BACKGROUND:Magnetic resonance imaging is the gold standard for the diagnosis of osteonecrosis of femoral head,and previous methods of predicting osteonecrosis of femoral head collapse based on magnetic resonance images mostly require the combined assessment of coronal and sagittal images.However,osteonecrosis of femoral head tends to occur bilaterally,most hospitals perform bilateral hip magnetic resonance imaging scans during clinical examinations,but the bilateral hip scans can only view coronal and cross-sectional images,and it is difficult to obtain sagittal images,which affects the assessment of the risk of collapse.Therefore,it is of clinical value to establish a method to assess the risk of early osteonecrosis of femoral head collapse by applying the images that can be obtained after bilateral hip magnetic resonance scanning. OBJECTIVE:To establish a method of applying coronal and cross-sectional images of bilateral hip magnetic resonance imaging to assess the risk of osteonecrosis of femoral head collapse. METHODS:The medical records of 111 patients(181 hips)with early-stage osteonecrosis of femoral head diagnosed at the outpatient clinic of Honghui Hospital Affiliated to Xi'an Jiaotong University from October 2017 to October 2019 were retrospectively analyzed.They were categorized into collapsed and non-collapsed groups according to the femoral head collapse at the final follow-up,with 69 hips in the collapsed group and 112 hips in the non-collapsed group.The angle of necrotic range on the images of median coronal plane,transverse plane or one level above and below it was measured on the magnetic resonance imaging system.The sum of the two angles of necrotic angle on the coronal and transverse planes was used as the combined necrotic angle.The average of the three combined necrotic angles of each hip was taken to get the average combined necrotic angle of each hip.Finally,the correlation between the three combined necrotic angles and the average combined necrotic angle with the collapse of osteonecrosis of femoral head was analyzed,and the specificity and sensitivity of the four combined necrotic angles in predicting collapse were evaluated by using receiver operating characteristic curves. RESULTS AND CONCLUSION:(1)Totally 69 hips(38.1%)had femoral head collapse at the last follow-up and were included in the collapsed group;112 hips(61.9%)did not have progression of collapse and were included in the non-collapsed group.(2)The difference between the collapsed group and the non-collapsed group in terms of Association Research Circulation Osseous(ARCO)stage was significant(P<0.001).The difference in age,body mass index,follow-up time,gender distribution,side of onset,and causative factors was not significant(P>0.05).(3)The results of independent samples t-test suggested that all four combined necrotic angles were significantly correlated with collapse(P<0.000 1);and the differences in combined necrotic angles between the collapsed group and the non-collapsed group of ARCO stage I and the two groups of ARCO stage II were all significant(P<0.000 1).(4)In the analysis of the receiver operating characteristic,the area under the curve of the average combined necrotic angle was greater than that of the combined necrotic angle on the lower level of the median,the middle level,and the upper level of the median.(5)The average combined necrotic angle had a higher accuracy in the prediction of collapse than the lower level of the median,the middle level,and the upper level of the combined necrotic angle.(6)It is concluded that the accuracy of the average combined necrotic angle in predicting the risk of osteonecrosis of femoral head collapse is higher,and the clinical practicability is stronger,so we can consider using this method to predict the risk of osteonecrosis of femoral head collapse.

Objective:To study the impact of fluoride exposure through drinking water on the risk of hypertension among residents in Jishan County, Shanxi Province.Methods:From March to April 2023, a cluster sampling method was used to select permanent residents aged ≥18 years and residing for ≥10 years in 12 villages in drinking water-borne endemic fluorosis areas of Jishan County, Shanxi Province as the survey subjects. A questionnaire survey, physical examination, and morning urinary fluoride level testing were conducted. The least absolute shrinkage and selection operator (Lasso) regression were used to analyze the key influencing factors of hypertension. Restricted cubic spline was used to evaluate the linear relationship between urinary fluoride and hypertension. Logistic regression was used to analyze the impact of urinary fluoride on hypertension.Results:Finally, 2 453 survey subjects were included, aged (62 ± 10) years, including 1 565 patients (63.80%) with hypertension. There were significant differences in the distribution of age, gender, education level, annual household income, body mass index (BMI), and the level and distribution of urinary fluoride between hypertension group and normal blood pressure group ( P < 0.05). The Lasso regression results showed that age, education level, BMI, and urinary fluoride were the key influencing factors of hypertension, with coefficients of 1.04, - 0.12, 0.24 and 0.01, respectively. The results of the restricted cubic spline showed that there was a linear relationship between urinary fluoride and hypertension after adjusting for age, education level, and BMI ( Poverall = 0.018, Pnonlinear = 0.482). The logistic regression results showed that after adjusting for age, education level, and BMI, urinary fluoride > 4.68 mg/L was a risk factor for hypertension ( OR = 1.42, 95% CI: 1.10 - 1.84, P = 0.007). Conclusion:High urinary fluoride is a risk factor for hypertension in drinking water-borne endemic fluorosis areas of Jishan County, Shanxi Province.

