OBJECTIVE To standardize the strategies for prevention and control of Chikungunya(CHIK)in healthcare in-stitutions so as to reduce the risk of transmission in the institutions.METHODS A working group comprising the ex-perts in hospital infection control,infectious diseases,and microbiology systematically reviewed domestic and international evidence and current guidelines,integrated China's vector ecology and healthcare realities,conducted two rounds of Delphi to achieve expert consensus,and graded the evidence and recommendation strength using the Oxford Centre for Evidence Based Medicine system.RESULTS The consensus issues 18 actionable recommendations on triage,patient mosquito-proof isolation,integrated vector control,protection of susceptible populations,environmental cleaning and disinfection,specimen management,medical textile handling,and outbreak emergency response,with each statement assigned an evi-dence level and recommendation strength.CONCLUSION This consensus is for the first time in China to provide evidence-graded strategies for control of CHIK in healthcare institutions,offering work flow-oriented,implementable guidance for clinicians,laboratorians,and infection-control personnel under different risk scenarios and enhancing the comprehensive coping capacity of the healthcare institutions.

ObjectiveTo evaluate the clinical efficacy and safety of Huaban Jiedu Formulation （化斑解毒方， HJF） in treating psoriasis vulgaris with blood-heat syndrome. MethodsA randomized， double-blind， placebo-controlled study was conducted with 60 patients diagnosed with psoriasis vulgaris of blood-heat syndrome. Patients were randomly assigned to either a treatment group or a control group， with 30 cases in each. The treatment group received HJF granules orally， one dose a day， combined with topical Qingshi Zhiyang Ointment （青石止痒软膏）， while the control group received placebo granules， one dose a day， combined with the same topical ointment. Both groups were topically treated twice daily of 28 days treatment cours. Psoriasis area and severity index （PASI）， visual analogue scale for pruritus （VAS）， traditional Chinese medicine （TCM） syndrome scores， dermatology life quality index （DLQI）， and psoriasis life stress inventory （PLSI） were assessed before treatment and on day 14 and day 28. Response rates for PASI 50 （≥50% reduction） and PASI 75 （≥75% reduction）， as well as overall clinical efficacy， were compared between groups. Serum levels of interleukin-6 （IL-6） and interleukin-17 （IL-17） were measured before and after 28 days of treatment. Adverse reactions during treatment were recorded. ResultsAfter 28 days of treatment， both groups showed significant reductions in PASI total score， lesion area score， erythema， scaling， and infiltration scores， pruritus VAS score， TCM syndrome score， DLQI， PLSI， and serum IL-6 and IL-17 levels （P＜0.05）. Compared to the control group， the treatment group had significantly greater improvements in PASI total score and erythema score， TCM syndrome score， serum IL-6 and IL-17 levels， and PASI 50 response rate after 28 days （P＜0.05）. Between-group comparisons of score differences before and after 28-day treatment revealed that the treatment group showed significantly better improvements in PASI total， lesion area score， erythema score， TCM syndrome score， DLQI， PLSI， and inflammatory markers （P＜0.05 or P＜0.01）. The total effective rate on day 14 and day 28 was 40.00% （12/30） and 83.33% （25/30） in the treatment group， versus 6.90% （2/29） and 41.38% （12/29） in the control group， respectively. The clinical efficacy in the treatment group was significantly superior to that in the control group （P＜0.05）. Mild gastric discomfort occurred in 3 patients in the treatment group and 1 in the control group. ConclusionHJF can effectively improve skin lesions and TCM symptoms relieve pruritus， enhance quality of life， and reduce inflammatory markers IL-6 and IL-17， in patients with blood-heat syndrome of psoriasis vulgaris， with a good safety profile.

Pancreatic cancer is a severe malignant tumor that poses a significant threat to human health worldwide, with its incidence and mortality rates increasing annually, especially in economically developed regions. The progress of surgical treatment is of great significance in improving the prognosis of pancreatic cancer patients. This article reviews the recent progress in surgical treatment strategies for pancreatic cancer, with a particular emphasis on the multidisciplinary team (MDT) approach, neoadjuvant therapy, conversion therapy, and the assessment of the effectiveness of neoadjuvant/conversion therapy. The MDT approach, by integrating the strengths of multiple disciplines, provides personalized treatment plans for patients, improving the resection rate and survival rate of patients with pancreatic cancer. Neoadjuvant and conversion therapy provide surgical opportunities for patients with advanced pancreatic cancer, improving their prognosis. Additionally, accurate assessment of treatment effects is crucial for determining the timing and method of surgery.

