Academician forum

• An exploration of accountability frameworks for artificial intelligence-driven clinical decision support systems

  PENG Ying, YANG Chaoran, YU Guangjun

  2025,46(8):963-969 ,DOI: 10.16781/j.CN31-2187/R.20250443

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  With the rapid advancement of artificial intelligence (AI) in healthcare, clinical decision support system (CDSS) is gradually integrated into clinical workflows. While CDSS enhances diagnostic and therapeutic efficiency and accuracy, it has also sparked complex debates regarding accountability. This article systematically examines the current global landscape of accountability challenges associated with CDSS. It delves into the mechanisms underlying these challenges, focusing on 5 key dimensions: ambiguity in liability attribution, the “black-box” nature of algorithms, data bias, backward legal and regulatory systems, and heterogeneity in deployment environments. To address these issues, a collaborative governance framework centered on whole-lifecycle governance is proposed. Specifically, the framework advocates: enhancing AI trustworthiness through technical pathways; constructing innovative mechanisms such as risk-based tiered regulation and no-fault compensation funds through legal and regulatory pathways; strengthening institutional internal controls through organizational pathways; and reshaping a new professional paradigm of “human-AI collaboration” through ethical and educational pathways. The study argues that resolving CDSS accountability dilemmas is not only critical for fostering trustworthy AI in medicine but also essential for safeguarding patient safety, ensuring healthcare equity, and providing clinicians with clear liability boundaries and robust professional protections amid technological transformation.

Monographic report: Ethical exploration of medical artificial intelligence

• Ethical challenges in artificial intelligence-based mental health interventions

  GONG Xinyan, LIU Weizhi, SHANG Zhilei

  2025,46(8):970-976 ,DOI: 10.16781/j.CN31-2187/R.20250449

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  In recent years, artificial intelligence (AI) has been introduced into the field of mental health interventions, which not only brings innovation and progress, but also causes a series of ethical problems. This paper systematically analyzes the triple ethical challenges of AI applying to mental health interventions. Firstly, the current ethical frameworks for AI-based mental health interventions primarily expand upon medical ethics principles, emphasizing benefit maximization, risk minimization, and patient autonomy. However, these frameworks face challenges such as insufficient standardization and difficulties in dynamically capturing and regulating ethical risks arising from rapid technological iteration. Secondly, ethical challenges related to data governance in AI-based mental health applications include data privacy issues and decision fairness concerns stemming from algorithmic bias. Finally, AI as a proxy resource risks eroding user autonomy and fostering interpersonal alienation, primarily through exerting influence beyond comprehension to undermine autonomous decision-making capabilities. Overreliance and blind trust in AI systems during usage may weaken social motivation, thereby threatening autonomy and psychological integrity.

• Legal liability and ethical challenges of artificial intelligence in medical decision making: analysis based on diagnosis and treatment scenarios

  WANG Yuanming, GE Junxiao, XU Qingsong

  2025,46(8):977-981 ,DOI: 10.16781/j.CN31-2187/R.20250127

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  When artificial intelligence is integrated into medical decision-making, the ambiguous definition of technological autonomy and the multi-party game of responsibility allocation lead to legal disputes over rights and responsibilities as well as ethical challenges. Focusing on clinical diagnosis, treatment strategy generation, and prognosis assessment, this paper reveals the data bias and decision traceability deficiencies caused by the “black box” of algorithms, and then proposes solutions from 3 dimensions: defining responsible parties, standardizing technical defect assessments, and promoting interdisciplinary collaboration. From a legal perspective, based on the “high-risk system” classification under the European Union Artificial Intelligence Act and no-fault liability principle under the product liability relative laws, a 3-tier responsibility framework of developer-operator-medical institution is constructed: for auxiliary systems, operating physicians bear ultimate responsibility; for decision-making systems, developers are required to provide verifiable algorithms and take joint liability. Ethically, dynamic review mechanisms (such as mandatory disclosure of decision tree logic and data balance metrics) are suggested to balance technological efficiency with patients’ right to informed consent.

