To systematically analyzed the reporting status of core elements in publicly available clinical practice guideline(hereafter referred to as "guideline") protocols published domestically and internationally over the past decade, identified existing problems, and provided evidence to inform the standardized writing and publication of future guideline protocols.

Over the past three decades， China has made significant progress in the prevention and control of viral hepatitis， and the incidence rates of new-onset pediatric hepatitis B virus infections and acute viral hepatitis in the population have reduced to a relatively low level； however， there is still a heavy disease burden of chronic viral hepatitis in China， which severely affects the health status of the population. This study systematically summarizes the achievements of viral hepatitis prevention and control in China， analyzes existing problems and challenges， and proposes comprehensive prevention and control strategies and measures to eliminate viral hepatitis as a public health threat based on the national conditions of China， in order to provide a reference for related departments in China on how to achieve the action targets for eliminating viral hepatitis as a public health threat by 2030.

Based on the core collection retrieval of the Web of Science database,researches related to the medicinal field of plant-derived vesicles(PDVs)were retrieved.The research hotspots and their changes in the pharmaceutical field of PDVs are visually analyzed by using bibliometric software VOSviewer and CiteSpace.A detailed discussion is held around the author,institution,country,key research hotspots and annual develop-ment hotspots,revealing the current research status of PDVs in the pharmaceutical field and predicting future trends,which provides valuable perspectives for researchers to understand the current research status of PDVs in the pharmaceutical field and discover possible unexplored areas in this field.

Objective:The objective of this study is to analyze the detection rate, the pathogenic fungus distribution, risk factors and drug sensitivity of fungal infection of external auditory canal in patients diagnosed with chronic otitis media. Methods:The data of a total of 419 patients with chronic suppurative otitis media or middle ear cholesteatoma who were admitted from January 2019 to February 2023 were retrospectively analyzed. Results:A total of 419 patients were included, and 71 patients（16.9%） were positive for fungal culture. The disease mostly occurred in subjects aged 51-60 years old, and patients over 60 years old（47 cases, 66.2%）. From the fungal culture of external auditory canal secretions, 48 cases（11.4%） of Aspergillus and 14 cases（3.3%） of Candida were identified. The prevalence of fungal cultures in patients with chronic suppurative otitis media（20.8%） was significantly higher than that in patients with middle ear cholectestoma（4.9%）. The detection rate of Fungal was significantly increased after topical treatment with antibiotic ear drops（47.0% vs 13.6%）. Most of the isolated fungal strains are wild-type, and they are the sensitivity to voriconazole and fluconazole was the highest（97.2%）. For patients with positive fungal culture, iodoform gauze with triamcinolone acetonide and econazole cream was used to fill the external auditory canal during surgery. There was no significant difference in the tympanic membrane healing rate between patients with positive fungal culture and patients with negative fungal culture at 3 weeks after surgery（98.6% vs 97.7%）. Conclusion:Fungal infections of external auditory canal in patients with chronic otitis media tend to occur in older patients, which is more common in patients with chronic suppurative otitis media. Long-term topical treatment with antibiotic ear drops is an independent risk factor for fungal infection of external auditory canal in patients with chronic otitis media. The isolated fungal strains were highly sensitive to antifungal drugs. Therefore, it is advisable to refrain from employing topical antibiotic treatment for elderly patients with chronic suppurative otitis media/middle ear cholesteatoma, abuse of local antibiotic therapy should be avoided, and Fungal-related pathogenic examinations should be actively performed and anti-fungal drugs should be added if necessary.
Humans ; Middle Aged ; Female ; Male ; Risk Factors ; Retrospective Studies ; Chronic Disease ; Otitis Media, Suppurative/microbiology* ; Ear Canal/microbiology* ; Antifungal Agents/therapeutic use* ; Adult ; Mycoses/epidemiology* ; Aspergillus/isolation & purification* ; Candida/isolation & purification* ; Otitis Media/complications* ; Aged ; Cholesteatoma, Middle Ear/microbiology*

