In April 2025,Global consensus recommendations for metabolic dysfunction-associated steatotic liver disease and steatohepatitis was published online in Gastroenterology.These recommendations address the areas with significant divergence,such as metabolic dysfunction-associated steatotic liver disease(MASLD)screening steps,the use of noninvasive tests for risk stratification,management of comorbidities,and the recent advances in resmetirom for the treatment of metabolic dysfunction-associated steatohepatitis(MASH),covering the most debated topics in current MASLD management.This article makes an excerpt of the main contents in these consensus recommendations.

In April 2025,Global consensus recommendations for metabolic dysfunction-associated steatotic liver disease and steatohepatitis was published online in Gastroenterology.These recommendations address the areas with significant divergence,such as metabolic dysfunction-associated steatotic liver disease(MASLD)screening steps,the use of noninvasive tests for risk stratification,management of comorbidities,and the recent advances in resmetirom for the treatment of metabolic dysfunction-associated steatohepatitis(MASH),covering the most debated topics in current MASLD management.This article makes an excerpt of the main contents in these consensus recommendations.

Objective To assess the exposure levels of heavy metals,including lead,arsenic,mercury,and cadmium,in the local population in Sichuan and Chongqing,China,to compare and analyze the differences in reference intervals(RIs)obtained from direct and indirect sampling methods,and to explore the interchangeability and limitations of these two sampling methods.Methods RIs were obtained by the direct sampling method and the indirect sampling method.In the direct sample method,the levels of blood arsenic,urinary cadmium,urinary mercury,and blood lead levels of 5562 healthy participants aged 22-50 years in Sichuan and Chongqing,China were measured by atomic absorption spectrometry and inductively coupled plasma-mass spectrometry.Using the human biomonitoring(HBM)data,we established RIs for the population by a nonparametric method.On the other hand,in the indirect sampling method,RIs were established via a nonparametric method based on data from the laboratory information system(LIS)of a local hospital after stratifying healthy individuals using a Gaussian mixture model(GMM).Comparative analysis of the RIs derived from the two sampling methods were then conducted.Results The RI for blood arsenic was 0.11-1.3 μmol/L.The RI for urinary cadmium was 0.51-2.80 μmol/mol creatine for adults aged 22 to under 43 years and 0.66-2.96 μmol/mol creatine for adults aged 43-50 years.The RI for urinary mercury was 0.12-1.10 μmol/mol creatine.The RI for blood lead was 14.00-47.00 pg/L for adults aged 22 to under 41 year,16.00-53.38 pg/L for males aged 41-50 year,and 15.00-51.02 pg/L for females aged 41-50 year.Most of the RIs established by the direct sampling method had a narrower range compared to those established by the indirect sampling method,and the RIs established by both sampling methods were partially biased.Conclusions The RIs for blood arsenic,urine cadmium,urine mercury,and blood lead in healthy individuals aged 22-50 years in Sichuan and Chongqing,China were established using both direct and indirect sampling methods,which contributes to a better understanding of environmental exposure to metals in the general population and provides a reference for metal poisoning.For data from the same lab,the GMM-based indirect sampling method demonstrated relatively consistent performance in establishing RIs compared with the direct sampling method.

