure,forming pseudo lobules,a large number of bile duct hyperplasia and inflammatory cell infiltration,and a significant increase in collagen fiber deposition(P<0.01);the activities of serum AST,ALT,ALP,GGT,as well as the contents of TBIL and TBA significantly increased(P<0.01);the positive expressions of CK19,CK7 and EpCAM in liver tissue significantly increased(P<0.01),and the protein expressions of CK19,CK7,EpCAM and SOX9 significantly increased(P<0.01).Compared with the model group,the appearance and texture of the liver of the rats in the ursodeoxycholic acid group and Dahuang Lingxian Prescription group were relatively softer,the lobular structure was less damaged,the inflammatory cells infiltration was less,the collagen fiber deposition was significantly reduced(P<0.01),the activities of serum AST,ALT,ALP,GGT,and the contents of TBIL and TBA were significantly decreased(P<0.01);the expressions of TBA and TBIL were significantly decreased(P<0.01),the positive expressions of CK19,CK7 and EpCAM significantly decreased(P<0.01),and the protein expression of CK19,CK7,EpCAM and SOX9 significantly decreased(P<0.01).Conclusion Dahuang Lingxian Prescription can inhibit the bile duct reaction associated with liver progenitor cells,decrease the expression of CK19,CK7,EpCAM and SOX9,and thus improve the cholestatic liver fibrosis of rats induced by bile duct ligation.

Objective To analyze the distribution and characteristics of hearing and deafness susceptibility genes in newborns who failed the initial hearing screening,and to explore the association rules for those referred the re-screening.Methods A multicenter retrospective cohort study conducted in 12 339 infants who failed the initial hearing screening in Beijing.Data analysis was conducted on the results of genetic screening for deafness susceptibil-ity genes and the results of the hearing re-screening and diagnosis.The Apriori algorithm was utilized to mine strong association rules related to the failure of the hearing re-screening.Results The detection rate of deafness suscepti-bility gene mutations was 7.14％(881/12 339),withGJB2,SLC26A4,GJB3,and MT-RNR1 being the most fre-quently identified genes.The positive predictive values for initial hearing screening and re-screening referred were 15.93％(1 965/12 339)and 17.87％(226/1 265).Association rule mining revealed that newborns who referred the initial hearing screening in both ears and had twins/multiple births,NICU admission,and deafness gene muta-tion detection had relatively increased risks of 4.47％,9.25％,and 16.72％.Newborns with deafness gene muta-tion detection who referred the initial hearing screening in both ears and female newborns had relatively increased risks of 3.99％and 12.60％who referred the hearing re-screening.Conclusion Newborns who fail the initial hear-ing screening have a relatively high detection rate of deafness susceptibility gene mutations.Those who fail initial bi-lateral hearing screening and have detected deafness gene mutations are at a significantly increased risk of failing the hearing rescreening.

Objective:To carry out a systematic review of the development, introduction or validation of drug literacy assessment tools for adults at home and abroad, and to summarize and analyze the characteristics of the assessment tools.Methods:The research framework of the scoping review was used to systematically search 8 Chinese and English databases, such as China National Knowledge Infrastructure, China Biology Medicine disc, PubMed, Web of Science, and Embase. The search period was from database establishment to October 31, 2023. Studies on adult drug literacy assessment tools were screened and included, tool characteristics were extracted and analyzed, and ultimately the extracts were standardized for reporting.Results:A total of 31 articles that met the criteria were included, of which 26 were on the development and validation of assessment tools, three were on the localization and application of assessment tools, and two were on the revision of assessment tools, covering 33 assessment tools.Conclusions:It is needed to recognize the importance of drug literacy assessment, actively explore the diversity of drug literacy assessment tools, clarify the limitations of existing drug literacy assessment tools, further improve the reliability and validity of existing tools, continue to develop and introduce assessment tools suitable for China's national conditions, so as to increase the accuracy of drug literacy assessment.

Objective To quantitatively compare the dosimetric differences among 4 volumetric modulated arc therapy(VMAT)plans by analyzing the number of arcs and collimator angle settings,aiming to establish a standardized planning template for hippocampal-sparing prophylactic cranial irradiation(HS-PCI)in clinic and improve both planning quality and clinical efficiency.Methods Twenty HS-PCI patients were enrolled,with 4 VMAT plans(V2c,V2p,V3,and V4)for each patient.The differences in target dose,organs-at-risk dose,and monitor units were compared.Results V4 plan had the highest PTV D98%and V95%,and the differences of PTV D98%in V2c vs V2p,V2c vs V4,and PTV V95%in V2c vs V4 were statistically significant(P<0.05).Meanwhile,V4 plan had the lowest PTV Dmax and Dmin doses.Specifically,statistically significant differences were observed in PTV Dmax in V4 vs V2c,V4 vs V2p,V4 vs V3,as well as PTV Dmin in V2c vs V2p,V2c vs V3,V2c vs V4,V2p vs V4(P<0.05).The PTV Dmean was the highest in V2p plan,with statistically significant differences observed in V2c vs V2p,V2c vs V4,V2p vs V3,and V3 vs V4(P<0.05).The highest PTV D2%dose was observed in V2p plan,and the differences in V2c vs V2p,V2c vs V4,V2p vs V3,V3 vs V4 were statistically significant(P<0.05).The homogeneity index and conformity index were close in 4 plans(P=0.946,P=0.380).V4 plan had the lowest Dmax,Dmean,and Dmin of the hippocampus,with significant differences in hippocampal Dmax in V4 vs V2c,V4 vs V2p,hippocampal Dmean in V4 vs V2c,V4 vs V2p,V3 vs V2c,and hippocampal Dmin in V2c vs V2p/V3/V4,and V4 vs V2p(P<0.05).V3 plan had the lowest Dmax for bilateral lenses,and V4 plan showed the lowest Dmax for lenses with a 3 mm expansion,with significant differences between V2c and V2p/V3/V4(P<0.05).V4 plan had the lowest dose for the right optic nerve,with significant differences in V4 vs V2p,and V4 vs V3(P<0.05).No significant differences were observed for the left optic nerve and optic chiasm.The monitor units in V2p plan was the lowest.Conclusion When differences in organs-at-risk doses and plan quality parameters are insignificant,V2p plan is recommended as it can ensure treatment quality while reducing delivery time.