Obesity is a significant risk factor for cancer and is associated with breast cancer metastasis. Nevertheless, the mechanism by which alterations in systemic metabolism affect tumor microenvironment (TME) and consequently influence tumor metastasis remains inadequately understood. Herein, we found that perturbations in circulating metabolites induced by obesity promote metastasis-like phenotypes in breast cancer. Oleoylcarnitine (OLCarn) concentrations were elevated in the serum of obese mice and humans. Administration of exogenous OLCarn induces metastasis-like characteristics in breast cancer cells. Mechanistically, OLCarn directly interacts with the Arg176 site of adenylate cyclase 10 (ADCY10), leading to the activation of ADCY10 and enhancement of cAMP production. Mutations at Arg176 prevent OLCarn from binding to ADCY10, disrupting the ADCY10-mediated activation of cyclic adenosine monophosphate (cAMP) signaling pathway. This activation promotes transcription factor 4 (TCF4)-dependent kinesin family member C1 (KIFC1) transcription, thereby driving breast cancer metastasis. Conversely, the neutralization of both ADCY10 and KIFC1 through knockdown or pharmacological inhibition abrogates the oncogenic effects mediated by OLCarn. Hence, obesity-induced systemic environmental changes lead to the aberrant accumulation of OLCarn within the TME, making it a potential therapeutic target and biomarker for breast cancer.

Algorithmic systems based on artificial intelligence(AI)and machine learning(ML)have undergone rapid advancement in recent years, demonstrating extensive application across diverse ophthalmic disorders. Owing to the public availability of multiple global databases, significant progress has been achieved in the training and development of AI-integrated algorithms utilizing multimodal ophthalmic imaging modalities, including fundus photography and optical coherence tomography(OCT). These advancements have established a foundation for precision medicine and efficient healthcare delivery. The diagnosis of macular diseases relies on the identification of subtle alterations in tissue anatomy, where AI demonstrated exceptional performance in detecting intraocular biomarkers and evaluating anatomical changes during disease progression, with particularly prominent utility in the field of macular pathologies. This article provides a comprehensive review of the current applications of AI in macular diseases, aiming to synthesize existing research achievements and current challenges, while proposing visionary prospects for the broader implementation of AI in ophthalmology and even systemic medicine in the future.

Objective: To investigate the effects of paeoniflorin (Pae) on acute kidney injury ( AKI) and mouse renal tubular epithelial cell ( mRTEC) damage induced by lansoprazole (LPZ) and cisplatin (CIS) through in vivo and in vitro experiments . Methods : The C57BL/6J mice or mRTECs were divided into four groups : normal control (NC) group , NC + LPZ group , CIS group , and CIS + LPZ group . Serum creatinine (CRE) and blood urea nitro- gen (BUN) levels in mice were measured , and kidney pathology was observed with HE staining. Western blot , im- munohistochemistry , and immunofluorescence were used to detect the expression levels of kidney injury molecule-1 (KIM-1) and receptor-interacting protein kinase (RIPK) 1 , RIPK3 , and mixed lineage kinase domain-like protein (MLKL) . Subsequently , C57BL/6J mice or mRTECs were divided into six groups : NC group , NC + Pae group , CIS + LPZ (M) group , and CIS + LPZ + Pae ( M + Pae) group . Serum CRE and BUN levels in each group were measured , kidney pathology was observed with HE staining , and ultrastructural changes in the kidney were observed with transmission electron microscopy. The KIM-1 and necroptosis-related protein expression levels were detected by Western blot , immunohistochemistry , and immunofluorescence . Results: Compared with the NC group , CRE and BUN levels were elevated in the CIS group , and these levels were further increased after LPZ in- tervention (all P < 0. 001) . Compared with the CIS group , renal tubular dilation and brush border loss were evi- dent in the CIS + LPZ group based on HE staining of kidney tissue (P < 0. 001) . Compared with the NC group , the expression levels of KIM-1 , RIPK1 , RIPK3 , and MLKL in the renal tissues of mice in the CIS group increased ( all P < 0. 001) , and compared with the CIS group , The expression levels of KIM-1 , RIPK1 , RIPK3 and MLKL in the renal tissues of mice in the CIS + LPZ group increased (all P < 0. 001) . After Pae treatment , compared with group M , the expression levels of CRE , BUN , KIM-1 , RIPK1 , RIPK3 and MLKL in each group of mice decreased significantly and in a dose-dependent manner (all P < 0. 001) . Conclusion LPZ promotes CIS-induced AKI by enhancing necroptosis in renal tubular epithelial cells , and Pae can improve CIS and LPZ-induced AKI by inhibi- ting necroptosis .