Exercise fatigue is a complex physiological and psychological phenomenon that includes peripheral fatigue in the muscles and central fatigue in the brain. Peripheral fatigue refers to the loss of force caused at the distal end of the neuromuscular junction, whereas central fatigue involves decreased motor output from the primary motor cortex, which is associated with modulations at anatomical sites proximal to nerves that innervate skeletal muscle. The central regulatory failure reflects a progressive decline in the central nervous system’s capacity to recruit motor units during sustained physical activity. Emerging evidence highlights the critical involvement of central neurochemical regulation in fatigue development, particularly through neurotransmitter-mediated modulation. Alterations in neurotransmitter release and receptor activity could influence excitatory and inhibitory signal pathways, thus modulating the perception of fatigue and exercise performance. Increased serotonin (5-HT) could increase perception of effort and lethargy, reduce motor drive to continue exercising, and contribute to exercise fatigue. Decreased dopamine (DA) and noradrenaline (NE) neurotransmission can negatively impact arousal, mood, motivation, and reward mechanisms and impair exercise performance. Furthermore, the serotonergic and dopaminergic systems interact with each other; a low 5-HT/DA ratio enhances motor motivation and improves performance, and a high 5-HT/DA ratio heightens fatigue perception and leads to decreased performance. The expression and activity of neurotransmitter receptors would be changed during prolonged exercise to fatigue, affecting the transmission of nerve signals. Prolonged high-intensity exercise causes excess 5-HT to overflow from the synaptic cleft to the axonal initial segment and activates the 5-HT1A receptor, thereby inhibiting the action potential of motor neurons and affecting the recruitment of motor units. During exercise to fatigue, the DA secretion is decreased, which blocks the binding of DA to D1 receptor in the caudate putamen and inhibits the activation of the direct pathway of the basal ganglia to suppress movement, meanwhile the binding of DA to D2 receptor is restrained in the caudate putamen, which activates the indirect pathway of the basal ganglia to influence motivation. Furthermore, other neurotransmitters and their receptors, such as adenosine (ADO), glutamic acid (Glu), and γ‑aminobutyric acid (GABA) also play important roles in regulating neurotransmitter balance and fatigue. The occurrence of central fatigue is not the result of the action of a single neurotransmitter system, but a comprehensive manifestation of the interaction between multiple neurotransmitters. This review explores the important role of neurotransmitters and their receptors in central motor fatigue, reveals the dynamic changes of different neurotransmitters such as 5-HT, DA, NE, and ADO during exercise, and summarizes the mechanisms by which these neurotransmitters and their receptors regulate fatigue perception and exercise performance through complex interactions. Besides, this study presents pharmacological evidence that drugs such as agonists, antagonists, and reuptake inhibitors could affect exercise performance by regulating the metabolic changes of neurotransmitters. Recently, emerging interventions such as dietary bioactive components intake and transcranial electrical stimulation may provide new ideas and strategies for the prevention and alleviation of exercise fatigue by regulating neurotransmitter levels and receptor activity. Overall, this work offers new theoretical insights into the understanding of exercise central fatigue, and future research should further investigate the relationship between neurotransmitters and their receptors and exercise fatigue.

Objective To analyze the treatment effects of extracorporeal cardiopulmonary resuscitation(ECPR)in 3 patients with cardiac arrest due to cardiac causes in a mountain area hospital,providing a reference for clinical diagnosis and treatment.Methods The combined treatment process of 3 patients with cardiogenic cardiac arrest admitted to Wufeng Tujia Autonomous County People's Hospital from January to December 2023 was retrospectively analyzed,and the treatment experience was summarized.Results All 3 patients underwent continuous cardiopulmonary resuscitation and defibrillation while urgently initiating the ECPR combined rescue process.First,a central venous catheter(CVC)was established under ultrasound guidance to create access for extracorporeal membrane oxygenation(ECMO).Once the ECMO equipment from a higher-level hospital arrived,the circuit was replaced,significantly reducing the time required for subsequent patient treatment.Finally,two patients with acute myocardial infarction underwent emergency coronary angiography and percutaneous coronary intervention(PCI)under ECMO support,resulting in the restoration of spontaneous cardiac rhythm and gradual stabilization of vital signs.The last patient was discharged after recovery following transfer to a higher-level hospital,while another patient received rehabilitation treatment after hemodynamic stability was achieved.The third patient,who experienced cardiac arrest due to hypertrophic cardiomyopathy,regained spontaneous rhythm after ECMO,but due to poor neurological recovery after transfer to a higher-level hospital,the family chose to withdraw treatment.Conclusions ECPR is a rapid extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation method for patients who cannot regain spontaneous rhythm or experience recurrent cardiac arrest.It aims to improve patient survival rates.In grassroots medical centers lacking the necessary conditions,early assistance from regional advanced medical centers can ensure rapid transfer and surgery under ECMO support,providing a guarantee for favorable patient outcomes.