• Ethical paradoxes and coping strategies of medical artificial intelligence

  LIU Junlin, FENG Gong*

  2025,46(8):982-988 ,DOI: 10.16781/j.CN31-2187/R.20250345

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  In recent years, artificial intelligence (AI) has been widely used in the medical field. Research shows that medical AI can not only improve diagnosis and treatment efficiency, but also enable personalized health management and optimize the allocation of medical resources, demonstrating enormous potential. However, while “technology empowers”, medical AI is also accompanied by a series of ethical paradoxes, mainly manifested as the conflict between technological innovation and the protection of humanistic value. Based on the AI ethical framework proposed by Italian philosophy and ethicist Floridi, this paper systematically analyzes paradoxical manifestations of medical AI and the possible causes in 5 core ethical principles: respecting autonomy, not harming, doing good, fairness, and interpretability. It also explains the causes of these paradoxes from technical, social, and philosophical levels, and puts forward the following coping strategies: first, to improve explainability, algorithm audit technology, differentiated data collection technology, privacy protection technology, and human supervision and control technology, strengthening technical governance; second, to improve ethical regulations and establish a dynamic ethical governance mechanism that adapts to the pace of technological development, a hierarchical management model, and a responsible innovation mechanism, further improving the legal and regulatory frameworks in terms of data security, algorithm ethical responsibility recognition, etc; and third, to establish a global collaborative system, build a global governance framework for medical AI, establish unified development and application standards, and promote cross-border policy coordination and technical standard docking.

• Patient privacy and data security in medical artificial intelligence from a global perspective: focus and strategies

  MO Linfang, LI Zhe, GAN Huiliang, LI Li, WANG Yueyang, ZHANG Huijie

  2025,46(8):989-999 ,DOI: 10.16781/j.CN31-2187/R.20250363

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  In the era of big data, artificial intelligence (AI) technology has developed rapidly, with medical field being one of its most deeply penetrated application domains. Leveraging the advantages of big data and AI requires the sharing and integration of medical data, yet balancing privacy protection and data sharing poses significant challenges. This paper analyzes the focus issues of patient privacy and data security in medical AI from a global perspective across 6 dimensions: challenges in data sovereignty and cross-border flow compliance, technical vulnerabilities in de-anonymization and re-identification risks, failure of informed consent mechanisms and dynamic authorization needs, regulatory gaps in algorithmic “black boxes” and data misuse, technological dependency and supply chain security risks, and the dilemma of balancing privacy protection with public health interests. Corresponding solutions and strategies are also proposed.

Original article

• Outer membrane vesicles derived from Pasteurella multocida inhibit proliferation,invasion,and migration of bladder cancer cells and promote apoptosis

  WANG Yang, WANG Zeyi, CAO Xiangqian, SHEN Bing

  2025,46(8):1000-1008 ,DOI: 10.16781/j.CN31-2187/R.20250269

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  Objective To investigate the biological effects of Pasteurella multocida (Pm) culture supernatant and Pm-derived outer membrane vesicle (OMV) on bladder cancer cells. Methods Pm was cultured and its supernatant was collected. The effects of the supernatant on proliferation, migration and invasion of bladder cancer cell lines (T24 and 5637) were assessed by cell counting kit 8 (CCK-8), wound healing assay, and Transwell migration and invasion assays with phosphate-buffered saline (PBS) and brain heart infusion (BHI) broth as controls. Pm-OMV were isolated from the supernatant via ultracentrifugation, and the remaining components of the supernatant served as control. The effects of Pm-OMV on proliferation, migration and invasion of T24 and 5637 cells were assessed by CCK-8 and Transwell migration and invasion assays. Apoptosis was analyzed by flow cytometry. A nude mouse xenograft tumor model was established. After intratumoral multi-point injections of Pm-OMV or PBS, the tumor growth was evaluated and the effects of Pm-OMV on proliferation and apoptosis of bladder cancer cells in vivo were verified by Ki67 (a proliferation marker) immunohistochemical staining and TUNEL assay. Results Pm culture supernatant significantly inhibited the proliferation, invasion, and migration of T24 and 5637 cells in vitro compared with PBS and BHI controls (all P＜0.01). Pm-OMV not only inhibited the proliferation, invasion, and migration of T24 and 5637 cells, but also induced the apoptosis, and the differences were significant compared with the remaining components of the supernatant (all P＜0.05). The nude mouse subcutaneous tumor transplantation experiment further confirmed that Pm-OMV inhibited the proliferation of bladder cancer cells and promoted apoptosis in vivo, and the differences were significant compared with the PBS control (all P＜0.05). Conclusion Pm-OMV can inhibit the proliferation, invasion, and migration of bladder cancer cells and promote the apoptosis. It provides an experimental basis for studying the mechanism of microbial regulation of tumor progression and for developing new treatment strategies for bladder cancer.