Objective:To investigate the predictive value of tumor morphology in hepatoce-llular carcinoma (HCC) immunotherapy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinical data of 227 HCC patients who underwent immunotherapy in The First Affiliated Hospital of University of Science and Technology of China from January 2021 to December 2023 were collected. There were 203 males and 24 females, aged (57±11)years. Of the 227 patients, 93 patients with regular tumor morphology of HCC evaluated by computed tomography (CT) or magnetic resonance imaging (MRI) were divided into the regular morphology group, and 134 patients with irregular tumor morphology of HCC evaluated by CT or MRI were divided into the irregular morphology group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) analysis of factors affecting prognosis of patients; (3) prognosis of patients after propensity score matching. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve. The Log-rank test was used for survival analysis. The Cox proportional hazards regression model was used for univariate and multivariate analyses. Propensity score matching was done by the 1∶1 nearest neighbor matching method, with a caliper value of 0.02. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 227 HCC patients undergoing immunotherapy, 164 cases were successfully matched, including 82 cases in the regular morphology group and 82 cases in the irregular morphology group. After propensity score matching, the elimination of patients who underwent radical surgical resection in the past, tumor number and alpha fetoprotein confounding bias ensured comparability between the two groups. (2) Analysis of factors affecting prognosis of patients. Results of multivariate analysis showed that body mass index ≥25 kg/m 2 and irregular tumor morphology were independent risk factors affecting overall survival time of patients ( hazard ratio=0.891, 1.870, 95% confidence interval as 0.825-0.963, 1.151-3.038, P<0.05). (3) Prognosis of patients after propensity score matching. After propensity score matching, the median progression-free survival time was 11.9(95% confidence interval as 9.2-16.1)months for patients in the regular tumor morphology group and 6.4(95% confidence interval as 4.4-8.1)months for patients in the irregular tumor morphology group, the 1-year progress-free survival rate was 48.48% for patients in the regular tumor morphology group and 22.25% for patients in the irregular tumor morphology group. There was a significant difference in progress-free survival between patients in the regular tumor morphology group and the irregular tumor morphology group ( χ2=16.000, P<0.05). The median overall survival time was 27.2(95% confidence interval as 23.7-not reached)months for patients in the regular tumor morphology group and 18.1 (95% confidence interval as 15.8-20.8)months for patients in the regular tumor morphology group, the 1-year overall survival rate was 83.27% for patients in the regular tumor morphology group and 66.98% for patients in the irregular tumor morphology group. There was a significant difference in overall survival between patients in the regular tumor morphology group and the irregular tumor morphology group ( χ2=13.400, P<0.05). Conclusions:Tumor morphology has a predictive value for the efficacy of immunotherapy for HCC. Compared with HCC patients of regular tumor morphology, immunotherapy is less effective in patients with irregular tumor morphology.

Objective To investigate the role and molecular mechanism of SOX4 in Helicobacter pylori(H.pylori)-mediated gastric mucosal epithelial dysplasia.Methods The expression of SOX4 in gastric tissues and cells was analyzed with reverse transcription-polymerase chain reaction(RT-PCR),Western blotting,and immunohistochemical staining.The effects of SOX4 on gastric epithelial cell proliferation and colony formation were determined with CCK-8 and colony formation assays.A PCR array was used to screen downstream target genes involved in H.pylori-induced dysplasia mediated by SOX4.The transcriptional regulation and binding sites of the target gene MLH3 by SOX4 were elucidated with luciferase reporter assay,promoter truncation assay,and chromatin immunoprecipitation(ChIP).Results SOX4 expression was significantly increased in H.pylori-infected gastric tissues(P<0.05).Overexpression of SOX4 markedly enhanced the proliferation and colony formation abilities of normal gastric epithelial cells(P<0.05).Elevated SOX4 led to the dysregulation of MLH3 and other DNA damage repair-related molecules after H.pylori infection in gastric epithelial cells(|logFC|>1,P<0.05).H.pylori promoted MLH3 expression in gastric epithelial cells through SOX4.SOX4 transcriptionally activated MLH3 expression by binding to the 5th site of the MLH3 promoter.The increased expression of SOX4 and MLH3 is associated with poor prognosis of gastric cancer patients.Conclusion SOX4 is closely associated with H.pylori-induced dysplasia in gastric epithelial cells.Upregulation of SOX4 promotes H.pylori-related dysplasia by transcriptionally activating MLH3,leading to the imbalance of proliferation and colony formation in gastric epithelial cells.

