In recent years, owing to advances in understanding of hepatocarcinogenesis, the treatment of primary liver cancer (PLC), including hepatocellular-cholangio-carcinoma, fibrolamellar carcinoma, and hepatic epithelioid hemangioendothelioma have garnered increased attention. In this position paper, an international panel of experts representing oncology, hepatology, pathology, radiology, and surgery has systematically summarised the available information and evidence on the pathogenesis, diagnosis, and treatment of rare PLC. While clinical trials of systemic treatments are underway for some rare PLC—more researches, involving national and international collaboration—are required.

Objective:To determine the levels of interleukin-2 (IL-22) and interleukin-26 (IL-26) in pleural effusion and serum in patients with tuberculous pleurisy, and analyze the diagnostic value of their combination for tuberculous pleurisy.Methods:From January 2016 to December 2023, 310 patients with tuberculous pleurisy admitted to Xi′an Hi-tech Hospital were included as the study group, and another 310 patients with non tuberculous pleurisy were regarded as the control group. The pleural effusion and serum samples of hospitalized patients were collected. Serum samples were collected from patients at 2 months after treatment for testing of IL-22 and IL-26 levels. The diagnostic value and correlation of IL-22 and IL-26 levels in pleural effusion and serum were analyzed.Results:Compared with the control group, the levels of pleural effusion and serum IL-26 and IL-22 in the study group were increased: (84.68 ± 12.17) ng/L vs. (69.33 ± 9.82) ng/L, (82.45 ± 11.75) ng/L vs. (39.53 ± 5.66) ng/L and (74.38 ± 10.57) ng/L vs. (53.32 ± 7.54) ng/L, (21.45 ± 3.14) ng/L vs. (14.45 ± 2.05) ng/L, and the differences were statistically significant ( P<0.01). Compared with before treatment, serum IL-26 and IL-22 levels decreased after treatment: (61.66 ± 8.72) ng/L vs. (74.38 ± 10.57) ng/L, (17.38 ± 2.59) ng/L vs. (21.45 ± 3.14) ng/L, and the difference was statistically significant ( P<0.01). The AUC of IL-26 and IL-22 in pleural effusion and serum samples in the diagnosis of tuberculous pleurisy was 0.895, 0.820, 0.929 and 0.893, respectively. The AUC of IL-26 and IL-22 combined detection in pleural effusion and serum samples in the diagnosis of tuberculous pleurisy was 0.964 and 0.970, respectively. Pleural effusion IL-26 was positively correlated with serum IL-26 ( r = 0.733, P<0.01) and positively correlated with pleural effusion IL-22 ( r = 0.544, P<0.01); pleural effusion IL-22 was positively correlated with serum IL-22 ( r = 0.532, P<0.01); serum IL-22 was positively correlated with serum IL-26 ( r = 0.619, P<0.01). Conclusions:The levels of IL-22 and IL-26 in pleural effusion and serum of patients with tuberculous pleurisy are elevated, and the two may jointly participate in the immune regulation of tuberculous pleurisy. It can be used as one of the biochemical diagnostic methods for patients with tuberculous pleurisy.

