With the rapid changes in lifestyle,the prevalence of nonalcoholic fatty liver disease(NAFLD)has become increasingly severe in China,and it has become a major public health concern.With a deeper understanding of this disease,the latest consensus statement has changed the name from NAFLD to MAFLD,and this updated definition transitions from an exclusion-based approach to an inclusive framework,which not only improves clinical diagnostic accuracy,but also highlights the key role of metabolic disorders in the progression of NAFLD.In recent years,the in-depth studies on the mechanism of carcinoembryonic antigen-associated cell adhesion molecule 1-mediated insulin clearance have highlighted the importance of insulin clearance in the development and progression of NAFLD.This article reviews the research advances in the role of insulin clearance in MAFLD.

With the rapid changes in lifestyle,the prevalence of nonalcoholic fatty liver disease(NAFLD)has become increasingly severe in China,and it has become a major public health concern.With a deeper understanding of this disease,the latest consensus statement has changed the name from NAFLD to MAFLD,and this updated definition transitions from an exclusion-based approach to an inclusive framework,which not only improves clinical diagnostic accuracy,but also highlights the key role of metabolic disorders in the progression of NAFLD.In recent years,the in-depth studies on the mechanism of carcinoembryonic antigen-associated cell adhesion molecule 1-mediated insulin clearance have highlighted the importance of insulin clearance in the development and progression of NAFLD.This article reviews the research advances in the role of insulin clearance in MAFLD.

In recent years, the number of patients with vaginal relaxation has increased year by year, and the minimally invasive vaginal contraction has been carried out more and more widely in clinical practice, but the treatment normalization and safety have not been thoroughly studied. We summarized six cases of characteristics and treatment measures for patients with various complications after minimally invasive vaginal contraction surgery from September 2021 to December 2023 at Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital. The patients' age ranged from 26 to 44 years. Two cases accepted vaginal contraction with embedded vaginal thread, and four accepted vaginal contraction with acellular allogenic dermis. One patient showed vaginal hyper-tightness, one patient showed subcutaneous suture nodules, two patients showed explosion of acellular allogenic dermis, and three patients showed vaginal infection symptoms such as yellow leucorrhea and peculiar smell. All patients had sexual pain and discomfort. One patient underwent vaginal orifice dilation, one patient underwent suture extraction and secondary vaginal contraction, one patient underwent acellular allogenic dermis extraction and immediate vaginal contraction, two patients underwent acellular allogenic dermis extraction and secondary vaginal contraction, and one patient underwent secondary vaginal contraction. The symptoms of all six patients were relieved after treatment. Despite the short operation time and fast postoperative recovery of minimally invasive vaginal contraction, there are still complications after surgery, causing physical and mental damage to patients. Plastic surgeons, therefore, should be cautious in the treatment process to avoid collateral damage, so that patients get the best treatment effect.