Objective To analyze the treatment effects of extracorporeal cardiopulmonary resuscitation(ECPR)in 3 patients with cardiac arrest due to cardiac causes in a mountain area hospital,providing a reference for clinical diagnosis and treatment.Methods The combined treatment process of 3 patients with cardiogenic cardiac arrest admitted to Wufeng Tujia Autonomous County People's Hospital from January to December 2023 was retrospectively analyzed,and the treatment experience was summarized.Results All 3 patients underwent continuous cardiopulmonary resuscitation and defibrillation while urgently initiating the ECPR combined rescue process.First,a central venous catheter(CVC)was established under ultrasound guidance to create access for extracorporeal membrane oxygenation(ECMO).Once the ECMO equipment from a higher-level hospital arrived,the circuit was replaced,significantly reducing the time required for subsequent patient treatment.Finally,two patients with acute myocardial infarction underwent emergency coronary angiography and percutaneous coronary intervention(PCI)under ECMO support,resulting in the restoration of spontaneous cardiac rhythm and gradual stabilization of vital signs.The last patient was discharged after recovery following transfer to a higher-level hospital,while another patient received rehabilitation treatment after hemodynamic stability was achieved.The third patient,who experienced cardiac arrest due to hypertrophic cardiomyopathy,regained spontaneous rhythm after ECMO,but due to poor neurological recovery after transfer to a higher-level hospital,the family chose to withdraw treatment.Conclusions ECPR is a rapid extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation method for patients who cannot regain spontaneous rhythm or experience recurrent cardiac arrest.It aims to improve patient survival rates.In grassroots medical centers lacking the necessary conditions,early assistance from regional advanced medical centers can ensure rapid transfer and surgery under ECMO support,providing a guarantee for favorable patient outcomes.

Aim To explore the mechanism of process¬ing and increasing efficiency of Arisaematis rhizomz preparatum. Methods UPLC-Q-TOF-MS/MS tech¬nology was used to detect the chemical components be¬fore and after processing of Arisaematis rhizomz prepara¬tum, and its mechanism of action was analysed in the treatment of 44 asthma and phlegm " by using network pharmacology. A rat model of allergic asthma was es- tablished to compare the efficacy of Arisaematis rliizoma before and after processing. Results A total of 27 chemical components were identified, among which cur- cumin ,6-gingerol and other components increased after processing. Combined with the database prediction, the action mechanism of the 36 chemical components in the treatment of 44 asthma and phlegm" diseases was dis¬cussed and predicted through network pharmacology. The results of animal experiments showed that the effect of processed Arisaematis rhizoma on allergic asth¬ma was better than that of Arisaematis rhizoma, but there was no significant difference. Conclusions The addition of curcumin, 6-gingerol, camphor, demethyl- curcumin and other components after the processed Ari¬saematis rhizomz preparatum may be the reason for the synergistic effect of Arisaematis rhizomz preparatum in the treatment of allergic asthma.

Objective To develop a bead-based xTAG assay for the rapid detection of Salmonella，Vibrio parahaemolyticus，Listeria monocytogenes and Staphylococcus aureus． Methods Specific primers with xTAG were designed and synthesized based on the target gene sequences and MagPlex-TAG Microspheres . After a multiplex PCR amplification，the PCR products hybridized with MagPlex-TAG Microspheres． The Luminex200 array system was used to detect the results of hybridization． The sensitivity and specificity of the method was valued． Results The Luminex xTAG Assay was developed for a specific，rapid，accurate detection of Salmonella，Vibrio parahaemolyticus，Listeria monocytogenes and Staphylococcus aureus. The sensitivity of detection of toxR gene of Salmonella，hly gene of Vibrio parahaemolyticus，and invA gene of Listeria monocytogenes was 100 CFU ／mL． The sensitivity of detection of Sa442 gene of Staphylococcus aureus was 1×10³CFU／mL． Conclusion The Luminex xTAG Assay could rapidly, accurately and specifically detect four foodborne pathogens Salmonella，Vibrio parahaemolyticus，Listeria monocytogenesand, Staphylococcus aureus.

