Objective To investigate the correlation between different forms of serum vitamin D levels and liver fibrosis in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Methods Data from the National Health and Nutrition Examination Survey in 2021–2023 were analyzed. Logistic regression models were used to evaluate the relationship between serum total vitamin D, 25(OH)D₃ levels, and liver fibrosis in the MAFLD patients. Results A total of 2 628 patients were included. There were significant differences between MAFLD patients with liver fibrosis and those without fibrosis in age, smoking history, waist circumference, body mass index, high-density lipoprotein cholesterol, total cholesterol, fasting plasma glucose, hypertension history, vitamin D, and 25(OH)D₃ levels (P＜0.05). Logistic regression analysis revealed that compared to the low total serum vitamin D group (11.2-61.8 nmol/L), MAFLD patients with high total vitamin D levels (89.1 nmol/L＜vitamin D≤290 nmol/L) exhibited a 22% reduced risk of liver fibrosis (OR＝0.78, 95%CI 0.64-0.94, P＝0.015). Similarly, compared to the low 25(OH)D₃ group (4.1-57.0 nmol/L), those with high 25(OH)D₃ level [84.7 nmol/L＜25(OH)D₃≤288 nmol/L] showed a 23% lower risk of liver fibrosis (OR＝0.77, 95%CI 0.62-0.95, P＝0.021). After adjusting for covariates, high total vitamin D levels remained significantly associated with reduced liver fibrosis risk (OR＝0.63, 95%CI 0.42-0.94, P＝0.036). Conclusions Elevated serum total vitamin D and 25(OH)D₃ levels are protective factors against early liver fibrosis in MAFLD patients.

Objective To investigate the factors influencing the natural outcome of low-grade squamous intraepithelial lesions(LSIL)of the cervix.Methods A total of 154 patients who underwent colposcopic cervical biopsy in the Third Affiliated Hospital of Zhengzhou University from January 2022 to January 2023 were selected and divided into negative conversion group(55 cases),continuous group(70 cases)and upgraded group(29 cases)according to the follow-up results.Logistic regression was used to analyze the influence of related factors on the outcome of LSIL.Results There were statistically significant differences in the number of vaginal births,the results of thin-prep cytology test,human papilloma virus(HPV)typing,whether vaginal LSIL was combined,whether there were symptoms,and vaginal microecology among three groups(P＜0.05).Multivariate Logistic analysis showed that combined vaginal LSIL,vaginal microecological abnormalities,atypical squamous cell-cannot exclude high-grade squamous intraepithelial lesion(ASC-H)/high-grade squamous intraepithelial lesion(HSIL),HPV 16/18 positive or mixed positive were independent risk factors for persistent infection(P＜0.05),combined vaginal LSIL,symptomatic,vaginal microecological abnormalities,ASC-H/HSIL,HPV 16/18 positive or mixed positive were all independent risk factors for escalation of lesions(P＜0.05).Conclusion Patients with vaginal LSIL,vaginal microecological abnormalities,ASC-H/HSIL,HPV 16/18 positive or mixed positive should be followed up and early intervention to reduce the risk of disease escalation.

Objective To investigate the factors influencing the natural outcome of low-grade squamous intraepithelial lesions(LSIL)of the cervix.Methods A total of 154 patients who underwent colposcopic cervical biopsy in the Third Affiliated Hospital of Zhengzhou University from January 2022 to January 2023 were selected and divided into negative conversion group(55 cases),continuous group(70 cases)and upgraded group(29 cases)according to the follow-up results.Logistic regression was used to analyze the influence of related factors on the outcome of LSIL.Results There were statistically significant differences in the number of vaginal births,the results of thin-prep cytology test,human papilloma virus(HPV)typing,whether vaginal LSIL was combined,whether there were symptoms,and vaginal microecology among three groups(P＜0.05).Multivariate Logistic analysis showed that combined vaginal LSIL,vaginal microecological abnormalities,atypical squamous cell-cannot exclude high-grade squamous intraepithelial lesion(ASC-H)/high-grade squamous intraepithelial lesion(HSIL),HPV 16/18 positive or mixed positive were independent risk factors for persistent infection(P＜0.05),combined vaginal LSIL,symptomatic,vaginal microecological abnormalities,ASC-H/HSIL,HPV 16/18 positive or mixed positive were all independent risk factors for escalation of lesions(P＜0.05).Conclusion Patients with vaginal LSIL,vaginal microecological abnormalities,ASC-H/HSIL,HPV 16/18 positive or mixed positive should be followed up and early intervention to reduce the risk of disease escalation.