• Astragaloside Ⅳ improves pulmonary arterial hypertension by inhibiting p38 MAPK signaling pathway in SD rats

  LIU Yu, TANG Bailin, LU Meili, WANG Hongxin, YANG Yuhong*

  2025,46(8):1009-1017 ,DOI: 10.16781/j.CN31-2187/R.20230653

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  Objective To investigate the protective effect and mechanism of astragaloside Ⅳ (AS-Ⅳ) on the pulmonary arterial hypertension (PAH) model induced by monocrotaline (MCT)/monocrotaline pyrrole (MCTP) in SD rats/human pulmonary artery endothelial cell (HPAEC). Methods In vivo experiment, 60 male SD rats were randomly assigned to control group, PAH model group, AS-Ⅳ low-dose (20 mg/kg) group, AS-Ⅳ medium-dose (40 mg/kg) group, AS-Ⅳ high-dose (80 mg/kg) group, or sildenafil (Sil, 100 mg/kg) group, with 10 rats in each group; except for the control group, PAH rat models were established by single intraperitoneal injection of MCT (60 mg/kg) in other groups. In vitro experiment, HPAECs were randomly assigned to control group, PAH model group, AS-Ⅳ low-dose (10 μmol/L) group, AS-Ⅳ medium-dose (20 μmol/L) group, MCTP＋AS-Ⅳ high-dose (40 μmol/L) group, or p38 mitogen-activated protein kinase (MAPK) signaling pathway inhibitor (SB203580, 5 μmol/L) group; except for the control group, in vitro PAH cell models were established by MCTP (60 μg/mL) induction for 24 h in other groups. In vivo experiments, after 4 weeks of drug intervention, the right ventricular systolic pressure (RVSP) and mean pulmonary artery pressure (mPAP) of rats were measured by hemodynamic methods, the right ventricle hypertrophy index was measured by weighing methods, the percentage of pulmonary arteriole wall thickness to outer diameter (WT%) and percentage of the wall area to total vascular area (WA%) were observed by hematoxylin-eosin staining, the expression of cysteine aspartic acid specific protease 3 (caspase 3) protein in lung tissue was observed by immunohistochemistry (IHC), and the apoptosis of lung tissue cells was detected by TUNEL assay. In vitro experiments, JC-1 staining was used to detect the mitochondrial membrane potential in cells, and immunofluorescence was used to detect caspase 3 protein expression. In vitro and in vivo experiments, Western blotting was used to detect the expression of caspase 3, B-cell lymphoma gene 2 (Bcl-2), Bcl-2 associated X protein (Bax), p38 MAPK, and phosphorylated p38 MAPK proteins in lung tissue and HPAECs. Results In vivo experiments, the RVSP, mPAP, and right ventricle hypertrophy index were decreased in the Sil group and each dose group of AS-Ⅳ (all P＜0.01); the WA% and WT% of each dose group of AS-Ⅳ were decreased (all P＜0.01), the expression of caspase 3 protein in lung tissue was decreased (all P＜0.01), and the apoptosis of lung tissue cells was decreased (all P＜0.01). In vitro experiments showed that after intervention with each dose of AS-Ⅳ and SB203580, the mitochondrial membrane potential of HPAEC was increased (all P＜0.01) and the expression of caspase 3 was decreased (all P＜0.01). In vivo and in vitro experiments, each dose of AS-Ⅳ and SB203580 reduced the expression of Bax and phosphorylated p38 MAPK proteins, and increased the expression of Bcl-2 protein (all P＜0.01). Conclusion AS-Ⅳ reduces apoptosis by inhibiting p38 MAPK signaling pathway, improving PAH in SD rats.