OBJECTIVE: To observe the effect of five-element music therapy of traditional Chinese medicine (TCM) on the clinical symptoms and the quality of life in the patients with suboptimal health status (SHS) of liver stagnation and spleen deficiency and explore the corresponding specificity changes in the temperature of acupoints when zangfu functions are of dysfunction and recovered to be balanced, separately. METHODS: Sixty patients with SHS of liver stagnation and spleen deficiency were randomized into an observation group and a control group, 30 cases in each one. In the control group, the conventional health education was provided. In the observation group, on the base of the therapeutic regimen as the control group, the patients received the five-element music therapy to pacify the liver qi and strengthen the spleen functions, once every two days, 30 min each time, 3 treatments a week. The course of treatment consisted of 4 weeks. Before and after treatment, the TCM syndrome score and the MOS 36-item short form healthy survey (SF-36) score were compared between the two groups and the clinical therapeutic effect was evaluated. Using infrared thermal imaging, the temperature at the acupoints of the affected organs (liver, spleen), the related organs (gallbladder, stomach) and the other non-related zangfu organs (pericardium, lung) was detected before and after treatment in the two groups. RESULTS: After treatment, the TCM syndrome scores were reduced when compared with those before treatment in the two groups (P<0.01, P<0.05); the reduction in the observation group was larger than that of the control group (P<0.01). The score of each domain for the SF-36 in the observation group and the score of role-emotional domain in the control group were all increased when compared with the scores before treatment (P<0.01, P<0.05); and the score of each domain for the SF-36 in the observation group was higher than that in the control group (P<0.01). The total effective rate was 66.7% (20/30) in the observation group, which was higher than 10.0% in the control group (3/30, P<0.05). In the observation group, the temperature of the yuan-primary point, the back-shu point and the front-mu point related to the liver, as well as those related to the gallbladder after treatment was reduced when compared with the temperature before treatment; and the changes were larger than those of the control group (P<0.01). The temperature of the yuan-primary point, the back-shu point and the front-mu point related to the spleen, as well as the back-shu point and the front-mu point related to the stomach in the observation group was increased when compared with the temperature before treatment (P<0.01); and the changes were larger than those of the control group (P<0.01). For the temperature of the non-specific points related to the liver and spleen, as well as the yuan-primary point, the back-shu point and the front-mu point related to the pericardium and the lung, there was no significant differences when compared with the temperature at the above-mentioned acupoints before and after treatment (P>0.05). CONCLUSION TCM five-element music therapy associated with the conventional health education may effectively relieve the clinical symptoms and improve the quality of life in the patients with suboptimal health status of liver stagnation and sleep deficiency; and the therapeutic effect is better than the simple health education. The changes in the temperature of acupoints may reflect the functional regulation of the related zangfu organs in the body.
Humans ; Acupuncture Points ; Medicine, Chinese Traditional ; Spleen ; Music Therapy ; Quality of Life ; Temperature ; Liver ; Health Status

The epidemic of coronavirus disease 2019 (COVID-19) puts higher demands on critical care medicine. Lots of studies have been conducted to solve COVID-19-related problems. Therefore, we reviewed the annual progress for COVID-19-related issues including antivirals threapies, respiratory support and immunomodulatory therapies and other critical issues, including the effect of antibiotic on mitochondrial damage and its relationship with sepsis, the goal and direction of antimicrobial de-escalation, drug prophylaxis of constipation, bleeding in gastrointestinal disorders and management of critical illness in the informalization era and so on. We hope to provide reference for clinical and scientific research work of the intensivists.