Unveiling the structural transformation and activity origin of heteroatom-doped carbons for hydrogen evolution.

Heteroatom-doped carbon materials have been widely used in many electrocatalytic reduction reactions. Their structure-activity relationships are mainly explored based on the assumption that the doped carbon materials remain stable during electrocatalysis. However, the structural evolution of heteroatom-doped carbon materials is often ignored, and their active origins are still unclear. Herein, taking N-doped graphite flake (N-GP) as the research model, we present the hydrogenation of both N and C atoms and the consequent reconstruction of the carbon skeleton during the hydrogen evolution reaction (HER), accompanied by a remarkable promotion of the HER activity. The N dopants are gradually hydrogenated and almost completely dissolved in the form of ammonia. Theoretical simulations demonstrate that the hydrogenation of the N species leads to the reconstruction of the carbon skeleton from hexagonal to 5,7-topological rings (G5-7) with thermoneutral hydrogen adsorption and easy water dissociation. P-, S-, and Se-doped graphites also show similar removal of doped heteroatoms and the formation of G5-7 rings. Our work unveils the activity origin of heteroatom-doped carbon toward the HER and opens a door to rethinking the structure-performance relationships of carbon-based materials for other electrocatalytic reduction reactions.

The association of triglyceride-glucose-waist circumference with metabolic associated fatty liver disease and the severity of liver steatosis and fibrosis in American adults: a population-based study.

BACKGROUND: The global obesity pandemic has led to an alarming rise in the prevalence of metabolic-associated fatty liver disease (MAFLD), making it a substantial clinical and economic burden on society. Early detection and effective treatment of MAFLD are imperative to mitigate its impact. METHODS: This cross-sectional study was conducted involving 4634 adults from the National Health and Nutrition Examination Surveys (NHANES) 2017-2018 cycle. Transient elastography (TE) was used to diagnose MAFLD and assess the extent of liver steatosis and fibrosis. Multivariate logistic regression models were utilized to examine the association between the triglyceride and glucose index-waist circumference (TyG-WC) and the risk of MAFLD, liver fibrosis, and steatosis. RESULTS: A positive association between TyG-WC and MAFLD persisted across all three models: model1: OR = 8.44, 95% CI: 6.85-10.38 (unadjusted), model2: OR = 8.28, 95% CI: 6.53-10.50 (partially adjusted), and model3: OR = 7.98, 95% CI: 4.11-15.46 (fully adjusted). Further investigation through interaction and stratified analysis revealed that this association was more pronounced in the non-obese and Non-Hispanic White persons groups. Moreover, a non-linear relationship analysis unveiled threshold and saturation effects between TyG-WC and MAFLD. Specifically, a TyG-WC value of approximately 600 may represent the threshold effect for MAFLD risk, while 1200 may signify the saturation effect of MAFLD risk. Finally, a robust correlation between TyG-WC and the severity of liver steatosis and fibrosis was found. CONCLUSIONS: The findings suggest that the TyG-WC index exhibits excellent predictive value for MAFLD in the general American population.

Structural Degradation of M-N-C (M=Co, Ni and Fe) Single-Atom Electrocatalysts at Industrial-Grade Current Density for Long-Term Reduction.

M-N-C single-atom catalysts (SACs) are promising electrode materials for many electro-reduction reactions. However, their stability is far from practical applications, and their deactivation mechanism has been rarely investigated. Herein, we demonstrate the structural degradation of M-N-C (M=Co, Ni, and Fe) at industrial-grade current density for long-term electro-reduction. Both M-N and N-C bonds are broken, resulting in the gradual hydrogenation and dissolution of N in the form of ammonia. The residual M is finally converted to M-containing core-shell nanoparticles after sequential dissolution, redeposition, and electro-reduction. The destruction of the M-N-C structure and the formation of nanoparticles greatly affect the electrocatalytic performance. Our work highlights the structural degradation and deactivation mechanism of M-N-C-type SACs under strong reductive conditions and provides useful information for inspiring researchers to develop new strategies to improve the electrocatalytic stability of similar types of materials.

Mulberry fruit repairs alcoholic liver injury by modulating lipid metabolism and the expression of miR-155 and PPARα in rats.