BACKGROUND:Tissue engineering has brought new hope to the clinical challenge of liver failure,and the preparation of plant-derived decellularized fiber scaffolds holds significant importance in liver tissue engineering. OBJECTIVE:To prepare apple tissue decellularized scaffold material by using fresh apple slices and a solution of sodium dodecyl sulfate,and assess its biocompatibility. METHODS:Fresh apples were subjected to decellularization using phosphate buffer saline and sodium dodecyl sulfate solution,separately.Afterwards,the decellularized apple tissues and apple decellularized scaffold materials were decontaminated with phosphate buffer saline.Subsequently,scanning electron microscopy was used to assess the effectiveness of decellularization of the apple materials.Adipose-derived mesenchymal stem cells were extracted from the inguinal fat BALB/C of mice,and their expression of stem cell-related markers(CD45,CD34,CD73,CD90,and CD105)was identified through flow cytometry.The cells were then divided into a scaffold-free control group and a scaffold group.Equal amounts of adipose-derived mesenchymal stem cells were seeded onto both groups.The biocompatibility of the decellularized scaffold with adipose-derived mesenchymal stem cells was evaluated using CCK-8 assay,hematoxylin-eosin staining,and phalloidine staining.Cell adhesion and growth on the scaffold were observed under light microscopy and scanning electron microscopy.Furthermore,the scaffold was subdivided into the non-induced group and the hepatogenic-induced group.Adipose-derived mesenchymal stem cells were cultured on the decellularized apple scaffold,and they were cultured for 14 days in regular culture medium or hepatogenic induction medium for comparison.Immunofluorescent staining using liver cell markers,including albumin,cytokeratin 18,and CYP1A1,was performed.Enzyme-linked immunosorbent assay was used to detect the secretion of alpha fetoprotein and albumin.Additionally,scanning electron microscopy was employed to observe the morphology of the induced cells on the scaffold,verifying the expression of liver cell-related genes on the decellularized scaffold material.Finally,the cobalt-60 irradiated and sterilized decellularized apple scaffolds were transplanted onto the surface of mouse liver and the degradation of the scaffold was observed by gross observation and hematoxylin-eosin staining after 28 days. RESULTS AND CONCLUSION:(1)The scanning electron microscopy results revealed that the decellularized apple scaffold material retained a porous structure of approximately 100 μm in size,with no residual cells observed.(2)Through flow cytometry analysis,the cultured cells were identified as adipose-derived mesenchymal stem cells.(3)CCK-8 assay results demonstrated that the prepared decellularized apple tissue scaffold material exhibited no cytotoxicity.Hematoxylin-eosin staining and phalloidine staining showed that adipose-derived mesenchymal stem cells were capable of adhering and proliferating on the decellularized apple tissue scaffold.(4)The results obtained from immunofluorescence staining and enzyme-linked immunosorbent assay revealed that adipose-derived mesenchymal stem cells cultured on the decellularized apple scaffolds exhibited elevated expression of liver-specific proteins,including albumin,alpha-fetoprotein,cytokeratin 18,and CYP1A1.These results suggested that they were induced differentiation into hepatocyte-like cells possessing functional characteristics of liver cells.(5)The decellularized apple scaffold implanted at 7 days has integrated with the liver,with partial degradation of the scaffold observed.By 28 days,the decellularized apple scaffold has completely degraded and has been replaced by newly-formed tissue.(6)The results indicate that the decellularized scaffold material derived from apple tissue demonstrates favorable biocompatibility,promoting the proliferation,adhesion,and hepatic differentiation of adipose-derived mesenchymal stem cells.