BACKGROUND:Postoperative fever is one of the common clinical symptoms after posterior lumbar interbody fusion. There is no clear etiology or pathogenesis. The postoperative body temperature of patients is easy to repeat,the course of the disease is long,and the therapeutic effect of western medicine is poor,which affects the postoperative recovery of patients. OBJECTIVE:To review the relationship between inflammatory signaling pathways and postoperative fever and the mechanism of Chinese medicine inpreventing and treating fever after posterior lumbar interbody fusion,and to explore new therapeutic drugs for postoperative fever.METHODS:The CNKI Chinese Journal full-text database,WanFang database,and PubMed database were searched for articles published from June 2006 to December 2023. Chinese search terms were "Chinese medicine,postoperative fever,inflammation,interleukin-1,interleukin-6,interleukin-8,interferon gamma,tumor necrosis factor,prostaglandin E2,p38 mitogen-activated protein kinase,nuclear factor-κB,Toll-like receptor,Janus kinases/signal transduction and transcriptional activator,Notch signaling pathway." English search terms were "medicinal herb,postoperative fever,inflammation,interleukin-1,interleukin-6,interleukin-8,γ-interferon,tumor necrosis factor,prostaglandin E2,p38 mitogen-activated protein kinase,nuclear factor-κB,toll-like receptor,janus kinases/signal transducer and activator of transcription,notch signaling pathway." Articles with irrelevant research content and poor quality were excluded,and 100 articles were included and summarized.RESULTS AND CONCLUSION:(1) The operation induced the release of inflammatory factors,and the pro-inflammatory factors acted on the thermoregulatory center in the anterior hypothalamus to promote fever. (2) The absorption of bleeding and oozing fluid in the incision after surgery,and the phagocytosis of the egg white decomposition products of the necrotic cells,produce endogenous pyrogen (interleukin,tumor necrosis factor,interferon,etc.),leading to fever. (3) Cytokines pass through inflammatory signals,play an inflammatory role,and promote fever. (4) Chinese herbs or Chinese herbal compounds can regulate inflammatory signaling pathways and play an anti-inflammatory and antipyretic role in preventing and treating postoperative fever. Due to the lack of the mechanism of action of traditional Chinese medicine,it is necessary to further study and clarify the signaling pathways related to the prevention and treatment of postoperative fever by traditional Chinese medicine,and use modern technology to link cellular and molecular technology with the pharmacological mechanism of traditional Chinese medicine,so as to guide clinicians to use medicine and promote postoperative recovery of patients. (5) Chinese medicine combined with Western medicine in the treatment of postoperative fever is a future research hotspot. We should give full play to the advantages of Chinese medicine,and clarify the target mechanism of action of different syndrome types of Chinese medicine monomer or active ingredient extracts and Chinese medicine decoction.

With the rapid advancement and iterative development of new artificial intelligence technologies, there remains a regulatory vacuum in corresponding governance measures among governments worldwide. Simultaneously, a technological and governance gap exists between developing countries and developed economies. In response, the World Health Organization (WHO) has released "Ethics and Governance of Artificial Intelligence for Health: Guidance on Large Multi-Modal Models" to assist governments in strengthening governance capabilities in this field. This paper provides an in-depth analysis of the Guidance, aiming to identify challenges and risks associated with the application of multimodal large models in healthcare. Guided by ethical principles for advancing health through artificial intelligence, the paper examines the three-tier governance framework and recommendations outlined in the Guidance. Additionally, it evaluates the current state of AI governance in China, offering insights and reference points for improving AI governance in China′s healthcare sector.