As alcohol consumption increases, alcoholic liver disease (ALD) has become more popular and is threating our human life. In this study, we found mulberry fruit extract (MFE) repaired alcohol-caused liver diseases by regulating hepatic lipid biosynthesis pathway and oxidative singling in alcoholically liver injured (ALI) rats. MFE administration inhibited hepatic lipid accumulation and improved liver steatosis in ALI rats. MFE also enhanced the antioxidant capacity and alleviated the inflammatory response by increasing the activities of antioxidant enzymes and decreasing the contents of interleukin (IL)-1ß and tumor necrosis factor (TNF)-α. Additionally, MFE regulated the expression of miRNA-155 and lipid metabolism-related PPARα protein in rats. Both miR-155 and PPARα play important roles in liver function. The results indicate that MFE has hepatoprotective effects against ALI in rats.

Evaluation of guidelines for diagnosis and treatment of Helicobacter pylori infection.

BACKGROUND: To systematically evaluate the quality of the guidelines for the diagnosis and treatment of Helicobacter pylori infection and to analyze the differences and reasons for the key recommendations in the guidelines. METHODS: Databases and websites were systematically searched to obtain guidelines for the diagnosis and treatment of Helicobacter pylori infection. Four independent reviewers used the Guideline Evaluation Tool (AGREE II) to evaluate the included guidelines. The intraclass correlation coefficient (ICC) and Fleiss' kappa coefficient were used to measure the consistency of evaluation guidelines between guide reviewers. Differences between guidelines and the reasons for the differences were analyzed by comparing the recommendations of different guidelines and the evidence supporting the recommendations. RESULTS: A total of 17 guidelines for Helicobacter pylori infection were included in this study. The AGREE II scores of these guidelines were low overall, with 4 of them had a score of over 60%, which indicates that the guidelines are recommended, and 13 of them having a score ranging from 30 to 60%, which indicates that the guidelines are recommended but need to be revised, while no guideline had a score of 30% or less, which indicates that they were not recommended. The analysis of these guidelines found that there were some differences in the main recommendations. Not all guidelines recommend sequential therapy as the recommended therapy. Whether bismuth quadruple therapy should be used as the recommended first-line therapy is unclear. The antibiotic resistance rate is different in different regions. Combined with the local antibiotic sensitivity test, the eradication rate of Helicobacter pylori can be improved. CONCLUSION: There are significant differences in the quality of Helicobacter pylori infection guidelines and the key recommendations. Improving the deficiencies of existing guidelines is an effective way to develop high-quality guidelines and make reasonable recommendations for the treatment of Helicobacter pylori infection in the future.

Tunable and switchable multi-wavelength pulsed fiber laser based on a nonlinear optical loop mirror and an improved Sagnac filter.

We propose and experimentally demonstrate a tunable and switchable multi-wavelength erbium-doped fiber ring pulsed laser based on a nonlinear optical loop mirror (NOLM) and an improved Sagnac filter. To achieve multi-wavelength pulsed laser output, we adopt a NOLM as a quasi-saturable absorber and an improved Sagnac loop as a wavelength selected filter. The constructed laser has a maximum output wavelength number of five with a pulse repetition frequency of 40.45 kHz and pulse duration of 108 ns. The laser can output single-wavelength and dual-wavelength pulsed lasers within a certain wavelength tuning range and a five-wavelength pulsed laser with a constant wavelength interval of 3 nm by adjusting the polarization controller. Dual-wavelength, three-wavelength, and four-wavelength pulsed lasers with various wavelength intervals are also obtained. The output performance of the constructed laser is tested with a maximum average output power of 127.45 µW and minimum pulse duration of 52 ns, and the stability of the laser output is also tested with a maximum power fluctuation of 0.62 dB and minimum wavelength drift of 0.51 nm with pump power of 350 mW.

Dissolution of the Heteroatom Dopants and Formation of Ortho-Quinone Moieties in the Doped Carbon Materials during Water Electrooxidation.

Heteroatom-doped carbon materials are widely used as metal-free electrocatalysts and supporting substrates for many metal-based composites. However, almost all the current researches are based on the assumption of the self-stability of the heteroatom-doped carbon materials, neglecting their possible structural evolution during electrocatalysis, especially under harsh oxygen evolution reaction (OER) conditions. Besides, previous researches always focused on the dropcast carbon-based materials with only a few participated dopants, leading to unobservable structural evolution during the electrolysis. Here, heteroatom-doped graphite flakes (GP) with a large quantity of participated dopants are chosen as the research model to multiply the transformation during the electrolysis. Through the combination of theoretical calculations and experiments, we present the nearly complete dissolution of the heteroatoms in N-, P-, and Se-doped carbon materials in the form of the high-valence oxoanions during OER. The oxygen-abundant residues are proven to be responsible for the OER activity. Among the oxygen-containing functional groups in the residues, the ortho-quinone moieties, whose structures change with the doping elements, are finally identified as the active sites. Heteroatom-doped carbon materials as the supporting substrates for the metal-based composite experience a similar transformation, leading to unexpectedly different activity origins. Our work not only reveals the real active sites of the heteroatom-doped carbon materials for OER but also provides new insight into understanding the heteroatom-doped carbon materials as the supporting substrates for other anodic reactions.