Objective:To investigate the diagnostic value of lung ultrasound in hospitalized children with community-acquired pneumonia (CAP).Methods:In the cross-sectional study, a total of 422 children with CAP who were hospitalized in the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, from February 2021 to August 2022 and completed lung ultrasound examination within 48 hours after admission were enrolled. The clinical characteristics, lung ultrasound and chest CT were collected. The patients were divided into two groups according to the signs of pneumonia indicated by chest CT, and the signs of lung ultrasound with diagnostic value were screened according to the signs of pneumonia indicated by chest CT by least absolute shrinkage and selection operator (Lasso) regression. According to severity of the disease, the children were divided into the severe group and the mild group, and the differences of lung ultrasound signs between the two groups were compared. Kruskal-Wallis test, Fisher′s exact test was selected for comparison between groups. Random forest classifier wes used to evaluate the value of lung ultrasound in the diagnosis of CAP and prediction of severe pneumonia in children. The receiver operating characteristic curve was used to evaluate the prediction effect. Use DeLong test to compare the area under the curve.Results:Among the 422 cases of CAP, there were 258 males and 164 females, and the age of onset was 2.8 (1.3, 4.3) years. The confluent B-line, consolidation and pleural effusion detected by lung ultrasound were 309 cases (73.2%), 232 cases (55.0%) and 16 cases (3.8%), respectively, and the size of consolidation was 3.0 (0, 11.0) mm. One hundred and ten children (26.1%) with CAP completed chest CT. There were 90 cases with signs of pneumonia in chest CT and 20 cases without signs of pneumonia. Lasso was used for feature selection.Lung consolidation ( OR=2.46), bilateral lung consolidation ( OR=1.16) and confluent B-line ( OR=1.34) were the main index. With random forest classifier, the accuracy of models using full variables and Lasso-selected variables were 0.79 (95% CI 0.70-0.86) and 0.79 (95% CI 0.70-0.86), the sensitivity were 0.81 and 0.81, and the specificity were 0.75 and 0.70, and the area under curve were 0.87 (95% CI 0.81-0.94, P<0.001) and 0.84 (95% CI 0.76-0.91, P<0.001), respectively. There were 97 cases in severe group and 325 cases in mild group. Compared with the mild group, the detection rate of consolidation, multiple consolidation, the size of consolidation and the size of consolidation was adjusted by body surface area (consolidation size/body surface area) in severe group were higher (66 cases (68.0%) vs. 166 cases (51.1%), 42 cases (43.3%) vs. 93 cases (28.6%), 8.0 (0, 17.0) vs. 1.0 (0, 9.0) mm, 12.5 (0, 24.6) vs. 2.1 (0, 17.6), χ2=8.59, 9.98, Z=14.40, 12.79, all P<0.05). Using lung ultrasound lung consolidation size and consolidation size/body surface area to predict the severe CAP, the optimal cut-off value were 6.7 mm and 10.2, the accuracy was 0.80 (95% CI 0.75-0.83) and 0.89 (95% CI 0.86-0.92), the sensitivity was 0.99 and 0.99, the specificity was 0.14 and 0.56, respectively, and the area under the curve was 0.66 (95% CI 0.60-0.72, P<0.001) and 0.76 (95% CI 0.70-0.83, P<0.001), respectively. The area under the curve of consolidation size/body surface area was higher than that of consolidation size ( Z=5.50, P<0.001). Conclusions:Consolidation and confluent B-line, are important index for lung ultrasound diagnosis of CAP in children. The actual consolidation size adjusted by body surface area is superior to the size of consolidation in predicting severe CAP.

Objective To investigate the clinical value of fiber nasopharyngoscope applied in adenoid hypertrophy(AH)combined with allergic rhinitis(AR)in children.Methods Clinical data of 174 pediatric patients from January 2021 to March 2024 was collected and analyzed.Among them,129 cases were diagnosed with AH via fiber nasopharyngoscope examination(79 cases with AR were assigned to the AH with AR group,the remaining 50 cases of simple AH without AR were assigned to the AH group),and 45 cases of simple AR without AH through fiber nasopharyngoscope examination were assigned to the AR group.And 25 healthy children who came to our pediatric health department for health examinations during the same period were selected as the healthy control(HC)group.On the day of admission,all subjects underwent lateral X-ray examination of the nasopharynx,and the ratio of the maximum thickness of adenoids to the anterior posterior diameter of the nasopharynx cavity(A/N ratio)was calculated.Meanwhile their of peripheral blood eosinophil(EOS)percentage,serum interleukin-17(IL-17),and tumor necrosis factor-α(TNF-α)levels were tested.The A/N ratio,peripheral blood EOS percentage,serum IL-17 and TNF-α levels were compared among the AH with AR group,AH group,AR group,and HC group.The A/N ratio,peripheral blood EOS percentage,serum IL-17 and TNF-α levels of children with different degrees of adenoid obstruction under fiber nasopharyngoscope were compared in AH and AR group.Spearman correlation coefficient was used to analyze the correlation between the degree of adenoid obstruction under fiber nasopharyngoscope and the levels of peripheral blood EOS percentage,serum IL-17 and TNF-α in children from AH and AR group.Result A/N ratio:the value in AH with AR group was higher than that in AH group(P＜0.05),the value in AH group was higher than that in AR group(P＜0.05),and the value in AR group was higher than that in HC group(P＜0.05).Peripheral blood EOS percentage,serum IL-17 and TNF-α levels:AH with AR group had higher levels than those in AR group(P＜0.05),AR group had higher levels than those in AH group(P＜0.05),and AH group had higher levels than those in HC group(P＜0.05).The A/N ratio,peripheral blood EOS percentage,serum IL-17 and TNF-α levels in children with adenoid obstruction degree Ⅲ～Ⅳ under fiber nasopharyngoscope in the AH group were significantly higher than those in children with degree Ⅰ～Ⅱ(P＜0.05).Spearman correlation analysis showed that the degree of adenoid obstruction under fiber nasopharyngoscope in children with AH accompanied by AR significantly positively correlated with peripheral blood EOS percentage,serum IL-17 and TNF-α levels(r values were 0.527,0.451,and 0.402 respectively,P＜0.05).Conclusion Fiber nasopharyngoscope can be used for the diagnosis of AH with AR in children,and can be positive in determining severity of the patient's condition when combined with peripheral blood EOS percentage,serum IL-17 and TNF-α levels.

