Chronic liver diseases are a group of diseases in which the liver is subjected to a variety of injuries over a long period of time， resulting in irreversible pathological changes that last longer than 6 months. Emodin （EMO） is a natural anthraquinone derivative derived from Rheum officinale， and its pharmacological effect has been extensively studied， exhibiting a variety of biological properties and involving multiple signaling molecules and pathways. Western medicine or surgical treatment is currently the main treatment regimen for chronic liver diseases， and the advance in treatment is limited by various reasons such as side effects and high costs. Due to its natural origin and efficacy， EMO has unique advantages in the treatment of chronic liver diseases and has now become a research hotspot. This article summarizes the therapeutic effect of EMO on chronic liver diseases and its mechanism， in order to provide a certain scientific basis for the traditional Chinese medicine treatment of chronic liver diseases and the development of drugs in clinical practice.

Standardizing the emergency assessment and management process for patients with implantable continuous-flow left ventricular assist device (LVAD) in emergency and intensive care settings is of great significance for reducing delays in diagnosis and treatment, lowering the mortality associated with LVAD-related emergencies, and improving overall prognosis and long-term survival. To this end, a multidisciplinary expert committee was convened to develop this consensus, integrating international evidence-based findings with clinical practice experience in China, with an emphasis on highlighting the characteristics of domestically manufactured devices. The aim is to establish an actionable standardized emergency management protocol to enhance clinical identification and response efficiency, reduce the risk of LVAD-related emergencies, and improve patient outcomes. Using a modified Delphi method, this consensus proposes a structured decision-making pathway that integrates an "ABC" rapid assessment with parallel device troubleshooting, prioritizing the use of point-of-care echocardiography for hemodynamic evaluation and complication assessment. Key emergency scenarios covered include low-flow alarms, pump thrombosis, right heart dysfunction, bleeding and anticoagulation imbalance, arrhythmias, and cardiac arrest. This consensus applies to implantable continuous-flow LVADs commonly used in China, including domestically manufactured devices such as Corheart 6, CH-VAD, EVAHEART, and HeartCon, as well as the imported device HeartMate 3.

BackgroundNon-suicidal self-injury （NSSI） behavior is highly prevalent during adolescence. Previous studies have mainly focused on the relationship between NSSI behavior and emotional regulation， pain perception， reward mechanisms， and impulsivity. However， the cognitive mechanisms underlying the occurrence and maintenance of NSSI behavior have not been sufficiently explored. Adolescence is a critical period for the development of cognitive control. However， it remains unclear whether adolescents with depressive disorder accompanied by NSSI behavior have abnormal cognitive control. ObjectiveTo reveal the potential deficits in cognitive control among adolescents with depressive disorder accompanied by NSSI behavior. MethodsThis study was a case-control study including 166 adolescent patients who visited the Third People's Hospital of Lanzhou from November 2024 to May 2025 and met the diagnostic criteria for depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. According to whether they had NSSI behavior or not， patients were divided into the NSSI group （n=86） and the non-NSSI group （n=80）. At the same time， healthy adolescents who passed mental health screenings in five public middle schools in the northwest region were selected as the control group （n=71）. All participants completed the color-word Stroop task， and the accuracy rates and reaction time in congruent and incongruent conditions of each group were recorded， and the interference effect based on accuracy rates and reaction time was calculated. ResultsIn terms of accuracy rate， the main effect of trial type was statistically significant （F=46.900， P<0.01， ηp²=0.160）， and the interaction effect between group and trial type was also statistically significant （F=3.390， P=0.035， ηp²=0.028）. In terms of reaction time， the main effect of trial type was statistically significant （F=72.020， P<0.01， ηp²=0.240）， and the interaction effect between group and trial type was also statistically significant （F=6.400， P=0.002， ηp²=0.050）. Simple effect analysis revealed that under both congruent and incongruent conditions， the reaction time of the NSSI group was longer than those of the non-NSSI group and the control group， and the reaction time of the non-NSSI group was also longer than that of the control group （P<0.01）. There were statistically significant differences in the interference effects among three groups based on reaction time （H=10.231， P=0.006）. The interference effect in the NSSI group was higher than that in the control group （Z=3.012， P_adj=0.008） and the non-NSSI group （Z=2.453， P_adj=0.043）. There was no statistically significant difference in the interference effect among the three groups based on accuracy rate （H=5.666， P=0.059）. ConclusionAdolescents with depressive disorder accompanied by NSSI behavior exhibit cognitive control deficits beyond depressive symptoms， particularly showing impaired conflict suppression ability. ［Funded by Lanzhou Municipal Health Industry Scientific Research Project （number，A2026019）］

