Metabolic associated fatty liver disease （MAFLD） is a chronic liver disease closely associated with metabolic syndrome， characterized by a complex pathogenesis involving genetic， environmental， and lifestyle factors. Recent studies have shown significant disparities in the prevalence rate and clinical features of MAFLD across different racial and ethnic groups， and such disparities might be associated with various factors such as genetic background， environmental factors， socioeconomic disparities， and metabolic profiles. This article reviews the latest research advances in racial and ethnic differences in MAFLD in China and globally， discusses its potential pathogenic mechanisms and clinical significance， proposes future research directions and interventional measures， and emphasizes the critical need to enhance MAFLD screening and preventive health education in multiethnic populations.

AIM: To construct a risk nomogram prediction model of macular edema(ME)based on the risk factors of ME after phacoemulsification in diabetic cataract(DC)patients.METHODS: A retrospective collection of data was conducted on 1 751 DC patients(1 751 eyes)who underwent cataract phacoemulsification surgery in the hospital from January 2022 to December 2024. Based on whether they developed ME after surgery, the patients were divided into the ME group(n=138)and the N-ME group(n=1 613). By conducting univariate and Logistic multiple regression analysis, the risk factors for postoperative ME in DC patients undergoing phacoemulsification were identified. A nomogram of risk prediction model was constructed, and the receiver operating characteristic(ROC)curve, calibration curve, Hosmer-Lemeshow goodness of fit test were plotted to evaluate the discrimination and calibration of the model. The decision curve was used to evaluate the clinical return on investment of the model.RESULTS: Age, course of diabetes, proportion of insulin treatment, proportion of retinopathy, best corrected visual acuity(BCVA), central subfield macular thickness(CSMT), macular volume, glycated hemoglobin(HbA1c), vascular endothelial growth factor(VEGF)in the ME group were higher than those in the N-ME group(all P<0.05). Multivariate Logistic regression analysis showed that diabetes course, retinopathy, BCVA, CSMT, macular volume, HbA1c and VEGF were the risk factors for ME after phacoemulsification in DC patients(all P<0.05). A nomogram of risk prediction model was constructed based on risk factors, and the ROC curve suggested good model differentiation [AUC of training set was 0.998(95% CI: 0.997-1.000), and AUC of validation set was 0.999(95% CI: 0.997-1.000)], set: R2=0.917, χ2=0.806, P=0.999; verification set: R2=0.900, χ2=0.675, P=1.000). The decision curve showed that the model had a high net return rate within the probability range of 0.00-1.00 threshold.CONCLUSION: Diabetes course, retinopathy, BCVA, CSMT, macular volume, HbA1c and VEGF are risk factors for ME after cataract phacoemulsification in DC patients. The nomogram of risk prediction model based on this construction has good differentiation and consistency in predicting the risk of ME after cataract phacoemulsification in DC patients.

Objective To explore the value of support vector machine(SVM)model based on gray matter volume(GMV)for identifying amyotrophic lateral sclerosis(ALS),also to analyze the relevant brain regions.Methods MR 3D T1WI data of 60 ALS patients(ALS group)and 60 healthy volunteers(control group)were retrospectively analyzed.Taken GMV of each brain region obtained by voxel-based morphometry as the input features.F-score analysis was used to select feature with the highest classification accuracy to construct SVM model.Receiver operating characteristic curve was drawn to evaluate the efficacy of SVM model for identifying ALS,and top 10％was used as the weight threshold to obtain gray matter brain regions contributed the most to this model.Results SVM model constructed based on the top 40％GMV features had the highest classification accuracy(82.50％),with sensitivity,specificity and area under the curve(AUG)of 85.05％,80.40％and 0.890,respectively.The left precentral gyrus,left anterior cingulate gyrus and paracingulate gyrus,right middle temporal gyrus,opercular part of left inferior frontal gyrus,right dorsolateral superior frontal gyrus,left temporal pole:middle temporal gyrus,right superior occipital gyrus,orbital part of right middle frontal gyrus,right calcarine fissure and surrounding cortex,right fusiform gyrus were the top 1-10 gray matter brain regions contributed to this model.Conclusion ALS had specific GMV change pattern.SVM model based on GMV could be used to effectively identify ALS,while the left precentral gyrus was the most contributive brain region to this model.