In recent years, the number of patients with vaginal relaxation has increased year by year, and the minimally invasive vaginal contraction has been carried out more and more widely in clinical practice, but the treatment normalization and safety have not been thoroughly studied. We summarized six cases of characteristics and treatment measures for patients with various complications after minimally invasive vaginal contraction surgery from September 2021 to December 2023 at Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital. The patients' age ranged from 26 to 44 years. Two cases accepted vaginal contraction with embedded vaginal thread, and four accepted vaginal contraction with acellular allogenic dermis. One patient showed vaginal hyper-tightness, one patient showed subcutaneous suture nodules, two patients showed explosion of acellular allogenic dermis, and three patients showed vaginal infection symptoms such as yellow leucorrhea and peculiar smell. All patients had sexual pain and discomfort. One patient underwent vaginal orifice dilation, one patient underwent suture extraction and secondary vaginal contraction, one patient underwent acellular allogenic dermis extraction and immediate vaginal contraction, two patients underwent acellular allogenic dermis extraction and secondary vaginal contraction, and one patient underwent secondary vaginal contraction. The symptoms of all six patients were relieved after treatment. Despite the short operation time and fast postoperative recovery of minimally invasive vaginal contraction, there are still complications after surgery, causing physical and mental damage to patients. Plastic surgeons, therefore, should be cautious in the treatment process to avoid collateral damage, so that patients get the best treatment effect.

Objective To investigate the effects of N-acetylcysteine(NAC)on liver tissue inflammation,pyroptosis levels,and NOD-like receptor pyrin domain-containing protein 3(NLRP3)inflammasome in rats with alcoholic liver disease(ALD).Methods Male SD rats were divided into a normal group,an ALD model group,a 100 mg·kg-1 NAC group,and a 200 mg·kg-1 NAC group.HE staining was used to observe pathological changes in liver tissue,and TUNEL method was used to detect the apoptosis rate of liver cells.Biochemical kits were used to measure serum levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),and triglyceride(TG).Normal rat hepatocytes BRL-3A were divided into a control group,a 200 mmol/L alcohol group(model group),a 2 mmol/L NAC group,and a 5 mmol/L NAC group.MTT method was used to detect the survival rate of BRL-3A cells;Western blot was used to detect the protein expression levels of cleaved caspase-1,apoptosis-associated speck-like protein containing a CARD(ASC),N-terminal gasdermin D(GSDMD-N),and NLRP3.Total superoxide dismutase(SOD)activity detection kit and malondialdehyde(MDA)kit were used to measure SOD and MDA levels.ELISA was used to detect IL-1β and IL-18 levels.Fluorometric assay were used to measure reactive oxygen species(ROS)level in liver tissue,and immunofluorescence staining was used to determine ROS level in BRL-3A cells.Results Compared with the normal group,the model group showed diffuse fatty degeneration in the liver,increased serum levels of ALT,AST and TG,elevated levels of IL-1β and IL-18 in liver tissue,increased ROS and MDA levels,and upregulated protein expression levels of cleaved caspase-1,ASC,GSDMD-N and NLRP3,while a decrease in SOD level.Compared with the model group,the NAC groups exhibited reduced fatty degeneration in the liver,decreased expression levels of pyroptosis-related proteins,reduced levels of IL-1β and IL-18,lower ROS and MDA levels,and increased SOD level.Compared with the control group,the model group of BRL-3A cells showed increased levels of IL-1β and IL-18 in the supernatant,elevated ROS and MDA levels in cells,and upregulated pyroptosis-related protein expression,while a decrease in SOD level.These indicators were reversed in the NAC group as compared to the model group.Conclusion NAC suppresses liver tissue inflammation and pyroptosis in ALD rats,possibly through blocking the NLRP3 inflammasome signaling pathway.

