Background/Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a chronic liver disease characterized by hepatic steatosis. Ubiquitin-specific protease 29 (USP29) plays pivotal roles in hepatic ischemiareperfusion injury and hepatocellular carcinoma, but its role in MASLD remains unexplored. Therefore, the aim of this study was to reveal the effects and underlying mechanisms of USP29 in MASLD progression. Methods: USP29 expression was assessed in liver samples from MASLD patients and mice. The role and molecular mechanism of USP29 in MASLD were assessed in high-fat diet-fed and high-fat/high-cholesterol diet-fed mice and palmitic acid and oleic acid treated hepatocytes. Results: USP29 protein levels were significantly reduced in mice and humans with MASLD. Hepatic steatosis, inflammation and fibrosis were significantly exacerbated by USP29 deletion and relieved by USP29 overexpression. Mechanistically, USP29 significantly activated the expression of genes related to fatty acid β-oxidation (FAO) under metabolic stimulation, directly interacted with long-chain acyl-CoA synthase 5 (ACSL5) and repressed ACSL5 degradation by increasing ACSL5 K48-linked deubiquitination. Moreover, the effect of USP29 on hepatocyte lipid accumulation and MASLD was dependent on ACSL5. Conclusions USP29 functions as a novel negative regulator of MASLD by stabilizing ACSL5 to promote FAO. The activation of the USP29-ACSL5 axis may represent a potential therapeutic strategy for MASLD.

Background/Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a chronic liver disease characterized by hepatic steatosis. Ubiquitin-specific protease 29 (USP29) plays pivotal roles in hepatic ischemiareperfusion injury and hepatocellular carcinoma, but its role in MASLD remains unexplored. Therefore, the aim of this study was to reveal the effects and underlying mechanisms of USP29 in MASLD progression. Methods: USP29 expression was assessed in liver samples from MASLD patients and mice. The role and molecular mechanism of USP29 in MASLD were assessed in high-fat diet-fed and high-fat/high-cholesterol diet-fed mice and palmitic acid and oleic acid treated hepatocytes. Results: USP29 protein levels were significantly reduced in mice and humans with MASLD. Hepatic steatosis, inflammation and fibrosis were significantly exacerbated by USP29 deletion and relieved by USP29 overexpression. Mechanistically, USP29 significantly activated the expression of genes related to fatty acid β-oxidation (FAO) under metabolic stimulation, directly interacted with long-chain acyl-CoA synthase 5 (ACSL5) and repressed ACSL5 degradation by increasing ACSL5 K48-linked deubiquitination. Moreover, the effect of USP29 on hepatocyte lipid accumulation and MASLD was dependent on ACSL5. Conclusions USP29 functions as a novel negative regulator of MASLD by stabilizing ACSL5 to promote FAO. The activation of the USP29-ACSL5 axis may represent a potential therapeutic strategy for MASLD.

Cardiovascular diseases （CVD），a group of common diseases in clinical practice，are witnessing a steady rise in both incidence and mortality rates，posing a challenge to public health. Gualou Xiebai Banxiatang，originating from Synopsis of the Golden Chamber （《金匮要略》），was initially used to treat severe cases of chest impediment. The formula consists of Trichosanthis Fructus，Allii Macrostemonis Bulbus，Pinelliae Rhizoma，and Baijiu. It has a wide range of clinical applications，with therapeutic effects including moving Qi to relieve depression，activating Yang to dissipate mass，and expelling phlegm to alleviate chest congestion. In recent years，clinical research has confirmed that Gualou Xiebai Banxiatang，with or without modification，used alone or in combination with Western medicine，has definite effects in the treatment of CVD such as hyperlipidemia，coronary atherosclerotic heart disease，hypertension，heart failure，and arrhythmia. It can alleviate disease symptoms and reduce the risk of re-hospitalization. Basic research indicates that the mechanisms of Gualou Xiebai Banxiatang include improving endothelial functions，exhibiting anti-inflammatory properties，countering oxidative stress，preventing apoptosis，inhibiting ventricular remodeling，regulating mitochondrial functions，improving hemorheology，and modulating autophagy and neurotransmitters. This article reviews relevant articles in recent years with focuses on the compatibility，clinical application，and mechanism of Gualou Xiebai Banxiatang. This review is expected to provide a theoretical basis for the mechanism research and clinical application of this formula in treating CVD and to offer ideas and reference for in-depth research.