Objective:To investigate the molecular epidemiological characteristics of norovirus (NoV) among infectious diarrhea patients in Linyi from 2021 to 2023, and provide the scientific evidence for norovirus control and prevention.Methods:The epidemiological information and fecal samples of patients with infectious diarrhea in Linyi from 2021 to 2023 were collected and detected by real-time fluorescent quantitative PCR. The RdRp and capsid gene VP1 region of norovirus-positive specimens were amplified and sequenced used to analyze their genotype, phylogeny and homology.Results:Among the 2 311specimens, 123 (5.32%) were positive of NoV, with GI/GII group infection accounted for 17.07% (21/123) and 77.24% (95/123), respectively, GI/GII group mixed infection accounted for 5.69% (7/123). The detection rate of <1 year age group was the highest (8.86%), followed by the 1-3 years group (7.11%, 30/422) and the over 60 years group (5.29%, 23/123). The highest NoV detection rate was 7.96% (45/565) in the urban area, and the most abundant genotypes were found in the northern mountainous area. Sequence analysis showed that 61 identified NoV strains could be divided into 12 genotypes, with 4 NoV GI and 8 NoV GII. The dominant genotype differed during the 3 years, with GII.4 Sydney [P16] in 2021, GII.4 Sydney [P31] in 2022, and GII.2[P16] in 2023.Conclusions:NoV GII group was the main NoV infection in Linyi from 2021-2023 and genotypes were diverse. Children under 3 years of age and elderly people over 60 years old as susceptible groups should be given special protection. In addition, the monitoring of NoV genotype diversification should be strengthened in northern mountainous areas.

[Objective]To introduce Director CAO Yuxia's experience in treating congenital preauricular fistula infection and abscess with SHI's thick fire needle based on the thought of"treating fire depression with effusion".[Methods]By following the clinical works and case collation,the basic pathomechanism of congenital preauricular fistula infection and abscess was elaborated,and the innovative use of SHI's thick fire needle based on the therapeutic principle of"treating fire depression with effusion"to implement the"burnt needle robbing and stabbing"method was analyzed,and Director CAO's clinical experience in treating this disease by using SHI's thick fire needle and robbing stabbing method based on the therapeutic principle of"treating fire depression with effusion"was summarized,and a medical case was presented to support it.[Results]Director CAO believes that the disease was caused by the accumulation of heat and the decay into pus.The treatment should be based on the theory of"treating fire depression with effusion".For the first time,she proposes and adopts one of the new nine needles,SHI's thick fire needle,to quickly stab and eliminate pus,which can obtain the effect of"discharging heat,expelling pus,eliminating pathogens and stopping pain".In the medical case cited,the patient was suffered from this disease,combining the tongue and pulse with symptoms,he was identified as the syndrome of the accumulation of fire-heat toxin.Therefore,the key treatment principle was to eliminate pathogens and expel pus,relieve heat and resolve toxin,and after once fire needle treatment,good effect was obtained.[Conclusion]Director CAO treats congenital preauricular fistula infection and abscess,focusing on the"treating fire depression with effusion"principle,taking the fire and heat nature of fire needle and exerting the effect of"opening the way to eliminate pathogens,and expelling heat with heat",and achieves better clinical efficacy.The experience can provide ideas for the treatment of fire-heat and toxicity-containing diseases,which is worthy of clinical reference.