Objective To investigate the effects of N-acetylcysteine(NAC)on liver tissue inflammation,pyroptosis levels,and NOD-like receptor pyrin domain-containing protein 3(NLRP3)inflammasome in rats with alcoholic liver disease(ALD).Methods Male SD rats were divided into a normal group,an ALD model group,a 100 mg·kg-1 NAC group,and a 200 mg·kg-1 NAC group.HE staining was used to observe pathological changes in liver tissue,and TUNEL method was used to detect the apoptosis rate of liver cells.Biochemical kits were used to measure serum levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),and triglyceride(TG).Normal rat hepatocytes BRL-3A were divided into a control group,a 200 mmol/L alcohol group(model group),a 2 mmol/L NAC group,and a 5 mmol/L NAC group.MTT method was used to detect the survival rate of BRL-3A cells;Western blot was used to detect the protein expression levels of cleaved caspase-1,apoptosis-associated speck-like protein containing a CARD(ASC),N-terminal gasdermin D(GSDMD-N),and NLRP3.Total superoxide dismutase(SOD)activity detection kit and malondialdehyde(MDA)kit were used to measure SOD and MDA levels.ELISA was used to detect IL-1β and IL-18 levels.Fluorometric assay were used to measure reactive oxygen species(ROS)level in liver tissue,and immunofluorescence staining was used to determine ROS level in BRL-3A cells.Results Compared with the normal group,the model group showed diffuse fatty degeneration in the liver,increased serum levels of ALT,AST and TG,elevated levels of IL-1β and IL-18 in liver tissue,increased ROS and MDA levels,and upregulated protein expression levels of cleaved caspase-1,ASC,GSDMD-N and NLRP3,while a decrease in SOD level.Compared with the model group,the NAC groups exhibited reduced fatty degeneration in the liver,decreased expression levels of pyroptosis-related proteins,reduced levels of IL-1β and IL-18,lower ROS and MDA levels,and increased SOD level.Compared with the control group,the model group of BRL-3A cells showed increased levels of IL-1β and IL-18 in the supernatant,elevated ROS and MDA levels in cells,and upregulated pyroptosis-related protein expression,while a decrease in SOD level.These indicators were reversed in the NAC group as compared to the model group.Conclusion NAC suppresses liver tissue inflammation and pyroptosis in ALD rats,possibly through blocking the NLRP3 inflammasome signaling pathway.

