With persistent breakthrough and maturity of surgical procedures and postoperative immunosuppressive therapy, the survival rate of liver transplant recipients and grafts has been significantly increased. The shortage of donor liver has become the main obstacle for clinical development of liver transplantation. How to expand the source of donor liver has become an urgent issue. Groundbreaking progresses have been made in the use of common marginal donor livers in clinical liver transplantation, such as elderly donor liver, steatosis donor liver, viral hepatitis donor liver and liver from donation after cardiac death. Nevertheless, multiple restrictions still exist regarding the use of marginal donor liver. Consequently, the definition of marginal donor liver and research progress in the application of common marginal donor livers were reviewed, and the opportunities and challenges of mariginal donoor liver were illustrated, aiming to provide reference for expanding the donor pool for clinical liver transplantation and bringing benefits to more patients with end-stage liver disease.

Objective To systematically retrieve,evaluate and integrate evidences about the assessment and management of perioperative pain in patients with acute aortic dissection.Methods PIPOST model was used to identify themes of assessment and management of perioperative pain.The literatures in the themes was systematically searched through the databases of UpToDate,JBI,BMJ Best Practice,practice guide REgistration for trans RAREncy(PREPARE),Guidelines International Network(GIN),National Guideline Clearinghouse(NGC),National Institute for Health and Care Excellence(NICE),Scottish Intercollegiate Guidelines Network(SIGN),New Zealand Guidelines Group(NZGG),Registered Nurses'Association of Ontario(RNAO),Australian Clinical Practice Guidelines(ACPG),American Heart Association(AHA),European Society of Cardiology(ESC),the Chinese Cochrane Center,Medlive,Cochrane library,PubMed,SinoMed,CNKI,Wangfan Data,and VIP.The retrieved literatures were evaluated and the evidences that met the inclusive criteria were extracted from the literatures by researchers who had trained for evidence-based study.Results A total of 17 studies,including 5 guidelines,3 expert consensus,6 systematic reviews and 3 randomised controlled trials were included in this study.Totally,29 pieces of best evidence were extracted in the assessment and management of pain in perioperative patients with acute aortic dissection,including pain assessment,basic principles of pain management,medication intervention strategies of pain management,non-medication intervention strategies of pain management,pain evaluation,education of pain management and organising pain management.Conclusion Evidences in assessment and management of pain in perioperative patients with acute aortic dissection can provide references and guidance for clinical practice.

Antineoplastic drugs refer to the drugs that act at the cellular and molecular levels to inhibit tumor growth or eliminate tumors through pathways such as cell killing,immune regulation,and endocrine regulation.Antineoplastic drugs generally including chemotherapeutic drugs,molecular targeted therapeutic drugs,immunotherapeutic drugs,and endocrine therapeutic drugs.The management and rational application of antineoplastic drugs in medical institutions are related to the safety of patient treatment.The standard for management of antineoplastic drugs use in clinical is compiled by the Pharmaceutical Affairs Committee of China Hospital Association,which specification requirements 18 key elements in the organizational management and system,medication management,drug monitoring and evaluation of antineoplastic drug management in healthcare institutions.This standard is applicable to all levels and types of healthcare institutions carrying out oncology diagnosis and treatment.This paper describes the methodology and basic content of the standard,hoping to providing a reference for medical institutions to carry out relevant work.

Acute pancreatitis （AP） is a gastrointestinal disease that requires early intervention， and when it progresses to moderate-severe AP （MSAP） or severe AP （SAP）， there will be a significant increase in the mortality rate of patients. Machine learning （ML） has achieved great success in the early prediction of AP using clinical data with the help of its powerful computational and learning capabilities. This article reviews the research advances in ML in predicting the severity， complications， and death of AP， so as to provide a theoretical basis and new insights for clinical diagnosis and treatment of AP through artificial intelligence.