OBJECTIVE To provide a reference for the quality control of Hypericum perforatum. METHODS High- performance liquid chromatography （HPLC） was used to establish fingerprints for 20 batches of H. perforatum and determine the contents of its main components： chlorogenic acid， rutin， hyperin， isoquercitrin， avicularin， quercitrin and quercetin. Cluster analysis was conducted using SPSS 26.0 software. The chromaticity values （luminance value L*， red-green value a*， and yellow- blue value b*） of H. perforatum powder were measured using electronic eye. A prediction model for the contents of seven components in H. perforatum based on its appearance chromaticity values was established using machine learning algorithms. The predictive performance of the models was evaluated using root-mean-square-error （RMSE）. RESULTS A total of 16 common peaks were calibrated in the fingerprints of 20 batches of H. perforatum， and 9 peaks were identified， which were chlorogenic acid， rutin， hyperin， isoquercitrin， avicularin， quercitrin， quercetin， hypericin and hyperforin； the similarities of the 20 batches of samples and reference fingerprint ranged from 0.889-0.987. The contents of chlorogenic acid， rutin， hyperin， isoquercitrin， avicularin， quercitrin and quercetin were 0.025%-0.166%， 0.048%-0.339%， 0.082%-0.419%， 0.017%-0.209%， 0.011%-0.134%， 0.020%-0.135%， 0.041%-0.235%， respectively. Cluster analysis results showed that 18 batches of qualified H. perforatum were grouped into three categories， when the Euclidean distance was set to 1.4. L* of the 20 batches of H. perforatum ranged from 62.814 to 75.668， a* ranged from 1.409 to 3.490， and b* ranged from 25.249 to 30.759. RMSE of three prediction models， namely XGBoost， LightGBM， and AdaBoost， ranged from 0.008 to 0.070， indicating good fitting performance. XGBoost model predicted the contents of the other six components with high accuracy， except for rutin. CONCLUSIONS The established fingerprints and content determination methods are accurate， reproducible， and reliable. The content prediction model based on appearance chromaticity values， combined with machine learning algorithms， can be used for the quality control of H. perforatum.

Background/Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a chronic liver disease characterized by hepatic steatosis. Ubiquitin-specific protease 29 (USP29) plays pivotal roles in hepatic ischemiareperfusion injury and hepatocellular carcinoma, but its role in MASLD remains unexplored. Therefore, the aim of this study was to reveal the effects and underlying mechanisms of USP29 in MASLD progression. Methods: USP29 expression was assessed in liver samples from MASLD patients and mice. The role and molecular mechanism of USP29 in MASLD were assessed in high-fat diet-fed and high-fat/high-cholesterol diet-fed mice and palmitic acid and oleic acid treated hepatocytes. Results: USP29 protein levels were significantly reduced in mice and humans with MASLD. Hepatic steatosis, inflammation and fibrosis were significantly exacerbated by USP29 deletion and relieved by USP29 overexpression. Mechanistically, USP29 significantly activated the expression of genes related to fatty acid β-oxidation (FAO) under metabolic stimulation, directly interacted with long-chain acyl-CoA synthase 5 (ACSL5) and repressed ACSL5 degradation by increasing ACSL5 K48-linked deubiquitination. Moreover, the effect of USP29 on hepatocyte lipid accumulation and MASLD was dependent on ACSL5. Conclusions USP29 functions as a novel negative regulator of MASLD by stabilizing ACSL5 to promote FAO. The activation of the USP29-ACSL5 axis may represent a potential therapeutic strategy for MASLD.

