ObjectiveTo investigate the value of predictive models established based on machine learning methods in predicting the risk of metabolic associated fatty liver disease （MAFLD）， and to analyze its key risk factors. MethodsA retrospective analysis was performed for the 50 variables of 2 168 healthy individuals who underwent physical examination in Department of Health Assessment， Xiyuan Hospital， China Academy of Chinese Medical Sciences， from January 2021 to December 2024， including body composition， past history， and laboratory tests， and according to whether they were diagnosed with MAFLD or not， they were divided into MAFLD group with 265 individuals and non-MAFLD group with 1 903 individuals. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. Randomly split the research data into a training set and a validation set in a 70% to 30% ratio. Predictive factors were screened from the training set data using univariate analysis， LASSO regression， and multivariate Logistic regression analysis. Predictive models were then constructed using seven machine learning methods： Logistic regression， decision tree， random forest （RF）， eXtreme gradient boosting， light gradient boosting machine， support vector machine， and artificial neural network. Model performance was evaluated by plotting receiver operating characteristic curve for the validation set and calculating the area under the curve （AUC）， sensitivity， specificity， and Youden index for each model. Furthermore， the SHapley Additive exPlanation （SHAP） method was used to analyze the contribution of variables in the optimal model. ResultsThe prevalence rate of MAFLD among the 2 168 subjects was 12.22% （265/2 168）. Smoking， diastolic blood pressure， phase angle， visceral fat area， muscle fat ratio， waist-to-hip ratio， aspartate aminotransferase， non-HDL-C/HDL-C ratio， triglyceride-glucose index， and gallstones were independent risk factors for MAFLD （all P<0.05）. The seven predictive models of support vector machine， eXtreme gradient boosting， decision tree， light gradient boosting machine， artificial neural network， RF， and Logistic regression had an AUC of 0.738， 0.754， 0.757， 0.786， 0.795， 0.796， and 0.815， respectively， in the validation set， among which the RF model had the best discriminatory ability （AUC=0.796， 95% confidence interval： 0.754 — 0.839）， with a sensitivity of 81.01%， a specificity of 63.16%， and a Youden index of 44.17%. The SHAP analysis showed that visceral fat area， waist-to-hip ratio， and diastolic blood pressure were the top three predictive factors in terms of importance. ConclusionThe RF model， constructed based on body composition and clinical indicators， has a good performance in predicting the risk of MAFLD， and its interpretability can help to identify high-risk individuals in the early stage in clinical practice.

It is believed that there is a pathogenesis of yang deficiency in polycystic ovary syndrome （PCOS） infertility， and it is concluded that warm-yang method has a better effect in improving endometrial abnormality， enhancing the quality of follicles， correcting endocrine disorders， and resolving or alleviating clinical symptoms in PCOS infertility. Based on Yanghe Decoction （阳和汤）， a representative traditional Chinese medicine decoction for warming yang， Yanghe Xiaonang Decoction （阳和消囊汤） was formulated， combining with warm medicinals according to symptoms， and aerobic exercise was also advocated to help generate and develop yang qi， in order to provide ideas for clinical treatments.

