In November 2024， the Expert Group on Alcohol-related Liver Disease released a position statement on metabolic dysfunction and alcohol-related liver disease （MetALD）. MetALD is a new subtype of steatotic liver disease and refers to MASLD patients with a relatively large amount of alcohol consumption. The position statement points out the importance of accurate evaluation of alcohol consumption and recommends to quantify alcohol consumption using standard methods and alcohol biomarkers， and a comprehensive diagnosis should be made based on metabolic risk factors. In addition， the position statement analyzes the influence of drinking pattern on the diagnosis of MetALD and recommends to consider long-term drinking history during typing. The position statement also discusses the complex association between drinking and the diseases including metabolic syndrome， hepatic steatosis， fibrosis， and type 2 diabetes mellitus， and it is pointed out that the hierarchical management of patients should be optimized based on liver histological models and noninvasive models. The position statement elaborates on the definition of MetALD， drinking assessment， the interaction between alcohol use and metabolic dysfunction， and the methods for comprehensive management of MetALD， in order to facilitate learning and provide guidance for clinicians and researchers in clinical practice.

ObjectiveTo understand the prevalence of hookworm infection and its relevant behavioral factors in rural areas of Tiantai County， Zhejiang Province， and to provide scientific evidence for prevention and control of hookworm disease. MethodsBy using a stratified cluster random sampling strategy， local residents aged ≥3 years was divided into 5 districts according to geographical location； furthermore， those in one administrative village （surveillance site） were investigated in each district. Species of hookworm were identified by filter paper culture in vitro， and enterobius vermicularis eggs were detected by cellophane anal swab in children aged 3‒9 year. Risk factors were determined by questionnaire. ResultsA total of 1 013 residents were investigated in 5 surveillance sites. Thirty nine cases with hookworm infection were detected， with the total infection rate of 3.85% . All species detected were determined to be Necator americanus. The infection rate significantly differed across the towns （χ²=48.32， P<0.05）， with the highest rate in Nanping Town （10.95%） . It significantly differed by age groups （χ²=65.65， P<0.05）， with the highest rate in those aged >70 years （9.75%）. Furthermore， it decreased with educational background. It was significantly associated with fertilize with fresh manure （χ²=6.87， P<0.05） and barefoot labor （χ²=157.69， P<0.05）. ConclusionThe overall infection rate of hookworm in Tiantai County remains low. Dominant species of hookworm is hookworm Necator americanus. It is necessary to strengthen the advocacy of hookworm prevention and control knowledge， improve hygiene in work and life style， and increase self-protection awareness.

Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.

Objective To observe the value of shear wave elastography(SWE),superb microvascular imaging(SMI)and their combination with conventional ultrasound for diagnosing cervical cancer.Methods Data of 178 patients with cervical lesion confirmed by pathology were retrospectively analyzed.The patients were divided into malignant group(n=32)and benign group(n=146),and those in benign group were further divided into low-grade or high-grade cervical intraepithelial neoplasia subgroups,cervical leiomyosarcoma subgroup,cervical polyps subgroup and cervicitis subgroup.The manifestations of lesion on conventional ultrasound,SWE and SMI were observed,and the mean value of Young's modulus(Emean)and SMI flow index(Ratio)were collected.The optimal cut-off value of SWE Emean and SMI Ratio were obtained with receiver operating characteristic(ROC)curves,and the classification of benign or malignant lesions were predicted.The consistency of predictive results and pathology results were assessed with the Kappa test.The diagnostic efficacies of conventional ultrasound,SWE and SMI alone and their combination were compared.Results The age of patients in malignant group was higher than that in benign group(P＜0.05).SWE Emean and SMI Ratio were both higher in malignant group than those in each benign subgroup(all P＜0.05).Taken 44.35 kPa and 3.95％ as the best cut-off values,the consistency of SWE Emean classification results and pathological results was good(Kappa=0.818),while of SMI Ratio was moderate(Kappa=0.453).The efficacy of conventional ultrasound,SWE and SMI alone for classifying benign and malignant cervical lesions(AUC=0.845,0.914,0.892)were all higher than that of their combination(AUC=0.806,all adjusted P＜0.05).The sensitivity of SWE and SMI for diagnosing cervical cancer was 90.60％ and 93.78％ respectively,with specificity of 95.20％ and 72.60％,respectively.Conclusion SWE hag higher efficacy for diagnosing cervical cancer,while SMI had better sensitivity but lower specificity.Combination of conventional ultrasound,SWE and SWI did not increase the efficacy of ultrasound for diagnosing cervical cancer.

