Hepatocellular carcinoma （HCC） is a malignant tumor with high incidence and mortality rates worldwide. Recent studies have shown that neutrophil extracellular traps （NETs） play an important role in the development， progression， and immune escape of HCC. NETs are released by neutrophils and mainly consist of DNA， histones， and antimicrobial molecules， and in addition to immune defense， they are also involved in the initiation， metastasis， and thrombosis of HCC. This article elaborates on the formation and regulatory mechanisms of NETs， explores their potential mechanisms in the initiation， metastasis， immune escape， and thrombosis of HCC， and discusses the prospect of NETs as a target for the diagnosis and treatment of HCC， in order to provide new ideas for the precise treatment of HCC in the future and promote the early diagnosis and effective treatment of HCC.

Objective To explore the public's cognition and attitude towards general medicine,general practitioners,and pre-hospital first-aid knowledge in Ludian County,Yunnan Province,to find out the training and learning methods that are more acceptable to the public for this kind of related knowledge,and to propose targeted solutions.Methods A complete random sampling survey was conducted among the nucleic acid collection office at the gate of the vegetable market from October 15,2022,to December 30,2022,and the outpatient clinic of Wenping Street Health Center from January 1,2023,to February 28,2023,by using electronic questionnaire and paper questionnaire.Results Nearly 50%of the people in Ludian County of Yunnan Province lack the knowledge of general medicine and pre-hospital emergency care,especially the knowledge of electrical defibrillation.People with higher education and the medical profession have a higher understanding of general medicine,and people with a higher understanding of general medicine are more willing to participate in pre-hospital emergency care.The average Ridit value is:very familiar with general medicine(0.774)>Knowledge of some general practices(0.565)>Never heard of general practice(0.400).The higher education level and the more comprehensive understanding of general medicine had a positive impact on participation in pre-hospital emergency care,with B values of 0.624 and 0.619,OR 95%CI of 1.867(1.544～2.257)and 1.857(1.298～2.657),respectively.Taking medical staff as a reference,the B value of medical students was = 0.942,P = 0.234,the difference was not significant,and the B value of non-medical professional population was all less than 0,the effect is negative.In addition,most people have a positive attitude towards learning pre-hospital first aid,and more than 70%of people are willing to learn and train related knowledge of pre-hospital first aid.Conclusions People in urban areas of Ludian County,Yunnan Province have poor understanding of general practice,low recognition of general practitioners,low demand for general practitioners,and lack of awareness of the importance of pre-hospital emergency treatment.Because of the cognitive differences among different groups,it is necessary to conduct specific training for different groups.

Background::Cardiovascular disease (CVD) has emerged as the leading cause of death from prostate cancer (PCa) in recent decades, bringing a great disease burden worldwide. Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy (ADT). The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods::Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling. CVD was defined as myocardial infarction, arrhythmia, heart failure, stroke, ischemic heart disease, and others. CVD risk was estimated by calculating Framingham risk scores (FRS). Patients were accordingly divided into low-, medium-, and high-risk groups. χ2 or Fisher’s exact test was used for comparison of categorical variables. Results::A total of 4253 patients were enrolled in the present study. A total of 27.0% (1147/4253) of patients had comorbid PCa and CVD, and 7.2% (307/4253) had two or more CVDs. The enrolled population was distributed in six regions of China, and approximately 71.0% (3019/4253) of patients lived in urban areas. With imaging and pathological evaluation, most PCa patients were diagnosed at an advanced stage, with 20.5% (871/4253) locally progressing and 20.5% (871/4253) showing metastasis. Most of them initiated prostatectomy (46.6%, 1983/4253) or regimens involving ADT therapy (45.7%, 1944/4253) for prostate cancer. In the present PCa cohort, 43.1% (1832/4253) of patients had hypertension, and half of them had poorly controlled blood pressure. With FRS stratification, as expected, a higher risk of CVD was related to aging and metabolic disturbance. However, we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT. This was in accordance with clinical practice, i.e., aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery. Among patients who underwent medical castration, only 4.0% (45/1118) received gonadotropin releasing hormone antagonists, in stark contrast to the grim situation of CVD prevalence and risk.Conclusions::PCa patients in China are diagnosed at an advanced stage. A heavy CVD burden was present at the initiation of treatment. Patients who accepted ADT-related therapy showed an original higher risk of CVD, but the awareness of cardiovascular protection was far from sufficient.