Objective To analyze the clinical characteristics,laboratory test,imaging examination,and treatment outcome of invasive Klebsiella pneumoniae liver abscess syndrome(IKPLAS)in the elderly,and improve clinicians' understanding on this disease.Methods Clinical data of 7 elderly patients who were diagnosed with IKPLAS in a hospital from January 2020 to February 2024 were analyzed retrospectively.Results Among the 7 elderly patients with IKPLAS,there were 3 males and 4 females,ranging in age from 60 to 78 years old.All 7 patients were with community-acquired infection.The main clinical symptoms were fever(n=7),chills(n=6),upper abdominal pain(n=4),fatigue and poor appetite(n=3),cough and expectoration(n=5),vomiting(n=3),vision decrease(n=2),and disturbance of consciousness(n=1).All 7 patients had pathogenic evidence of Klebsiella pneumoniae(KP),including 4 cases with KP isolated from liver puncture pus,3 from blood culture,and 1 from both liver puncture pus and intraocular pus.Among the 7 patients,there were 5,2,1,3,1,1 cases combined with pulmonary abscess,endophthalmitis,brain abscess,bloodstream infection,urinary system infection,and pelvic infection,re-spectively.Conclusion Elderly patients with IKPLAS have a variety of underlying diseases and diverse clinical symptoms,showing no specificity.Once IKPLAS was suspected,timely testing for pathogen and screening for other metastatic infection sites outside the liver should be performed.Timely drainage of liver abscess and selection of ap-propriate antimicrobial agents for treatment based on antimicrobial susceptibility testing result can improve patients' survival rate.

Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

Objective:To investigate the prevalence and risk factors of overweight and obesity among Chinese children aged 3-18 years from 11 provinces, antonomous regions, or municipalities.Methods:This national cross-sectional community health survey utilized a multistage stratified cluster-random sampling method to recruit 193 997 nationally representative participants from 11 provinces, autonomous regions, or municipalities between January 2017 and December 2019. All participants underwent physical examinations, and their caregivers completed questionnaires assessing participants′ dietary, lifestyle, familial, and perinatal information. Multilevel multinomial logistic regression models were employed to identify the potential risk factors.Results:The cohort comprised 193 997 children (102 178 boys, 91 819 girls),aged (10±4) years. Overall prevalence rates were 30 574(15.8%)overweight children and 17 217(8.9%) obesity children. Boys exhibited higher overweight and obesity rates than girls (17.0% (17 368/102 178) vs. 14.4% (13 206/102 178), 11.3% (11 553/91 819) vs. 6.2% (5 664/91 819), χ2=249.12,1 578.69,both P<0.001). The detection rates of obesity in Tanner stage 2 and 3 were the highest in boys and girls, with 13.4%(2 231/16 665) and 8.6%(880/10 221) respectively. Risk factors for obesity included parental overweight (paternal OR=2.34 and maternal OR=2.29), annual household income of 100 000-200 000 yuan (compared with<100 000 yuan, OR=1.04), higher paternal education (compared with below high school,high school and a college education OR=1.09,1.14), birth weight >4.0 kg (≤5 and>5 years old OR=1.74, 1.44,respectively), and western food consumption≥1 time/month (compared with<1, 1-2, 3-4,>4 times/month OR=1.36, 1.30, 1.67(≤5 years), 1.19, 1.16, 1.15 (>5 years), respectively) (all P<0.05). Conversely, coarse grain intake≥1 times/week (compared with<1 times/week, every day, 3-4, 1-2 times/week OR=0.74, 0.80, 0.71 (≤5 years), 0.75, 0.87, 0.90(>5 years), respectively, all P<0.05) was associated with reduced obesity risk. Conclusions:Obesity epidemiology in children demonstrates significant heterogeneity across age, gender, geographic regions, and pubertal stages. It is necessary to establish a personalized prevention and control strategy.

