Since the Asia-Pacific Association for the Study of the Liver （APASL） issued the clinical practice guidelines for metabolic associated fatty liver disease （MAFLD） in 2020， the research on MAFLD has been further deepened. Therefore， APASL has made comprehensive updates and revisions based on the previous guidelines， and the latest version of the clinical practice guidelines for diagnosis and management of MAFLD， which was released in February 2025， has updated the epidemiology， screening， assessment， and treatment of MAFLD， aiming to promote the clinical practice， knowledge popularization， and scientific research of MAFLD. This article makes an excerpt and an interpretation of the updated key points of the guidelines.

Objective To investigate the predictive value of combined PD-L1 expression,radiomics,and deep learning features for the efficacy of immunotherapy in patient with non-small cell lung cancer(NSCLC).Methods A total of 83 NSCLC patients who underwent immunotherapy were analyzed retrospectively.The volume of interest(VOI)was segmented on CT images,and features were extracted through the Pyradiomics and ResNet18 networks.The Radiomics score(Radscore)and deep learning score(Deepscore)were constructed based on the features after dimensionality reduction.Univariate and multivariate analyses were performed on the clinical parameters,Radscore,and Deepscore,and the independent predictive risk factors were selected to establish the clinical model,radiomics model,and combined prediction model,respectively.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)of the three models was calculated.Decision curve analysis(DCA)was used to compare the clinical practicability of the three models.Results Three radiomics features and three deep learning features were selected to calculate Radscore and Deepscore,respectively.PD-L1 expression,Radscore,and Deepscore were independent predictors of the efficacy of immunotherapy for NSCLC.The AUC of the combined prediction model in the training set and validation set were 0.885 and 0.877,respectively,which were higher than that of the clinical model(0.654 and 0.640),and the difference in AUC was statistically significant(P=0.006,0.029,respectively).The DCA showed that the combined prediction model achieved better clinical practicability at the threshold of 0-0.25 and 0.3-1.Conclusion The combined prediction model can better predict the efficacy of immunotherapy in NSCLC patients.

Objective The aim of this study was to investigate the molecular regulatory mechanism of cancer susceptibility candidate 15(CASC15),a long-stranded non-coding RNA(lncRNA),in hepatocellular carcinoma(HCC).Methods Bioinformat-ics methods were used to predict the expression of target genes and analyze the relationship between the expression of target genes and the survival time of patients;Hepatocellular carcinoma tissues and adjacent tissues from patients with HCC were collected;CCK-8,Tr-answell,and flow cytometry experiments were used to detect proliferation,invasion,migration and apoptosis of SMMC7721 cells and Huh-7 cells;The dual-luciferase assay was used to detect the targeting relationship between miR-144-3p and CASC15,as well as leucine rich repeat containing protein 1(LRRC1);RT-qPCR and Western blot were used to detect mRNA and protein expression of target genes;Immunofluorescence was used for protein localization of target genes;Replicate experiment was performed to verify the effect of CASC15/miR-144-3p/LRRC1 on the progression of HCC.In vivo experiment was performed to verify the effect of CASC15 on HCC progression.Results TCGA database and RT-qPCR assay showed high expression of CASC15,low expression of miR-144-3p,and high expression of LRRC1 in HCC tissues and cells(P<0.05).The results of cell function experiments on proliferation,inva-sion and migration showed that CASC15 and LRRC1 played a promoting role in tumor development,while miR-144-3p had an inhibi-tory effect,consistent with the results of apoptosis experiments(P<0.05).Cell function experiments showed that CASC15 inhibited miR-144-3p function,miR-144-3p inhibited LRRC1,and CASC15 bound to miR-144-3p,leading to the upregulation of LRRC1.The replicate experimental results indicated that CASC15 promoted LRRC1 expression through inhibiting miR-144-3p,thereby pro-moting HCC cell proliferation,invasion and migration,and inhibiting apoptosis.Conclusion CASC15 may promote HCC progression by regulating the miR-144-3p/LRRC1 axis.