Objective:To investigate the efficacy and toxicity of blinatumomab in the first-line and second-line treatment of pediatric B-cell acute lymphoblastic leukemia (B-ALL).Methods:A multi-center retrospective cohort study was conducted to analyze clinical data from 323 pediatric B-ALL patients treated with blinatumomab across 14 hospitals in China from May 2021 to July 2023. Patients were divided into four groups based on the treatment phase and disease status when blinatumomab was used: relapsed/refractory group, post-consolidation minimal residual disease (MRD)-positive group, early MRD-positive group, and MRD-negative group. Blinatumomab for the relapsed/refractory group was considered as second-line treatment, while the other 3 groups as first-line treatment. The MRD negativity rate after treatment, the survival rates and the incidence of severe adverse events were compared across these groups. Patients who received blinatumomab for more than 7 days were included in the efficacy analysis. Survival analysis was performed using the Kaplan-Meier method, and Log-Rank test was used to compare the survival rates among groups.Results:Among the 323 patients, 191 (59.1%) were male, with the age of 6.2 (3.9, 10.5) years. There were 117 patients in the relapsed/refractory group, 62 cases in the post-consolidation MRD-positive group, 43 cases in the early MRD-positive group, and 101 cases in the MRD negative group. In the relapsed/refractory group, the complete remission rate and MRD negativity rate after one course of blinatumomab were 71.4% (35/49) and 81.5% (75/92) for the 49 children without complete remission and the 92 children with flow cytometry-positive MRD, respectively. In the post-consolidation MRD-positive group, the MRD negativity rates after one course of blinatumomab were 100.0% (27/27), 12/16 and 9/19 for patients with MRD positivity detected by flow cytometry, polymerase chain reaction and next-generation sequencing, respectively. In the early MRD-positive group, the MRD negativity rates were 96.7% (29/30) and 9/9 for flow cytometry and next-generation sequencing, respectively. The 2-year overall survival rate and event-free survival rate for the 319 children evaluable for efficacy were (90.6±1.7)% and (87.6±1.9)%, respectively, with the relapsed/refractory group showing significantly lower overall survival rates and event-free survival rate compared to the other groups ( χ2=21.40, 26.21,both P<0.001). Grade 3 or higher adverse events occurred in 128 cases (39.6%), with hematological toxicity observed in 101 cases, while cytokine release syndrome (CRS), infection, and neurotoxicity occurred in 11, 26 and 8 cases, respectively. In addition, there were statistically significant differences in the grade 3 or higher CRS among the four groups ( χ2=8.03, P<0.05). Conclusion:Blinatumomab can clear MRD more effectively and achieve superior survival outcomes when used as first-line treatment for pediatric B-ALL, with less CRS.

Objective:To observe the clinical effect of comprehensive reconstruction of grades Ⅰ-Ⅱ thumb and finger defects with hallux osteo-onychocutaneous flaps of great toe.Methods:This is a retrospective study. From June 2020 to December 2023, comprehensive reconstruction surgery for Grade Ⅰ-Ⅱ digital defect were performed with hallux osteo-onychocutaneous flaps of great toe for 3 thumbs and 7 fingers in 9 patients in the Department of Hand and Microsurgery of Baoji Third Hospital. Causes of digital injury were: 4 of machine crush, 3 of electric saw cut, 1 of door crush, and 1 of electrical burn. There were 6 grade I digital defects (beyond the nail root) and 4 grade Ⅱ defects (last segment of digit). The defects of the digits were reconstructed by taking references of the shape and structure of the contralateral normal thumbs and fingers. Then the hallux osteo-onychocutaneous flaps of great toe were designed and harvested accordingly from the left and right great toes. Donor sites were covered by skin grafting or local dressing change. One patient was treated in emergency surgery, 6 in sub-emergency surgery and 2 in elective surgery. Integrated perioperative patient management was provided to all of the patients. Postoperative follow-ups were conducted through the visit of outpatient clinic, telephone calls or WeChat interviews. Flap survival, appearance and sensation recovery were evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:Vascular insufficiency of 1 digit occurred in surgery, and relieved by local treatment with lidocaine and warm saline. All 10 digits successfully survived, and all donor sites healed spontaneously. The postoperative follow-up period was 10 to 30 months, with an average of 18 months. One transferred nail was found in poor appearance (not flat), the rest of the reconstructed digits were good in appearance and function. The nail, finger print and fine sensation (TPD 5~8 mm), as well as digital flexion, extension, grasping and opposition of the reconstructed digits were all good. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, at the last follow-up visit, 5 digits were in excellent, 4 in good and 1 in fair.Conclusion:The comprehensive reconstruction of grades Ⅰ-Ⅱ digital defects with hallux osteo-onychocutaneous flap of great toe is an ideal surgical technique that can reconstruct the nail, finger print and sensation of a digit, with good postoperative function as well as an aesthetic and realistic appearance.

Behavioral economics offers an innovative theoretical and practical framework for HIV/AIDS prevention by elucidating the irrational tendencies in individual decision-making. This review explores core behavioral economics concepts and their applications in HIV/AIDS prevention, including how salience bias, present bias, and loss aversion influence high-risk populations′ behaviors. It also synthesizes empirical evidence on the effectiveness of nudge-based interventions in enhancing public health strategies, increasing HIV testing uptake, and improving treatment adherence.Additionally, the paper addresses key challenges in the field, such as interdisciplinary collaboration, cost-effectiveness analyses of economic incentives, and ethical and cultural considerations in implementation. Future research should further integrate sociocultural contexts specific to China to localize behavioral economics applications, refine intervention strategies, and optimize resource allocation. Such efforts will advance progress toward the global goal of ending the HIV epidemic by 2030.