[Objective]To introduce Director CAO Yuxia's experience in treating congenital preauricular fistula infection and abscess with SHI's thick fire needle based on the thought of"treating fire depression with effusion".[Methods]By following the clinical works and case collation,the basic pathomechanism of congenital preauricular fistula infection and abscess was elaborated,and the innovative use of SHI's thick fire needle based on the therapeutic principle of"treating fire depression with effusion"to implement the"burnt needle robbing and stabbing"method was analyzed,and Director CAO's clinical experience in treating this disease by using SHI's thick fire needle and robbing stabbing method based on the therapeutic principle of"treating fire depression with effusion"was summarized,and a medical case was presented to support it.[Results]Director CAO believes that the disease was caused by the accumulation of heat and the decay into pus.The treatment should be based on the theory of"treating fire depression with effusion".For the first time,she proposes and adopts one of the new nine needles,SHI's thick fire needle,to quickly stab and eliminate pus,which can obtain the effect of"discharging heat,expelling pus,eliminating pathogens and stopping pain".In the medical case cited,the patient was suffered from this disease,combining the tongue and pulse with symptoms,he was identified as the syndrome of the accumulation of fire-heat toxin.Therefore,the key treatment principle was to eliminate pathogens and expel pus,relieve heat and resolve toxin,and after once fire needle treatment,good effect was obtained.[Conclusion]Director CAO treats congenital preauricular fistula infection and abscess,focusing on the"treating fire depression with effusion"principle,taking the fire and heat nature of fire needle and exerting the effect of"opening the way to eliminate pathogens,and expelling heat with heat",and achieves better clinical efficacy.The experience can provide ideas for the treatment of fire-heat and toxicity-containing diseases,which is worthy of clinical reference.

Objective To explore the value of support vector machine(SVM)model based on gray matter volume(GMV)for identifying amyotrophic lateral sclerosis(ALS),also to analyze the relevant brain regions.Methods MR 3D T1WI data of 60 ALS patients(ALS group)and 60 healthy volunteers(control group)were retrospectively analyzed.Taken GMV of each brain region obtained by voxel-based morphometry as the input features.F-score analysis was used to select feature with the highest classification accuracy to construct SVM model.Receiver operating characteristic curve was drawn to evaluate the efficacy of SVM model for identifying ALS,and top 10％was used as the weight threshold to obtain gray matter brain regions contributed the most to this model.Results SVM model constructed based on the top 40％GMV features had the highest classification accuracy(82.50％),with sensitivity,specificity and area under the curve(AUG)of 85.05％,80.40％and 0.890,respectively.The left precentral gyrus,left anterior cingulate gyrus and paracingulate gyrus,right middle temporal gyrus,opercular part of left inferior frontal gyrus,right dorsolateral superior frontal gyrus,left temporal pole:middle temporal gyrus,right superior occipital gyrus,orbital part of right middle frontal gyrus,right calcarine fissure and surrounding cortex,right fusiform gyrus were the top 1-10 gray matter brain regions contributed to this model.Conclusion ALS had specific GMV change pattern.SVM model based on GMV could be used to effectively identify ALS,while the left precentral gyrus was the most contributive brain region to this model.

Objective:To investigate the molecular epidemiological characteristics of norovirus (NoV) among infectious diarrhea patients in Linyi from 2021 to 2023, and provide the scientific evidence for norovirus control and prevention.Methods:The epidemiological information and fecal samples of patients with infectious diarrhea in Linyi from 2021 to 2023 were collected and detected by real-time fluorescent quantitative PCR. The RdRp and capsid gene VP1 region of norovirus-positive specimens were amplified and sequenced used to analyze their genotype, phylogeny and homology.Results:Among the 2 311specimens, 123 (5.32%) were positive of NoV, with GI/GII group infection accounted for 17.07% (21/123) and 77.24% (95/123), respectively, GI/GII group mixed infection accounted for 5.69% (7/123). The detection rate of <1 year age group was the highest (8.86%), followed by the 1-3 years group (7.11%, 30/422) and the over 60 years group (5.29%, 23/123). The highest NoV detection rate was 7.96% (45/565) in the urban area, and the most abundant genotypes were found in the northern mountainous area. Sequence analysis showed that 61 identified NoV strains could be divided into 12 genotypes, with 4 NoV GI and 8 NoV GII. The dominant genotype differed during the 3 years, with GII.4 Sydney [P16] in 2021, GII.4 Sydney [P31] in 2022, and GII.2[P16] in 2023.Conclusions:NoV GII group was the main NoV infection in Linyi from 2021-2023 and genotypes were diverse. Children under 3 years of age and elderly people over 60 years old as susceptible groups should be given special protection. In addition, the monitoring of NoV genotype diversification should be strengthened in northern mountainous areas.