The application of artificial intelligence(AI)in medical diagnosis and treatment is becoming increasingly widespread,providing doctors and patients with more high-quality,efficient and personalized medical services.However,it also raised a series of ethical issues such as data security,algorithm transparency,responsibility definition,fairness and justice,doctor-patient relationships,and other aspects.Based on the combing of existing research results,this paper analyzed the research status of medical ethics in the application of AI in diagnosis and treatment,as well as expected that future medical ethics research can further explore the ethical issues of AI technology in medical treatment in greater depth,thus ensuring the rational application of AI in the medical field and maximizing the protection of patients'rights and interests.

ObjectiveTo explore the relationships between internet gaming disorder (IGD), interpersonal needs, loneliness, and depression in adolescents through the construction of a chain mediation model, to clarify the underlying mechanisms of these associations, and to provid a theoretical basis for depression prevention and intervention. MethodsBased on the data of the 7th Population Census, using convenient sampling method 1 106 adolescents aged between 10‒19 years in South China (176), North China (147), Central China (332), and East China (451) were selected to conduct a cross-sectional survey, with a ratio of 1∶1∶1.5∶2.5. The survey was conducted with a questionnaire consisting of general information (sex, age, grade, parents’ education level), the Chinese version of the IGDS9-SF, the INQ-15, the short-form of the ULS-8 and the PHQ-9 were used to evaluate the depression status of adolescents. Spearman correlation analysis was used to explore the correlation between the variables. A multiple-mediator model was constructed using IBM SPSS Statistics 22.0 PROCESS to examine the mediating effects of interpersonal needs and loneliness on the relationship between IGD and depression. The significance of the chain mediating effect was tested using the Bootstrap method. ResultsOverall, 39.06% (432/1 106) adolescents experienced depression. The incidence of depression among adolescents with smoking and without smoking was 62.50% and 38.36%, respectively. Similarly, the incidence of depression among adolescents with alcohol consuming and without alcohol consuming was 61.94% and 35.94%, respectively. There were statistically significant differences between IGD, interpersonal needs, loneliness, and depression (P<0.01). The chain mediation model demonstrated a good fit, and the bootstrap test showed that the 95%CI of each mediation path did not include 0, indicating significant mediation effects. The overall effect was 0.337. The direct effect of IGD on depression was significant (effect value=0.138, 95%CI:0.102-0.173, P<0.001). The mediation effects included three paths: ① IGD →interpersonal needs → depression (effect value=0.073, P<0.05), accounting for 21.47% of the total effect;② IGD→ loneliness → depression (effect value=0.093, P<0.05), accounting for 27.35%; and ③ IGD → interpersonal needs → loneliness → depression (effect value=0.036, P<0.05), accounting for 10.59%. ConclusionInterpersonal needs and loneliness independently and jointly mediate the relationship between IGD and depression among adolescents. To reduce depression and improve mental health in this population, measures should be taken to prevent and intervene in IGD, address adolescents’ social and emotional needs, enhance satisfaction of interpersonal needs, and reduce loneliness.

Objective:To explore the clinical phenotype and genetic characteristics of a Chinese pedigree affected with Spastic paraplegia type 5A (SPG5A).Methods:A pedigree suspected for Hereditary spastic paraplegia (HSP) at Henan Children′s Hospital on August 15 2022 was selected as the study subject. Clinical data of the pedigree was collected. Peripheral blood samples were collected from members of the pedigree. Following extraction of genomic DNA, trio-WGS was carried out, and candidate variant was verified by Sanger sequencing.Results:The child, a 1-year-old boy, had presented with microcephaly, hairy face and dorsal side of distal extremities and trunk, intellectual and motor development delay, increased muscle tone of lower limbs, hyperreflexes of bilateral knee tendons, and positive pathological signs. His parents and sister both had normal phenotypes. Trio-WGS revealed that the child has harbored a homozygous c. 1250G>A (p.Arg417His) variant of the CYP7B1 gene, for which his mother was heterozygous, the father and sister were of the wild type. The variant was determined to have originated from maternal uniparental disomy (UPD). The result of Sanger sequencing was in keeping with the that of trio-WGS. SPG5A due to maternal UPD of chromosome 8 was unreported previously. Conclusion:The child was diagnosed with SPG5A, a complex type of HSP, for which the homozygous c. 1250G>A variant of the CYP7B1 gene derived from maternal UPD may be accountable.

