The decrease in blood glucose in perinatal dairy cows affects the energy supply and im-mune function of peripheral blood neutrophils(PMN).Fibroblast growth factor 21(FGF21)is an important regulator of glucose metabolism,and serum FGF21 levels in some perinatal cows are significantly elevated after farrowing.In order to explore the effect of FGF21 on PMN glucose ho-meostasis in perinatal dairy cows,the cows were divided into high FGF21 group(high FGF21,n=8,FGF21＞800 ng/L)and low FGF21 group(low FGF21,n=8,FGF21＜200 ng/L)within 3 weeks postpartum.The results showed that compared with the low FGF21 group,the glucose up-take of PMN and the mRNA expression of glucose transporters SLC2A1 and SLC2A3 were signifi-cantly increased in the high FGF21 group.The activities of phosphofructokinase 1(PFK1)and glu-cose-6-phosphate dehydrogenase(G6PDH)were significantly increased,and the activity of glyco-gen synthase(GCS)was significantly decreased in PMN in the high FGF21 group.The lactate con-tent and ATP content of PMN were significantly increased,and the mRNA and protein expressions of hexokinase(HK2)and PFK1 were significantly increased in the high FGF21 group.These re-sults indicated that the uptake and utilization of glucose by PMN in perinatal peripheral blood FGF21 increased to ensure the ATP supply of PMN,which provided a theoretical basis for the pro-posal of a new strategy to alleviate immunosuppression in perinatal dairy cows.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

The decrease in blood glucose in perinatal dairy cows affects the energy supply and im-mune function of peripheral blood neutrophils(PMN).Fibroblast growth factor 21(FGF21)is an important regulator of glucose metabolism,and serum FGF21 levels in some perinatal cows are significantly elevated after farrowing.In order to explore the effect of FGF21 on PMN glucose ho-meostasis in perinatal dairy cows,the cows were divided into high FGF21 group(high FGF21,n=8,FGF21＞800 ng/L)and low FGF21 group(low FGF21,n=8,FGF21＜200 ng/L)within 3 weeks postpartum.The results showed that compared with the low FGF21 group,the glucose up-take of PMN and the mRNA expression of glucose transporters SLC2A1 and SLC2A3 were signifi-cantly increased in the high FGF21 group.The activities of phosphofructokinase 1(PFK1)and glu-cose-6-phosphate dehydrogenase(G6PDH)were significantly increased,and the activity of glyco-gen synthase(GCS)was significantly decreased in PMN in the high FGF21 group.The lactate con-tent and ATP content of PMN were significantly increased,and the mRNA and protein expressions of hexokinase(HK2)and PFK1 were significantly increased in the high FGF21 group.These re-sults indicated that the uptake and utilization of glucose by PMN in perinatal peripheral blood FGF21 increased to ensure the ATP supply of PMN,which provided a theoretical basis for the pro-posal of a new strategy to alleviate immunosuppression in perinatal dairy cows.

OBJECTIVE To summarize the clinical characteristics and diagnosis and treatment experiences in dealing with non-severe Chlamydia psittaci pneumonia.METHODS The clinical data were collected from 34 patients who were diagnosed with non-severe C.psittaci pneumonia through quantitative polymerase chain reactiong(qPCR)for sputum in fever clinic of the First Medical Center of Chinese PLA General Hospital from Mar.2023 to Mar.2024 and were retrospectively analyzed.The clinical characteristics and treatment outcomes were evaluated.RESULTS The average age of the patients was(44.82±13.74)years old,the ratio of male to female was 1∶1.83;all of the patients had fever;major symptoms were cough(70.59％),pharyngodynia(44.12％),and flu-like symptoms(41.18％);82.35％of the patients had the history of contact with poultry.The C-reactive pro-tein(CRP)level,interleukin-6(IL-6),systemic inflammatory response index(SIRI)and aggregate index of sys-temic inflammation(AISI)were higher among the patients aged no less than 44 years old than among the patients less than 44 years old(P＜0.05);the percentage of lymphocytes of the patients aged no less than 44 years old was lower than that of the patients aged less than 44 years old(P＜0.05).As for the imaging findings,73.53％of the patients had consolidation shadows,26.47％had ground-glass opacities,and 32.35％involved both lungs.All of the patients received quinolones or tetracyclines for treatment of 7-14 days and all symptoms relieved.CT reexami-nated 1 month after the treatment showed that 55.88％of the cases had complete absorption of pulmonary infec-tious lesions,and 35.29％had partial absorption.CONCLUSIONS The patients with non-severe Chlamydia psitta-ci pneumonia are characterized by the history of contact with poultry,fever complicated with respiratory tract symptoms,rise of inflammatory markers(more significant among patients of advanced age)and lower lobe con-solidation shadow/ground-glass opacities.Early identification and standardized treatment may facilitate the favora-ble treatment outcomes.

