Hepatic alveolar echinococcosis is a highly invasive zoonotic parasitic disease with poor prognosis. Surgical intervention serves as the pivotal approach to achieve radical cure and improve the prognosis of hepatic alveolar echinococcosis patients. In recent years, with the popularization of the concept of precision surgery and the development of the multidisciplinary diagnosis and treatment model, the surgical treatment strategies for hepatic alveolar echinococcosis have been continuously enriched, and the selection of surgical procedures has become increasingly diversified. Although key surgical techniques such as radical hepatectomy, autologous liver transplantation and allogeneic liver transplantation have achieved remarkable progress in clinical application, many insurmountable challenges still remain. Therefore, by sorting out the latest evidence-based advances in the field of surgical treatment for hepatic alveolar echinococcosis, this article focuses on discussing the application status and bottlenecks of radical hepatectomy, autologous liver transplantation and allogeneic liver transplantation in hepatic alveolar echinococcosis, aiming to provide a reference for the clinical treatment of hepatic alveolar echinococcosis.

This article provides a systematic interpretation and review of the Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design. Developed based on the Grading of Recommendations Assessment, Development and Evaluation methodology, the guideline address five core themes: ICU layout, room design, infection control, infrastructure, and staff spaces, and put forward 17 evidence-based recommendations, including 5 good practice statements. This article briefly introduces the guideline development methods and evidence characteristics, and focuses on summarizing key recommendations, including high-visibility layouts, single-bed ward settings, natural lighting and noise reduction strategies, integrated infection prevention and control design, remote monitoring, and flexible capacity expansion capabilities. Furthermore, it delves into the applicability and localized implementation pathways within China's healthcare environment, analyzing limitations in terms of evidence quality, specialty applicability, and cost-effectiveness. Furthermore, by integrating the Chinese Guidelines for the Construction and Development of Critical Care Medicine (2025 Edition) and current domestic practices, the article proposes tiered and phased implementation recommendations. This article aims to provide domestic healthcare institutions with a scientific reference that balances international cutting-edge concepts with China's real-world conditions for the construction and renovation of ICUs, thereby promoting the development of intensive care environments centered on patient safety, healthcare worker well-being, and infection control.

Objective: To explore the associations between caregivers nutrition literacy and pediatric nonalcoholic fatty liver disease (NAFLD), so as to provide scientific evidence for the key contents of family intervention measures. Methods: In September 2022, a study involving 1 609 thirdgrade students and their caregivers from six schools in Yinzhou, Haishu, and Zhenhai Districts of Ningbo City, Zhejiang Province, was conducted. Venous blood samples were collected to measure lipid profiles and investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) among the children. Family Food Environment Questionnaire was used to assess the nutrition literacy levels of the caregivers. Generalized linear regression analysis was employed to explore the correlation between caregivers nutrition literacy levels and the prevalence of NAFLD in children. Results: Among the surveyed students, 191 were in the NAFLD group, whereas 1 418 were in the nonNAFLD group. The median nutrition literacy score of caregivers in the NAFLD group and nonNAFLD group all were 11.00 (9.00,12.00), which was not significantly different (Z=-0.40, P=0.71). The generalized linear regression results revealed that the level of nutrition literacy of caregivers had no significant effect on childrens Triglyceride-glucose (TyG) index and Triglyceride-glucose-Waisttoheight ratio (TyG-WHtR) [β(95%CI) were 0.001(-0.005-0.006) and 0.000(-0.014-0.014), P>0.05]. Conclusions The nutrition literacy level of caregivers has no significant correlation with the direct incidence of NAFLD in children. As for family intervention measures, it is necessary not only to improve the nutrition literacy level of caregivers but also to effectively apply nutritional knowledge in practice to optimize health management.

Objective: To evaluates the association between maternal overweight/obesity during pregnancy and offspring risk of metabolic dysfunction associated steatotic liver disease (MASLD), providing theoretical evidence for early life MASLD prevention. Methods: An online search was conducted across ten databases (CNKI, Wanfang, SinoMed, PubMed, Embase, Web of Science, Cochrane Library, PROSPERO, PQDT Global, ScienceDirect) for research literature on the association between maternal overweight/obesity during pregnancy and the development of MASLD in offspring, with the search period spanning from January 2014 to December 2024. Two researchers independently screened literature, extracted data, and assessed study quality. Statistical analysis was performed using R 4.3.3. Results: Ten studies involving 10 229 participants were included, comprising 4 cohort studies and 6 case control studies. Cohort studies showed that maternal overweight and obesity significantly increased offspring MASLD risk ( RR=1.59, 95%CI=1.06-2.39, P <0.05), with moderate heterogeneity ( I 2=56.9%, P =0.07). Case control studies indicated a positive association between maternal overweight/obesity during pregnancy and offspring risk of MASLD( OR=2.00, 95%CI=1.68-2.39, P < 0.05), with low heterogeneity ( I 2=48.8%, P =0.08). Conclusions Maternal overweight/obesity during pregnancy positively correlates with offspring MASLD risk. Gestational weight management may reduce the risk.