σ-Alkynyl Adsorption Enables Electrocatalytic Semihydrogenation of Terminal Alkynes with Easy-Reducible/Passivated Groups over Amorphous PdSx Nanocapsules.

Highly chemo- and regioselective semihydrogenation of alkynes is significant and challenging for the synthesis of functionalized alkenes. Here, a sequential self-template method is used to synthesize amorphous palladium sulfide nanocapsules (PdSx ANCs), which enables electrocatalytic semihydrogenation of terminal alkynes in H2O with excellent tolerance to easily reducible groups (e.g., C-I/Br/Cl, C═O) and the metal center deactivating skeletons (e.g., quinolyl, carboxyl, and nitrile). Mechanistic studies demonstrate that specific σ-alkynyl adsorption via terminal carbon and negligible alkene adsorption on isolated Pd2+ sites ensure successful synthesis of various alkenes with outstanding time-irrelevant selectivity in a wide potential range. The key hydrogen and carbon radical intermediates are validated by electron paramagnetic resonance and high-resolution mass spectrometry. Gram-scale synthesis of 4-bromostyrene and expedient preparation of deuterated alkene precursors and drugs with D2O show promising applications. Impressively, PdSx ANCs can be applied to the prevailing thermocatalytic semihydrogenation of functionalized alkyne using H2.

Analysis of the aqueous humor lipid profile in patients with polypoidal choroidal vasculopathy.

This study aimed to investigate the lipid profiles of aqueous humor from polypoidal choroidal vasculopathy (PCV) patients and identify potential biomarkers to increase the understanding of PCV pathomechanism. An ultra-high performance liquid chromatography-tandem mass spectrometry based untargeted lipidomic analysis was performed to acquire lipid profiles of aqueous humor of PCV patients and control subjects. Differentially expressed lipids were identified by univariate and multivariate analyses. A receiver operator characteristic curve (ROC) analysis was conducted to confirm the potential of identified lipids as biomarkers. Sixteen PCV patients and twenty-eight control subjects were enrolled in this study. In total, we identified 33 lipid classes and 639 lipid species in aqueous humor using the LipidSearch software. Of them, 50 differential lipids were obtained by combining univariate and multivariate statistical analyses (VIP>1 and P < 0.05), and 19 potential lipid biomarkers were identified by ROC analysis. In addition, significant alterations were found in several metabolic pathways, including glycerophospholipid, glycerolipid, and glycosylphosphatidylinositol-anchor biosynthesis. This study is the first to systematically characterize the alterations in lipid profiles in aqueous humor of PCV patients and screen for the potential lipid biomarkers for PCV diagnosis and treatment intervention. The results of this study are likely to broaden our understanding of the pathogenesis of PCV and contribute to improvements in the diagnosis and treatment of the disease.

Multivalent Phthalocyanine-Based Cationic Polymers with Enhanced Photodynamic Activity for the Bacterial Capture and Bacteria-Infected Wound Healing.

The solubility and photosensitive activity of phthalocyanine are crucial to photodynamic antibacterial performance. However, highly conjugated phthalocyanine with high singlet oxygen generation efficiency tends to aggregate in aqueous environments, leading to poor solubility and photodynamic antibacterial activity. Herein, we propose a novel photodynamic antibacterial therapeutic platform by a phthalocyanine-based polymeric photosensitizer for the efficient healing of a bacteria-infected wound. A prepared phthalocyanine-based chain-transfer agent and a tertiary amino group-containing monomer are applied in the reversible addition-fragmentation chain-transfer polymerization for the preparation of the polymeric photosensitizer, which is subsequently quaternized to obtain a positively charged surface. This water-soluble phthalocyanine-based polymer can strongly concentrate on bacterial membranes via electrostatic interaction. The formed singlet oxygen by the phthalocyanine-based polymer after 680 nm light irradiation plays an essential role in killing the Gram-positive and Gram-negative bacteria. The study of antibacterial action indicates that this nanocomposite can cause irreversible damage to the bacterial membranes, which can cause cytoplasm leakage and bacterial death. Moreover, this therapeutic platform has excellent biocompatibility and the capacity to heal the wounds of bacterial infections. Experimental results indicate that the design strategy of this phthalocyanine-based polymer can extend the application of the hydrophobic photosensitizer in the biomedical field.