ObjectiveTo analyze the epidemiological characteristics of varicella in Yangpu District， Shanghai from 2005 to 2022， predict the trend of varicella in Yangpu District in 2023， and provide evidence for prevention and control of varicella outbreaks. MethodsInformation of varicella cases reported in Yangpu District from 2005 to 2022 was obtained from the China Information System for Disease Control and Prevention. Descriptive statistics was used to characterize the varicella epidemiology. An autoregressive integrated moving average （ARIMA） model was established by using the number of cases per month from 2005 to2022 to predict the trend of varicella epidemics in Yangpu District in 2023. The varicella incidence in 2022 was used to evaluate the fitness of the ARIMA model. ResultsFrom January 2005 to December 2021， a total of 11 527 cases of varicella were reported in Yangpu District， Shanghai. After excluding duplicates and clinical diagnoses， 11 413 cases were included into the analysis. The annual average incidence rate was 51.87/10⁵， the age of onset was mainly under 20 years old （66.5%）， and the occupation was mainly students （49.7%）. The ARIMA （1，1，0）×（0，1，1）₁₂ model was constructed and showed a good fitness while using monthly reported varicella cases in 2022 for model fitting. It was predicted that 1 089 cases of varicella would be reported in Yangpu District in 2023. ConclusionIt is predicted that varicella cases in Yangpu District will increase in 2023. It is recommended to continue promoting delayed varicella vaccination to maintain a high level of vaccination rate. Before the peak of the epidemic， health education regarding varicella should be strengthened， and measures for epidemic prevention and control should be reinforced to prevent varicella outbreaks.

Marine microorganisms, especially marine fungi, have historically proven their value as a prolific source for structurally novel and pharmacologically active secondary metabolites (Deshmukh et al., 2018; Carroll et al., 2022). The corals constitute a dominant part of reefs with the highest biodiversity, and harbor highly diverse and abundant microbial symbionts in their tissue, skeleton, and mucus layer, with species-specific core members that are spatially partitioned across coral microhabitats (Wang WQ et al., 2022). The coral-associated fungi were very recently found to be vital producers of structurally diverse compounds, terpenes, alkaloids, peptides, aromatics, lactones, and steroids. They demonstrate a wide range of bioactivity such as anticancer, antimicrobial, and antifouling activity (Chen et al., 2022). The genetically powerful genus Emericella (Ascomycota), which has marine and terrestrial sources, includes over 30 species and is distributed worldwide. It is considered a rich source of diverse secondary metabolites with antimicrobial activity or cytotoxicity (Alburae et al., 2020). Notably, Emericella nidulans, the sexual state of a classic biosynthetic strain Aspergillus nidulans, was recently reported as an important source of highly methylated polyketides (Li et al., 2019) and isoindolone-containing meroterpenoids (Zhou et al., 2016) with unusual skeletons.
Animals ; Aspergillus nidulans ; Polyketides/chemistry* ; Anthozoa/microbiology* ; Anti-Infective Agents/pharmacology* ; Alkaloids

Objective:To evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for treatment of duodenal lesions.Methods:A retrospective analysis was performed on the data of 45 patients with 46 duodenal lesions who underwent ESD at the Second Xiangya Hospital of Central South University from January 2011 to May 2019. The lesion features, en bloc resection rate, complete resection rate, complications, postoperative pathology and recurrence were assessed.Results:Among the 45 patients, 20 were males and 25 were females, with age of 52.0±11.8 years. Of the 46 lesions, 31 (67.4%) were located in the duodenal bulb, 12 (26.1%) in the descending part, and 3 (6.5%) at the junction of bulb and descending part. The diameter of the lesions was 2.4±1.9 cm. There were 14 (30.4%) lesions originated from mucosal layer, 29 (63.1%) from submucosal layer, and 3 (6.5%) from muscularis propria.Postoperative pathology showed 11 (23.9%) cases of Brunner gland tumors, 9 (19.6%) neuroendocrine tumors, 5 (10.9%) ectopic pancreas, 5 (10.9%) lipomas, and 16 (34.8%) other pathological patterns. All 45 patients with 46 lesions underwent ESD successfully, and the en bloc resection rate was 100.0% (46/46), complete resection rate was 91.3% (42/46). Intraoperative bleeding occurred in 1 case (2.2%), which was successfully treated by endoscopy. One (2.2%) delayed perforation occurred and was treated by surgical intervention. Electrocoagulation syndrome occurred in 1 case (2.2%), which was relieved after conservative medical therapy. Two cases received further surgery after ESD. The mean hospital stay was 6.2 days (ranged 2-21 days) and no death occurred. Forty-one cases were followed up for 1-78 months, with mean time of 30 months. During the follow-up period, local recurrence occurred in 1 patient (2.4%).Conclusion:ESD is an effective and safe treatment for duodenal lesions and has a good clinical practical value.