Objective To explore the mechanism of total saponin from Panax japonicus(TSPJ)in alleviating neuroinflammation in experimental autoimmune encephalomyelitis(EAE)based on the activation of microglia mediated by MAPK signaling pathway.Methods In vivo experiments,mice were divided into normal group,model group and TSPJ low-and high-dosage groups.EAE mouse model was induced by myelin oligodendrocyte glycoprotein polypeptide.Each medication group was gavaged with corresponding drug solution once a day for 28 days.The number of Iba-1-positive cells was assessed using immunofluorescence,the protein expressions of tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-1β and MAPK signaling pathway related factors were detected by Western blot.In vitro experiments,murine microglia BV2 were divided into normal group,model group and TSPJ low-and high-dosage groups.LPS+IFN-γ was used to induce M1 polarization of BV2 cells,medication groups were given TSPJ intervention,the content of nitric oxide(NO)in cell supernatant,the expression of M1 microglia markers and MAPK signaling pathway related factors were detected,and ERK and JNK signaling pathway inhibitors were further used to clarify the molecular mechanism of TSPJ antagonizing neuroinflammation.Results The results of in vivo experiments showed that compared with the normal group,the cell body and number of microglia in cerebral cortex of the model group mice increased significantly(P<0.01),and the protein expressions of TNF-α,IL-6,IL-1β,p-p38/p38,p-JNK/JNK,p-ERK1/2/ERK1/2 significantly increased(P<0.05,P<0.01);compared with the model group,the number of microglia in cerebral cortex of TSPJ low-and high-dosage groups significantly decreased(P<0.01),the expressions of TNF-α,IL-6,p-p38/p38,p-JNK/JNK,p-ERK1/2/ERK1/2 protein significantly decreased(P<0.05,P<0.01),and the expression of IL-1β protein in TSPJ high-dosage group significantly decreased(P<0.05).The results of in vitro experiments showed that compared with the normal group,the content of NO in cell supernatant of the model group significantly increased(P<0.01),the protein expressions of CD16,CD86,p-p38/p38,p-JNK/JNK,p-ERK1/2/ERK1/2 significantly increased(P<0.01);compared with the model group,the content of NO in cell supernatant of TSPJ low-and high-dosage groups significantly decreased(P<0.01),and the protein expressions of CD16,CD86,p-p38/p38,p-JNK/JNK,p-ERK1/2/ERK1/2 significantly decreased(P<0.05,P<0.01).TSPJ combined with ERK and JNK pathway inhibitors could further inhibit the expressions of TNF-α and IL-6,but there was no significant difference compared with inhibitors alone.Conclusion TSPJ can inhibit the activation of microglia by regulating MAPK signaling pathway,thereby reducing EAE induced central nervous inflammation.

Background and Aims:To overcome the limitations of the transoral endoscopic thyroidectomy vestibular approach,such as restricted operative space and high complication risks,our team proposed a modified technique—endoscopic thyroidectomy via oral vestibule and submandibular approach(ETOSA).Preliminary studies have confirmed its safety and feasibility.This study aims to systematically evaluate the key factors affecting postoperative complications and operative time in ETOSA,explore the interactions among these variables,and construct a learning curve model to support its broader clinical adoption.Methods:A retrospective analysis was conducted on 125 patients with papillary thyroid carcinoma who underwent ETOSA at Xiangya Hospital,Central South University,between March 2022 and March 2023.Clinical characteristics,surgical parameters,and postoperative complications were extracted.A random forest model was employed to identify the major influencing factors for complications and operative time,as well as their interaction effects.Partial dependence plots based on case sequence were used to generate the learning curve.Results:All 125 patients successfully underwent ETOSA with no conversion to open surgery.The median operative time was 95.0 min,and the median intraoperative blood loss was 15.0 mL.The overall postoperative complication rate was 16.0%,with no cases of permanent hypoparathyroidism or hypocalcemia.The average neck appearance score was 1.05,indicating high patient satisfaction.The random forest analysis identified case number,surgical extent,lymph node yield(LNY),Hashimoto's thyroiditis(HT),and body mass index(BMI)as the key predictors of postoperative complications,while surgical extent,case number,LNY,HT,and blood loss were the key factors affecting operative time.A significant positive interaction was observed between case number and both surgical extent and HT,particularly in the first 20 cases,suggesting a higher risk during the early learning phase.The learning curve analysis indicated that surgical proficiency stabilized after 20 cases.Operative time and complication rate in the proficient phase were significantly lower than those in the learning phase(90.0 min vs.102.5 min;11.4%vs.40.0%,both P<0.05).Conclusion:ETOSA is a safe and feasible technique characterized by minimal invasiveness,favorable cosmetic outcomes,and a relatively short learning curve.case number,surgical extent,LNY,HT,BMI,and blood loss are key factors affecting complications and operation time.