Objective:To investigate the therapeutic value of visual endoscopic retrograde appendicitis therapy (vERAT) in pediatric patients with acute suppurative appendicitis (ASA).Methods:This was a retrospective cohort study. A total of 55 ASA patients who underwent vERAT at the Pediatric Department of the Tangdu Hospital of Air Force Medical University between November 2023 and January 2025 were selected and divided into groups based on the presence or absence of fecaliths: fecalith group and non-fecalith group. The baseline characteristics, initial treatment success rates, treatment costs, hospital stay duration, procedure time, and recurrence rates between two groups were compared. Mann-Whitney U test and χ2 test were used to evaluate group differences. Results:A total of 55 ASA patients were enrolled, including 38 males and 17 females, with the age of 11.2 (9.2, 13.1) years. Based on the presence of fecaliths, patients were divided into two groups: fecalith group (32 cases) and non-fecalith group (23 cases). No statistically significant differences were observed between the two groups in terms of age, gender, duration of abdominal pain, white blood cell count, neutrophil percentage, diameter of appendix, thickness of appendix clinical symptoms or signs (all P>0.05). The initial treatment success rates were 91% (29/32) in fecalith group and 96% (22/23) in non-fecalith group, with no statistically significant difference ( P=0.632). However, significant differences were noted in stent placement ( χ2=5.85, P=0.026) and procedure time ( Z=4.75, P<0.001). The follow-up duration time was 6.0 (2.0, 12.0) and 7.0 (2.0, 8.5) months for the fecalith and non-fecalith groups, respectively, with no significant difference ( Z=0.05, P=0.962). The recurrence rates were 14% (4/29) in fecalith group and 5% (1/22) in non-fecalith group, with no statistically significant difference ( P=0.375). Conclusions:vERAT can safely and effectively treat pediatric ASA, regardless of the presence or absence of fecaliths. It can provide a new treatment option for ASA.

Accessory mitral valve（AMV）refers to the additional valvular structural components connected to the normal mitral valve. It is a rare congenital cardiovascular malformation with an incidence of approximately 1/26 000. Most patients have no obvious symptoms and are often accidentally detected during echocardiography due to the presence of other associated cardiac malformations. The combination of AMV with left ventricular outflow tract（LVOT）vegetations is extremely rare and may be related to infective endocarditis. In this case，a 48-year-old male patient was discovered to have a "cardiac mass" during treatment for a cerebral infarction at an external hospital and was admitted to China-Japan Union Hospital of Jilin University for further diagnosis and treatment. Over the past 3 months，the patient experienced intermittent fever，accompanied by chest tightness and pain during physical exertion. The patient had a history of gout and diabetes. Transthoracic echocardiography（TTE）and transesophageal echocardiography revealed left ventricular outflow tract obstruction，accessory mitral valve（membranous fixed type），and a space-occupying lesion on the ventricular septal side within the left ventricular outflow tract. The final diagnosis of vegetation in the left ventricular outflow tract and accessory mitral valve was confirmed through surgical resection and postoperative pathology. Postoperative TTE showed a significant reduction in the flow velocity and pressure gradient within the left ventricular outflow tract. Echocardiography，with its advantages of simplicity，non-invasiveness，and repeatability，allows for the direct observation of accessory mitral valve and other cardiac abnormalities，evaluation of valve function and hemodynamic changes，and assessment of the left ventricular outflow tract obstruction condition. It facilitates preoperative diagnosis and postoperative follow-up，serving as the gold standard for diagnosing accessory mitral valve.

Objective:To observe the efficacy and safety of micro-focusing ultrasound (MFU) combined with dye pulsed light (DPL) in the treatment of facial skin aging.Methods:A retrospective study was conducted in 133 patients treated for facial skin aging at Zhiyan Medical Beauty Clinic, the Fifth Affiliated Hospital of Guangzhou Medical University, and Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May to September 2023. There were 46 males and 87 females, aged 24-45 (34.5±3.7) years. Patients were divided into two groups based on the treatment they received: combined treatment group: 55 cases, treated with MFU combined with DPL; control group: 77 cases, treated with MFU only. After the completion of treatment in all patients, three clinical physicians evaluated the pre-treatment and immediate post-treatment photos for efficacy, including improvement, deterioration, and ineffectiveness. The pain degree scores and skin reaction scores were compared between the two groups. The occurrence of adverse reactions was recorded.Results:After treatment, the improvement rate of all patients was 100 % (133/133). The pain score of the combined treatment group was 0.10 (0.05, 0.20) points, and that of the control group was 0.75 (0.60, 0.90) points. The difference was statistically significant between the two groups ( Z=-6.66, P<0.001). The skin reaction score of the combined treatment group was 0.40 (0.20, 0.60) points, and that of the control group was 1.20 (0.90, 1.50) points. The difference was statistically significant between the two groups ( Z=-5.18, P<0.001). There were no treatment site wounds and other serious adverse reactions during the treatment of all patients. Conclusion:MFU combined with DPL is effective in the treatment of facial skin aging without serious adverse reactions.