Objective To explore the value of multi-sequence MRI radiomics for predicting clinical stage of cervical squamous cell carcinoma(CSCC).Methods Totally 190 patients with single CSCC confirmed by pathology were retrospectively collected.Among them,67 cases with International Federation of Gynecology and Obstetrics(FIGO)stage ⅠB—ⅡA were classified into early stage group,while 123 cases with FIGO ⅡB—ⅢC were enrolled in middle-late stage group.The patients were divided into training set(n=114,including 40 cases in early stage subgroup and 74 cases in middle-late stage subgroup)and test set(n=76,including 27 cases in early stage subgroup and 49 cases in middle-late stage subgroup)at the ratio of 6∶4.Single factor and logistic analyses were used to screen clinical relevant factors,and a clinical model was constructed.The best radiomics features of lesions were extracted and selected based on pre-treatment pelvic MR T2WI,diffusion-weighted imaging(DWI),dynamic contrast enhancement(DCE)-T1WI and all the three,respectively,and the radiomics models were constructed,including T2WI,DWI,DCE-TWI and combined sequences models,then a clinical-radiomics model was established based on clinical model and combined sequences model.The predictive efficacy of each model was evaluated by receiver operating characteristic curves,and the area under the curves(AUC)were calculated.The integrated discrimination improvement(IDI)index was also calculated to compare the diagnostic efficacy of each model in training set,and decision curve analysis(DCA)was used to evaluate their clinical value.Results Squamous cell carcinoma associated antigen in middle-late stage subgroup was higher than that in early stage subgroup in both training and test sets(both P＜0.05),which was used to establish the clinical model.The AUC of clinical,T2WI,DWI,DCE-TWI,combined sequences and clinical-radiomics models for predicting clinical stage of CSCC was 0.66,0.71,0.78,0.81,0.88 and 0.89 in training set,respectively,which was 0.62,0.64,0.72,0.73,0.77 and 0.76 in test set,respectively.In training set,the predictive efficacy of clinical-radiomics model was higher than that of combined sequences model(IDI=0.19,P＜0.05),both higher than that of the rest models(IDI=0.19-0.47,all P＜0.05).When the thresholds were 0.02-1.00 and 0.05-1.00,combined sequences and clinical-radiomics models had higher clinical net benefits in training set.Conclusion Multi-sequence MRI radiomics could effectively predict clinical stage of CSCC,and combining clinical data could improve its diagnostic efficacy.

Objective:To investigate the potential source of infection for a cluster outbreak of human brucellosis in Yantai City, Shandong Province.Methods:The information of a human brucellosis cluster outbreak case in Yantai City, Shandong Province in 2022 was collected, the strains were isolated and cultured, and DNA was extracted. BCSP31-PCR was used for species identification, and AMOS-PCR was used for species type identification. Multiple locus variable-number tandem-repeat analysis (MLVA)-16 was used for clustering analysis, and the results were compared with the public database MLVAbank and the monitoring data of Brucella in Shandong Province in 2022. At the same time, whole genome single nucleotide polymorphism (wgSNP) typing was used to analyze the 53 Brucella strains that had completed whole genome sequencing in Shandong Province in 2022, and the wgSNP phylogenetic tree was constructed. Results:According to BCSP31-PCR and AMOS-PCR identification, the three strains related to the cluster outbreak of brucellosis in Yantai City, Shandong Province in 2022 were all Brucella melitensis biotype. The results of MLVA-16 typing showed that the MLVA-16 typing of the three isolated strains was completely consistent, with 16 tandem repeat loci of 1-5-3-13-2-2-3-2-4-41-8-4-4-3-6-5, belonging to the Eastern Mediterranean clade. Compared with MLVAbank, the MLVA-16 typing of two strains isolated from Kazakhstan was consistent with the results of this study. Compared with the monitoring data of Brucella in Shandong Province in 2022, it was found that the MLVA-16 typing of 11 isolated strains was consistent with the results of this study, which were isolated from Zaozhuang, Linyi, Taian, Yantai, and Weifang cities, respectively. The results of wgSNP typing showed that the distance between the 11 strains and the strains of the current outbreak was less than 7 single nucleotide polymorphisms, and the strains were isolated from Taian, Zibo, Linyi, Binzhou, Jinan, Jining, Yantai and Weihai cities, respectively. Conclusion:After tracing the source of a human brucellosis cluster outbreak in Yantai City, Shandong Province in 2022, it is speculated that the strains of Brucella melitensis isolated from Linyi, Taian and Yantai cities are closely related, indicating that sheep in these areas have homology.