Malignant tumors (commonly referred to as cancer) represent a major global public health challenge and contribute significantly to the worldwide disease burden. Early screening plays a critical role in improving detection rates, enabling timely intervention, and enhancing patient survival rates. However, current cancer screening guidelines primarily focus on site-specific screening, which may not fully address the need for comprehensive early detection. A scientifically rational, multi-cancer screening approach offers several advantages: it optimizes the use of biological samples, reduces time costs for participants, enhances the efficiency and comprehensiveness of screening, and minimizes overall expenses. Such an approach also facilitates the rational allocation of healthcare resources, ultimately helping to reduce the societal burden of cancer. To address this need, the Cancer Epidemiology Committee of the Chinese Anti-Cancer Association has developed the Expert Consensus on Combined Screening for Common Cancers in China. This consensus integrates multidisciplinary expertise and synthesizes the latest domestic and international researches on cancer screening, early detection, and treatment for prevalent malignancies. Drawing upon China's unique demographic and healthcare context, as well as practical screening experiences, the consensus provides evidence-based recommendations on target populations, screening technologies, and procedural workflows for multi-cancer screening. These guidelines align with the principles and methodologies established by the World Health Organization (WHO), aiming to enhance the effectiveness of combined cancer screening in China, improve early detection rates, and provide a scientific foundation for national cancer prevention and control strategies.

AIM:To investigate the therapeutic effects and potential mechanism of pachymic acid(PA)on li-popolysaccharide(LPS)-induced acute kidney injury(AKI)in mice.METHODS:(1)Genes related to AKI were screened using the DAVID database.Core genes were identified by intersecting related genes and analyzed using Cyto-scape software.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)analyses were performed through the DAVID database for the cross-targets.Molecular docking and activity assays were conducted on the primary core targets.(2)A total of 100 C57BL/6J mice were randomly divided into five groups:normal control(NC),model(LPS),solvent control(LPS+DMSO),and treatment groups(LPS+PA-10 and LPS+PA-20),with 20 mice in each group.The LPS-AKI model was established by intraperitoneal injection of 18 mg/kg LPS.The treatment groups received 10 mg/kg and 20 mg/kg PA,respectively,and the solvent control group was administered an equivalent dose of DMSO.Mice were euthanized 24 h after injection.Serum was collected for biochemical analysis,and Western blot was used to detect neutro-phil gelatinase-associated lipocalin(NGAL),kidney injury molecule-1(KIM-1),caspase-3,cleaved caspase-3,interleu-kin-1β(IL-1β),and monocyte chemoattractant protein-1(MCP-1)protein expression.RT-qPCR was employed to detect inflammatory factor mRNA levels.Molecular docking was used to simulate the optimal binding site of PA to caspase-3.En-zyme activity assays were performed to assess caspase protein activity,and renal lesions were observed via hematoxylin and eosin(HE)staining.Apoptosis was detected by TUNEL staining.RESULTS:(1)Thirty-one potential targets of PA against AKI were identified through network pharmacology.GO and KEGG enrichment analyses indicated that these tar-gets were primarily involved in immune response,inflammatory processes,apoptosis and survival,angiogenesis and hemo-dynamics,oxidative stress,and endoplasmic reticulum stress.Key targets included CASP3(caspase-3),PTGS2,BCL2,CCL2,and CYP219.(2)PA treatment improved renal function and reduced tubular epithelial injury.It significantly de-creased NGAL,KIM-1,and cleaved caspase-3 protein levels,as well as inflammatory factors TNF-α,IL-1β,and MCP-1 mRNA and protein expression.PA also reduced apoptosis of renal tubular epithelial cells.Enzyme activity assays and mo-lecular docking revealed that PA exerted its anti-apoptotic effect by directly binding to caspase-3,thereby inhibiting its ac-tivation by caspase-8.CONCLUSION:PA demonstrated a therapeutic effect in LPS-AKI,potentially through the inhibi-tion of inflammatory factor synthesis and release,as well as the inhibition of caspase-3 activation by caspase-8,reducing apoptosis in renal tubular epithelial cells.