Objective To investigate the clinical significance of anti-Sj?gren′s syndrome type A antibody(SSA)and anti-Sj?gren′s syndrome type B antibody(SSB)in idiopathic inflammatory myopathies(IIM)and IIM associated interstitial disease(ILD).Methods A total of 102 patients with IIM were selected.The general information,clinical manifestations and auxiliary examinations were collected.Their positive rates of anti-SSA and anti-SSB antibodies in IIM patients were analyzed.IIM patients were divided into the SS antibody negative group(73 patients)and the SS antibody positive group(29 patients)according to the results of anti SSA and SSB antibody tests.The clinical significance of anti-SSA and anti-SSB antibodies in IIM and IIM related ILD was analyzed.Results Compared with patients in the SS antibody positive group,patients in the SS antibody negative group were more likely to experience dry mouth,increased erythrocyte sedimentation rate(ESR)and increased immunoglobulin A(IgA)levels(P＜0.05).The general situation score of the MDAAT(myositis disease activity assessment tool)was significantly higher in the SS antibody positive group than that in the SS antibody negative group(P＜0.05),and there were no significant differences in scores of other MDAAT items between the two groups(P＞0.05).There were no significant differences in the positive rate of myositis autoantibodies,recurrence rate,hormone therapy and immunosuppressive therapy between the two groups(P＞0.05).The proportion of patients treated with intravenous human immunoglobulin was higher in the SS antibody positive group than that of the SS antibody negative group(P＜0.05).Non-specific interstitial pneumonia(NSIP)was the most type of ILD in both the SS antibody negative group and the positive group,followed by usual interstitial pneumonia(UIP).Patients with IIM who were positive for anti-SSA/SSB antibodies were more likely to progress to the overlapping syndrome of combined SS.Conclusion Positive anti-SSA and anti-SSB antibodies in IIM patients are associated with dry mouth symptoms,and anti-SSA/SSB antibodies may become one of the important laboratory indicators for judging patient conditions and predicting disease outcomes.

Objective To evaluate the risk of disease of Vibrio parahaemolyticus in aquatic products of raw food animals for population in guangzhou,and determine risk management points. Methods VP quantitative detection was carried out in aquatic products of raw food animals sold in Guangzhou from 2009 to 2022.sQMRA was applied to assess Vibrio parahaemolyticus risk of aquatic products of raw food animals. According to stratified analysis based on the pollution of Vibrio parahaemolyticus and evaluation results,carry out risk management and analysis. Results Among the 98 samples were detected positive of VP from 1 343 samples from 2009 to 2022 , with an overall positive rate of 7.30%.The number of Vibrio parahaemolyticus infection cases caused by eating aquatic products of raw food animals in Guangzhou was 3012. If the proportion of raw food is reduced , the number of Vibrio parahaemolyticus infection cases will be significantly reduced. The number of cases caused by eating raw fash will be reduced from 2128 to 217.The detection rate of Vibrio parahaemolyticus in raw fresh water products was much higher than that in marine products. The probability of infection in the population was higher. The number of cases caused by eating raw fash was the highest.The detection rate of Vibrio parahaemolyticus was higher in raw crustaceans and molluscs. The incidence of Vibrio parahaemolyticus infection cases caused by eating raw fash in the four quarters varied from high to low as such sequence ,4.93×10^-5 in the three quarters , 2.53×10^-5 in the second quarter , 2.40×10^-5 in the first quarter ,1.77×10^-5 in the fourth quarter . Conclusion The risk of disease of Vibrio parahaemolyticus in aquatic products of raw food animals was higher. The public health education should be done well. Aquatic products should be cooked thoroughly before eating . Reduce the intake of raw aquatic products and avoid cross contamination. Focus on the risks of summer and autumn seasons and seafood such as crustaceans and molluscs. Concentrate on scientific research on Vibrio parahaemolyticus pollution of fresh water products.