OBJECTIVE To summarize the clinical characteristics and diagnosis and treatment experiences in dealing with non-severe Chlamydia psittaci pneumonia.METHODS The clinical data were collected from 34 patients who were diagnosed with non-severe C.psittaci pneumonia through quantitative polymerase chain reactiong(qPCR)for sputum in fever clinic of the First Medical Center of Chinese PLA General Hospital from Mar.2023 to Mar.2024 and were retrospectively analyzed.The clinical characteristics and treatment outcomes were evaluated.RESULTS The average age of the patients was(44.82±13.74)years old,the ratio of male to female was 1∶1.83;all of the patients had fever;major symptoms were cough(70.59％),pharyngodynia(44.12％),and flu-like symptoms(41.18％);82.35％of the patients had the history of contact with poultry.The C-reactive pro-tein(CRP)level,interleukin-6(IL-6),systemic inflammatory response index(SIRI)and aggregate index of sys-temic inflammation(AISI)were higher among the patients aged no less than 44 years old than among the patients less than 44 years old(P＜0.05);the percentage of lymphocytes of the patients aged no less than 44 years old was lower than that of the patients aged less than 44 years old(P＜0.05).As for the imaging findings,73.53％of the patients had consolidation shadows,26.47％had ground-glass opacities,and 32.35％involved both lungs.All of the patients received quinolones or tetracyclines for treatment of 7-14 days and all symptoms relieved.CT reexami-nated 1 month after the treatment showed that 55.88％of the cases had complete absorption of pulmonary infec-tious lesions,and 35.29％had partial absorption.CONCLUSIONS The patients with non-severe Chlamydia psitta-ci pneumonia are characterized by the history of contact with poultry,fever complicated with respiratory tract symptoms,rise of inflammatory markers(more significant among patients of advanced age)and lower lobe con-solidation shadow/ground-glass opacities.Early identification and standardized treatment may facilitate the favora-ble treatment outcomes.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

Cervical lymph node metastasis in thyroid cancer is closely related to the disease recurrence and prognosis of patients. Accurate judgment of lymph node metastasis is vital for tumor stage and treatment in patients with thyroid cancer, which can effectively improve the prognosis of patients. However, preoperative detection of cervical lymph node metastasis is the key points and difficulties in individualized treatment of thyroid cancer. Currently, fine needle aspiration washout fluid thyroglobulin is often used to assess cervical lymph node metastasis of differentiated thyroid cancer preoperatively, and it has a higher diagnostic efficacy. The continuous exploration and application of tumor markers and emerging biomarkers have provided new perspectives for the preoperative diagnosis of lymph node metastasis in thyroid cancer. As a new non-invasive detection technique, liquid biopsy is convenient to obtain samples and has broad clinical application in early diagnosis of cervical lymph node metastasis of thyroid cancer. In addition, the analysis and application of liquid biopsy biomarkers will help the development of clinical diagnosis and treatment strategies, and provide the possibility of early precision therapy for thyroid cancer patients. This review summarizes current research surrounding the molecular markers related to cervical lymph node metastasis of thyroid cancer.

Circular RNA(circRNA)is an emerging class of endogenous non-coding RNA,which is widely expressed in the brain and plays an important role in a variety of biological processes.Research has shown that circRNA plays a key role in physiological and pathological processes of the brain,such as neurodevelopment,synaptic plasticity and neurodegenerative diseases through a variety of mecha-nisms such as adsorption of microRNA,binding to proteins and translation of peptides.In the field of drug addiction,the expression of circRNA is significantly changed in animal models and brains of addicts,and the regulation involves neural adaptation in brain regions that form the reward circuit such as the nucleus accumbens and prefrontal cortex.Additionally,addiction-related circRNAs are closely associated with neurotransmitter systems,signaling pathways,and neuroinflammatory responses,and they influ-ence the formation and maintenance of drug addiction by modulating gene expression networks related to drug addiction.Here,the biogenesis and regulatory mechanism of circRNA as well as its important role in brain function and drug addiction are reviewed in order to provide a new perspective for explora-tions of the pathological mechanism of drug addiction.