• Potential targets and mechanisms of Huatan drugs and Qushi drugs in treating obesity-related polycystic ovary syndrome based on bioinformatics

  DING Jie, SONG Di, YU Jin, YU Chaoqin

  2025,46(8):1018-1026 ,DOI: 10.16781/j.CN31-2187/R.20240730

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  Objective To investigate the similarities and differences in the mechanisms of Huatan drugs and Qushi drugs in treating obesity-related polycystic ovary syndrome (PCOS) and to identify the key active components. Methods Components and targets of Huatan drugs and Qushi drugs were screened by HERB database. The OmicsCloud platform was employed for enrichment analyses of targets by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes. Pathway networks were constructed by Cytoscape 3.8.0 software to visualize pathway differences. PCOS-related key targets were identified by Gene Expression Omnibus database and R 4.2.2 software. Molecular docking techniques were used to predict binding affinities between the key components and targets, followed by validation through molecular dynamics simulations. Results Huatan drugs and Qushi drugs shared 52 active components and 81 targets. Common pathways involved lipid metabolism, insulin regulation, hormonal regulation, and oocyte maturation, aligning with the pathological mechanisms of obesity-related PCOS. Huatan drugs exhibited superior efficacy in hormonal and insulin regulation, while Qushi drugs excelled in vitamin metabolism and anti-inflammatory pathways. Quercetin, β-sitosterol, and stigmasterol were identified as key components. Stigmasterol demonstrated optimal binding with PCOS-associated key targets Churchill domain-containing protein 1 (CHURC1) and tumor necrosis factor ligand superfamily member 11 (TNFSF11), while molecular dynamics simulations confirmed the robust stability of β-sitosterol and TNFSF11 binding. Conclusion This study elucidates potential targets and mechanisms of Huatan drugs and Qushi drugs in treating obesity-related PCOS, providing insights for identifying key active components and guiding clinical application.

• Association between unilateral or bilateral hearing loss and multimorbidity among the oldest old in China

  LIU Yijun, ZHAO Zhe, ZHU Juanfang, SUN Jinhai, YUAN Lei*

  2025,46(8):1027-1034 ,DOI: 10.16781/j.CN31-2187/R.20240609

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  Objective To investigate the associations between unilateral or bilateral hearing loss and 12 chronic diseases as well as multimorbidity among the oldest old in China, and to identify disparities in these associations of left- and right-side hearing loss with chronic diseases. Methods Totally 7 437 people aged ≥80 years old were selected from the Chinese Longitudinal Health and Longevity Survey (CLHLS) 2018 cross-sectional data. With 12 chronic diseases and multimorbidity as outcome variables, the hearing loss as explanatory variable, socio-demographic characteristics, family factors, and lifestyle as covariates, the correlations of unilateral (left- or right-side) and bilateral hearing loss with chronic diseases and multimorbidity were analyzed using multivariate logistic regression model, and the trend analyses were carried out. Results There were 205 (2.76%), 227 (3.05%) and 3 598 (48.38%) old people with left-side, right-side and bilateral hearing loss, respectively. After adjusting for confounders, the oldest old with left-sided or bilateral hearing loss had a greater risk of multimorbidity compared with those with normal hearing function, with odds ratio (95% confidence interval) of 2.14 (1.58-2.90) and 1.27 (1.13-1.43), respectively, while no association between right-sided hearing loss and multimorbidity was observed (P＞0.05). Trend analysis showed that the risk of multimorbidity increased with hearing loss from none to unilateral and then to bilateral (P＜0.001). Conclusion Hearing loss may be related to the increased risk of multimorbidity in the oldest old, and the risk of those with bilateral hearing loss is higher. More attention should be paid to the prevention and treatment of hearing loss in the oldest old.

• Brain and central nervous system tumors in the world and China: epidemic status in 2022

  ZHANG Xin, JIANG Ao, HU Zerui, GAO Minchan, GE Wangshuqi, ZHU Xiaoqiong, ZHAO Cunxi