{L-End}Objective To investigate the current status of long working hours of food-delivery workers from food-delivery platform, and analyze its impact on their health such as occupational stress, depressive symptoms, insomnia symptoms, fatigue accumulation, and life satisfaction. {L-End}Methods A total of 2 145 food-delivery workers from two food-delivery platforms in Guangzhou City were selected as the research subjects using convenience sampling method. The occupational stress, depressive symptoms, insomnia symptoms, fatigue accumulation, and life satisfaction were investigated using the Core Occupational Stress Scale, Patient Health Questionnaire-9 items, Self-sleep Management Questionnaire, Self-diagnosis Questionnaire of Fatigue Accumulation of Workers, and World Health Organization Five-item Well Being Index. {L-End}Results The median and the 25th and 75th percentiles of weekly working hours were 63 (49,77) hours. And 92.2% (1 978/2 145) of workers, who worked more than 40 hours per week, were long working hours workers. While 70.1% (1 504/2 145) workers, who worked 55 hours or more per week, were ultra-long working hours workers. The detection rate of occupational stress, depressive symptoms, insomnia symptoms, fatigue accumulation, and low life satisfaction was 30.1%, 27.5%, 34.7%, 40.8%, and 75.1%, respectively. The longer the weekly working hours of the research subjects, the higher the detection rate of occupational stress and fatigue accumulation (all P<0.01). The results of multivariate logistic regression analysis showed that ultra-long working hours (weekly working hours ≥55 hours) was the influencing factor of occupational stress and fatigue accumulation after excluding the influence of confounding factors among workers (all P<0.05). {L-End}Conclusion The food-delivery workers of food-delivery platforms generally work long hours. Ultra-long working hours is a risk factor for occupational stress and fatigue accumulation among these workers.

Objective:In order to explore the possibility of expanding the surgical indications of the ambulatory laparoscopic transcystic common bill duct exploration(LTCBDE).Methods:A retrospective case-control study analysis was performed on the clinical data of 585 patients who underwent laparoscopic transcystic common bill duct exploration in the Beijing Friendship Hospital Affiliated to Capital Medical University from January 2015 to December 2018, including 155 cases of the ambulatory LTCBDE (study group) and 430 cases of the overnight LTCBDE (control group). The propensity score was used to match the related variables, and 144 pairs were successfully matched. The two groups were compared in surgery-related indicators, such the preoperative tests, history of acute exacerbation in the last one month, history of upper abdominal surgery, concomitant diseases (high blood pressure, diabetes mellitus, coronary heart disease, cerebrovascular disease and respiratory diseases), american society of anesthesiology (ASA) score, intraoperative bleeding, operation time, total medical costs, unplanned readmission rate. Measurement data with normal distribution were expressed as mean±standard deviation( ± s), chi-square test was used for comparison between groups, and M( Q1, Q3) was used for measurement data with non-normal distribution. Fisher exact probability test and Wilcoxon rank-sum test were used for comparison between groups. Results:The indexes of aspartate aminotransferase (AST), alanine aminotransferase(ALT), total bilirubin, direct bilirubin (DBIL), alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGT), ASA score, intraoperative bleeding and total medical costs of the study group were 21.8(18.0, 31.0) U/L, 21.5(15.0, 42.5) U/L, 14.2(11.2, 18.6) umol/L, 2.6(2.1, 3.5) μmol/L, 91.0(73.3, 118.5) U/L, 44.5(22.0, 109.8) U/L, 2.0(2.0, 2.0) grade, 7.5(5.0, 10.0) mL, 9 659.0(8 704.8, 10 640.2) yuan respectively, and the control group were 26.0(17.7, 45.3) U/L, 29.5(16.0, 85.5) U/L, 17.2(13.0, 27.5) μmol/L, 3.8(2.4, 8.7) μmol/L, 105.0(81.0, 156.0) U/L, 86.5(25.0, 224.8) U/L, 2.0(2.0, 2.0) grade, 10.0(6.3, 20.0) mL, 14 366.6(11 766.4, 16 764.4) yuan, which the differences between the two groups were statistically significant ( P<0.05). In two groups of the surgery-related indicators, such as the history of acute exacerbation in the last one month, history of upper abdominal surgery, hypertension are significant statistical differences ( P<0.05). Then there were no significant differences in diabetes, coronary heart diseases, cerebrovascular disease, respiratory diseases, surgical time and unplanned readmission rate. Conclusion:The concomitant diseases may not be the absolute contraindications of the ambulatory LTCBDE. More patients can be treated with ambulatory LTCBDE in experienced centers if relevant outpatient assay and examinations can be further improved, risks of surgery and anesthesia can be fully evaluated, and surgical contraindications can be clearly excluded.