CD11c + microglia are a type of important immune cells in the central nervous system. They maintain the homeostasis of internal environment during normal development and are massively activated in aging and various neuro-pathological conditions, playing roles in phagocytic clearance and neuroinflammation regulation; however, their specific mechanism remains unclear. In recent years, more and more studies have focused on mechanism of this cell subpopulation in the central nervous system development and diseases. Therefore, this article reviews the recent advance in the biological characteristics, signal regulation mechanisms of CD11c + microglia, as well as their roles in neurodevelopment and various CNS diseases (ischemic stroke, traumatic brain injury, neuropathic pain, Alzheimer's disease, Parkinson's disease, multiple sclerosis and neuromyelitis optica), aiming to provide theoretical basis and reference for the development of drugs targeting CD11c + microglia.

Background and Aims:To overcome the limitations of the transoral endoscopic thyroidectomy vestibular approach,such as restricted operative space and high complication risks,our team proposed a modified technique—endoscopic thyroidectomy via oral vestibule and submandibular approach(ETOSA).Preliminary studies have confirmed its safety and feasibility.This study aims to systematically evaluate the key factors affecting postoperative complications and operative time in ETOSA,explore the interactions among these variables,and construct a learning curve model to support its broader clinical adoption.Methods:A retrospective analysis was conducted on 125 patients with papillary thyroid carcinoma who underwent ETOSA at Xiangya Hospital,Central South University,between March 2022 and March 2023.Clinical characteristics,surgical parameters,and postoperative complications were extracted.A random forest model was employed to identify the major influencing factors for complications and operative time,as well as their interaction effects.Partial dependence plots based on case sequence were used to generate the learning curve.Results:All 125 patients successfully underwent ETOSA with no conversion to open surgery.The median operative time was 95.0 min,and the median intraoperative blood loss was 15.0 mL.The overall postoperative complication rate was 16.0%,with no cases of permanent hypoparathyroidism or hypocalcemia.The average neck appearance score was 1.05,indicating high patient satisfaction.The random forest analysis identified case number,surgical extent,lymph node yield(LNY),Hashimoto's thyroiditis(HT),and body mass index(BMI)as the key predictors of postoperative complications,while surgical extent,case number,LNY,HT,and blood loss were the key factors affecting operative time.A significant positive interaction was observed between case number and both surgical extent and HT,particularly in the first 20 cases,suggesting a higher risk during the early learning phase.The learning curve analysis indicated that surgical proficiency stabilized after 20 cases.Operative time and complication rate in the proficient phase were significantly lower than those in the learning phase(90.0 min vs.102.5 min;11.4%vs.40.0%,both P<0.05).Conclusion:ETOSA is a safe and feasible technique characterized by minimal invasiveness,favorable cosmetic outcomes,and a relatively short learning curve.case number,surgical extent,LNY,HT,BMI,and blood loss are key factors affecting complications and operation time.