Objective: To understand the prevalence and related factors of depressive symptoms among primary and secondary school students in the in depth monitoring counties of China s Rural Compulsory Education Nutrition Improvement Program, so as to provide a basis for prevention and psychological intervention of depressive symptoms among children and adolescents in rural areas. Methods: In November 2022, a stratified random sampling method was adopted to collect height and weight data, basic personal and family information of 7 949 primary and secondary school students from grade three to grade nine through physical measurements and questionnaires in 56 key monitoring schools implementing the Student Nutrition Improvement Program in 7 in depth monitoring counties (Jalaid Banner in Inner Mongolia, Jinzhai County in Anhui, Mao Xian in Sichuan, Tiandeng County in Guangxi, Mian County in Shaanxi, Zhaozhou County in Heilongjiang and Youxi County in Fujian), and to obtain the information related to their depressive symptoms through the self assessment questionnaire on depression. Multivariate Logistic regression analysis was conducted to analyze the prevalence of depressive symptoms among primary and secondary school students, as well as their related factors. Results: The detection rate of depressive symptoms among primary and secondary school students in the in depth monitored counties was 23.5%. Logistic regression analysis showed that the probability of detecting depressive symptoms was higher among female students, middle school students, students whose video screen duration per day was >2 h, and students whose parents marital status was divorced or widowed ( OR =1.40, 1.64, 1.60, 1.24), and students whose sleep duration reached the recommended standard, whose parents usually accompanied them daily for time was 60-<120 min and ≥120 min, and students whose mothers literacy level was middle school graduation had lower probability of detecting depressive symptoms ( OR =0.85, 0.84, 0.71, 0.76) ( P < 0.05 ). Conclusion The detection rate of depressive symptoms among students in the in depth monitoring area is high, and targeted interventions need to be developed for students to reduce the risk of mental health problems.

Comprehensive performance appraisal,continuous optimization of performance appraisal indicators,reform of internal performance appraisal methods,and linking the appraisal results to salary allocation are important measures for the high-quality development of public hospitals.It is based on the performance allocation mechanism improvement in case hospital under the requirements of high-quality development.The implementation of performance reform practice based on incremental assessment has achieved the social benefits improvement,income structure optimization,performance distribution equity improvement,and more refined management of disciplines and other management objectives,with a view to providing lessons and references for medical colleagues to follow up to deepen the performance reform and improve the performance distribution.

Objective To investigate the improvement of interleukin-1 receptor associated kinase(IRAK1)/nuclear factor κB(NF-κB)signaling pathway regulated by"srperficiality-origin matching acupoints"electroacupuncture on intestinal damage in diabetic rats and lipid metabolism.Methods SD rats were randomly separated into control group,diabetes group,diabetes+electroacupuncture group,diabetes+pcDNA group,diabetes+pcDNA-IRAK1 group,diabetes+electroacupuncture+pcDNA group,and diabetes+electroacupuncture+pcDNA-IRAK1 group,18 rats in each group.Except for the control group,rats in other groups were fed with high glucose and high fat diet and intraperitoneal injection of streptozotocin(STZ)to construct the model of diabetes rats.After successful modeling,rats in each group were treated every other day for 8 consecutive weeks.The weight,fasting blood glucose,serum triglycerides and total cholesterol levels of rats were detected.16S rRNA amplicon sequencing was applied to detect the relative abundance of rat gut microbiota;the intestinal permeability and water content of rats were tested.Immunohistochemistry was applied to detect the average optical densities of zonula occludens-1(ZO-1)proteins in small intestine tissue.Western blot was applied to detect the expression of IRAK1,phosphorylated nuclear factor inhibitory protein(p-IκBα),and phosphorylated nuclear factor B p65(p-NF-κB p65)proteins in rat small intestine tissue.Results Compared with the control group,the levels of fasting blood glucose,triglyceride,total cholesterol,relative abundances of Firmicutes,Proteobacteria,Actinomycetes,Allobaculum,fluorescein isothiocyanate(FITC)-glucan concentration,intestinal water content and the expression of IRAK1,p-IκBα,p-NF-κB p65 proteins in the diabetes group increased significantly(P<0.05).Weight,the relative abundance of Bacteroidetes,Lactobacillus,Romboutsia,Lachnospiraceae,Ruminocoaceae,the average optical densities of occludin and ZO-1 proteins decreased significantly(P<0.05).Compared with the diabetes group,the levels of fasting blood glucose,triglyceride,total cholesterol,relative abundances of Firmicutes,Proteobacteria,Actinomycetes,Allobaculum,FITC-glucan concentration,intestinal water content and the expression of IRAK1,p-IκBα,p-NF-κB p65 proteins in the diabetes+electroacupuncture group decreased significantly(P<0.05).Weight,the relative abundance of Bacteroidetes,Lactobacillus,Romboutsia,Lachnospiraceae,Ruminocoaceae,the average optical densities of occludin and ZO-1 proteins increased significantly(P<0.05),the change trend of corresponding indicators in the diabetes+pcDNA-IRAK1 group was opposite to the above(P<0.05).Compared with the diabetes+electroacupuncture group and the diabetes+electroacupuncture+pcDNA group,the levels of fasting blood glucose,triglyceride,total cholesterol,relative abundances of Firmicutes,Proteobacteria,Actinomycetes,Allobaculum,FITC-glucan concentration,intestinal water content and the expression of IRAK1,p-IκBα,p-NF-κB p65 proteins in the diabetes+electroacupuncture+pcDNA-IRAK1 group increased significantly(P<0.05).Weight,the relative abundance of Bacteroidetes,Lactobacillus,Romboutsia,Lachnospiraceae,Ruminocoaceae,the average optical densities of occludin and ZO-1 proteins decreased significantly(P<0.05).Conclusion"Srperficiality-origin matching acupoints"electroacupuncture may improve intestinal flora imbalance and intestinal barrier damage in diabetes rats by inhibiting IRAK1/NF-κB signaling pathway,and improve diabetic glucose and lipid metabolism.

