OBJECTIVE To investigate the effects and mechanisms of Buyang huanwu decoction （BYHWD） and its active fractions in ameliorating non-alcoholic fatty liver disease. METHODS BYHWD and its effective fractions obtained through ethanol precipitation， as well as 30% ethanol， 50% ethanol， and 75% ethanol fractions （namely， the CC effective fraction， 30YC effective fraction， 50YC effective fraction， and 75YC effective fraction）， were prepared. These preparations were administered to rats via intragastric administration to prepare corresponding drug-containing serum （blank serum and simvastatin-containing serum were prepared using the same protocol）. Human L02 hepatocytes were divided into control group， model group， simvastatin-containing serum group， BYHWD-containing serum group， CC-containing serum group， 30YC-containing serum group， 50YC-containing serum group， and 75YC-containing serum group. Except for the control group， other groups were given 0.2 mol/L oleic acid for 24 h to induce a lipid accumulation model， and then intervened with 20% drug-containing serum/blank serum for 24 h. The lipid deposition in cells was observed， and the proportion of lipid droplet area was calculated； the levels of triglycerides （TG） and indicators of oxidative stress [malondialdehyde （MDA）， superoxide dismutase （SOD）] as well as liver function [alanine amino- transferase （ALT）， aspartate amino-transferase （AST）] in cells were detected； protein and mRNA expressions of AMP-activated protein kinase （AMPK）/sterol regulatory element-binding protein-1 （SREBP-1）/glycerol-3-phosphate acyltransferase （GPAT） signaling pathway were also measured. RESULTS Compared with the control group， cells in the model group exhibited severe cellular steatosis， with a significantly increased proportion of lipid droplet area， as well as the elevated levels of TG， ALT， AST， and MDA in cells， along with significantly up-regulated mRNA and protein expression levels of SREBP-1 and GPAT （P＜0.05）. The level of SOD， mRNA expression of AMPK， as well as the protein phosphorylation level of AMPK were decreased significantly （P＜0.05）. Compared with the model group， cellular steatosis was alleviated in all drug-containing serum groups， and the levels of most of the aforementioned quantitative indicators were significantly reversed （P＜0.05）. CONCLUSIONS BYHWD and its active fractions can exert a therapeutic effect on improving non-alcoholic fatty liver disease by regulating the AMPK/SREBP-1/GPAT signaling pathway， inhibiting oxidative stress responses， and reducing lipid deposition.

Objective This study reports on the obligatory parasitism of water mites Arrenurus sp. on Anopheles messeae at the Manzhouli Port, Inner Mongolia, China. Methods Duing July 2024, a survey on the mosquito diversity was conducted at the Manzhouli Port. Captured mosquitoes and their ectoparasites were identified to species level. Results A total of 1840 adult mosquitoes were collected, representing species from three genera: Culex(Cx. modestus, Cx. pipiens pallens), Aedes(Ae. dorsalis, Ae. flavidorsalis, Ae. flavescens), and Anopheles (An. messeae). Among all the mosqutioes specimens,3 out of 150 captured An. messeae were found to carry ectoparasitic mites, with number of 2,4,27 mites separately. Morphological and molecular identification reached the same result as water mites(Hydrachnidiae, Hydracrina). COI gene sequence showed 94% similarity with the closest species Arrenurus truncatellus. Conlusions Literature review suggests water mites are host-specific parasitism of mosquito species and herein with the first record of Arrenurus sp. parasiting on An. Messeae in the most high-latitude region globally.

In recent years, remarkable advances have been made in lung transplantation regarding donor evaluation, perioperative support, and immune regulation, laying a foundation for improving the long-term survival of recipients. The rational application of extended criteria donor lungs and the popularization of ex vivo lung perfusion technology have enhanced the utilization efficiency and safety of marginal donor lungs. Refined assessment of risk factors such as donors’ smoking history and infectious status has reduced the incidence of primary graft dysfunction and postoperative infection. In terms of recipient management, individualized assessment systems have been gradually optimized. The standardized application of intraoperative extracorporeal membrane oxygenation and the development of minimally invasive surgical techniques have effectively alleviated perioperative injuries. The optimization of postoperative immunosuppressive regimens and advances in rejection monitoring technologies have further improved the long-term survival of grafts. Nevertheless, chronic graft dysfunction and recurrent or refractory infections remain the major bottlenecks restricting long-term prognosis. Future research should focus on expanding donor sources, improving the repair quality of marginal donor lungs, promoting precise immunosuppression and anti-infection strategies, and comprehensively enhancing the long-term survival rate and quality of life of lung transplant recipients.