Objective:To investigate the effect of diabetes on the occurrence of early adverse reactions of intensity-modulated radiotherapy in patients after radical mastectomy for breast cancer.Methods:The clinical data of 102 breast cancer patients who underwent intensity-modulated radiotherapy after radical mastectomy for breast cancer in Nanjing Drum Tower Hospital Group Suqian Hospital from October 2014 to December 2020 were retrospectively analyzed, including 32 cases in the diabetes group and 70 cases in the non-diabetes group. The incidence of early adverse reactions of intensity-modulated radiotherapy in the two groups was compared, the effects of blood glucose before radiotherapy on the early adverse reactions of intensity-modulated radiotherapy and the lymphocyte count before and after intensity-modulated radiotherapy were analyzed.Results:There were 9 cases (28.1%) and 1 case (3.1%) of grade 1 and 2 acute radiation pneumonitis in the diabetes group, and 6 cases (8.6%) and 1 case (1.4%) in the non-diabetes group, respectively, and there was a statistical difference between the two groups ( χ2 = 7.22, P = 0.027). Grade 1-3 acute radiation dermatitis occurred in 16 cases (50.0%), 13 cases (43.8%) and 3 cases (6.2%) in the diabetes group, and 53 cases (75.7%), 15 cases (21.4%) and 2 cases (2.9%) in the non-diabetes group, respectively, and the difference between the two groups was statistically significant ( χ2 = 6.99, P = 0.030). According to the level of fructosamine before radiotherapy, the patients with diabetes were divided into normal blood glucose control group (fructosamine ≤2.5 mmol/L) and poor blood glucose control group (fructosamine >2.5 mmol/L), and there was statistical difference in the morbidity of acute radiation dermatitis between the two groups ( P = 0.039). Before radiotherapy, there was no significant difference in lymphocyte count between the normal and poor blood glucose control groups ( P > 0.05). After radiotherapy, the lymphocyte count in both groups was significantly lower than that before radiotherapy, and the decrease was more obvious in the poor blood glucose control group, the difference was statistically significant ( P = 0.021). Conclusions:The postoperative patients with breast cancer complicated with diabetes have a high incidence of acute radiation pneumonia and acute radiation dermatitis. Patients with poor blood glucose control are more likely to have acute radiation dermatitis.

Objective: To investigate the feasibility of differential diagnosis of invasive lung adenocarcinoma and non-calcified lung tuberculoma on CT plain images based on texture analysis. Methods: Data of plain CT images of 52 patients with single pulmonary nodules confirmed pathologically were retrospectively analyzed, including 31 cases of invasive lung adenocarcinoma and 21 cases of non-calcified lung tuberculosis. Totally 300 texture features of each kind of lesions were extracted with MaZda software, then 10 optimized texture parameters were selected for texture analysis with fisher coefficient (Fisher), minimization of both probability of classification error and average correction coefficient (POE+ACC), mutual information coefficients (MI) methods, respectively, and the optimal texture features combination combined with three methods (MPF) was obtained. The four groups of optimal texture characteristics were classified using linear discriminant analysis (LDA) and nonlinear discriminant analysis (NDA), while classification of LDA and NDA were performed using K-nearest neighbor classifier (K-NN) and artificial neural network (ANN), respectively. The minimum error probability of 4 groups of texture features in differential diagnosing of 2 kinds of lesions was analyzed, the differences of 30 optimal texture features were compared between 2 kinds of lesions, their ROC curves for identifying 2 kinds of lesions were drawn, and then AUC of the curves were calculated to evaluate their diagnostic performance. Results: For single group of optimal texture features, NDA/ANN-Fisher method had the lowest error rate (7.69% [4/52]), while for MPF, the error rate of NDA/ANN-MPF was the lowest (5.77% [3/52]). There was no statistical difference of error rate between NDA/ ANN-Fisher and NDA/ ANN-MPF method (χ2=0.15, P>0.05). Statistical differences of 10 optimal texture features were noticed between 2 kinds of lesions, among which difference entropy S(1,1), difference variance S(1,1) and gradient variance had good diagnostic efficacy (AUC=0.71, 0.71, 0.70), and their AUC were not statistically different (all P>0.05). Conclusion: Based on texture analysis of plain CT images, invasive lung adenocarcinoma and non-calcified lung tuberculosis can be well distinguished, providing objective and reliable basis for differential diagnosis of these two lesions.