Multivalent SnO2 quantum dot-decorated Ti3C2 MXene for highly sensitive electrochemical detection of Sudan I in food.

Quantum dots functionalization has been proven to be a simple modification strategy for improving the electroanalytical performance of two-dimensional electrode materials by increasing the specific surface area and active reaction sites. Herein, a new electrochemical sensing platform was fabricated by SnO2 quantum dot-functionalized Ti3C2 MXene (Ti3C2-SnO2QDs) for the highly sensitive detection of Sudan I in food. Ti3C2-SnO2QDs were prepared via in situ synthesis, which can control the nucleation and growth of SnO2QDs, resulting in the well-dispersed SnO2QDs with 2-3 nm size on the intersheet surface of MXene. Moreover, the formation of Ti3C2-SnO2QDs can effectively restrict the aggregation of Ti3C2 and improve the stability of SnO2QDs in aquatic environment. The prepared nanocomposite can be used as an improved modified material to further increase the electrocatalytic performance and electrochemical signal of Sudan I on the surface of a glassy carbon electrode. Under optimized conditions, the proposed analytical method displayed a linear dependence for Sudan I concentration ranging from 0.008 to 10 µM with a detection limit of 0.27 nM (S/N = 3) by electrochemical cyclic voltammetry. This sensor with excellent selectivity, reproducibility and accuracy was quantitatively validated in commercial ketchup and chili powder. This Ti3C2-SnO2QDs-based Sudan I sensor is expected to expand the application of MXene nanocomposites in electrochemical analysis and is envisioned as a promising candidate for monitoring illegal food additives in real food samples.

SnO2 quantum dots-functionalized Ti3C2 MXene nanosheets for electrochemical determination of dopamine in body fluids.

A novel SnO2 quantum dots (SnO2QDs)-functionalized Ti3C2 MXene nanocomposite was prepared via in situ synthesis method, resulting in well-regulated the nucleation and growth of SnO2QDs to evenly distribute onto MXene nanosheets. Ultra-small size SnO2QDs decorated on the surface of Ti3C2 MXene nanosheets can effectively prevent the restacking of MXene and remarkably increase the electroactive surface area of the electrode, which can further increase electrocatalytic activity toward dopamine. Then, an ultrasensitive electroanalytical method based on SnO2QDs-functionalized Ti3C2 MXene nanocomposite for dopamine monitoring was developed, and the effects of experimental condition were investigated systematically. Under optimized conditions, the prepared sensor presented a linear dependence for dopamine in the concentration range from 0.004 to 8.0 µM with the detection limit of 2.0 nM (S/N = 3). Moreover, it selectively perceived dopamine in presence of physiological interferents in urine and serum samples with excellent linearities (correlation coefficients higher than 0.9920). The relative recoveries were in the range 97.67-105.3% and 103.0-106.8%, while the limits of quantitation were 10.12 nM and 9.62 nM in urine and serum sample, respectively, demonstrating the method suitability for dopamine sensing and being envisioned as a promising candidate for neurotransmitter monitoring in biological diagnosis.

Electrocatalytic Reduction of CO2 to Ethanol at Close to Theoretical Potential via Engineering Abundant Electron-Donating Cuδ+ Species.

Electrochemical CO2 reduction to liquid multi-carbon alcohols provides a promising way for intermittent renewable energy reservation and greenhouse effect mitigation. Cuδ+ (0<δ<1) species on Cu-based electrocatalysts can produce ethanol, but the in situ formed Cuδ+ is insufficient and easily reduced to Cu0 . Here a Cu2 S1-x catalyst with abundant Cuδ+ (0<δ<1) species is designedly synthesized and exhibited an ultralow overpotential of 0.19 V for ethanol production. The catalyst not only delivers an outstanding ethanol selectivity of 86.9 % and a Faradaic efficiency of 73.3 % but also provides a long-term stability of Cuδ+ , gaining an economic profit based on techno-economic analysis. The calculation and in situ spectroscopic results reveal that the abundant Cuδ+ sites display electron-donating ability, leading to the decrease of the reaction barrier in the potential-determining C-C coupling step and eventually making the applied potential close to the theoretical value.