Objective : To investigate the willingness to receive HIV testing in primary health service institutions (PHSIs) among young students in Wuhan City, so as to provide the evidence for improving the detection of HIV testing among young students. Methods: Fifteen PHSIs were sampled using a stratified random sampling method in 14 districts of Wuhan City, and school students at ages of 15 to 24 years were sampled from each district using a convenience sampling method. Participants' demographics, awareness of AIDS-related knowledge, HIV testing and willingness to receive HIV testing were collected using questionnaires, and factors affecting the willingness to receive HIV testing in PHSIs were identified among school students using a multivariable logistic regression model. Results : A total of 301 questionnaires were allocated, and 299 valid questionnaires were recovered, with an effective recovery rate of 99.34%. The respondents included 143 men (47.83%) and 156 women (52.17%), and had a mean age of (19.36±2.40) years; there were 223 respondents with an educational level of diploma and above (74.58%). The awareness of AIDS-related knowledge was 71.57% among the respondents, and 144 respondents had received AIDS-related health education in PHSIs (48.16%). There were 34 respondents that had received HIV testing (11.37%) and 203 respondents that were willing to receive HIV testing in PHSIs (67.89%). The respondents that were unwilling to receive HIV testing in PHSIs were mainly attributed to considering to be unlikely to get HIV infections (82.29%). Multivariable logistic regression analysis showed that school students who knew AIDS-related knowledge (OR=2.797, 95%CI: 1.583-4.941), knew free HIV counseling and testing services in PHSIs (OR=2.070, 95%CI: 1.123-3.814), and had received AIDS-related health education in PHSIs (OR=2.814, 95%CI: 1.573-5.032) were more willing to receive HIV testing in PHSIs. Conclusions There were 67.89% of school students that were willing to receive HIV testing in PHSIs in Wuhan City, and the willingness to receive HIV testing was correlated with the awareness of risk of HIV infections, and awareness and experience of AIDS control services in PHSIs.

Objective To analyse the high-risk human papilloma virus (HPV) infection in women, and to analyze the protective effect of bivalent HPV vaccine on HPV infection. Methods A case-control study method was used to retrospectively investigate the HPV infection status of 9246 women who received high-risk HPV infection examination in the outpatient department of Shiyan people's Hospital of Hubei from January 2018 to December 2018. The second-generation hybrid capture method and colposcopy examination were used to diagnose. Using a 1:1 matching method, the uninfected individuals who were examined during the same period were taken as the control group, and the confirmed infected group was taken as the case group, and the differences in the vaccination rates of the bivalent HPV vaccine between the two groups were compared. At the same time, the case group was divided into two groups according to the vaccinated and unvaccinated groups and followed up. The events ranged from 24 to 36 months. The incidence of persistent HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer were counted to understand Protective effect of bivalent HPV vaccination against HPV infection in a high-risk female population. Results A total of 1 632 cases (17.65%) of 9 246 women were screened positive for high-risk HPV infection. Chi-square results showed that the HPV positive infection rate of rural women (32.84%) was lower than that of urban women (67.16%). , Marital status also has a certain influence on HPV infection. Among the 1632 cases of HPV positive infection, 629 cases (38.54%) were vaccinated with bivalent HPV vaccine, and 1003 cases (61.46%) were not vaccinated with bivalent HPV vaccine. During the follow-up period of 24-36 months, the vaccination group finally obtained follow-up data of 584 cases due to unwillingness to cooperate (18 cases), unable to conduct research due to organic changes (24 cases), and mental disorders (3 cases), with a loss to follow-up rate of 7.15 cases. %; In the unvaccinated group, 949 cases of follow-up data were finally obtained due to change of residence (32 cases), low degree of cooperation (20 cases) and psychological factors (2 cases), and the loss to follow-up rate was 5.38%. The results after follow-up showed that the persistent HPV infection rate in the bivalent HPV vaccination group, the positive rate of high-risk HPV infection at the last follow-up, the cumulative incidence of CIN1 during the follow-up period, the cumulative incidence of CIN2+ during the follow-up period, the incidence of CIN1 at the last follow-up, and the incidence of CIN2+ at the last follow-up. and cervical cancer incidence rates were 3.07%, 0.82%, 1.84%, 1.02%, 0.82%, 0.20%, and 0.00%, respectively, and the bivalent HPV unvaccinated groups were 12.91%, 15.52%, 7.14%, 4.40%, and 3.02%, respectively. , 1.37% and 0.27%. Persistent HPV infection rate, positive rate of high-risk HPV infection at last follow-up, cumulative incidence of CIN1 during follow-up, cumulative incidence of CIN2+ during follow-up, incidence of CIN1 at last follow-up, and incidence of CIN2+ at last follow-up were significantly lower in bivalent HPV vaccination group in the control group (P<0.05). Conclusion Bivalent HPV vaccination has an important protective effect on HPV persistent infection, cervical lesions and cervical cancer in high-risk women.