Objective To investigate the auxiliary effect of artificial tiger bone powder on the fragile fracture healing and functional recovery.Methods From June 2014 to June 2015,64 patients with fragile fracture in the second Hospital of Tangshan were randomly divided into treatment and control groups,32 cases in each group.All the selected patients were given routine treatment of fracture.The treatment group was given artificial tiger bone powder,while the control group was given vitamin D and calcium carbonate.The clinical fracture healing time of the selected patients were recorded.At the beginning and 3,6 months after treatment,the Barthel Index ( BI) and functional independent measure ( FIM) were recorded.Results There was no significant difference in general condition, BI score and FIM score between the two groups before treatment.At the 3rd and 6th month after treatment,the BI scores were(( 65.74 ± 7.94 ),( 76.05 ±8.07 ) value),and FIM scores were(( 76.61± 9.08),(( 87.91 ± 6.76) valu)],those in the treatment group were higher than those in the control group( BI:( 61.12 ± 8.67), ( 71.25 ± 8.32) value and FIM:(71.03±9.34),(79.01±7.32) value),( P＜0.05).The the fracture healing time in the treatment group was shorter((12.78±2.09) weeks) than that in the control group((13.94± 2.32) weeks),( t＝2.101,P＜0.05).Conclusion Artificial tiger bone powder can shorten the healing time of fracture, which has auxiliary effect on the healing of fragile fracture.It can promote the functional recovery of fragile fracture patients,and improve their life and activity.

The 11α-hydroxylation of 16α, 17-epoxyprogesterone (EP) catalyzed by Rhizopus nigricans is crucial for the steroid industry. However, lower conversion rate of the biohydroxylation restricts its potential industrial application. The 11α-steroid hydroxylase CYP509C12 from R. oryzae were reported to play a crucial role in the 11α-hydroxylation in recombinant fission yeast. In the present study, the CYP509C12 of R. oryzae (RoCYP) was introduced into R. nigricans using the liposome-mediated mycelial transformation. Heterologous expression of RoCYP resulted in increased fungal growth and improved intracellular reactive oxygen species content in R. nigricans. The H₂O₂ levels in RoCYP transformants were approximately 2-folder that of the R. nigricans wild type (RnWT) strain, with the superoxide dismutase activities increased approximately 45% and catalase activities decreased approximately 68%. Furthermore, the 11α-hydroxylation rates of EP in RoCYP transformants (C4, C6 and C9) were 39.7%, 38.3% and 38.7%, which were 12.1%, 8.2% and 9.4% higher than the rate of the RnWT strain, respectively. This paper investigated the effect of heterologous expression of RoCYP in R. nigricans, providing an effective genetic method to construct the engineered strains for steroid industry.

Objective: To investigate the helping role of Kangfuxin liquid on early enteral nutrition in craniocerebral injury patients with mechanical ventilation, and the indirect effect on mechanical ventilation. Methods: 60 craniocerebral injury patients with mechanical ventilation and early enteral nutrition were selected, and they were randomly divided into treatment group and control group according to the digital table, 30 cases in each group.All patients were given conventional treatment and nutritional support, the patients in the treatment group were given Kangfuxin liquid.Before and 7 days after treatment, the levels of albumin(ALB), pre albumin(PA) and totalprotein(TP) were tested.The incidence of abdominal distension, reflux and aspiration in 7 days were recorded.The time of mechanical ventilation and the stay time in ICU were recorded.The mortality rate in 28 days was recorded. Results: 7 days after treatment, the levels of ALB[(33.47±4.82)g/L vs.(30.47±4.64)g/L], PA[(206.21±41.87)mg/L vs.(185.62±38.94)mg/L]and TP[(57.82±5.96)g/L vs.(54.47±6.17)g/L]in the treatment group were higher than those in the control group(t=2.456, 2.338, 2.139, all P<0.05). The incidence rates of abdominal distension(20.00% vs.53.33%), reflux(16.67% vs.43.33%), time of mechanical ventilation[(11.76±2.02)d vs.(13.02±1.96)d]and the stay time in ICU[(13.74±2.31)d vs.(15.43±2.14)d]in the treatment group were lower than those in the control group(χ²=7.177, 5.07, t=2.452, 2.940, all P<0.05). There was no statistically significant difference in 28-day mortality rate (P>0.05). Conclusion Kangfuxin liquid has helping role on early enteral nutrition in craniocerebral injury patients with mechanical ventilation.And it is helpful to shorten the time of mechanical ventilation.