Objective To evaluate the efficacy,safety and cost-effectiveness of tofacitinib in the treatment of ulcerative colitis using a rapid health technology assessment,and to provide an evidence-based basis for rational clinical use and decision-making.Methods PubMed,Embase,Cochrane Library,CNKI,WanFang Data,VIP and relevant HTA websites and databases were electronically searched to collect high-quality clinical evidence and economic evaluation literature of tofacitinib in the treatment of ulcerative colitis from inception to July 31,2024.The results were qualitatively analyzed by two researchers after independently screening the literature,extracting information and evaluating quality.Results A total of 17 studies were included,including 1 HTA report,9 systematic reviews/Meta-analyses,and 8 pharmacoeconomic studies.In terms of efficacy,the clinical response rate,clinical remission rate,mucosal healing rate,endoscopic remission rate and short-term colectomy rate were significantly improved by the treatment of tofacitnib in ulcerative colitis patients(P＜0.05).In terms of safety,tofacitinib was similar to placebo in the incidence of adverse events,serious adverse events,withdrawal from treatment due to adverse events,incidence of serious infections,and overall mortality(P＞0.05),with only a slight increase in the incidence of infections(P＜0.05).In terms of cost-effectiveness,the treatment of moderate-to-severe ulcerative colitis with tofacitinib was cost-effective compared with conventional therapy or other biologics in many countries including China.Conclusion Tofacitinib is effective and safe in the treatment of ulcerative colitis,and is significantly cost-effective for moderate-to-severe ulcerative colitis patients.Since it is still an off-label drug used for treating ulcerative colitis in China,the efficacy,safety and cost-effectiveness of tofacitinib need to be further evaluated based on the real-world clinical research and medical background in China in the future.

Objectives:To report the sexual functional outcomes of vaginal dilation therapy in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome patients.Methods:From March 2020 to February 2023, 97 MRKH syndrome patients performed vaginal dilation therapy with guidance from Peking Union Medical College Hospital, and 45 of them engaged in penetrative intercourse and were included in this prospective cohort study. The Chinese version of female sexual function index (FSFI) was used to assess sexual function. Functional success was defined as FSFI>23.45. Forty age-matched healthy women were selected as controls. Kaplan-Meier survival analysis was used to calculate the median time to success. Pearson correlation analysis was used to explore the relationship between neovagina length and sexual function. Complications were collected using follow-up questionnaires.Results:The functional success rate of vaginal dilation therapy was 89% (40/45) with a median time to success of 4.3 months (95% CI: 3.0-6.1 months). Compared to controls, MRKH syndrome patients had significantly lower scores in the orgasm domain (4.72±1.01 vs 4.09±1.20; P=0.013) and pain domain (5.03±0.96 vs 4.26±0.83; P<0.001). However, there were no significant differences in the FSFI total score (26.77±2.70 vs 26.70±2.33; P=0.912), arousal domain (4.43±0.77 vs 4.56±0.63; P=0.422) and satisfaction domain (4.88±0.98 vs 4.65±0.86; P=0.269) between MRKH syndrome patients and controls. MRKH syndrome patients had significantly higher scores in the desire domain (3.33±0.85 vs 3.95±0.73; P<0.001) and lubrication domain (4.37±0.56 vs 5.20±0.67; P<0.001). The prevalence of sexual dysfunction in MRKH patients was non-inferior to controls: low desire [3% (1/40) vs 23% (9/40); P=0.007], arousal disorder [3% (1/40) vs 3% (1/40); P>0.999], lubrication disorder [5% (2/40) vs 25% (10/40); P=0.012], orgasm disorder [40% (16/40) vs 20% (8/40); P=0.051], sexual pain [30% (12/40) vs 15% (6/40); P=0.108]. Conclusions:MRKH syndrome patients undergoing non-invasive vaginal dilation therapy could achieve satisfactory sexual life. Given its high functional success rate and slight complication, vaginal dilation therapy should be recommended as the first-line option, reducing the need for unnecessary surgeries.