Objective To understand the status quo of midwives' core competency in Fujian Province and analyze its influencing factors.Methods A total of 374 midwives from 13 hospitals in Fujian Province were surveyed by the midwife core competency scale.Results The average score of midwives' core competency were(3.96±0.54).The scores of vocational literacy,postnatal care skills and health care skills during pregnancy were relatively high.The scores of public health care knowledge,public health care skills and women's health knowledge were relatively low.The scores of core competence for junior,senior and expert abilities for midwives were (4.03±0.55),(3.78±0.59)and (3.54±0.75),respectively.In seven dimensions,the scores for skills were all higher than those for knowledge.Multivariate stepwise regression analysis showed that years of working,hospital grade,marital status and form of employment were influencing factors of midwives' core competency (P＜0.05).Conclusion The core competence of midwives in 13 hospitals in Fujian Province was generally at the middle level.The junior ability was satisfactory,and the senior and expert abilities should be improved.Midwives who were newly employed,working in primary institutes,non-institution personnels should be paid more attention in order to promote midwives' core competency holistically.

Objective To detect altered levels and clinical significance of serum miR-216a and prognosis monitoring in acute pancreatitis (AP) patients.Methods Serum miR-216a levels were determined by quantitative reverse-transcription PCR (qRT-PCR) assay among 80 mild acute pancreatitis (MAP) patients,80 severe acute pancreatitis (SAP) patients and 74 healthy controls.And amylase (AMY),lipase (LPS),Ca2+,glucose (Glu),hematocrit (HCT),triglyceride (TG),total cholesterol (TC) and C reactive protein (CRP) were measured by biochemical analyzer.The clinical usefulness of miR-216a for AP patients was assessed by ROC curve analysis and correlation analysis.Results Compared with healthy controls (11.12 × 10-5 [5.83 × 10-5,19.12 × 10-5],the serum miR216a levels were significantly increased in AP patients(38.49 × 10-5 [24.05 × 10-5,62.02 × 10-5],(U =-9.10,P ＜ 0.01) . The serum miR-216a levels in MAP and SAP patients were (36.46 × 10-5 [22.29 × 10-5,55.80 × 10-5] vs 40.44 × 10-5 [25.84 × 10-5,65.48 × 10-5]),there was no significant difference between MAP and SAP patients (U =-0.96,P ＞ 0.05).The areas under ROC curve (AUCROC) of miR-216a for differential healthy controls and AP patients was 0.870 (95％ CI:0.825-0.915),cut-off value is 0.61.AUCROC of miR-216a for differential healthy controls and MAP patients was 0.865 (95％ CI:0.808-0.921),cut-off value is 0.59.And AUCROC of miR-216a for differential healthy controls and SAP patients was 0.876 (95％ CI:0.822-0.930),cut-off value is 0.66.Moreover,after the clinical improvement of the patients,the levels of serum miR-216a were significantly lowered from (41.88 × 10-5 [24.24 × 10-s,64.44 × 10-5]) to (20.58 × 10-5 [11.01 × 10-5,41.91 × 10-5]),the differences was significant(U =5.24,P ＜ 0.0l).Correlation analysis showed that miR-216a was positively correlated with CRP (r =0.215,P =0.006) in AP patients.Conclusion The levels of miR-216a in serum of AP patients were increased,which is a potential biomarker for the diagnosis and prognosis monitoring of AP.

Objective: To evaluate the vitamin D nutritional status in Chinese women of child-bearing age by analyzing serum 25-hydroxyvitamin D level in 2010-2012. Methods: Data were obtained from the China Nutrition and Health Survey in 2010-2012. Using cluster sampling and proportional stratified random sampling, 1 514 women of child-bearing age (18-44 years old) from 34 metropolis and 41 small and medium-sized cities were included in this study. Demographic information was collected by questionnaire and serum 25-hydroxyvitamin D concentration was determined by radioimmunoassay, in accordance with the 2010 Institute of Medicine of the National Academies standards. We compared differences in vitamin D levels, specifically serious deficiency, lack of deficiency, insufficiency, and excess. Results: The overall serum 25-hydroxyvitamin D level of Chinese urban women of child-bearing age (P₅₀ (P₂₅-P₇₅)) was 20.1 (15.1-26.3) ng/ml; minorities had a significantly higher serum 25-hydroxyvitamin D level of 22.0 (15.9-27.5) ng/ml compared with women of Han nationality (19.8 (14.9-26.2) ng/ml) (χ²=7.02, P=0.008). The proportions of women with serious deficiency, lack of deficiency, insufficiency, and excess vitamin D were 11.6% (n=175), 37.9% (n=574), 35.1% (n=531), and 0.3% (n=5), respectively. Only 15.1% (n=229) of women of child-bearing age had normal vitamin D nutritional status. No significant differences in vitamin D nutritional status were observed according to age, body mass index, city, nationality, educational level, marital status, or household income per capita (P>0.05). Conclusion Most Chinese urban women of child-bearing age have poor vitamin D levels and require vitamin D supplementation.