BACKGROUND:Postoperative fever is one of the common clinical symptoms after posterior lumbar interbody fusion. There is no clear etiology or pathogenesis. The postoperative body temperature of patients is easy to repeat,the course of the disease is long,and the therapeutic effect of western medicine is poor,which affects the postoperative recovery of patients. OBJECTIVE:To review the relationship between inflammatory signaling pathways and postoperative fever and the mechanism of Chinese medicine inpreventing and treating fever after posterior lumbar interbody fusion,and to explore new therapeutic drugs for postoperative fever.METHODS:The CNKI Chinese Journal full-text database,WanFang database,and PubMed database were searched for articles published from June 2006 to December 2023. Chinese search terms were "Chinese medicine,postoperative fever,inflammation,interleukin-1,interleukin-6,interleukin-8,interferon gamma,tumor necrosis factor,prostaglandin E2,p38 mitogen-activated protein kinase,nuclear factor-κB,Toll-like receptor,Janus kinases/signal transduction and transcriptional activator,Notch signaling pathway." English search terms were "medicinal herb,postoperative fever,inflammation,interleukin-1,interleukin-6,interleukin-8,γ-interferon,tumor necrosis factor,prostaglandin E2,p38 mitogen-activated protein kinase,nuclear factor-κB,toll-like receptor,janus kinases/signal transducer and activator of transcription,notch signaling pathway." Articles with irrelevant research content and poor quality were excluded,and 100 articles were included and summarized.RESULTS AND CONCLUSION:(1) The operation induced the release of inflammatory factors,and the pro-inflammatory factors acted on the thermoregulatory center in the anterior hypothalamus to promote fever. (2) The absorption of bleeding and oozing fluid in the incision after surgery,and the phagocytosis of the egg white decomposition products of the necrotic cells,produce endogenous pyrogen (interleukin,tumor necrosis factor,interferon,etc.),leading to fever. (3) Cytokines pass through inflammatory signals,play an inflammatory role,and promote fever. (4) Chinese herbs or Chinese herbal compounds can regulate inflammatory signaling pathways and play an anti-inflammatory and antipyretic role in preventing and treating postoperative fever. Due to the lack of the mechanism of action of traditional Chinese medicine,it is necessary to further study and clarify the signaling pathways related to the prevention and treatment of postoperative fever by traditional Chinese medicine,and use modern technology to link cellular and molecular technology with the pharmacological mechanism of traditional Chinese medicine,so as to guide clinicians to use medicine and promote postoperative recovery of patients. (5) Chinese medicine combined with Western medicine in the treatment of postoperative fever is a future research hotspot. We should give full play to the advantages of Chinese medicine,and clarify the target mechanism of action of different syndrome types of Chinese medicine monomer or active ingredient extracts and Chinese medicine decoction.

AIM:To investigate the therapeutic effects and potential mechanism of pachymic acid(PA)on li-popolysaccharide(LPS)-induced acute kidney injury(AKI)in mice.METHODS:(1)Genes related to AKI were screened using the DAVID database.Core genes were identified by intersecting related genes and analyzed using Cyto-scape software.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)analyses were performed through the DAVID database for the cross-targets.Molecular docking and activity assays were conducted on the primary core targets.(2)A total of 100 C57BL/6J mice were randomly divided into five groups:normal control(NC),model(LPS),solvent control(LPS+DMSO),and treatment groups(LPS+PA-10 and LPS+PA-20),with 20 mice in each group.The LPS-AKI model was established by intraperitoneal injection of 18 mg/kg LPS.The treatment groups received 10 mg/kg and 20 mg/kg PA,respectively,and the solvent control group was administered an equivalent dose of DMSO.Mice were euthanized 24 h after injection.Serum was collected for biochemical analysis,and Western blot was used to detect neutro-phil gelatinase-associated lipocalin(NGAL),kidney injury molecule-1(KIM-1),caspase-3,cleaved caspase-3,interleu-kin-1β(IL-1β),and monocyte chemoattractant protein-1(MCP-1)protein expression.RT-qPCR was employed to detect inflammatory factor mRNA levels.Molecular docking was used to simulate the optimal binding site of PA to caspase-3.En-zyme activity assays were performed to assess caspase protein activity,and renal lesions were observed via hematoxylin and eosin(HE)staining.Apoptosis was detected by TUNEL staining.RESULTS:(1)Thirty-one potential targets of PA against AKI were identified through network pharmacology.GO and KEGG enrichment analyses indicated that these tar-gets were primarily involved in immune response,inflammatory processes,apoptosis and survival,angiogenesis and hemo-dynamics,oxidative stress,and endoplasmic reticulum stress.Key targets included CASP3(caspase-3),PTGS2,BCL2,CCL2,and CYP219.(2)PA treatment improved renal function and reduced tubular epithelial injury.It significantly de-creased NGAL,KIM-1,and cleaved caspase-3 protein levels,as well as inflammatory factors TNF-α,IL-1β,and MCP-1 mRNA and protein expression.PA also reduced apoptosis of renal tubular epithelial cells.Enzyme activity assays and mo-lecular docking revealed that PA exerted its anti-apoptotic effect by directly binding to caspase-3,thereby inhibiting its ac-tivation by caspase-8.CONCLUSION:PA demonstrated a therapeutic effect in LPS-AKI,potentially through the inhibi-tion of inflammatory factor synthesis and release,as well as the inhibition of caspase-3 activation by caspase-8,reducing apoptosis in renal tubular epithelial cells.