ObjectiveTo clarify the repair effect of Mume Fructus on the intestinal mucosal epithelial barrier in the mouse model of inflammatory bowel disease （IBD） and explore the repair mechanism. MethodsThirty-six male C57BL/6 mice were randomly assigned into six groups： normal， model， low-， medium-， and high-dose （200， 400， and 800 mg·kg^-1） Mume Fructus， and sulfasalazine （300 mg·kg^-1）. Except the normal group， the rest groups had free access to 2% dextran sulfate sodium （DSS） solution for seven days to establish the IBD model， followed by a seven-day drug intervention. The body weight change and disease activity index （DAI） were recorded. After the last administration， spleen and colon tissue samples were collected to analyze the differences in colon length and spleen index. Hematoxylin-eosin staining was used to observe the morphology of the colon tissue. The level of diamine oxidase （DAO） in the serum was measured by the DAO assay kit. Immunohistochemistry was employed to determine the expression of tight junction proteins such as Claudin-1， Occludin， and zonula occludens-1 （ZO-1） in the colon tissue. Real-time PCR was performed to measure the mRNA levels of tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） in the colon tissue. Finally， Western blot was employed to determine the protein levels of mitogen-activated protein kinase kinase （MEK）， extracellular signal-regulated kinase （ERK）， phosphorylated （p）-MEK， and phosphorylated ERK in the colon tissue. ResultsCompared with the normal group， the model group exhibited decreases in body weight and colon length （P<0.01）， increases in DAI， spleen index， and serum DAO level （P<0.01）， damaged colonic epithelium and goblet cells， and obvious infiltration of inflammatory cells. In addition， the model group exhibited higher positive expression of Claudin-1， Occludin， and ZO-1 （P<0.01）， higher mRNA levels of TNF-α and IL-1β （P<0.01）， and higher protein levels of p-MEK and p-ERK （P<0.05， P<0.01） than the normal group. However， sulfasalazine and three doses of Mume Fructus markedly decreased the body weight and DAI （P<0.05）， recovered the colon length and spleen index， alleviated colon tissue damage， lowered the level of DAO in the serum （P<0.01）， and down-regulated the mRNA levels of TNF-α and IL-1β （P<0.01） and the protein levels of p-MEK and p-ERK （P<0.05）. Sulfasalazine and low- and medium-dose Mume Fructus increased the positive expression of Occludin， Claudin-1， and ZO-1 （P<0.05， P<0.01）. Furthermore， high-dose Mume Fructus elevated the protein expression of Occludin （P<0.05）. ConclusionMume Fructus can restore the expression of intestinal epithelial tight junction proteins by inhibiting the phosphorylation of proteins in the MEK/ERK signaling pathway and down-regulating the levels of TNF-α and IL-1β， thus repairing the intestinal mucosal barrier in the mouse model of IBD.