Objective:To investigate the association between metabolic dysfunction-associated steatotic liver disease(MASLD)and the risk of adverse pregnancy outcomes,and to analyze the impact of the type and severity of cardiometabolic risk factor(CMRF)abnormalities on this association.Methods:A retrospective cohort study was conducted among primiparous women with singleton pregnancies who had registered at Beijing Friendship Hospital from March 10,2020,to December 31,2022.A total of 2 623 women were included.Basic characteristics and delivery outcomes were documented,liver ultrasound and relevant prenatal examinations were performed,and adverse pregnancy outcomes were diagnosed.Modi-fied Poisson regression models were used to analyze the association between MASLD and adverse pregnan-cy outcomes.The relationship between the type or severity of CMRF abnormalities in MASLD and the risk of adverse pregnancy outcomes was also explored.Results:After adjusting for confounding factors including age,gestational weight gain,and education level,MASLD was associated with an increased risk of cesarean section(RR=1.531,95％CI:1.304-1.799,P＜0.001),gestational diabetes melli-tus(GDM;RR=2.409,95％CI:1.948-2.979,P＜0.001),pregnancy-associated hypertension(PAH;RR=3.062,95％CI:2.069-4.533,P＜0.001),preterm birth(RR=2.145,95％CI:1.342-3.429,P=0.001),and large for gestational age(LGA;2.224,95％CI:1.599-3.095,P＜0.001).However,no significant associations were found for small for gestational age or postpartum hemorrhage.After adjusting for other CMRF abnormalities,the risk of adverse pregnancy outcomes varied among MASLD pregnant women with different CMRF abnormalities:the body mass index abnormal group had higher risks of cesarean section,GDM,PAH,preterm birth,and LGA;the glucose abnormal group had an increased risk of GDM;the blood pressure abnormal group had a higher risk of PAH;the high density lipoprotein cholesterol abnormal group had higher risks of cesarean section,GDM,and PAH;and the tri-glyceride abnormal group was associated with higher risks of GDM and preterm birth.Additional,as the severity of CMRF abnormalities increased,the risks of cesarean section(RR=1.199,95％CI:1.112-1.292,P＜0.001),GDM(RR=1.478,95％CI:1.345-1.624,P＜0.001),PAH(RR=1.626,95％CI:1.367-1.934,P＜0.001),preterm birth(RR=1.384,95％CI:1.120-1.710,P=0.003),and LGA(RR=1.422,95％CI:1.224-1.650,P＜0.001)continued to rise.Conclusion:MASLD during pregnancy is associated with an increased risk of multiple adverse pregnancy outcomes,and the type and severity of CMRF abnormalities significantly influence this association.These results suggest that attention should be paid to the specific CMRF abnormalities when diagnosed MASLD,as this may help to facilitate targeted interventions and reduce the risk of adverse pregnancy outcomes.

Objective:To identify strain-specific features of Klebsiella pneumoniae by analyzing metagenomics next generation sequencing (mNGS) data, thereby expanding the downstream applications of mNGS. Methods:The sequences of K.pneumoniae strains were organized from both the self-built database of the long-term multi-center research cohort in China established by the Peking University People′s Hospital from 2009 to 2020 (with 2 345 sequences) and the public databases (with 19 648 sequences). The existing large-scale databases were compressed, and a set of strains representative of clonal groups were screened. A strain genome information library was constructed based on k-mer features, and the most matching representative sequences in the database were searched for the raw mNGS data. The search results of the self-built library and public library were merged and optimized to update the prediction of antimicrobial-resistance characteristics and avoid the impact of uneven data distribution on the results. A total of 314 clinical samples from patients with K.pneumoniae detected by mNGS in the Clinical Microbiology Laboratory of Peking University People′s Hospital from 2022 to 2024 were retrospectively collected, and 101 samples with positive clinical culture results were selected to validate the prediction results. The antimicrobial-resistance phenotypes were verified by clinical antimicrobial susceptibility test results. Whole-genome sequencing was performed on the culture strains of 14 samples randomly selected using random numbers to verify the genotypes. Single nucleotide polymorphism distance analysis was used to verify the occurrence of outbreak events. The χ2 test and Mann-Whitney U test were used for statistical analysis. Results:A representative strain sequence k-mer feature library containing self-built and public sub-libraries was constructed. The library construction required only about 1 hour with <3 GB storage, with a high compression ratio and low update cost. Using k-mer-based analysis, mNGS data achieved precise strain characterization within 4 minutes and and <5 GB memory occupation. There was a significant difference in the antimicrobial-resistance rates to more than half of the antibiotics between the self-built database (90.8%, 2 130/2 345) and the public database (22.7%, 4 457/19 648) ( χ2=4 634.1, P<0.001). After optimizing the search results, the mean category agreement, sensitivity, and specificity of the prediction for eight antibiotics reached 84.8% (323/381), 78.9% (131/166), and 91.2% (196/215), respectively. The target genotypes were successfully detected in 10 out of 12 samples, and two outbreak events (2 samples per event) were successfully identified. Conclusions:An independent analysis process adapted to the needs of identifying the features of K. pneumoniae strains in mNGS data was developed. This process requires minimal computational resources and processing time and can directly achieve the simultaneous analysis of the antimicrobial-resistance phenotypes of K. pneumoniae at the strain level and their corresponding genomic characteristic profiles based on the raw mNGS reads.