  2025,46(8):1035-1041 ,DOI: 10.16781/j.CN31-2187/R.20240802

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  Objective To compare the incidence and mortality of brain and central nervous system (CNS) tumors in countries and territories with different human development index (HDI) in 2022, to make a comparison with the current epidemiological situation in China, and to assess the association between HDI and the incidence and mortality of brain and CNS tumors. Methods The data on brain and CNS tumors from GLOBOCAN 2022 were collected, and HDI data were organized based on the Human development report 2022. Generalized additive model (GAM) was used to analyze the relationships between standardized incidence ratio (SIR), standardized mortality ratio (SMR), mortality-to-incidence ratio (M/I), and HDI. Results The incidence and mortality of brain and CNS tumors increased with age in 2022, with a significant increasing trend in countries and territories with very high HDI. Countries and territories with high and very high HDI had more cases and more deaths, and countries and territories with very high HDI had the highest SIR and SMR. SIR for brain and CNS tumors in China was higher than the global average, while China’s SMR was lower. M/I varied among countries and territories with different HDI, with lower M/I in countries and territories with high and very high HDI. HDI had a significant nonlinear effect on SIR (edf＝1.740, P＜0.000 1) and M/I (edf＝1.809, P＜0.000 1), and a significant linear effect on SMR (edf＝1, P＜0.000 1). As HDI increased, SIR and SMR generally showed an increasing trend, while M/I showed a decreasing trend. Conclusion There are significant global differences in incidence and mortality of brain and CNS tumors in patients with different HDI in 2022; increasing HDI can reduce the risk of brain and CNS tumors and improve treatment outcomes, and prevention and control strategies should be made for different age groups and HDI.

• Obinutuzumab in treating refractory primary membranous nephropathy: a single-center study

  DONG Rui, GUO Mengnan, SUN Jing, LI Shuangxi, BIAN Qi, XU Jing

  2025,46(8):1042-1048 ,DOI: 10.16781/j.CN31-2187/R.20240763

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  Objective To evaluate the efficacy and safety of obinutuzumab (OBZ) in the treatment of refractory primary membranous nephropathy (pMN). Methods The clinical data of 15 patients with refractory pMN who received OBZ treatment in Department of Nephrology of The First Affiliated Hospital of Naval Medical University between Jan. 2022 and Sep. 2024 were retrospectively analyzed, and they included basic information, relevant laboratory indexes, clinical and immunological outcomes, and adverse events. Results Among the 15 patients with refractory pMN, 14 (93.3%) were phospholipase A2 receptor (PLA2R)-associated membranous nephropathy (10 cases with positive PLA2R by renal biopsy and 4 cases with no recorded PLA2R results by renal biopsy but with positive serum PLA2R antibodies). During the follow-up period, all 15 patients achieved clinical remission, with 4 (26.7%) patients achieving complete remission and 11 (73.3%) patients achieving partial remission. Of the 12 patients with positive serum PLA2R antibodies, 11 patients had continuously positive serum PLA2R antibodies before OBZ treatment, and 9 (81.8%) patients achieved immunological remission after OBZ treatment. All the 15 patients had previously received immunosuppressive therapy, and all of them were classified as refractory pMN, with 7 (46.7%) patients having been treated with cyclophosphamide combined with corticosteroids, 2 (13.3%) patients having been treated with calcineurin inhibitor combined with corticosteroids, 11 (73.3%) patients having received rituximab. During the treatment, 2 (13.3%) cases of adverse events were observed: 1 patient experienced transient liver dysfunction, and the transaminase returned to normal after discontinuing atorvastatin; another patient developed a positive T-cell spot test for Tuberculosis infection during the intertreatment interval and successfully completed the subsequent OBZ treatment and achieved clinical remission after treatment with isoniazid and rifampicin. Conclusion OBZ demonstrates favorable clinical efficacy in the treatment of refractory pMN, with a low incidence of adverse events.

• Effect of heated povidone iodine solution on pain intensity and healing of chronic venous leg ulcer: a randomized controlled trial

