Abstract The issue of multimorbidity in children and adolescents is becoming increasingly prominent, but there is no consensus on the definition of multimorbidity. As research deepens, issues related to the comparability and standardization of relevant findings are gradually emerging. As a solution, a systematic review of both domestic and international research on multimorbidity is conducted, and a classification system for defining the concept of multimorbidity is proposed, offering more convenient conditions for the advancement of future research and cross study exchange.

ObjectiveTo investigate the modifiable areal unit problem （MAUP） in the spatial pattern of Pseudostellaria heterophylla production regions and reveal the impact of statistical scales on the spatial distribution characteristics of this medicinal plant species. MethodsUsing multi-source data （literature records， field surveys， and statistical data）， we systematically analyzed the spatial patterns across three administrative levels （provincial， prefectural， and county scales）. Spatial autocorrelation （Moran's I） analysis， high-low clustering （Getis-Ord General G）， and hot/cold spot analysis （Getis-Ord Gi*） were employed. ResultsThe literature-based analysis showed that the production regions of P. heterophylla presented random distribution on the provincial scale and significant aggregation on the prefectural scale. The field survey data showed that the production regions displayed random distribution on the provincial scale but significant aggregation on both prefectural and county scales. The statistical data revealed that the production regions lacked spatial autocorrelation on the provincial scale but demonstrated significant aggregation on prefectural and county scales. ConclusionMAUP effects have substantive implications for understanding and decision-making in the arrangement of medicinal plant production regions. The county scale proves to be the most sensitive and explanatory level for analyzing the spatial pattern of P. heterophylla production regions， providing a critical foundation for habitat modeling， suitability evaluation， and ecological cultivation planning of medicinal plants.

OBJECTIVE To analyze the chemical constituents and components absorbed into plasma of the extract of Ardisia crenata and to elucidate its possible pharmacodynamic material basis. METHODS Overall， 12 rats were randomly assigned to the blank group （n＝6） and A. crenata group （n＝6） by the paired comparison method. The drug was administered once daily in the morning and afternoon for three days. Serum samples were prepared from serum after redosing on 4th day. The UPLC-QE-HF-MS/ MS was used to analyze and identify the chemical constituents in A. crenata extract and serum samples. Compound Discoverer 3.0 was employed for retention time correction， peak identification， and peak extraction. According to the secondary mass spectrometry information， the Thermo mzCloud online and Thermo mzVault local databases， referring to the relevant literature and control quality spectrum information were used to preliminarily identify the chemical constituents and components absorbed into plasma of A. crenata. RESULTS A total of 34 compounds were identified from the extract of A. crenata， mainly coumarins， flavonoids， organic acids， amino acids， including bergenin， quercetin， gallic acid， L-pyroglutamic acid， etc. Besides， 5 components absorbed into plasma were identified from serum samples: L-pyroglutamic acid， syringic acid， bergenin， cinnabar root saponin A， and mycophenolic acid. CONCLUSIONS L-pyroglutamic acid， syringic acid， bergenin， cinnabar root saponin A， and mycophenolic acid may act as the pharmacodynamic material basis of A. crenata.

The morbidity of fungal infections increased year by year.Notably, the invasive fungal diseases (IFDs) in children lead to a high mortality.It is important to make the diagnosis of IFDs in early stage, thus reducing the mortality.The diagnosis of fungal infection is based on three factors, including host factors, clinical evidences (such as imaging findings) and the evidence of fungal etiology.This review described the progress in the diagnosis of IFDs in children, thus improving the ability of physicians to diagnose the fungal infection.

OBJECTIVE To study the inhibitory effect and mechanism of curcumin and its derivatives A and B on TGF-β induced LX-2 cell fibrosis. METHODS Established the liver fibrosis model of LX-2 cells induced by TGF-β(10 ng·mL−1).The effects on cell proliferation were detected by CCK-8. The effects on cell apoptosis was detected by flow cytometry. The effects on fibrosis related factors(Collagen I, Collagen Ⅳ, Fibronectin, Vimentin, α-SMA, PDGFRβ, TGFβR1, TGFβR2, MMP2, MMP9, TIMP1 and TIMP2) protein expression and gene transcription levels were detected by Western blotting and q-PCR. RESULTS The curcumin and its derivative A and B had the inhibition effects on normal LX-2 cells, and the IC25 values were 15.7, 2.6, 10.2 μmol·L−1, respectively. Compared to the model group, the curcumin(15.7 μmol·L−1) and its derivative A(2.6 μmol·L−1) and B(10.2 μmol·L−1) had the significant inhibition effects on cell proliferation of the TGF-β induced LX-2 cells(P<0.05). The cell apoptosis rate of curcumin derivative B group was higher than the model group(P<0.05). Collagen I, Fibronectin, Vimentin, α-SMA, TGFβR1 and TIMP-1 protein expression levels in curcumin group were lower, while the protein expression level of MMP-9 was higher(P<0.05). The protein expression levels of Collagen I, Collagen IV, Fibronectin, Vimentin, α-SMA, TIMP-1 and TIMP-2 in curcumin derivative A group were lower, while the protein expression level of MMP-2 was higher(P<0.05). The protein expression levels of Collagen I, Collagen IV, Fibronectin, Vimentin, α-SMA, PDGFRβ, TGFβR1, TGFβR2, TIMP-1 and TIMP-2 in curcumin derivative B group were lower, while the protein expression level of MMP-2 was higher(P<0.05). The gene transcription levels of Collagen I, Fibronectin, α-SMA and TIMP-1 in curcumin group were lower(P<0.05). The gene transcription levels of Collagen I, Fibronectin and α-SMA in curcumin derivative A and B groups were lower(P<0.05). CONCLUSION Curcumin and its derivatives A and B inhibit the abnormal activation and proliferation of TGF-β-induced LX-2 cells, inhibit the excessive secretion and accumulation of its extracellular matrix components, and promote its degradation, thus playing an anti-fibrotic effect in vitro, especially the curcumin derivative B.

