Objective: To investigate the objective characteristics of tongue manifestation in different stages of damp-heat syndrome in diabetic kidney disease (DKD). Methods: A cross-sectional study enrolled 134 patients with DKD G3-5 stages who met the diagnostic criteria for damp-heat syndrome in DKD. The patients were treated at Dongzhimen Hospital, Beijing University of Chinese Medicine, from May 2023 to January 2024. The patients were divided into three groups: DKD G3, DKD G4, and DKD G5 stage, with 53, 33, and 48 patients in each group, respectively. Clinical general data (gender, age, and body mass index) and damp-heat syndrome scores were collected from the patients. The YZAI-02 traditional Chinese medicine (TCM) AI Tongue Image Acquisition Device was used to capture tongue images from these patients. The accompanying AI Open Platform for TCM Tongue Diagnosis of the device was used to analyze and extract tongue manifestation features, including objective data on tongue color, tongue quality, coating color, and coating texture. Clinical data and objective tongue manifestation characteristics were compared among patients with DKD G3-5 based on their DKD damp-heat syndrome status. Results: No statistically significant difference in gender or body mass index was observed among the three patient groups. The DKD G3 stage group had the highest age (P<0.05). The DKD G3 stage group had a lower score for symptoms of poor appetite and anorexia(P<0.05) than the DKD G5 group. No statistically significant difference was observed in damp-heat syndrome scores among the three groups. Compared with the DKD G5 stage group, the DKD G3 stage group showed a decreased proportion of pale color at the tip and edges of the tongue (P<0.05). The DKD G4 stage group exhibited an increased proportion of crimson at the root of the tongue, a decreased proportion of thick white tongue coating at the root, a decreased proportion of pale color at the tip and edges of the tongue, an increased hue value (indicating color tone) of the tongue color in the middle, an increased brightness value (indicating color lightness) of the tongue coating color in the middle, and an increased thickness of the tongue coating (P<0.05). No statistically significant difference was observed in other tongue color proportions, color chroma values, body characteristics, coating color proportions, coating color chroma values, and coating texture characteristics among the three groups. Conclusion Tongue features differ in different stages of DKD damp-heat syndrome in multiple dimensions, enabling the inference that during the DKD G5 stage, the degree of qi and blood deficiency in the kidneys, heart, lungs, liver, gallbladder, spleen, and stomach is prominent. Dampness is more likely to accumulate in the lower jiao, particularly in the kidneys, whereas heat evil in the spleen and stomach is the most severe. These insights provide novel ideas for the clinical treatment of DKD.

OBJECTIVE To provide reference for the establishment and optimization of add-on payment policy in China. METHODS The two-party evolutionary game model was constructed， involving medical insurance and medical institutions，and simulation experiments were conducted. The effects of factors such as whether the establishment of add-on payment policy by the medical insurance department， the compensation ratio， and the cost and incremental utility of new technology on the adoption of innovative technologies by medical institutions were analyzed under the backdrop of the reform of the diagnosis-related groups （DRG） payment system. RESULTS & CONCLUSIONS The add-on payment policy can effectively incentivize the utilization of innovative technologies， but it also carries the risk of overuse or misuse of new technologies. The compensation ratio， unit price of new technology， and cost savings derived from the improved effectiveness of new technologies， as well as the incremental utility of new technology， will all affect the equilibrium state of the evolutionary game， potentially even reversing it. It is recommended to optimize the selection criteria for the scope of add-on payment， so as to incentivize the use of innovative technologies while controlling the risk of their misuse. Additionally， a reasonable approach should be taken to adopt either standalone payment or supplementary payment models based on the surplus level of medical insurance funds in the coordinated regions. Meanwhile， a regular adjustment mechanism should be established to ensure smooth integration between the add-on payment and the DRG payment system.

The precise localization of pulmonary nodules has become an important technical key point in the treatment of pulmonary nodules by thoracoscopic surgery, which is a guarantee for safe margin and avoiding removal of too much normal lung parenchyma. With the development of medical technology and equipment, the methods of locating pulmonary nodules are also becoming less trauma and convenience. There are currently a number of methods applied to the preoperative or intraoperative localization of pulmonary nodules, including preoperative percutaneous puncture localization, preoperative transbronchial localization, intraoperative palpation localization, intraoperative ultrasound localization, and localization according to anatomy. The most appropriate localization method should be selected according to the location of the nodule, available equipment, and surgeon鈥檚 experience. According to the published literatures, we have sorted out a variety of different theories and methods of localization of pulmonary nodules in this article, summarizing their advantages and disadvantages for references.