A 21-year-old unmarried female visited Obstetrics and Gynecology Hospital,Fudan University with the chief complaint,memory decline for more than 20 days and discovery of a pelvic mass for more than 10 days.Through systematic examination,she was diagnosed with teratoma-associated anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis.The patient underwent bilateral ovarian teratoma enucleation,and postoperative pathology revealed immature teratoma grade Ⅰ in the left ovary and mature teratoma in the right ovary.Perioperative combined immunotherapy significantly improved her neuropsychiatric symptoms.The diagnosis and treatment of ovarian teratoma-associated anti-NMDAR encephalitis require multidisciplinary collaboration,with accurate diagnosis,timely surgical resection within 1 month,and early initiation of immunotherapy being critical factors for improving prognosis.Clinicians should remain vigilant to avoid missed or misdiagnosed cases,as this condition can lead to severe outcomes.

Objective To investigate the anesthesia effects of different concentrations of sevoflurane combined with propofol during primary liver cancer resection surgery,as well as the changes in immune function in patients.Methods Using single-blind method,120 cases of primary hepatocellular carcinoma admitted to the Third Affiliated Hospital of Naval Military Medical University from January 2023 to September 2023 were prospectively selected as the study subjects,and the patients were randomly(using the randomized numerical table method)included in the control group(60 cases)and the observation group(60 cases).During hepatic cancer resection,the control group was given 0.5 alveolar minimum effective concentration(MAC)sevoflurane combined with propofol target-controlled infusion anesthesia,and the observation group was given 1.0 MAC sevoflurane combined with propofol target-controlled infusion anesthesia,and both groups were observed for 3 d postoperatively.The perioperative related indexes,the sedation and quality of awakening in the immediate moment of extubation,15 min after extubation,and 30 min after extubation,the cognitive function before and at 1 and 3 d postoperatively,vital signs before induction of anesthesia,after induction of anesthesia,at the moment of intubation,at the end of surgery,immune function before and 1 d postoperative,and adverse reactions during the observation period were compared between the two groups.Results The time for extubation,recovery of spontaneous respiration,recovery of orientation,and awakening in the observation group were(11.25±1.69)min,(9.76±1.34)min,(69.23±3.35)min,and(10.13±1.43)min,and the control group were(14.57±2.28)min,(13.55±2.76)min,(73.44±4.52)min,(14.26±2.25)min,all of which were shorter in the observation group than in the control group(P＜0.05).The Ramsay sedation score at the immediate moment of extubation was(4.16±0.22)in the observation group,and(3.21±0.10)in the control group;the standardized(Aldrete)score in the awakening room of the observation group at the immediate moment of extubation,and 15 min after extubation were(9.56±0.12)and(9.77±0.20),respectively,and the control group was(9.02±0.13),respectively,(9.05±0.17)points;the scores of the brief mental state examination(MMSE)scale in the observation group were(26.23±1.12)points and(25.17±0.98)points in the control group in the 1 d postoperative period,which were higher than those of the control group(P＜0.05).The heart rate(HR)at the moment of intubation and at the end of operation in the observation group were(73.08±4.10)beats/min,(75.27±6.03)beats/min,and the mean arterial pressure(MAP)was(81.56±4.49)mmHg and(86.07±5.48)mmHg,respectively,and in the control group the HR was(75.47±5.78)beats/min,(77.91±6.79)beats/min,and the MAP was(85.22±5.08)mmHg and(88.25±6.01)mmHg in the observation group,respectively,which were lower than those in the control group(P＜0.05).The whole blood natural killer(NK)cells,CD4+and CD4+/CD8+in the observation group at 1 d postoperatively were(35.62±5.54)％,(50.09±3.32)％,and(1.42±0.25),the control group were(24.12±4.09)％,(43.17±4.20)％,and(1.20±0.19),the observation group was higher than the control group(P＜0.05);whole blood CD8+was(26.55±3.02)％in the observation group and(28.71±4.45)％in the control group,the observation group was lower than the control group(P＜0.05).The total incidence of adverse reactions during the observation period was 16.67％in the observation group and 5.00％in the control group,which was higher than the control group(P＜0.05).Conclusion Compared with 0.5 MAC sevoflurane combined with propofol target-controlled infusion anesthesia,1.0 MAC sevoflurane combined with propofol target-controlled infusion anesthesia had less effect on hemodynamics and immune function in patients undergoing resection for primary hepatocellular carcinoma,and it could improve the quality of patients'awakening,cognitive function,and promote postoperative recovery,and the anesthesia was more effective,but it had more adverse effects.