ObjectiveTo explore the evolution of medication patterns and syndrome-herb associations of traditional Chinese medicine （TCM） in treating inflammatory bowel disease （IBD）， providing a theoretical foundation for precise syndrome differentiation and treatment in clinical practice. MethodsMedical case literature on TCM treatment of IBD from 1960 to 2024 was retrieved to establish a database. Frequency statistics， cluster analysis， change point detection， and association rule mining were employed to comprehensively analyze the syndrome distribution， therapeutic methods， medication patterns， and their temporal variations. ResultsA total of 685 medical cases were included. Common syndromes were dampness-heat （66.42%） and spleen deficiency （56.20%）. Primary therapeutic methods included heat clearing （63.65%）， spleen invigorating （47.45%）， and dampness draining （36.79%）. High-frequency herbs included Coptidis Rhizoma （354）， Paeoniae Radix Alba （303）， Aucklandiae Radix （292）， Codonopsis Radix （253）， and Glycyrrhizae Radix et Rhizoma （244）. Initial prescription clustering revealed three core therapeutic method combinations： heat clearing and detoxifying （represented by Baitouweng Tang）， spleen invigorating and Qi reinforcing （represented by Shenling Baizhusan）， and cold-heat regulation （represented by Wumeiwan combined with Shaoyao tang）. Temporal analysis identified 2008 as a key transition point in TCM treatment of IBD， with significantly increased usage frequency of heat-clearing and dampness-drying herbs such as Fraxini Cortex， Phellodendri Chinensis Cortex， Sophorae Flavescentis Radix， and Scutellariae Radix as well as hemostatic herbs such as carbonized Sanguisorbae Radix， Bletillae Rhizoma， Agrimoniae Herba， and Notoginseng Radix et Rhizoma. Follow-up efficacy analysis showed median improvement rates of 64.0% at the first follow-up， 76.0% at the second follow-up， and 78.7% at the third follow-up. Syndrome-drug association analysis revealed specific herb pairs with significant therapeutic advantages， including Notoginseng Radix et Rhizoma + Coicis Semen， Sanguisorbae Radix + Coptidis Rhizoma， and Codonopsis Radix + Aconii Lateralis Radix Praeparaia. ConclusionTCM medication patterns for treating IBD demonstrate distinct temporal evolution characteristics， with significantly increased usage frequency of herbs such as Fraxini Cortex， Notoginseng Radix et Rhizoma， and Agrimoniae Herba. Significant therapeutic method-herb associations and syndrome-herb association patterns exist， with the formation of specific herb pairs， providing evidence-based support for precise syndrome differentiation and treatment of IBD.

Objective:To investigate the 10-year incidence of reproductive system malignancies and their associated risk factors among overweight and obese women with different metabolic phenotypes aged 40 years and older in Guiyang City.Methods:A total of 6 444 female residents in Yunyan District, Guiyang City were included from the 2011 " Epidemiological Study on the Risk of Malignancy in Chinese Patients with Type 2 Diabetes Mellitus(REACTION)". Based on body mass index(BMI) and the presence or absence of metabolic syndrome(MetS), participants were categorized into four groups: metabolically healthy normal weight(MHNW, n=2 373), metabolically unhealthy normal weight(MUNW, n=1 098), metabolically healthy overweight/obese(MHO, n=2 229), and metabolically unhealthy overweight/obese(MUO, n=744). Baseline data were collected, and participants were followed up for 10 years to document the incidence of female reproductive system malignancies, including breast cancer, ovarian cancer, cervical cancer, and endometrial cancer. Logistic regression models were used to evaluate the association between metabolic phenotype and the 10-year risk of developing reproductive system malignancies. Results:Over a mean follow-up period of (9.89±0.77) years, the overall incidence of reproductive system malignancies was 1.15%(74/6, 444). Baseline characteristics such as age, BMI, high-density lipoprotein-cholesterol(HDL-C), and triglycerides(TG) differed significantly among the groups( P<0.05). The cumulative incidence of reproductive system malignancies in each group was: MHNW 0.93%(22/2 373), MUNW 0.73%(8/1 098), MHO 1.57%(35/2 229), and MUO 1.21%(9/744). There were no statistically significant differences in incidence across the four groups( P>0.05). However, multivariable logistic regression analysis revealed that, compared with the MHNW group, the adjusted HR (95% CI) were: MUNW 0.787(0.349-1.774, P>0.05), MHO 4.835(1.708-13.688, P<0.05), and MUO 3.719(1.144-12.089, P<0.05). Conclusion:Overweight and obesity are significant risk factors for reproductive system malignancies in women aged 40 and above. The presence of metabolic abnormalities in overweight or obese women further increases the risk of developing such malignancies.