BACKGROUND:Extracellular vesicles can regulate insulin resistance and control inflammatory response by participating in intercellular communication,while repairing skeletal muscles and promoting skeletal muscle regeneration,which is expected to be a novel treatment modality for sarcopenic obesity. OBJECTIVE:To review the biogenesis of extracellular vesicles,their biological functions,their relationship with sarcopenic obesity,and recent advances in the pathogenesis,diagnosis,and treatment of sarcopenic obesity. METHODS:The first author performed a computer search of PubMed,Embase,CNKI and other databases for relevant studies involving extracellular vesicle in sarcopenic obesity.The search keywords were"extracellular vesicle,exosome,sarcopenic obesity,obese sarcopenia,skeletal muscle regeneration,skeletal muscle mass regulation"in English and Chinese,respectively.The search period was from June 2022 to November 2022.After screening,87 articles were included for further review. RESULTS AND CONCLUSION:Extracellular vesicles are important vectors of bidirectional cell communication and participate in the regulation of normal physiological and pathological processes through autocrine,paracrine and endocrine ways.Sarcopenic obesity is a complex multi-factor disease.Extracellular vesicles are involved in the occurrence and development of sarcopenic obesity mainly by regulating the inflammatory response of skeletal muscle and the homeostasis of muscle cells.Cytokines secreted by adipose tissue and skeletal muscle are released into the extracellular circulation through extracellular vesicle encapsulation and interact with each other to promote skeletal muscle insulin resistance and lipogenesis,which is the main pathophysiology of skeletal muscle atrophy in sarcopenic obesity.Extracellular vesicles not only promote the development of sarcopenic obesity by providing specific pathogenic markers,but also are a valuable diagnostic indicator of sarcopenic obesity.Release of extracellular vesicles from skeletal muscle during exercise enhances metabolic response and promotes skeletal muscle regeneration.Extracellular vesicles can not only be used as therapeutic targets for sarcopenic obesity but also be used to treat sarcopenic obesity by loading drugs to effectively improve drug bioavailability.

Objective:To explore the clinical characteristics and outcomes of type 2 autoimmune pancreatitis (AIP) and compare with type 1 AIP.Methods:Clinical data of the patients diagnosed with type 2 AIP by the International Consensus on diagnostic criteria of AIP at Peking Union Medical College Hospital from January 2001 to December 2022 were retrospectively analyzed, and type 1 AIP patients diagnosed in Peking Union Medical College Hospital from January 1985 to December 2016 were collected as controls. The clinical symptoms, treatments and follow-ups were analyzed.Results:A total of 25 patients with type 2 AIP were included, of which 16 cases (64.0%) were pathologically confirmed cases (13 cases by endoscopic ultrasound puncture, 2 cases by surgery, and 1 case by interventional puncture), and 9 cases (36.0%) were suspected. The average age of onset was 40 years old. Most patients ( n=23, 92.0%) had abdominal pain along with emaciation to a various degree. Among them, 3 cases primarily presented as acute pancreatitis. Two cases were diagnosed after surgery for pancreatic masses. Eighteen cases were complicated with inflammatory bowel disease, including 16 cases with ulcerative colitis, one case with Crohn's disease, and one case with indeterminate colitis. All patients had typical imaging manifestations, including 13 cases (52.0%) with diffuse pancreatic enlargement, 12 cases (48.0%) with focal or multifocal pancreatic lesions, and 5 cases (20.0%) with simultaneous focal pancreatic masses and diffuse enlargement. All patients had normal serum IgG4 levels, anti-neutropil cytoplasmic antibodies (ANCA) positivity rate was 35.3% (6/17), and anti-nuclear antibody (ANA) positivity rate was 29.2% (7/24). Two surgical patients recovered well after surgery, and the other patients all achieved clinical and imaging relief after hormone therapy, and no recurrence was seen during follow-up. Compared with type 1 AIP, type 2 AIP had younger onset age, main manifestation as abdominal pain without jaundice, rare involvement with extra-pancreatic organs, the lesions mainly located in the intestine and normal IgG4 level with statistically significant differences. The recurrence rate of type 2 AIP was lower than that of type 1 AIP (0 vs 16%). Conclusions:Type 2 AIP has different clinical characteristics from type 1 AIP. Due to the lack of specific serum markers, the diagnosis is more difficult. It responds well to glucocorticoids and has a low recurrence rate.