Objective This study aimed to explore the spatial heterogeneity and risk factors for dental caries in 12-year-old children in Shanxi province,China. Methods The data encompassed 3,721 participants from the two most recent oral health surveys conducted across 16 districts in Shanxi Province in 2015 and 2018.Eighteen specific variables were analyzed to examine the interplay between socioeconomic factors,medical resources and environmental conditions.The Geo-detector model was employed to assess the impacts and interactions of these ecological factors. Results Socioeconomic factors(Q=0.30,P<0.05)exhibited a more substantial impact compared to environmental(Q=0.19,P<0.05)and medical resource factors(Q=0.25,P<0.05).Notably,the urban population percentage(UPP)demonstrated the most significant explanatory power for the spatial heterogeneity in caries prevalence,as denoted by its highest q-value(q=0.51,P<0.05).Additionally,the spatial distribution's heterogeneity of caries was significantly affected by SO2 concentration(q=0.39,P<0.05)and water fluoride levels(q=0.27,P<0.05)among environmental factors. Conclusion The prevalence of caries exhibited spatial heterogeneity,escalating from North to South in Shanxi Province,China,influenced by socioeconomic factors,medical resources,and environmental conditions to varying extents.

Objective:To evaluate the efficacies of intravenous immunoglobulin (IVIG) in the clearance of Bovine Kobu (BK) virus and treatment of BK virus nephropathy (BKVN) in kidney transplantation recipients.Methods:From March 1, 2018 to March 31, 2022, the relevant clinical data were retrospectively reviewed for 13 kidney transplantation recipients with histologically proven BKVN on a full course of IVIG. The changes of serum creatinine and glomerular filtration rate (GFR) were compared before and after Month 1/3/6/12. Univariate Cox regression analysis was performed for examining the overall risk factors of BK virus clearance failure.Results:kidney transplantation (12 cases) and combined pancreatorenal transplantation (1 case) were performed. Among them, 9/13 patients were pathologically classified as stage A (early changes without tubular necrosis) and another 4 cases as stage B (active nephropathy with viral tubular necrosis). After IVIG dosing, all patients with BK virus in blood turned negative. Urinary BK virus DNA load of 7 patients with BK virus declined by 10 3 copies/ml, and 6 patients with BK virus in urine turned negative. Blood BK viral DNA load, urinary BK viral DNA load, GFR and serum creatinine before IVIG were 26 100 (1 000, 254 000) copies /ml and 1 450 (438, 7 480) ×10 6 copies /ml, (35. 36±14. 57) ml/min and (208. 50±66. 89) μmol/L, respectively, after 12 months of use of IVIG were 0、0(0, 0. 58) ×10 6 copies/ml、(46. 05±13. 00) ml/min and(175. 38±50. 64) μmol/L, the differences were statistically significant ( P=0. 012, 0. 027, 0. 046 and 0. 039) . Univariate Cox regression analysis showed that the overall risk factor for viral clearance failure was high initial viral load ( HR=0. 780, 95% CI: 0. 64-0. 98, P=0. 032) , concurrent transplanted kidney rejection ( HR=0. 847, 95% CI: 0. 52-0. 93, P=0. 013) and higher BKVN grade ( HR=0. 426, 95% CI: 0. 22-0. 81 , P=0. 010) were the overall risk factors for urinary BK virus clearance failure. No major adverse events occurred. Conclusions:IVIG may achieve a high efficacy of BK virus clearance. IVIG is effective in the treatment of BKVN. The graft renal function was stable or improved after treatment.

Hepatocellular carcinoma(HCC)is the most common type of primary liver cancer and the third leading cause of cancer-related deaths,and it is a serious threat to human health and has become a clinical problem that needs to be solved urgently.Extracellular vesicles(EV)are membrane vesicles containing multiple components and play an important role in the development and progression of HCC.This article summarizes the effect of EVs of different origins on HCC and analyzes the mechanism of action of EV on HCC,so as to provide new perspectives for the diagnosis and treatment of HCC.

Treatment resistance of hepatocellular carcinoma(HCC)is an important factor restricting its treatment outcome.Autophagy is a process involving multiple steps and targets and is closely associated with the proliferation and apoptosis of tumor cells.At the same time,there is significant crosstalk between autophagy and tumor treatment resistance.Therefore,autophagy may be one of the key factors hindering tumor cell death after medical intervention.Transforming growth factor-β(TGF-β),epithelial-mesenchymal transition(EMT),and long non-coding RNA(lncRNA)are important factors leading to drug resistance of HCC.This article discusses the possible mechanism of TGF-β,EMT,and lncRNA mediating complex molecular networks and inducing drug resistance of HCC,in order to provide new ideas for improving the sensitivity of HCC treatment.

Tumor necrosis factor-α(TNF-α)is involved in the regulation of multiple biological processes such as the proliferation,invasion,migration,and chemotherapy resistance of hepatocellular carcinoma(HCC)cells through TNF receptor-mediated signaling pathways.At the same time,TNF-α also plays a role in inducing the apoptosis of HCC cells.Some TNF-α inhibitors have been shown to inhibit the progression of HCC and prolong survival time.At present,the potential mechanism of action of TNF-α in HCC remains unclear,and exploration of the interaction between TNF-α and HCC can help to determine the potential therapeutic targets for HCC.This article summarizes the latest research advances in the mechanism of action of TNF-α in HCC and introduces the possibility of targeting TNF-α as a treatment method for HCC,in order to provide a theoretical basis for the prevention and treatment of liver cancer and drug research and development.