  YING Maoji, YANG Yukun, WU Biao, LI Dazhi

  2025,46(8):1049-1054 ,DOI: 10.16781/j.CN31-2187/R.20240559

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  Objective To investigate the effect of heated povidone iodine solution on pain intensity and ulcer healing in patients with chronic venous leg ulcer after debridement and dressing change. Methods A total of 58 patients with chronic venous leg ulcer who first visited outpatients and wards of Department of Cardiovascular Surgery, Department of Burns and Department of Plastic Surgery of The First Affiliated Hospital of Naval Medical University from Jun. 1, 2023, to Jun. 1, 2024 were enrolled and randomly assigned to heated group (using 38 ℃ povidone iodine solution for debridement and flushing, n＝29) or normal group (using 24 ℃ povidone iodine solution for debridement and flushing, n＝29). The general baseline data of the 2 groups were compared, the pain intensity and wound bed temperature before and after debridement and dressing change were evaluated, and the change of pressure ulcer scale score for healing during the observation period and ulcer healing rate were observed. Results There were no significant differences between the 2 groups in age, gender, smoking, body mass index, whether the ulcer exudates, infection, duration of ulcer, ulcer area, pressure ulcer scale score for healing or analgesic use within 24 h (all P＞0.05). There was no significant difference in pain intensity between the 2 groups before or after dressing change and debridement (both P＞0.05). The pain intensity during debridement in the heated group was lower than that in the normal group (P＜0.05). There was no significant difference in the temperature of wound bed before flushing between the 2 groups (P＞0.05). The temperature of wound bed in the heated group was significantly higher than that in the normal group immediately after flushing and at the end of debridement and dressing change (P＜0.01, P＜0.05). The pressure ulcer scale score for healing in the heated group showed a trend of being lower than that in the normal group during the observation period, and the ulcer healing rate was significantly higher than that in the normal group (P＝0.033, hazard ratio＝0.452, 95% confidence interval 0.217-0.941). Conclusion In patients with chronic venous leg ulcer, the use of heated povidone iodine solution can reduce the pain intensity during dressing change and debridement, maintain the stability of wound bed temperature, and promote the healing of ulcer.

Review

• Role of copper transporter 1 in regulating cuproptosis and its potential value in tumor therapy

  WANG Yixian, OU Chongyang, HAO Lu, JIAO Yang, CAO Jianping

  2025,46(8):1055-1061 ,DOI: 10.16781/j.CN31-2187/R.20240789

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  As a new manner of cell death, cuproptosis depends on the accumulation of copper ions in cells. Copper ion is an essential trace element in normal physiological state of organisms. The excess of free copper in cells not only has toxic effect on normal cells, but also plays its specific killing function on tumor cells. Copper transporter 1 (CTR1) is a key transporter of transmembrane uptake of copper ions by cells. As a regulator of cuproptosis, its mutation and expression changes in tumors have an impact on the distribution of copper ions inside and outside the cells. It may participate in multiple biological processes such as proliferation, invasion and migration of tumor cells by regulating the pathway of cuproptosis. This article reviews the cuproptosis pathway mediated by CTR1 and the potential value of CTR1 in tumor treatment, elaborates the importance of copper ion homeostasis regulation for normal life activities and the mechanism of CTR1 in regulating cuproptosis, and discusses the potential value of CTR1 as a new target for tumor therapy, so as to provide a theoretical basis for the treatment of tumor patients.

• Pancreatic extracorporeal shock wave lithotripsy: pancreatic duct stone treatment and imaging-based prediction

  MO Shaojia, BIAN Yun, SHAO Chengwei*

  2025,46(8):1062-1066 ,DOI: 10.16781/j.CN31-2187/R.20240832

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  Pancreatic extracorporeal shock wave lithotripsy (P-ESWL), a non-invasive treatment, is widely accepted worldwide as the preferred option for pancreatic duct stone (PDS) treatment. P-ESWL provides significant relief of painful symptoms and improves patients’ quality of life through efficient lithotripsy and catheter removal. Although there is risk of post-operative complications such as pancreatitis, the overall incidence is low and can be further minimized by effective management strategies. It is worth noting that computed tomography-based quantitative analysis and radiomics prediction model provide a scientific basis for personalized P-ESWL, heralding more precise and efficient treatment in the future. P-ESWL for treating PDS will be further improved by future multi-center and large-sample studies, as well as by the integration of artificial intelligence and machine learning algorithms, which may lead to significant therapeutic effects and improvements in patients’ quality of life.

• Extrauterine growth retardation and neurodevelopment under multiple definitions: a new strategy for nutritional intervention

  LIU Yuxuan, LEI Lei*

  2025,46(8):1067-1073 ,DOI: 10.16781/j.CN31-2187/R.20240673

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  Extrauterine growth retardation is a critical indicator for assessing the development of preterm infants, yet its definition and diagnostic criteria remain inconsistent. This article analyzes the extrauterine growth retardation in preterm infants under various definitions and growth curves. Through a systematic review and comprehensive evaluation of existing studies, we elucidate the discrepancies among different definitions in diagnosing extrauterine growth retardation in preterm infants and predicting neurodevelopmental outcomes. Additionally, this paper provides an in-depth analysis of various methods and effects of neurodevelopmental nutritional interventions, offering novel insights and strategies to enhance the neurodevelopmental outcomes of preterm infants.