Objective To investigate the effects of salidroside(Sal)on inflammatory response,lung injury,and high mobility group protein B1/Toll-like receptor 4/nuclear factor kappa B(HMGB1/TLR4/NF-κB)signaling pathway in mice with mycoplasmal pneumonia(MP).Methods An MP mouse model was constructed and randomly assigned into a Model group,a positive control-Azithromycin group(Azithromycin group),low and high dose salidroside groups(Sal-L,Sal-H groups),and high dose salidroside+pathway activator group(Sal-H+rHMGB1 group),with 12 mice in each group.Another 12 healthy mice were included as the control group.The total number of inflammatory cells and levels of inflammatory factors(IL-1β,TNF-α,and IL-6)in mice bronchoalveolar lavage fluid(BALF),levels of inflammatory factors in serum,levels of oxidative stress factors in lung tissue(ELISA),degree of lung tissue injury(HE staining),apoptosis of lung tissue cells(TUNEL staining),and expression levels of HMGB1/TLR4/NF-κB signaling pathway related proteins(Western blot)were measured.Results The lung tissue of mice in the Model group showed obvious pathological injury and infiltration of inflammatory cells,the total inflammatory cell count,inflammatory cytokine levels in BALF,the serum inflammatory cytokine levels,the MDA and NO levels in lung tissue,apoptosis rate,HMGB1 and Bax protein expression levels and p-TLR4/TLR4,p-NF-κB p65/NF-κB p65 values were obviously higher,while the SOD and GSH-Px activities,and the Bel-2 protein expression level in lung tissue were obviously lower(P＜0.05).Compared with the Model group,with the increase of Sal dose,the degree of lung tissue injury and the infiltration of inflammatory cells were reduced in the Sal-L,Sal-H,and Azithromycin groups,the total cell count,inflammatory cytokine levels in BALF,the MDA and NO levels in lung tissue,apoptosis rate,HMGB1 and Bax protein expression levels and p-TLR4/TLR4,p-NF-κB p65/NF-κB p65 values were obviously lower,while the SOD and GSH-Px activities,and the Bcl-2 protein expression level in lung tissue were obviously higher(P＜0.05).Compared with the Sal-H group,the mice in the Sal-H+rHMGB1 group showed severe lung tissue injury,the total inflammatory cell count,inflammatory cytokine levels in BALF,the serum inflammatory cytokine levels,the MDA and NO levels in lung tissue,apoptosis rate,HMGB1 and Bax protein expression levels and p-TLR4/TLR4,p-NF-κB p65/NF-κB p65 values were obviously higher,while the SOD and GSH-Px activities,and the Bcl-2 protein expression level in lung tissue were obviously lower(P＜0.05).Conclusion Sal can inhibit inflammation and oxidative stress responses,improve lung tissue injury in MP mice,and its effect may be related to the inhibition of HMGB1/TLR4/NF-κB signaling pathway activation.

The Occupational Classification Dictionary of the People's Republic of China (2015 Edition) has added a new occupation type, Medical Nursing Assistants, aiming to meet the strong demand for medical care in the context of the aging population in China.In order to standardize the services of medical nursing assistants for the elderly in home and community settings and contribute to healthy aging, the National Health Commission issued the " Service Standards for Medical Nursing Assistants of Older Adults in Home and Community" ( WS/ T 803—2022) on September 28, 2022.The standards regulate the service processes, service items and requirements, as well as service evaluation and improvement for elderly medical nursing assistants.The interpretation of the standard's formulation background, the compilation process, and the standard's content are as follows.