Rare diseases have become an issue of public health concern globally. In China, two rare diseases lists have been released officially in 2018 and 2023, respectively. However, due to its importance in research, clinical management , therapeutic drug development and health security, we still need a clear definition of rare diseases in China. Considering the current actual condition of our country and our population size, we would suggest a prevalence of less than 1/10 000 to define a rare disease in China.

Objective:To evaluate the diagnostic performance of artificial intelligence-assisted diagnostic systems in cervical cytopathological examination.Methods:Cervical cytology slide data were retrospectively collected from four hospitals for the external validation of the developed artificial intelligence-assisted diagnostic system. Subsequently, prospective data collection was conducted for human-machine assisted studies.Results:In the retrospective study, a total of 3 162 valid samples were collected as external validation data. The system showed an area under the curve (AUC) of 0.890 (95% CI: 0.878-0.902), accuracy of 0.885 (95% CI: 0.873-0.896), sensitivity of 0.928 (95% CI: 0.914-0.941), and specificity of 0.852 (95% CI: 0.834-0.867). In the prospective study, 212 valid samples were collected, and five junior cytologists participated in the human-machine assisted study. Without artificial intelligence assistance, the average AUC for the five cytologists was 0.686 (95% CI: 0.650-0.722), the accuracy was 0.699 (95% CI: 0.671-0.727), the sensitivity was 0.653 (95% CI: 0.599-0.703), the specificity was 0.719 (95% CI: 0.685-0.750), the Fleiss κ value was 0.510, and the reading time was 223 seconds. With artificial intelligence assistance, the AUC, accuracy, sensitivity, and specificity increased by 0.166, 0.143, 0.225, and 0.107, respectively. Additionally, Fleiss κ was 0.730 and the reading time decreased by 188 seconds. All differences were statistically significant (all P<0.001). Conclusions:Artificial intelligence-assisted diagnosis system shows excellent performance and good generalizability, significantly improving the diagnostic accuracy, consistency, and efficiency of junior cytologists. It can be an effective auxiliary tool for junior cytologists in clinical practice.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To evaluate the effect of ultrasound-guided high ankle block (HAB) on the quality of postoperative recovery of patients undergoing foot and ankle surgery.Methods:In this randomized controlled trial, 90 patients of either sex, aged 18-64 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, scheduled for elective foot and ankle surgery, were divided into 2 groups ( n=45 each) using a random number table method: HAB group and spinal anesthesia group (SA group). Patients underwent ultrasound-guided HAB on the affected side in HAB group, while patients received spinal anesthesia in SA group. The Quality of Recovery-15 (QoR-15) scores were recorded at 24 and 48 h postoperatively. Additional data collected included anesthesia preparation and operation time, sensory and motor grading after anesthesia, anesthetic effect grading, surgery duration, intraoperative tourniquet time, block duration, time to first ambulation, and postoperative length of hospital stay. The time of first rescue analgesia and requirement for rescue algesia within 48 h postoperatively and the occurrence of adverse reactions such as hypotension, headache, nausea and vomiting, and urinary retention after anesthesia were also recorded. Results:Compared to SA group, QoR-15 scores and motor grading after anesthesia were significantly increased, the time to first ambulation and postoperative length of hospital stay were shortened, the duration of block and anesthesia preparation and operation time were prolonged at 24 h postoperatively, the rate of rescue analgesia wthin 48 h after operation and incidence of adverse reactions after anesthesia were decressed, and the time to first rescue analgesia was pronlonged in HAB group ( P<0.05). There were no significant differences between the two groups in sensory grading after anesthesia, anesthetic effect grading, intraoperative use of tourniquet time, and QoR-15 scores at 48 h postoperatively ( P>0.05). Conclusions:Ultrasound-guided HAB provides better quality of postoperative recovery than spinal anesthesia for the patients undergoing foot and ankle surgery.

With the rapid advancement and iterative development of new artificial intelligence technologies, there remains a regulatory vacuum in corresponding governance measures among governments worldwide. Simultaneously, a technological and governance gap exists between developing countries and developed economies. In response, the World Health Organization (WHO) has released "Ethics and Governance of Artificial Intelligence for Health: Guidance on Large Multi-Modal Models" to assist governments in strengthening governance capabilities in this field. This paper provides an in-depth analysis of the Guidance, aiming to identify challenges and risks associated with the application of multimodal large models in healthcare. Guided by ethical principles for advancing health through artificial intelligence, the paper examines the three-tier governance framework and recommendations outlined in the Guidance. Additionally, it evaluates the current state of AI governance in China, offering insights and reference points for improving AI governance in China′s healthcare sector.