There are numerous ethical dilemmas in families of children with kidney disease during the treatment stage. From the perspective of Giddens’ structured theory， this paper analyzed the ethical dilemmas， such as individual and family wealth disparity at the micro-level， doctor-patient information asymmetry and the attribution of medical decision-making rights at the meso-level， as well as unequal medical resources and an incomplete medical security system for children at the macro-level. The ethical dilemmas faced by families of children with kidney disease are the result of the structural constraint effect. The coping strategies they adopt in response to these dilemmas are the basis of structural reproduction and the products of the structural effect. As a group with subjective initiative， they are good at self-reflection. Through repeated cognitive evaluation， they can make a series of effective coping strategies to achieve their own goals， such as relying on family support and linking resources to seek social support， establishing online support groups and building an information sharing platform， assessing children’s best-interests judges and safeguarding their reasonable and legitimate rights and interests， planning and allocating high-quality medical resources and promoting the construction of the medical service system， as well as promoting the reform of the basic medical insurance system for children and improve the protection mechanism for major illnesses.

Objective:To explore the chain mediation role of career development planning and career success in the relationship between nurses' professional values and occupational embeddedness.Methods:From February to March 2024, a convenience sampling method was used to select 763 nurses from ClassⅢ Grade A hospitals in Wenzhou as research subjects. Data were collected using a General Information Questionnaire, the Occupational Embeddedness Scale for Nurses (OESN), the Nursing Professional Values Scale-Revised (NPVS-R), the Nurses' Career Planning Questionnaire (NCPQ), and the Career Success Scale for Nurses (CSSN). Pearson correlation analysis was performed to examine the correlations among the scores of OESN, NPVS-R, NCPQ, and CSSN. The AMOS 21.0 software was used to construct a structural equation model to explore the chain mediation role of career development planning and career success in the relationship between nurses' professional values and occupational embeddedness.Results:A total of 763 questionnaires were collected, with 749 valid responses, resulting in an effective recovery rate of 98.17%. The average scores for the 749 nurses were as follows: OESN (60.29±7.65), NPVS-R (108.99±11.82), NCPQ (42.98±4.44), CSSN (73.57±8.34). All four scale scores were positively correlated with each other ( P<0.05). The chain mediation effect of career development planning and career success in the relationship between nurses' professional values and occupational embeddedness was established, with the total indirect effect accounting for 46.04% (0.302/0.656) of the total effect and the chain mediation effect of career development planning and career success accounting for 10.21% (0.067/0.656) . Conclusions:The level of occupational embeddedness among nurses needs further improvement. Nurses' professional values not only directly influence their level of occupational embeddedness but also affect their career development planning, which in turn impacts their career success, ultimately exerting an indirect effect on occupational embeddedness. Nursing managers should strengthen nurses' professional values, assist them in formulating clear career development plans, and provide timely feedback and recognition of career success.

Abstract: Malaria is one of the deadliest vector-borne infectious diseases in Africa, seriously endangering human life and health. Among them, cerebral malaria (CM) has a higher morbidity and mortality rate in children, with clinical manifestations primarily involving neurological symptoms, and comprehensive treatment mainly using artemisinin derivatives. When children with cerebral malaria are complicated by congenital heart disease and induce acute hypoxic attacks, the diagnosis and treatment face great difficulties in the absence of effective examination and monitoring treatments. Similar cases have rarely been reported at home and abroad. The paper summarizes and reports a case of a child with cerebral malaria combined with cyanotic congenital heart disease, treated during an aid mission to Africa, who was improved and discharged from the hospital after receiving multidisciplinary anti-malarial, intracranial pressure lowering, neurotrophic and symptomatic supportive treatment. This paper also discusses the diagnosis and treatment process of this child under difficult conditions, combined with current literature reports, in hopes of providing a reference for clinical treatment.