ObjectiveIn recent years， with the sharp decline of wild resources in Arisaematis Rhizoma and Pinelliae Rhizoma and the immaturity of medicinal cultivation technology， their adulterants have appeared frequently in the market， and the main identifying characteristics have mostly disappeared in the circulation of medicinal materials. Therefore， there is an urgent need to establish a molecular identification method that can quickly and effectively identify the specificity of Arisaematis Rhizoma and Pinelliae Rhizoma. MethodAfter comparison of the rbcL sequences of Arisaematis Rhizoma，Pinelliae Rhizoma， and their adulterants， the specific enzyme cleavage sites Hae Ⅲ and Dra Ⅰ of Arisaematis Rhizoma and Pinelliae Rhizoma， respectively， were selected and identified by polymerase chain reaction-restriction fragment length polymorphism（PCR-RFLP）. The main system conditions of PCR-RFLP reaction were established and optimized， and their durability and the ability to detect genuine， adulterants， and mixed counterfeits were investigated. ResultThe PCR-RFLP identification method of Arisaematis Rhizoma and Pinelliae Rhizoma was established. After specific primer amplification， Arisaematis Rhizoma and Pinelliae Rhizoma could be digested by Hae Ⅲ and Dra Ⅰ-restricted endonucleases respectively， at annealing temperature of 54 ℃， the number of cycles of 35， and the amount of DNA template of 3-30 ng， producing two fragments or small cut fragments with a single band between 100-250 bp， whereas the mixed counterfeits were not cleaved and both showed a band at 250 bp. The method is highly accurate in identifying adulterants and mixed counterfeits of Arisaematis Rhizoma or Pinelliae Rhizoma. ConclusionThe PCR-RFLP method developed in this study allows for the rapid identification of Arisaematis Rhizoma and Pinelliae Rhizoma.

The International Agency for Research on Cancer (IARC) defines shift work as any arrangement of daily working hours other than the standard daylight hours (typically 7:00/8:00 am–5:00/6:00 pm). To meet the needs of rapid socioeconomic development, shift work is becoming more and more common. The impact of shift work, especially night shift work, on human health cannot be ignored. Female's health is not only important to the well-being of themselves, but also has a far-reaching impact on their children and even their entire family. Increasing epidemiological studies have focused on the effects of night shift work on female's reproductive health. This article reviewed epidemiological evidence of the associations between night shift work and reproductive outcomes, e.g. menstrual cycle, endometriosis, pregnancy rate, adverse pregnancy outcomes, and ovarian cancer. The potential biological mechanisms connecting night shift work to female reproductive health were also introduced, e.g. melatonin regulation, clock gene regulation, and sex hormone regulation. Through this review, we propose to provide a reference for determining occupational risk factors, conducting subsequent relevant studies, and formulating rational health promotion strategies.

Objective:To explore the effect of methamphetamine (MA) dependence on the attention of female youth, and to analyze the intervention effect of computer-based cognitive training on the attention of MA-dependent female youth.Method:From May to August 2021, a total of 64 MA-dependent female youths in abstinence period from a women's compulsory isolated drug rehabilitation center in Sichuan Province were selected as the MA group, and 53 ordinary female youths matched with their age and education level were selected as the normal control group.According to the matching principle of age, education level, and attention pre-test scores, the subjects in MA-dependent group were divided into MA-dependent intervention group( n=30)and MA-dependent waiting group( n=34). CogniPlus cognitive training system was used to train the attention of subjects in MA-dependent intervention group( n=30), while the subjects in MA-dependent waiting group( n=34) and normal control group did not receive training.The Vienna Test System was used to collect the attention scores of all subjects.SPSS 20.0 analysis software was used for data processing.Statistical analysis was performed using independent samples t test and paired samples t test. Results:The MA-dependent group had significantly longer endogenous alertness, temporary alertness, and concentration response time ((275.61±47.79)ms, (268.63±51.41)ms, (444.08±134.40)ms) compared with the normal control group ((247.02±34.09)ms, (237.60±46.04)ms, (355.15±44.37)ms) ( t=3.767, 3.405, 4.976; all P<0.05). After attention training, the post-test reaction time of endogenous alertness, temporary alertness, and concentration ((264.10±38.98)ms, (251.67±38.06)ms, (352.03±65.70)ms) in the MA-dependent intervention group were significantly shorter than those in the MA-dependent waiting group ((323.18±83.28)ms, (302.74±82.75)ms, (402.76±74.34)ms) ( t=-3.702, -3.232, -2.876; all P<0.05). The post-test reaction time of temporary alertness and concentration in the MA-dependent intervention group ((251.67±38.06)ms, (352.03±65.70)ms)were shorter than those of the pre-test ((265.70±37.84)ms, (428.67±120.11)ms) ( t=2.179, 3.588; both P<0.05). The MA-dependent waiting group had a longer post-test reaction time of endogenous alertness and temporary alertness(323.18±83.28)ms, (302.74±82.75)ms) compared with the pre-test ((285.35±51.43)ms, (271.21±61.42)ms) ( t=-2.752, -2.664; both P<0.05) and the post-test reaction time of concentration ((402.76±74.34)ms) was shorter than that of the pre-test ((457.68±146.29)ms)( t=2.431, P<0.05). The MA-dependent intervention group had longer endogenous alertness, temporary alertness, and pre-test reaction time of concentration ((264.57±41.41)ms, (265.70±37.84)ms, (428.67±120.11)ms)compared with the normal control group( t=2.083, 2.841, 3.230; all P<0.05). The post-test of endogenous alertness ((264.10±38.98)ms) was longer than that of the normal control group ( t=2.082, P<0.05). Conclusion:The cognitive training based on the CogniPlus system has a certain effect on the attention maintenance or recovery of MA-dependent female youth.It can be used as an intervention measure for cognitive impairment of drug addicts and help them healthy return to society.