Objective:To evaluate the efficacy and safety of mosapride citrate dispersible tablet (MP) combined with Shugan Jieyu capsule (SGJY) in the treatment of functional dyspepsia (FD).Methods:From April 2018 to January 2019, FD patients from 10 hospitals including Renji Hospital, Shanghai Jiaotong University School of Medicine, Luohe Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Handan Hospital of Traditional Chinese Medicine and Nanshi Hospital of Nanyang were selected for a randomized, double-blind, placebo-controlled trial. The patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder-7 (GAD-7) were used to assess depression and anxiety in FD patients, respectively. According to the random number table method, 200 FD patients who met the inclusion criteria were randomly divided into SGJY+ MP group and placebo+ MP group, with 100 patients in each group, and all the patients were given oral MP. The patients of the SGJY+ MP group and the placebo+ MP group were given oral SGJY or placebo on the basis of MP, respectively. The patients of both groups were treated continuously for 6 weeks. Total FD symptom scores, PHQ-9 and GAD-7 scores, as well as efficiency and safety were evaluated after treatment. Independent samples t-test and chi-square test were used for statistical analysis. Results:A total of 193 patients were included into the full analysis set with 94 cases in the SGJY+ MP group and 99 cases in the placebo+ MP group. A total of 183 patients completed the 6-week trial, including 89 cases in the SGJY+ MP group and 94 cases in the placebo+ MP group. A total of 198 patients were included in the safety analysis set, including 99 cases in the SGJY+ MP group and 99 cases in the placebo+ MP group.After treatment, the total FD symptom scores of the SGJY+ MP group and the placebo+ MP group were both lower than those of baseline before treatment (3.71±3.06 vs. 11.79±5.18 and 4.17±3.69 vs. 11.19±5.05), and the differences were both statistically significant ( t=-24.87 and -23.27, both P<0.001). The efficacy of the SGJY+ MP group was higher than that of the placebo+ MP group (86.5%, 77/89 vs. 74.5%, 70/94), and the difference was statistically significant ( χ2=4.69, P=0.030). The efficacy of patients with moderate-to-severe anxiety and depression in the SGJY+ MP group was both higher than that of patients in the placebo+ MP group (10/10 vs. 3/7, 85.0%, 17/20 vs. 8/14), and the differences were statistically significant ( χ2=5.66 and 5.33, P=0.017 and 0.010). The efficacy of patients with postprandial distress syndrome (PDS) subtype in the SGJY+ MP group was higher than that of patients in the placebo+ MP group (93.0%, 53/57 vs. 76.5%, 39/51), and the difference was statistically significant (χ 2=5.82, P=0.016). The PHQ-9 scores of patients with depression in both SGJY+ MP and placebo+ MP groups were lower than those at baseline before treatment (3.63±2.76 vs. 7.87±2.24 and 3.35±2.51 vs. 7.63±2.25), and the differences were statistically significant ( t=-14.88 and -15.87, both P<0.001). There was no significant difference in proportion of depressed patients with a ≥50% reduction in PHQ-9 scores from baseline value between the SGJY+ MP group and the placebo+ MP group (60.2%, 50/83 vs. 62.8%, 54/86; χ2=0.05, P=0.825). The GAD-7 scores of anxious patients both the SGJY+ MP group and the placebo+ MP group were lower than the baseline value before treatment (3.27±2.57 vs. 7.09±2.08 and 3.86±2.49 vs. 6.84±1.66), and the differences were statistically significant ( t=-13.30 and -11.47, both P<0.001). The proportion of anxious patients with a ≥50% reduction in GAD-7 scores from baseline in the SGJY+ MP group was higher than that of the placebo+ MP group (54.4%, 43/79 vs. 36.5%, 27/74), and the difference was statistically significant ( χ2=4.53, P=0.033). There were no serious adverse events in both the SGJY+ MP group and the placebo+ MP group during the treatment. There were no significant differences in the incidence of adverse events and adverse reactions during the treatment between the SGJY+ MP group and the placebo+ MP group (7.1%, 7/99 vs. 5.1%, 5/99, and 3.0%, 3/99 vs. 3.0%, 3/99, respectively; both P>0.05). Conclusion:SGTY can safely and effectively improve the efficacy of the prokinetic drugs in the treatment of FD symptoms, especially in FD patients with PDS subtype or with moderate-to-severe anxiety and with depression.