The medical mask,which is used as an important tool of preventing the spread of respiratory diseases,can effectively block the transmission of biological aerosols.The detection for the filtration efficiency of bacteria in medical mask is particular importance.The Andersen sampler,is one kind of device that samples microbial aerosols,is widely used in the inspection for the filtration efficiency for bacteria in medical masks.It mainly consists of six impactors with different pore sizes.It simulates the deposition process of the most of particles at different positions in respiratory system through the bacterial particles in biological aerosols impact respectively the surface of petri dishes with agar under different pore sizes.This paper explored the development background,structure and sampling principle,operation and counting procedures of the Andersen sampler,as well as its application and importance in the inspection for the filtration efficiency for bacteria in medical mask.

Objective:To investigate the effect of serum 25-hydroxyvitamin D3 level on ovarian reservation function and artificial insemination outcomes in infertile patients.Methods:A retrospective analysis was conducted based on clinical data of 108 infertile patients who underwent artificial insemination at Yan'an People's Hospital from January 2021 to January 2024. The patients' baseline data and test results of laboratory indicators were collected. Patients enrolled were divided into vitamin D deficiency group (73 cases) and non-vitamin D deficiency group (35 cases) according to serum 25-hydroxyvitamin D3 [25(OH)D3] level, and divided into pregnant group (60 cases) and non-pregnant group (48 cases) according to artificial insemination outcome. Baseline data and laboratory indicators of different groups were compared in order to analyze factors that influence failure of artificial insemination in infertile patients. Measurement data with normal distribution was represented by ±s. Comparison between groups was performed by two-sample t-test. Enumeration data was represented by n(%). Comparison between groups was performed by χ2 test. Logistic regression analysis was used to identify risk factors of artificial insemination failure in infertile patients. Results:Serum 25(OH)D3 and anti-Mullerian hormone (AMH) levels and antral follicle count (AFC) in the vitamin D deficiency group were lower than those in the non-vitamin D deficiency group [(14.9±2.6) μg/L vs. (22.6±2.1) μg/L, (3.0±1.0) μg/L vs. (3.4±1.0) μg/L, (9.9±2.3) vs. (11.1±2.6)], and the differences were statistically significant ( t=15.28, P<0.001; t=2.28, P=0.025; t=2.31, P=0.023). In the vitamin D deficiency group, serum 25(OH)D3 and AMH levels were positively correlated with AFC (r=0.40 and 0.37, both P<0.001). The proportion of retrieved oocytes ≥ 8, AFC, serum 25(OH)D3 and AMH levels in the pregnant group were higher than those in the non-pregnant group [56.7% (34/60) vs. 31.2% (15/48), (11.3±2.4) vs. (9.0±2.2), (23.2±2.2) μg/L vs. (10.1±2.0) μg/L, (3.5±1.1) μg/L vs. (2.6±0.7) μg/L], and the differences were statistically significant ( χ2=6.95, P=0.008, t=5.22, P<0.001; t=32.01, P<0.001; t=4.80, P<0.001). Multivariate logistic regression analysis results showed that low serum 25(OH)D3, AMH, and AFC were risk factors of artificial insemination failure in infertile patients (odds ratios=0.49, 0.56, 0.31, 95%CI: 0.25-0.96, 0.33-0.95, 0.11-0.87, P=0.037, 0.032, 0.026). Conclusions:Serum 25-hydroxyvitamin D3 level is closely related to ovarian reservation function in infertile patients. Moreover, it is a risk factor of artificial insemination failure.