The medical metaverse is a combination of medicine and other cutting-edge technologies such as computer and information ones. In the medical metaverse, medical knowledge in the real world will be transformed into a digital form, so that activities concerning diagnosis, treatment, education and clinical practice can be carried out in a virtual environment. Based on the latest research advances at home and abroad, this review expounds on the medical metaverse from the aspects of supporting technologies, applications in clinic and medical education, current deficiencies and future development.

Objective To investigate the clinical characteristics and risk of lymph node metastasis in patients with multiple primary lung adenocarcinoma nodules compared to those with a single lung adenocarcinoma nodule.Methods Retrospective analysis was conducted on 212 patients who underwent thoracic surgery at Zhujiang Hospital of Southern Medical University from 2022 to 2023.This included 149 cases of single lung adenocarcinoma nodules and 63 cases of multiple primary lung adenocarcinoma nodules.After propensity score matching,a comparison was made between the two groups in terms of imaging features,tumor serological indicators,pathological immunohis-tochemistry,and lymph node metastasis rate.Additionally,binary logistic regression was employed to explore the differences in lymph node metastasis rate between single and multiple nodules.Results After propensity score matching,statistically significant differences were observed in the Avr value of CT(P=0.001),KI-67 expression level(P<0.001),PD-L1 expression level(P=0.002),and lymph node metastasis rate(P=0.030)between the two groups.However,there were no statistically significant differences in nodule type,imaging features such as lobula-tion and vascular clustering,tumor serological indicators including CEA and NSE,ALK positive rate,and SYN posi-tive rate.The variables with significant differences(Avr,Ki-67,PD-L1)were identified through Spearman test for correlation analysis.Binary logistic regression analysis was performed using lymph node metastasis as the dependent variable and single or multiple nodules as categorical covariates along with the three correlated variables included as independent variables interactively.The results showed that the probability of lymph node metastasis in multiple primary lung adenocarcinoma nodules was 80.8%lower than that in single lung adenocarcinoma nodules(RR=0.192,P=0.042).Conclusions Multiple primary adenocarcinoma nodules exhibit a less aggressive biological behavior compared to solitary adenocarcinoma nodules,resulting in a reduced likelihood of lymph node metastasis.For cases involving multiple primary lung adenocarcinoma nodules,the implementation of aggressive surgical protocols is not advisable;instead,personalized treatment plans should be developed based on comprehensive evaluations including intraoperative frozen pathology and imaging.

Endometrial injury is the main fact leading to the damage of endometrial basal layer.It is usually caused by traumatic treatment,inflammatory injury,radiation,chemical drug-related injury,and delivery-related divertic-ulum.The use of hyaluronic acid,decellularized matrix,amniotic membrane,platelet-rich plasma,mesenchymal stem cells(especially scaffold-based therapeutic delivery)has been proved to reduce post-injury scar formation and promote endometrial growth and repair,which provides a new therapeutic strategy for repairing the damaged endo-metrium with improved tolerability and fertility outcomes.

The thinking process of medical diagnosis requires a comprehensive and analytical judgment.However,in both judgment processes,human thinking has inevitable limitations.With the development of artificial intelligence(AI)technology,symbolism and connectionism can effectively compensate for the deficiencies of human thinking in some respects,making more accurate diagnostic judgments,but they also have their limitations.It is conceivable that the integration and development of symbolism and connectionism will assist in enhancing the capabilities of medical-assisted diagnosis.However,there is still a tension between accuracy,transparency,and interpretability regarding the application of connectionism in AI,and many concerns about AI have arisen due to its lack of transparency and interpretability.By sorting out the thought process of medical diagnosis,organizing the differences among various AI paradigms and the changes in semantic philosophy and truth concepts behind AI,ethical concerns about the application of AI can be alleviated to a certain extent,and the practical application of AI in the field of medical diagnosis can be promoted.

The human immune system plays a key role in maintaining tissue homeostasis and disease progression. The development of biomaterials that can regulate the innate immune system and adapt to the immune system has great application prospects in the field of tissue engineering. This paper discusses how to design the surface interface topographies or the physicochemical properties of biomaterials, to regulate the fate of macrophages, such as activation, polarization, adhesion, migration, proliferation, and secretion. At the same time, the application of these biomaterials with immunoregulation function in the field of wound healing is discussed. In addition, this paper also put forward the limitations of biomaterials in immunoregulation applications and prospected the future development directions.