ObjectiveTo compare the quality of two kinds of honey-processed Lilii Bulbus（HPLB） prepared by empirical and pharmacopoeial methods based on chemical analysis and intelligent sensory technology， and to improve and upgrade the quality standard of HPLB on the basis of excavating and inheriting the traditional experience of famous experts in traditional Chinese medicine（TCM）. MethodSamples of HPLB were prepared according to the method in the 2020 edition of Chinese Pharmacopoeia（honey was added before frying） and the empirical method of the old pharmacists（honey was added after frying）， and the appearance characteristics， thin layer chromatography（TLC） identification， inspection， leachables and other items of the two kinds of samples were detected according to the methods under the Lilii Bulbus in the 2020 edition of Chinese Pharmacopoeia. The fingerprints of HPLB with different honey addition methods were established by high performance liquid chromatography（HPLC）， and the contents of regaloside A， regaloside B and 5-hydroxymethylfurfural（5-HMF） were determined， the quality difference between the two HPLB samples was evaluated by multivariate statistical analysis. Meanwhile， electronic nose and electronic tongue were used to measure the sense of smell and taste， and combined with multivariate statistical analysis， the difference sensors were screened with the variable importance in the projection（VIP） value>1 in order to compare the differences between the two kinds of HPLB. ResultCompared with HPLB prepared by the pharmacopoeial method， the sample prepared by the empirical method had lower water content， slightly higher soluble extract content， better appearance and easy storage. HPLC fingerprints of two kinds of HPLB samples were established， and the similarity between them was≥0.999， indicating that the composition of two species was similar. And 29 common peaks were calibrated， among which peaks 8 and 18 were regaloside A and regaloside B. The quantitative analysis of the index components in the two kinds of HPLB samples showed that the difference in the contents of regaloside A and regaloside B was not statistically significant， whereas the content of 5-HMF in empirical HPLB was significantly higher than that of the pharmacopoeial HPLB（P<0.01）. The electronic tongue and electronic nose test results showed that the umami， umami richness and saltiness of the empirical HPLB were higher than those of the pharmacopoeial HPLB. The results of electronic nose detection showed that the four sensors W1W， W2S， W5S and W1S were the differential odor sensors of the two samples， among which the response values of W1S and W2S sensors were higher than those of the pharmacopoeial HPLB， which might be related to the content of 5-HMF. ConclusionCompared with the pharmacopoeial HPLB， the empirical sample is of better quality， but the two can be clearly distinguished by electronic nose and electronic tongue， which can provide a reference for excavating and inheriting the traditional experience of famous experts in TCM and further improving the processing methods and quality standards of HPLB.

Objective:To investigate the association of serum uric acid (SUA) with the outcome in patients with acute ischemic stroke (AIS) at one year after onset.Methods:Patients with AIS admitted to the Department of Neurology, Dagang Hospital, Tianjin Binhai New Area were included retrospectively. According to the modified Rankin Scale (mRS) score at 1 year after onset, patients were divided into a good outcome group (0-2) and a poor outcome group (>2). They were also divided into a survival group and a death group based on their survival status at 1 year after onset. The clinical baseline data and laboratory tests were compared. Multivariate logistic regression analysis was used to determine the associations of SUA with poor outcome and death in patients with AIS. Results:A total of 651 patients were enrolled, including 430 males (66.1%) aged 67.5±11.7 years. Four hundred and fourteen patients (63.6%) were in the good outcome group, and 237 (36.4%) were in the poor outcome group. There were 568 patients (87.3%) in the survival group and 43 (16.7%) in the death group. Univariate analysis showed that there were differences in age, atrial fibrillation, history of stroke or transient ischemic attack, baseline National Institutes of Health Stroke Scale (NIHSS) score, and pre-admission mRS score between the poor outcome group and the good outcome group. The homocysteine, SUA, white blood cell count, and creatinine in the poor outcome group were higher than those in the good outcome group, while the red blood cell count and hemoglobin were lower than those in the good outcome group (all P<0.05). There were differences in age, history of ischemic heart disease, atrial fibrillation, history of stroke or transient ischemic attack, baseline NIHSS score, pre-admission mRS score, and stroke etiology classification between the survival group and the death group. Hemoglobin and triglycerides in the survival group were higher than those in the death group, while the white blood cell count and creatinine were lower than those in the death group (all P<0.05). Multivariate logistic regression analysis showed that SUA was an independent risk factor for poor outcome in patients with AIS (odds ratio 1.004, 95% confidence interval 1.001-1.006; P<0.01), but there was no independent correlation with death. Conclusion:Higher SUA is an independent risk factor for poor outcome at one year after onset in patients with AIS.