Naval health care

• Prevalence of metabolic associated fatty liver disease and its correlation with metabolic components in personnel on tropical islands

  DONG Xu, WANG Yujiao, WANG Chaoqun, CHEN Yi, KONG Deliang, XU Aijing

  2025,46(8):1074-1080 ,DOI: 10.16781/j.CN31-2187/R.20240486

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  Objective To investigate the prevalence of metabolic associated fatty liver disease (MAFLD) and its correlation with metabolic components among personnel on tropical islands. Methods The data of personnel who received health examination on islands in 2024 were analyzed, and they were grouped with the age limit of 30 years old to compare the detection rates of MAFLD and metabolic components in different age groups. In people aged≥30 years old, the age, gender, body mass index (BMI), waist circumference (WC), fasting blood glucose, blood lipids, liver function, kidney function and other indexes were compared between MAFLD and non-MAFLD groups. Univariate and multivariate logistic regression models were conducted to analyze the factors affecting the occurrence of MAFLD. The effects of various metabolic components on the risk of MAFLD in different age groups were analyzed by subgroup analyses. Results Among 1 213 personnel, 175 (14.4%) cases had MAFLD, of which 141 (80.6%) cases were mild, 32 (18.3%) were moderate, and 2 (1.1%) were severe. The detection rates of MAFLD (25.6% ［74/289］ vs 10.9% ［101/924］) and overweight/obesity (55.7% ［161/289］ vs 37.7% ［348/924］) in age≥30 years old were significantly higher than those in age＜30 years old (both P＜0.001). In people aged≥30 years old, compared with the non-MAFLD group, the BMI, WC, systolic blood pressure, diastolic blood pressure, triglyceride (TG), low density lipoprotein-cholesterol, alanine transaminase, aspartate transaminase, gamma glutamyltransferase and uric acid (UA) in the MAFLD group were significantly higher (all P＜0.05), and the high density lipoprotein-cholesterol (HDL-C) was significantly lower (P＜ 0.05). There were no significant differences in age, gender, fast blood glucose, total cholesterol, alkaline phosphatase, total bilirubin, serum creatinine, or blood urea nitrogen (all P＞0.05). Logistic regression analysis showed that WC was an independent risk factor for MAFLD (odds ratio ［OR］ ＝1.101, 95% confidence interval ［95%CI］ 1.030-1.176, P＝0.004); HDL-C was an independent protective factor for MAFLD (OR＝0.071, 95%CI 0.016-0.323, P＝0.001); and BMI≥24.0 kg/m² and WC≥90 cm were positively correlated with MAFLD (both P＜0.01). In people aged≥30 years old, the risk of MAFLD was increased in those with overweight/obesity, arterial blood pressure≥130/85 mmHg (1 mmHg＝0.133 kPa), TG≥ 1.7 mmol/L, HDL-C≤1.0 mmol/L and UA＞420 μmol/L (all P＜0.05), and the risk of MAFLD was most significantly increased in overweight/obesity people (hazard ratio ［HR］ ＝5.088, 95%CI 2.724-9.504, P＜0.001). Among people aged＜ 30 years old, the risk of MAFLD was increased in those with overweight/obesity and UA＞420 μmol/L (both P＜0.01), and the risk of MAFLD was most significantly increased in overweight/obesity individuals (HR＝6.305, 95%CI 3.973-10.006, P＜ 0.001). Conclusion The detection rates of MAFLD and various metabolic components are higher in the personnel on tropical islands, and the risk of MAFLD is higher in those with overweight/obesity, TG≥1.7 mmol/L and hyperuricemia.