Objective:To investigate the impact of minocycline on myocardial injury in diabetes cardiomyopathy(DCM)rats by regulating 5'-AMP activated protein kinase(AMPK)/sirtuin 1(SIRT1)/peroxisome proliferator activator receptor gamma coactiva-tor 1α(PGC-1α)signal pathway.Methods:SD rats were fed with high-fat diet for 4 weeks,and then a single intraperitoneal injection of 35 mg/kg streptozotocin was used to induce the DCM model.They were randomly grouped into model group,low-dose minocycline(20 mg/kg)group,high-dose minocycline(40 mg/kg)group,high-dose minocycline+Dorsomorphin(AMPK inhibitor,0.2 mg/kg)group,with 12 rats in each group,another 12 normal rats were fed with normal feed for 4 weeks,and then were given a single intraper-itoneal injection of the same dose of citric acid buffer,which was set as a sham operation group,after the intervention with minocy-cline and Dorsomorphin,and the fasting blood glucose(FBG),total cholesterol(TC)and triglyceride(TG)were measured;left ven-tricular ejection fraction(LVEF)and left ventricular short axis shortening(FS)were measured by ultrasound;HE staining and Mas-son staining were applied to detect the pathological morphology of myocardial tissue of rats in each group;the levels of serum and myo-cardial tissue inflammation IL-6,IL-18,and myocardial tissue oxidative stress indicators-superoxide dismutase(SOD)and malondial-dehyde(MDA)were measured with the kit;Western blot was applied to detect the expression of AMPK/SIRT1/PGC-1α pathway pro-tein in myocardial tissue of rats in each group.Results:Compared with the sham operation group,the myocardial tissue in the model group was seriously damaged,the levels of FBG,TC and TG,the cross-sectional area of myocardial cells and the proportion of myocar-dial fiber area,the levels of IL-6 and IL-18 in serum and myocardial tissue,and the level of MDA in myocardial tissue were obviously increased(P<0.05),the levels of LVEF,FS and SOD in myocardial tissue,and the protein expression of p-AMPK/AMPK,SIRT1 and PGC-1α were obviously decreased(P<0.05);compared with the model group,the myocardial tissue damage of rats in the low-dose and high-dose minocycline groups were reduced,the levels of FBG,TC and TG,the cross-sectional area of myocardial cells and the proportion of myocardial fiber area,the levels of IL-6 and IL-18 in serum and myocardial tissue,and the level of MDA in myocardial tissue were decreased(P<0.05),the LVEF,the levels of FS and SOD in myocardial tissue,and the protein expression of p-AMPK/AMPK,SIRT1 and PGC-1α were increased(P<0.05);compared with the low-dose minocycline group,the myocardial tissue damage in the high-dose minocycline group was further reduced,the levels of FBG,TC and TG,the cross-sectional area of myocardial cells and the proportion of myocardial fiber area,the levels of IL-6 and IL-18 in serum and myocardial tissue,and the level of MDA in myo-cardial tissue were further decreased(P<0.05),the levels of LVEF,FS and SOD in myocardial tissue,and the protein expression of p-AMPK/AMPK,SIRT1 and PGC-1α were further increased(P<0.05);compared with the high-dose minocycline group,the myocar-dial tissue damage of rats in the high-dose minocycline+Dorsomorphin group increased,the levels of FBG,TC and TG,the cross-sec-tional area of myocardial cells and the proportion of myocardial fiber area,the levels of IL-6 and IL-18 in serum and myocardial tis-sue,and the level of MDA in myocardial tissue were increased(P<0.05),the LVEF,the levels of FS and SOD in myocardial tissue,and the protein expression of p-AMPK/AMPK,SIRT1 and PGC-1α were decreased(P<0.05).Conclusion:Minocycline can reduce oxidative stress and inflammation in DCM rats by activating AMPK/SIRT1/PGC-1α signal,and improve glycolipid metabolism,thereby reducing myocardial injury and repairing cardiac function in rats.

Behavioral economics offers an innovative theoretical and practical framework for HIV/AIDS prevention by elucidating the irrational tendencies in individual decision-making. This review explores core behavioral economics concepts and their applications in HIV/AIDS prevention, including how salience bias, present bias, and loss aversion influence high-risk populations′ behaviors. It also synthesizes empirical evidence on the effectiveness of nudge-based interventions in enhancing public health strategies, increasing HIV testing uptake, and improving treatment adherence.Additionally, the paper addresses key challenges in the field, such as interdisciplinary collaboration, cost-effectiveness analyses of economic incentives, and ethical and cultural considerations in implementation. Future research should further integrate sociocultural contexts specific to China to localize behavioral economics applications, refine intervention strategies, and optimize resource allocation. Such efforts will advance progress toward the global goal of ending the HIV epidemic by 2030.