Objective:To evaluate the efficacy and safety of mosapride citrate dispersible tablet (MP) combined with Shugan Jieyu capsule (SGJY) in the treatment of functional dyspepsia (FD).Methods:From April 2018 to January 2019, FD patients from 10 hospitals including Renji Hospital, Shanghai Jiaotong University School of Medicine, Luohe Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Handan Hospital of Traditional Chinese Medicine and Nanshi Hospital of Nanyang were selected for a randomized, double-blind, placebo-controlled trial. The patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder-7 (GAD-7) were used to assess depression and anxiety in FD patients, respectively. According to the random number table method, 200 FD patients who met the inclusion criteria were randomly divided into SGJY+ MP group and placebo+ MP group, with 100 patients in each group, and all the patients were given oral MP. The patients of the SGJY+ MP group and the placebo+ MP group were given oral SGJY or placebo on the basis of MP, respectively. The patients of both groups were treated continuously for 6 weeks. Total FD symptom scores, PHQ-9 and GAD-7 scores, as well as efficiency and safety were evaluated after treatment. Independent samples t-test and chi-square test were used for statistical analysis. Results:A total of 193 patients were included into the full analysis set with 94 cases in the SGJY+ MP group and 99 cases in the placebo+ MP group. A total of 183 patients completed the 6-week trial, including 89 cases in the SGJY+ MP group and 94 cases in the placebo+ MP group. A total of 198 patients were included in the safety analysis set, including 99 cases in the SGJY+ MP group and 99 cases in the placebo+ MP group.After treatment, the total FD symptom scores of the SGJY+ MP group and the placebo+ MP group were both lower than those of baseline before treatment (3.71±3.06 vs. 11.79±5.18 and 4.17±3.69 vs. 11.19±5.05), and the differences were both statistically significant ( t=-24.87 and -23.27, both P<0.001). The efficacy of the SGJY+ MP group was higher than that of the placebo+ MP group (86.5%, 77/89 vs. 74.5%, 70/94), and the difference was statistically significant ( χ2=4.69, P=0.030). The efficacy of patients with moderate-to-severe anxiety and depression in the SGJY+ MP group was both higher than that of patients in the placebo+ MP group (10/10 vs. 3/7, 85.0%, 17/20 vs. 8/14), and the differences were statistically significant ( χ2=5.66 and 5.33, P=0.017 and 0.010). The efficacy of patients with postprandial distress syndrome (PDS) subtype in the SGJY+ MP group was higher than that of patients in the placebo+ MP group (93.0%, 53/57 vs. 76.5%, 39/51), and the difference was statistically significant (χ 2=5.82, P=0.016). The PHQ-9 scores of patients with depression in both SGJY+ MP and placebo+ MP groups were lower than those at baseline before treatment (3.63±2.76 vs. 7.87±2.24 and 3.35±2.51 vs. 7.63±2.25), and the differences were statistically significant ( t=-14.88 and -15.87, both P<0.001). There was no significant difference in proportion of depressed patients with a ≥50% reduction in PHQ-9 scores from baseline value between the SGJY+ MP group and the placebo+ MP group (60.2%, 50/83 vs. 62.8%, 54/86; χ2=0.05, P=0.825). The GAD-7 scores of anxious patients both the SGJY+ MP group and the placebo+ MP group were lower than the baseline value before treatment (3.27±2.57 vs. 7.09±2.08 and 3.86±2.49 vs. 6.84±1.66), and the differences were statistically significant ( t=-13.30 and -11.47, both P<0.001). The proportion of anxious patients with a ≥50% reduction in GAD-7 scores from baseline in the SGJY+ MP