Objective To comparatively observe the incidence of complications and patency rate within 1 year after implantation of totally implantable venous access port(TIVAP)through internal jugular vein(IJV)between different locations of catheter tip.Methods Data of 2 104 patients with tumors who received TIVAP implantation through IJV were retrospectively analyzed.Patients who underwent TIVAP implantation through the right IJV(group R,n=1 903)were divided into R1(n=376,with catheter tip located at the upper right atrium,i.e.0.5 to 1.0 cm below the cavoatrial junction[CAJ])and R2 subgroups(n=1 527,with catheter tips located between the lower 1/3 of superior vena cava[SVC]and CAJ),while those who underwent TIVAP implantation through the left IJV(group L,n=201)were divided into L1(n=64)and L2 subgroups(n=137),respectively.Patients'basic information,incidence of complication and patency rate of catheter 1 year after TIVAP implantation were collected and compared between subgroups.Results No significant difference of gender,age,clinical diagnosis,tumor stage,nor of incidence of complication including pneumothorax/hemopneumothorax,local skin injury,TIVAP infection,catheter-associated thrombosis,drug extravasation,catheter displacement and arrhythmia was found between subgroups within group R nor L(all P＞0.05).One year after TIVAP implantation,no significant difference of catheter patency rates was found between subgroup R1(94.15%)and R2(93.78%)(χ2=0.069,P=0.793),nor between subgroup L1(98.44%)and L2(89.78%)(Yates'continuity correction χ2=3.563,P=0.059).Conclusion No significant difference of incidence of complications nor catheter patency rate within 1 year after implantation of TIVAP was found between catheter tip location at the upper right atrium or between the lower 1/3 of SVC and CAJ through the right or left IJC.

Objective To construct a radiomic model based on intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI ) for preoperative prediction of hepatocellular carcinoma (HCC ) differentiation and validate its clinical value.Methods Clinical and imaging data of 187 HCC patients who received surgical treatment in the Third Affiliated Hospital of Chongqing Medical University from June 2018 to January 2024 were collected and retrospectively analyzed.According to the postoperative pathological results,they were divided into low-differentiation group (n=58)and non-low-differentiation group (n=129),andrandomly divided into the training group (n=149)and the validation group (n=38)with the ratio of 8∶2. Univariate analysis was used to assess the clinical indicators related to HCC differentiation,and then a clinical model was constructed. Pyramidimics software was used to extract the radiomic features of IVIM-DWI functional images,and minimum absolute contraction and selection operator logistic regression algorithm were employed to screen those highly correlated indicators with HCC differentiation.Support vector machine (SVM),logistic regression (LR)and random forest (RF)algorithms were utilized to construct different image omics models.SVM algorithm was applied to construct the combined imaging omics and clinical model. The internal verification of the model was carried out by using ten-fold cross-validation.Receiver operating characteristic (ROC)curve,area under the curve (AUC),calibration curve,and decision curve analysis (DCA)were used to evaluate the diagnostic value and clinical benefits of clinical model,radiomic model,and their combination.Results A total of 4060 radiological features were extracted,and after feature screening and dimensionality reduction,24 features were finally included to construct the model.Among all models,the predictive performance of the radiomic model and the radiomic-clinical combined model was better than that of the clinical model.In the comparison between the radiomic model constructed by SVM algorithm and the radiomics-clinical combined model,the AUC value was 0.954 (0.908～1.000)for the former model,and was 0.943 (0.905～0.982)for the latter model in the training set,and there was no significant difference between them.In the validation set,the AUC value was 0.807 (0.640～0.975 )and 0.876 (0.743～1.000),respectively,with statistical difference between the 2 models (P<0.05).Calibration curve analysis showed that the radiomic model and the radiomics-clinical combined model had good goodness of fit.DCA indicated that the net benefit was higher and the threshold probability range was larger in both the radiomic model and the radiomics-clinical combined model,and the net benefit of the combined model was larger. Conclusion Both the radiomic model and the combined radiomics-clinical model constructed on the basis of IVIM-DWI functional images can better predict the severity of HCC differentiation before surgery.