Objective To explore the effectiveness of transperineal tension-free repair of rectal seromuscular layer in the treatment of acquired rectovestibular fistula.Methods Clinical data of 97 girls with acquired rectovestibular fistula from May 2016 to November 2023 were enrolled.The surgical age ranged from 6 months to 11 years old(median,3 years old).The fistula was disconnected and resected via the perineal approach.The anterior wall of the rectum was fully disconnected.Then the fistula was repaired with horizontal continuous tension-free suture of rectal plasmomuscular layer with 5-0 PDS sutures.After continuous suture reinforcement,the perineal muscle layer and skin were longitudinally continuously sutured.The internal fistula opening was exposured with an anal dilator or small hook,and the mucosal layer was continuously sutured with 5-0 PDS sutures.Postoperatively,the anal tube and urinary tube were retained for 5-7 d and antibiotics was administered for treatment.Results The mean operation time was(60.5±9.0)min,the mean fistula diameter was(5.2±2.1)mm,and the mean hospital stay was(7.4±1.9)d.The follow-ups time was 4.5 months to 8.5 years(median,4.25 years).Primary healing was achieved in 92 cases(94.8％),with satisfactory perineal appearance,smooth stool passage,and regular defecation.Fistula recurred within 5-10 d after operation in 5 cases(5.2％),2 of which healed after 3 weeks of sitz baths by using 3％boric acid or Kangfuxin solution,2 of which healed after second operation,and 1 of which experienced recurrence after secondary fistula repair.Conclusion Transperineal tension-free rectal seromuscular layer repair is a simple,safe,and effective surgical method for the treatment of acquired rectovestibular fistula in girls.

Objective To collect data on imported malaria cases in Jiangsu Province from 2019 to 2023 after malaria elimination and to analyze the current epidemic situation and prevention and control measures of imported malaria, discussing future prevention and control strategies. Methods Malaria case information for Jiangsu Province from 2019 to 2023 was extracted and downloaded from the China Information System for Disease Control and Prevention (CISDCP) as well as the Jiangsu Provincial malaria epidemic database. Statistical analysis was conducted using Stata 12.0 and SPSS 16.0 software. Results From 2019 to 2023, a total of 534 cases of malaria were directly reported online in Jiangsu Province, with annual cases numbering 244, 90, 32, 36, and 132 respectively, all being laboratory-confirmed imported malaria cases from abroad. During the COVID-19 pandemic from 2020 to 2022, the number of imported malaria cases significantly decreased, with several months reporting zero cases. Among the 534 malaria cases, the vast majority were individuals who had traveled to countries in sub-Saharan Africa and Southeast Asia for work, business, international studies, or tourism. Over the five years, the median, minimum, and maximum days for patients from onset of illness to health-seeking were 1(0,12), 1(0,8), 0(0,6), 0(0,10), and 1(0,18) days, with a statistically significant difference in health-seeking time among patients (Fisher's exact test, P=0.03). Over the past three years of the COVID-19 pandemic, compared to outside centralized isolation stations, malaria cases within centralized isolation stations were diagnosed in a shorter time (Fisher exact test, P=0.007). A total of 24 severe malaria cases were reported, with no deaths, including 23 cases of P. falciparum and 1 case of P. ovale. Conclusions After the elimination of malaria, imported malaria cases in Jiangsu Province have sharply decreased due to the impact of the COVID-19 pandemic. Malaria cases in centralized isolation stations (CIS) for COVID-19 control of Jiangsu Province are more likely to be promptly diagnosed, and the timeliness from onset to health-seeking among malaria patients returning from high-malaria areas improved. As COVID-19 prevention and control policies adjusted, there has been a sharp increase in imported malaria cases in 2023. It's still necessary to strengthen measures for malaria prevention and control and maintain the capacity to prevent malaria re-transmission in Jiangsu Province.