group was higher than that of the placebo+ MP group (54.4%, 43/79 vs. 36.5%, 27/74), and the difference was statistically significant ( χ2=4.53, P=0.033). There were no serious adverse events in both the SGJY+ MP group and the placebo+ MP group during the treatment. There were no significant differences in the incidence of adverse events and adverse reactions during the treatment between the SGJY+ MP group and the placebo+ MP group (7.1%, 7/99 vs. 5.1%, 5/99, and 3.0%, 3/99 vs. 3.0%, 3/99, respectively; both P>0.05). Conclusion:SGTY can safely and effectively improve the efficacy of the prokinetic drugs in the treatment of FD symptoms, especially in FD patients with PDS subtype or with moderate-to-severe anxiety and with depression.

Objective:To evaluate and analyze the health status of the elderly from physical health, mental health and social health, so as to understand the health status and health service needs of rural elderly.Methods:A total of 263 elderly people aged 60 years and over(mean aged 70.9±7.9 years, 113 males and 150 females, 125 aged 60-69 years, 98 aged 70-79 years and 40 aged 80 years and over)in Nanwangkong Village, Shaozhuang Town, Qingzhou City, Weifang City, Shandong Province were selected by cluster sampling method.The physical, mental, social and overall health status of the elderly were comprehensively evaluated and analyzed by self-designed questionnaire.Results:The overall health rate was 30%(79 cases), and the physical health, mental health and social health rates were 73.8%(194 cases), 84.0%(221 cases)and 34.6%(91 cases), respectively, in rural elderly in this area.The physical health was better in males than in females in 80~ years old groups( χ2=5.736, P<0.05). The overall health was better in males than in females in the total age group and the 60~69 years old groups( χ2=7.468 and 11.116, both P<0.01). The proportions of unhealthy, basic healthy and healthy people in the overall and the dimensions of physical health, mental health and social health had significant differences in the 60~69, 70~79 and 80~ years old groups( χ2=40.590, 29.342, 18.503 and 27.615, all P<0.01), and the Chi-square test for trend showed that there was a statistically significant downward trend of overall health grade distribution with age( χ2=21.994, 12.831, 16.570 and 22.595, both P<0.01). Conclusions:In this study, 30.0% of the rural elderly were considered healthy, 48.3% were basically healthy, and 21.7% were unhealthy.The health status of the elderly gradually deteriorates with age.The government should strengthen the multidimensional health assessment of the rural elderly and provide the comprehensive health guidance services and targeted interventions for the elderly in terms of disease control, psychological counseling and social participation.

Abstract In order to achieve the goal of reducing the smoking rate among Chinese adults at ages of 15 years and above to below 20% by 2030, smoking cessation services require to be reinforced. The current Chinese smoking cessation service system includes short-term smoking cessation interventions and smoking cessation hotlines at the population level, and smoking cessation clinics at the individual level; however, these smoking cessation services suffer from problems of low awareness, low accessibility and low utilization rate. Based on the publications pertaining to smoking cessation services and released policy documents in China until June 2022, this review analyzes the current status, problems and causes of smoking cessation services, and proposes suggestions for improving the smoking cessation service system construction in China.