AIM:To investigate the impact of interleukin-17(IL-17D)knockout on lipid phagocytosis in ath-erosclerosis(AS)and bone marrow-derived macrophages.METHODS:Twenty 8-week-old ApoE-/-C57BL/6J mice were randomly assigned to experimental and control groups(10 mice per group).The experimental group was subjected to a high-fat diet for 8 weeks to induce AS,while the control group received a normal diet.Additionally,fifteen 8-week-old ApoE-/-IL-17D-/-and ApoE-/-mice were also fed a high-fat diet for the same duration.Body weight and blood lipid levels were measured.Aortas were harvested,and IL-17D expression was assessed using RT-qPCR.Bone marrow cells were iso-lated and differentiated into macrophages with colony-stimulating factors.Oil red O staining was employed to visualize lip-id deposition in aortic plaques and macrophages.To stimulate macrophages,oxidized low-density lipoprotein(oxLDL)was used,and RT-qPCR along with Western blot analyses were conducted to evaluate the expression of lipid phagocytosis-related genes and the p38 MAPK signaling pathway.Dehydrocorydaline(DHC),a p38 MAPK activator,was adminis-tered to IL-17D-/-macrophages,and the expression of CD36 and lipid phagocytosis were assessed.RESULTS:IL-17D ex-pression was significantly elevated in the aortas of AS mice and in oxLDL-treated macrophages(P<0.01).IL-17D-/-mice exhibited notably lower serum total cholesterol and low-density lipoprotein cholesterol levels(P<0.01),along with a sig-nificant reduction in plaque area in the aortas and aortic roots(P<0.01).Macrophages lacking IL-17D demonstrated de-creased expression of CD36,LOX-1,IL-1β,and IL-6(P<0.01)and showed diminished lipid phagocytosis.These mac-rophages also exhibited reduced phosphorylation of p38(P<0.01)compared to wild-type macrophages.Activation of p38 MAPK by DHC significantly countered the inhibitory effects of IL-17D knockout on CD36 expression(P<0.01)and en-hanced lipid phagocytosis in macrophages.CONCLUSION:Knockout of IL-17D may modulate lipid phagocytosis in macro-phages via the p38/CD36 signaling pathway,potentially inhibiting the formation and progression of aortic plaques in mice.

Objective This study aims to investigate controversial cases of forensic clinical re-identification of fractures,exploring the characteristics,causes,and countermeasures related to identification errors in primary bone injuries,complications,and subsequent changes.The goal is to provide identification strategies for similar cases regarding the collection of identification materials,timing,and examination method selection,ultimately establishing a paradigm for such identifications.Methods A total of 103 cases of clinical re-identification of fractures accepted by the West China Forensic Identification Center from 2020 to 2024 were collected,and the data from initial identifications and re-identifications were retrospectively analyzed.Results Male cases accounted for 69.90%of the re-identifications,with disability grade(67.96%)and injury degree(30.10%)being the primary concerns.Individual requests represented a high proportion(92.86%)in the initial assessment of disability levels,while unit or joint requests dominated the re-assessment(92.86%).The agreement rates for disability grade and injury degree were 55.26%and 59.38%,respectively.The reassessment of disability grades primarily involved fractures of limb long bones,spine,and ribs,with 75.53%of opinions resulting in downgraded disability levels.Rib,orbital,and nasal bone fractures were the main focus in injury degree reassessments,with 84.62%of opinions indicating aggravated injuries.The consistency rates for fracture identification in disability grade assessments was 92.21%,while rates for injury degree and sequelae were 65.63%and 48.94%,respectively.Inconsistencies in identifying damage facts—including the presence of fractures,distinguishing between fresh and old fractures,and determining the nature of fractures and sequelae—were primarily noted in rib,orbital,and nasal bone fractures.The utilization rate of CT metadata in initial evaluations(25.00%)was significantly lower than in re-evaluations(95.00%).The identification time for joint mobility dysfunction after fracture in re-identifications was significantly longer than in initial identifications(P=0.0002),and the identification time for cases with agreement was significantly shorter than for cases with disagreement(P=0.036).Conclusion Image data type and identification timing are critical factors that may influence the accuracy and consistency of forensic clinical identification of bone injuries.When necessary,dynamic CT metadata in conjunction with image post-processing technology can be routinely employed to identify fractures of the ribs,orbital bones,or nasal bones,thereby reducing the risk of misidentification.

Objective This study aims to investigate controversial cases of forensic clinical re-identification of fractures,exploring the characteristics,causes,and countermeasures related to identification errors in primary bone injuries,complications,and subsequent changes.The goal is to provide identification strategies for similar cases regarding the collection of identification materials,timing,and examination method selection,ultimately establishing a paradigm for such identifications.Methods A total of 103 cases of clinical re-identification of fractures accepted by the West China Forensic Identification Center from 2020 to 2024 were collected,and the data from initial identifications and re-identifications were retrospectively analyzed.Results Male cases accounted for 69.90%of the re-identifications,with disability grade(67.96%)and injury degree(30.10%)being the primary concerns.Individual requests represented a high proportion(92.86%)in the initial assessment of disability levels,while unit or joint requests dominated the re-assessment(92.86%).The agreement rates for disability grade and injury degree were 55.26%and 59.38%,respectively.The reassessment of disability grades primarily involved fractures of limb long bones,spine,and ribs,with 75.53%of opinions resulting in downgraded disability levels.Rib,orbital,and nasal bone fractures were the main focus in injury degree reassessments,with 84.62%of opinions indicating aggravated injuries.The consistency rates for fracture identification in disability grade assessments was 92.21%,while rates for injury degree and sequelae were 65.63%and 48.94%,respectively.Inconsistencies in identifying damage facts—including the presence of fractures,distinguishing between fresh and old fractures,and determining the nature of fractures and sequelae—were primarily noted in rib,orbital,and nasal bone fractures.The utilization rate of CT metadata in initial evaluations(25.00%)was significantly lower than in re-evaluations(95.00%).The identification time for joint mobility dysfunction after fracture in re-identifications was significantly longer than in initial identifications(P=0.0002),and the identification time for cases with agreement was significantly shorter than for cases with disagreement(P=0.036).Conclusion Image data type and identification timing are critical factors that may influence the accuracy and consistency of forensic clinical identification of bone injuries.When necessary,dynamic CT metadata in conjunction with image post-processing technology can be routinely employed to identify fractures of the ribs,orbital bones,or nasal bones,thereby reducing the risk of misidentification.