In order to make up for the innovation deficiency in the traditional residency training model and the shortcomings of active learning and lifelong learning, evidence-based medicine is introduced into the residency training of dental general practitioners. Theoretical knowledge training of evidence-based medicine is conducted through online course learning. PICO mode is used to conduct evidence-based analysis of clinical cases under the guidance of the instructor, so that trainees can get familiar with the process of evidence-based analysis. Students can finally design and complete the application cases of evidence-based medicine, and teachers give evaluation guidance. Through this process, students can learn and master the knowledge of evidence-based medicine step by step, thus obtaining better teaching results.

Objective:To investigate the classification of patients with gout, and further analyze their clinical features.Methods:Outpatients with gout were enrolled from January 2018 to July 2019 in Depart-ment of Rheumatology, Zhongshan Hospital. Subjects were classified into four groups according to their 24-hour urinaryexcretion and fractional excretion of urate. Clinical features of different groups were analyzed using one-way Analysis of Variance (ANOVA), Kruskal-Wallis H test, or χ2 test. Results:Finally, 378 subjects were enrolled in this cross-sectional study. Among them, 186(49.2%) were renal underexcretion type, 100(26.5%) were combined type, 57(15.1%) were renal overload type, 35(9.3%) were the normal type. Renal underexcretion type was the main subtype in any age-stratified groups. With aging, the proportion of combined type decreased, while the normal type increased. Participants in the combined type were the youngest [(42±14) years of age] with the highest estimated glomerular filtration rate [(94±18) ml·min -1·1.73 m -2], while their serum urate levels were the highest [(554±104) μmol/L]. Subjects in the normal type were the oldest [(60±15) years of age] with the lowest estimated glomerular filtration rate [(71±19) mL·min -1·1.73 m -2], however, their serum urate concentrations were the lowest [(427±118) μmol/L], The difference was statistically significant (age, F=13.98; estimated glomerular filtration rate, F=16.11; urate, F=17.14; P<0.01). Prevalence of urolithiasis were similar among the four groups ( χ2 =2.00, P>0.05). Conclusion:The renal underexcretion type is the main type of gout. Young patients are more likely to suffer from combined type with the highest serum urate levels and the best renal function.

BRAF is a serine/threonine kinase that harbors activating mutations in ∼7% of human malignancies and ∼60% of melanomas. Despite initial clinical responses to BRAF inhibitors, patients frequently develop drug resistance. To identify candidate therapeutic targets for BRAF inhibitor resistant melanoma, we conduct CRISPR screens in melanoma cells harboring an activating BRAF mutation that had also acquired resistance to BRAF inhibitors. To investigate the mechanisms and pathways enabling resistance to BRAF inhibitors in melanomas, we integrate expression, ATAC-seq, and CRISPR screen data. We identify the JUN family transcription factors and the ETS family transcription factor ETV5 as key regulators of CDK6, which together enable resistance to BRAF inhibitors in melanoma cells. Our findings reveal genes contributing to resistance to a selective BRAF inhibitor PLX4720, providing new insights into gene regulation in BRAF inhibitor resistant melanoma cells.