[Analysis of animal model of atopic dermatitis based on characteristics of clinical symptoms traditional Chinese and Western medicine].

Based on the clinical characteristics of atopic dermatitis( AD) in traditional Chinese medicine( TCM) and Western medicine,the existing animal models were analyzed,and the coincidence degree,advantages and disadvantages between the models and the clinical manifestations of AD were evaluated,so as to provide reference for establishing a rational animal model. After consulting relevant literatures in recent years and summarizing the existing modeling methods,it is found that spontaneous,transgenic/gene knockout models were highly consistent,but with high breeding conditions and expensive prices. The hapten-induced model was low in cost and fast in modeling. It revealed the corresponding mechanism of AD to a certain extent,but did not fully reflect the state of the entire process of AD. The modeling method was guided by Western medicine,but with a lack of pathogenic factors of traditional Chinese medicine,and so has certain limitations in TCM research. Therefore,it is necessary to combine the etiology,pathogenesis and clinical mani-festations of AD with traditional Chinese and Western medicine,so as to improve the coincidence degree between the model and the characteristics of clinical symptoms and lay the foundation for in-depth studies on AD.

Unveiling the In Situ Dissolution and Polymerization of Mo in Ni4 Mo Alloy for Promoting the Hydrogen Evolution Reaction.

NiMo alloys are efficient electrocatalysts in alkaline water electrolyzer for the hydrogen evolution reaction (HER). Metals are usually considered to be stable during the cathodic process. However, the actual behaviors of Mo in the NiMo alloys are unexplored. Here, we present the instability of Mo in the Ni4 Mo alloy as a highly efficient HER electrocatalyst in an alkaline medium. Mo in Ni4 Mo is oxidized and dissolved in the form of MoO4 2- first. The dissolved MoO4 2- will re-adsorb on the electrode surface and polymerize. Theoretical calculations indicate that the adsorption of the dimer Mo2 O7 2- can promote the HER activity of metal Ni. The addition of MoO4 2- to the electrolyte can not only repair the durability of Ni4 Mo alloy, but also facilitate the HER activity of pure metal of Ni, Fe, and Co. Our findings provide insight into the structural transformation mechanism and performance-enhanced origin of cathodic materials under the reaction conditions.

Unveiling the Activity Origin of Iron Nitride as Catalytic Material for Efficient Hydrogenation of CO2 to C2+ Hydrocarbons.

Developing efficient catalytic materials and unveiling the active species are significant for selective hydrogenation of CO2 to C2+ hydrocarbons. Fe2 N@C nanoparticles were reported to exhibit outstanding performance toward selective CO2 hydrogenation to C2+ hydrocarbons (C2+ selectivity: 53.96 %; C2 -C4 = selectivity, 31.03 %), outperforming corresponding Fe@C. In situ X-ray diffraction, ex situ Mössbauer and X-ray photoelectron spectra revealed that iron nitrides were in situ converted to highly active iron carbides, which acted as the real active species. Moreover, the combined results of in situ diffuse reflectance infrared Fourier transform spectroscopy and control experiments suggested an in situ formed carbonyl iron-mediated conversion mechanism from iron nitrides to iron carbides.

Long noncoding RNA CHL1-AS1 promotes cell proliferation and migration by sponging miR-6076 to regulate CHL1 expression in endometrial cancer.

Endometrial cancer (EC) is deemed to be the most typical gynecologic malignant tumor. Despite the incidence of EC being lower in Asia than that in western countries, substantial increased incidence has been observed in the past few decades in Asia. Although various molecular testing methods and genomic science have developed, the overall prognosis is still disappointing. LncRNAs have been found to influence the progression of various cancers. CHL1-AS1 has been found to be upregulated in ovarian endometriosis, nevertheless, the molecular mechanism and biological function of CHL1-AS1 in EC have not been explored. In our exploration, both CHL1-AS1 and CHL1 were upregulated in EC cells. Knockdown of CHL1-AS1 or CHL1 inhibited cell proliferation and migration in EC. Furthermore, microRNA-6076 (miR-6076) could bind with CHL1-AS1 or CHL1, and regulate the expression of CHL1. Finally, absence of miR-6076 or overexpression of CHL1 can partially rescue the effect of CHL1-AS1 knockdown or miR-6076 upregulation on cell proliferation and migration, respectively. All in all, our research was the first endeavor to study the underlying mechanism of CHL1-AS1 in EC and confirmed that CHL1-AS1 regulated EC progression via targeting the miR-6076/CHL1 axis, offering new insight into treating EC.

miRNA-5119 regulates immune checkpoints in dendritic cells to enhance breast cancer immunotherapy.