AIM:To investigate the impact of interleukin-17(IL-17D)knockout on lipid phagocytosis in ath-erosclerosis(AS)and bone marrow-derived macrophages.METHODS:Twenty 8-week-old ApoE-/-C57BL/6J mice were randomly assigned to experimental and control groups(10 mice per group).The experimental group was subjected to a high-fat diet for 8 weeks to induce AS,while the control group received a normal diet.Additionally,fifteen 8-week-old ApoE-/-IL-17D-/-and ApoE-/-mice were also fed a high-fat diet for the same duration.Body weight and blood lipid levels were measured.Aortas were harvested,and IL-17D expression was assessed using RT-qPCR.Bone marrow cells were iso-lated and differentiated into macrophages with colony-stimulating factors.Oil red O staining was employed to visualize lip-id deposition in aortic plaques and macrophages.To stimulate macrophages,oxidized low-density lipoprotein(oxLDL)was used,and RT-qPCR along with Western blot analyses were conducted to evaluate the expression of lipid phagocytosis-related genes and the p38 MAPK signaling pathway.Dehydrocorydaline(DHC),a p38 MAPK activator,was adminis-tered to IL-17D-/-macrophages,and the expression of CD36 and lipid phagocytosis were assessed.RESULTS:IL-17D ex-pression was significantly elevated in the aortas of AS mice and in oxLDL-treated macrophages(P<0.01).IL-17D-/-mice exhibited notably lower serum total cholesterol and low-density lipoprotein cholesterol levels(P<0.01),along with a sig-nificant reduction in plaque area in the aortas and aortic roots(P<0.01).Macrophages lacking IL-17D demonstrated de-creased expression of CD36,LOX-1,IL-1β,and IL-6(P<0.01)and showed diminished lipid phagocytosis.These mac-rophages also exhibited reduced phosphorylation of p38(P<0.01)compared to wild-type macrophages.Activation of p38 MAPK by DHC significantly countered the inhibitory effects of IL-17D knockout on CD36 expression(P<0.01)and en-hanced lipid phagocytosis in macrophages.CONCLUSION:Knockout of IL-17D may modulate lipid phagocytosis in macro-phages via the p38/CD36 signaling pathway,potentially inhibiting the formation and progression of aortic plaques in mice.

OBJECTIVE To standardize the strategies for prevention and control of Chikungunya(CHIK)in healthcare in-stitutions so as to reduce the risk of transmission in the institutions.METHODS A working group comprising the ex-perts in hospital infection control,infectious diseases,and microbiology systematically reviewed domestic and international evidence and current guidelines,integrated China's vector ecology and healthcare realities,conducted two rounds of Delphi to achieve expert consensus,and graded the evidence and recommendation strength using the Oxford Centre for Evidence Based Medicine system.RESULTS The consensus issues 18 actionable recommendations on triage,patient mosquito-proof isolation,integrated vector control,protection of susceptible populations,environmental cleaning and disinfection,specimen management,medical textile handling,and outbreak emergency response,with each statement assigned an evi-dence level and recommendation strength.CONCLUSION This consensus is for the first time in China to provide evidence-graded strategies for control of CHIK in healthcare institutions,offering work flow-oriented,implementable guidance for clinicians,laboratorians,and infection-control personnel under different risk scenarios and enhancing the comprehensive coping capacity of the healthcare institutions.

Pancreatic cancer is a severe malignant tumor that poses a significant threat to human health worldwide, with its incidence and mortality rates increasing annually, especially in economically developed regions. The progress of surgical treatment is of great significance in improving the prognosis of pancreatic cancer patients. This article reviews the recent progress in surgical treatment strategies for pancreatic cancer, with a particular emphasis on the multidisciplinary team (MDT) approach, neoadjuvant therapy, conversion therapy, and the assessment of the effectiveness of neoadjuvant/conversion therapy. The MDT approach, by integrating the strengths of multiple disciplines, provides personalized treatment plans for patients, improving the resection rate and survival rate of patients with pancreatic cancer. Neoadjuvant and conversion therapy provide surgical opportunities for patients with advanced pancreatic cancer, improving their prognosis. Additionally, accurate assessment of treatment effects is crucial for determining the timing and method of surgery.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.