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To investigate the effect of cytoskeleton-associated protein 4 (CKAP4) gene knockout on maxillary expansion osteogenesis and its regulatory mechanism on the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSC).Methods:Nineteen wild type (WT) and nineteen CKAP4 gene knockout (Ckap4 -/-) mice aged 6-8 weeks were selected to establish a mouse model of rapid maxillary expansion. Samples were taken on the 7th and 14th day after the operation. Micro-CT and HE staining were used to evaluate bone regeneration. Tissue proteins in the modeled area were collected, and Western blotting analysis (WB) was used to detect the protein expression levels of alkaline phosphatase (ALP), Runt-related transcription factor 2 (RUNX2), and osteocalcin (OCN). BMSC were isolated from WT and Ckap4 -/- mice. The expression of surface markers CD29, Sca-1, CD44, CD45, CD34, and CD11b was detected by flow cytometry, and cell proliferation ability was detected by 5-ethynyl-2'-deoxyuridine (EdU). After 7 days of osteogenic induction, real-time fluorescence quantitative PCR (RT-qPCR) and WB were used to detect the expression levels of RUXN2, ALP, OCN, protein kinase B (AKT), and phosphorylated protein kinase B (p-AKT). After 21 days, alizarin red staining and cetyl pyridine chloride quantification were used to detect the differences in mineralized nodule formation in each group. In CKAP4 gene knockout BMSC, the small-molecule AKT agonist sc79 (4 μg/ml) was added as the intervention group (Ckap4 -/- +sc79), and dimethyl sulfoxide (DMSO) treatment was used as the control group (Ckap4 -/- +DMSO). After osteogenic induction, RT-qPCR, WB, and alizarin red staining were used to compare the osteogenic differentiation differences between the two groups of cells. Results:The micro-CT results showed that at 7 days and 14 days after surgery, the new bone volume in the Ckap4 -/- group [(0.070±0.010) and (0.146±0.019) mm 3] was significantly lower than that in the WT group [(0.094±0.006) and (0.196±0.013) mm 3] (both P<0.01). HE-stained histological sections showed that the area of new bone tissue in the Ckap4 -/- group at 7 days and 14 days after surgery [(0.101±0.008) and (0.158±0.010) mm 2] was also significantly lower than that in the WT group [(0.116±0.005) and (0.183±0.008) mm 2] (both P<0.05). WB was used to detect the tissue proteins in the maxillary modeling area of mice in the two groups 7 days after surgery. The results showed that the expression levels of ALP, RUNX2 and OCN in the Ckap4 -/- group were significantly lower than those in the WT group. BMSC from wild-type mice and CKAP4 knockout mice were both positively expressed for CD29, CD44, and Sca-1, and basically not expressed for CD45, CD34, and CD11b. EdU assay showed that there was no significant difference in the proliferation ability of cells in the two groups. After 21 days of osteogenic induction of BMSC, alizarin red staining results showed that the number of mineralized nodules in the Ckap4 -/- group was significantly less than that in the WT group. After adding sc79, the number of mineralized nodules increased significantly, which was consistent with the results of cetyl pyridine chloride quantification. After 7 days of osteogenic induction, It was found that the expression levels of ALP, RUNX2, and OCN in the CKAP4 -/-group (0.751±0.066, 0.484±0.040, 0.679±0.063) were significantly lower than those in the WT group (1.000±0.113, 1.000±0.081, 1.000±0.113) (all P<0.001). The results of WB were consistent with those of RT-qPCR. At the same time, the WB results showed that the level of p-AKT protein in the CKAP4 -/-group (0.518±0.114) was significantly lower than that in the WT group (1.000±0.234) ( P<0.05). After treatment with sc79 for 7 days of osteogenic induction, RT-qPCR was used to detect the gene expression levels of ALP, RUNX2, and OCN. The results showed that the expression levels in the CKAP4 -/-+sc79 group (2.755±0.353, 4.800±0.990, 2.524±0.137) were significantly higher than those in the CKAP4 -/-+DMSO group (1.000±0.078, 1.000±0.247, 1.000±0.175) (all P<0.001). Conclusions:CKAP4 knockout inhibits the osteogenic differentiation of BMSC by reducing the activity of the PI3K/AKT signaling pathway, thereby suppressing osteogenesis in maxillary expansion.