Dendritic cell (DC) based immunotherapy is a promising approach to clinical cancer treatment. miRNAs are a class of small non-coding RNA molecules that bind to RNAs to mediate multiple events which are important in diverse biological processes. miRNA mimics and antagomirs may be potent agents to enhance DC-based immunotherapy against cancers. miRNA array analysis was used to identify a representative miR-5119 potentially regulating PD-L1 in DCs. We evaluated levels of ligands of immune cell inhibitory receptors (IRs) and miR-5119 in DCs from immunocompetent mouse breast tumor-bearing mice, and examined the molecular targets of miR-5119. We report that miRNA-5119 was downregulated in spleen DCs from mouse breast cancer-bearing mice. In silico analysis and qPCR data showed that miRNA-5119 targeted mRNAs encoding multiple negative immune regulatory molecules, including ligands of IRs such as PD-L1 and IDO2. DCs engineered to express a miR-5119 mimic downregulated PD-L1 and prevented T cell exhaustion in mice with breast cancer homografts. Moreover, miR-5119 mimic-engineered DCs effectively restored function to exhausted CD8+ T cells in vitro and in vivo, resulting in robust anti-tumor cell immune response, upregulated cytokine production, reduced T cell apoptosis, and exhaustion. Treatment of 4T1 breast tumor-bearing mice with miR-5119 mimic-engineered DC vaccine reduced T cell exhaustion and suppressed mouse breast tumor homograft growth. This study provides evidence supporting a novel therapeutic approach using miRNA-5119 mimic-engineered DC vaccines to regulate inhibitory receptors and enhance anti-tumor immune response in a mouse model of breast cancer. miRNA/DC-based immunotherapy has potential for advancement to the clinic as a new strategy for DC-based anti-breast cancer immunotherapy.

Solid-State Conversion Synthesis of Advanced Electrocatalysts for Water Splitting.

Electrolytic water technology is promising for sustainable energy utilization, but the lack of efficient electrocatalysts retards its application. The intrinsic activity of electrocatalysts is determined by its electronic structure, whereas the apparent activity can be further optimized by reasonable design on micro-/nanostructures of electrocatalysts. The core goal of electrocatalytic research is to reveal the relationship between the structure and performance of electrocatalysts, which is also the basis of reasonable design and construction of efficient electrocatalysts. Traditional synthetic methods, namely bottom-up and top-down routes, usually induce the change of different structural parameters at the same time. The solid-state conversion strategy, which is converts solid precursors into target materials through chemical reactions, has been widely adopted to produce materials with precisely controllable structures. In this Minireview, we focus on recent advances in the solid-state conversion synthesis of water-splitting electrocatalysts. First, the basis of solid-state conversion chemistry is introduced. Then, the specific methods of precise control of electronic structure by solid-state conversion and the relationship between electronic structure and performance are summarized. Based on the understanding of the electronic structure-performance relationship, synergistic regulation of electronic structure and micro-/nanostructures by solid-state conversion to achieve the copromotion of intrinsic activity and apparent activity are described. Finally, the remaining challenges in this field are discussed, and future research directions are proposed as well.

Quality assessment of the guidelines for the management of malignant pleural effusions and ascites.

OBJECTIVES: To fully assess the quality of the guidelines for the management of malignant pleural effusions (MPE) and ascites and reveal the heterogeneity of recommendations and possible reasons among guidelines. METHODS: A systematic search was performed in the database to obtain guidelines for the management of MPE and ascites. The AGREE IIGtool was used to assess the quality of these guidelines. The Measurement Scale of Rate of Agreement (MSRA) was introduced to assess the scientific agreement of formulated recommendations for the management of MPE and ascites among guidelines, and evidence supporting these recommendations was extracted and analyzed. RESULTS: Nine guidelines were identified. Only 4 guidelines scored more than 60% and are worth recommending. Recommendations were also heterogeneous among guidelines for the management of MPE, and the main reasons were the different emphases of the recommendations for the treatment of MPE, the contradictions in recommendations, and the unreasonably cited evidence for MPE. CONCLUSIONS: The quality of the management guidelines for patients with MPE and malignant ascites was highly variable. Specific improvement of the factors leading to the heterogeneity of recommendations will be a reasonable and effective way for developers to upgrade the recommendations in the guidelines for MPE.