Objective To investigate the therapeutic effect of artificial tiger bone powder on osteoporosis.Methods The postmenopausal women with osteoporosis were randomly divided into treatment group and control group,31 cases in each group.The treatment group orally received artificial tiger bone powder,the control group orally received Caltrate D.At the beginning and 3,6 months after treatment,European health index (EQ-5D),Barthel index (BI) and Faces Pain Scale-Revised (FPS-R) were used to evaluate the curative effect.Results There were no significant differences in EQ-5D,BI and FPS-R between the two groups at the beginning of treatment.At 3,6 months after treatment,EQ-5D of the two groups were (0.83 ± 0.09) points vs.(0.77 ± 0.08) points,(0.89 ± 0.07) points vs.(0.84 ± 0.08) points;BI were (74.61 ± 8.39) points vs.(70.07 ± 8.51) points,(77.24 ± 7.15) points vs.(73.31 ±7.41) points;FPS-R were (3.14 ± 1.06) points vs.(3.79 ± 1.12) points,(2.31 ± 0.92) points vs.(2.98 ±0.87) points,which in the treatment group were better than those in the control group (t =2.774,2.619,2.115,2.125,2.347,2.946,all P ＜ 0.05).Conclusion Artificial tiger bone powder can relieve pain in postmenopausal osteoporosis patients,improve the patients' ability and improve their quality of life.And artificial tiger bone powder can effectively treat postmenopausal osteoporosis.

Objective To analyze the occupational characteristics in patients with avascular necrosis of femoral head and related factors.Methods A random sample of 1062 patients with avascular necrosis of femoral head of inpatient medical record data from 2007 to 2008 was selected, all patients were confirmed by X-ray, CT, MRI or radionuclide bone scan.Patients were assigned to three groups of agriculture (320 cases), non-agricultural (424 cases), the other(318 cases) groups by different occupation.The patient's age, gender, ethnicity, single or bilateral, etiology, staging, time of onset and region were compared in each group.Results The proportions of gender (male/female) were 21.94％ (233/1062) and 8.19％ (87/1062) in agriculture group,32.77％ (348/1062) and 7.16％ (76/1062) , 21.66％ (230/1062) and 8.29％ (88/1062) in non-agricultural and the other groups respectively.The proportions of region (Northeast, North, East, South, Southwest, Northwest of China) were 3.30％ (35/1062), 8.00％ (85/1062), 8.10％ (86/1062), 4.80％ (51/1062), 3.11％(33/1062) ,2.82％ (30/1062) in agriculture group, 8.29％ (88/1062), 10.08％ (107/1062), 7.72％ (82/1062), 7.25％ (77/1062), 2.26％ (24/1062), 4.33％ (46/1062), and 4.05％ (43/1062), 8.38％ (89/1062) ,8.10％(86/1062) ,4.61％(49/1062) ,2.17％(23/1062) ,2.64％(28/1062) in the group of non-agricultural and the other.The proportions of etiology (alcohol, hormones, trauma, two or more, the other) were 5.46％ (58/1062), 6.97％ (74/1062), 4.43％ (47/1062), 0.94％ (10/1062), 12.34％ (131/1062) in agriculture group, 10.55％ (112/1062), 7.72％ (82/1062), 5.74％ (61/1062), 2.26％ (24/1062), 13.65％ (145/1062), and 4.90％ (52/1062), 5.93％ (63/1062), 4.90％ (52/1062), 0.66％ (7/1062), 13.56％ (144/1062) in the group of non-agricultural and the other.The proportions of gender, region, etiology in each group were analyzed by x2 test, the differences were statistically significant (x2 =12.77, 24.55, 26.36, P ＜0.05).The onset time and ARCO staging in each group, the correlations were analyzed by Spearman test, the differences were statistically significant(rs =0.282,0.232,0.208, P＜0.05).The onset of time and average age in different occupational group with different, due to factors such as gender, ethnicity, single or bilateral, region, and so on.Conclusion Patients with avascular necrosis of femoral head in different occupational group have different epidemiological characteristics.The occupational characteristics analysis can provide scientific data for diagnosis,treatment and prevention in patients with avascular necrosis of femoral head.