• Practice and reflection of reception and rescue team aboard simulated hospital ships

  HAN Xiangling, DING Tao, CHEN Qian, CHENG Xiao, LUO Fei, XU Fei

  2025,46(8):1081-1083 ,DOI: 10.16781/j.CN31-2187/R.20240477

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  Based on medical rescue operations aboard simulated hospital ships, this paper explores the medical care practice mode employed during maritime rescue missions, points out the deficiencies in current medical practices during rescue operations, and puts forward countermeasures to improve the practice based on past casualty reception and rescue training exercise. With a comprehensive analysis of casualty reception team practices on simulated hospital ships, this paper aims to provide insights for the continuous optimization of maritime medical care.

Short article

• Association between systemic lupus erythematosus and hypothyroidism: a two-sample Mendelian randomization study

  HAN Yushu, GUO Chao, JI Qianfei, ZOU Junjie*

  2025,46(8):1084-1089 ,DOI: 10.16781/j.CN31-2187/R.20240074

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  Abstract:

  Objective To investigate the relationship between systemic lupus erythematosus (SLE) and hypothyroidism using bidirectional two-sample Mendelian randomization (MR) method. Methods The Genome-Wide Association Study data of SLE and hypothyroidism were obtained online. Independent single nucleotide polymorphisms closely related to SLE were screened as instrumental variable (IV), and outlier values were tested and eliminated by MR-PRESSO tool of R 4.3.1 software. The inverse variance weighted (IVW), MR-Egger, weighted mode (WM), weighted median (WME) and simple mode (SM) were used for MR analysis, and the values of odds ratio (OR) and 95% confidence interval (95%CI) were used to evaluate whether there was an association between SLE and hypothyroidism. The Cochran’s Q heterogeneity test was performed for the results of IVW and MR-Egger, the pleiotropy test was performed by Egger-intercept method, and the sensitivity analysis was performed by elimination test one by one. F value was calculated to evaluate whether there was a weak IV bias. Results MR analysis results showed that there was a positive causal relationship between SLE and hypothyroidism in the overall population, and the results calculated by IVW, MR-Egger, WM and WME were statistically significant, with OR (95%CI) being 1.004 (1.002-1.005), 1.004 (1.001-1.008), 1.004 (1.002-1.007), and 1.004 (1.002-1.006), respectively. The heterogeneity test results for IVW and MR-Egger were P＝0.086 and P＝0.098, respectively, indicating no heterogeneity; the Egger-intercept result was P＝0.295, indicating no pleiotropy; sensitivity analysis showed MR results were stable; and all F values were greater than 10, indicating no weak IV bias. Conclusion Compared with healthy people, the risk of hypothyroidism in patients with SLE is significantly higher.

• Clinical application of high-frequency ultrasound-guided labial gland biopsy in patients with suspected Sjögren's syndrome

  WU Fan, ZHOU Jing, PAN Xin, HE Yikun, HE Zheng

  2025,46(8):1090-1094 ,DOI: 10.16781/j.CN31-2187/R.20250194

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  Abstract:

  Objective To explore the clinical value of high-frequency ultrasound-guided labial gland biopsy in patients with suspected Sjögren’s syndrome (SS). Methods Totally 126 patients with clinically suspected SS and salivary gland involvement who underwent labial gland biopsy in Department of Ultrasound and Department of Rheumatology and Immunology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from Sep. 2022 to Dec. 2024 were enrolled. The patients who underwent traditional excision labial gland biopsy from Sep. 2022 to Feb. 2023 were selected as control group (n＝53), and the patients who received high-frequency ultrasound-guided labial gland biopsy from Mar. 2023 to Dec. 2024 were selected as ultrasound-guided group (n＝73). The success rate of sampling, the number of salivary lobes, wound healing time, and adverse reaction incidence were analyzed in the 2 groups. Results The success rate of sampling in the ultrasound-guided group (100.00%, 73/73) was significantly higher than that in the control group (92.45%, 49/53), the number of salivary lobes (6 ［6, 7］) was significantly greater than that in the control group (6 ［5, 6］), and the wound healing time was significantly shorter than that in the control group (4 ［4, 5］ d vs 5 ［5, 6］ d) (all P＜0.05). One (1.37%) patient of the ultrasound-guided group had postoperative adverse reactions, and 5 (9.43%) patients of the control group had adverse reactions, with no significant difference (P＞0.05). Conclusion High-frequency ultrasound can clearly locate labial gland, improve the success rate of sampling and shorten the wound healing time, and it is worthy of clinical promotion and application.