Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated death globally. Liver transplantation (LT) has emerged as a key treatment for patients with HCC, and the Milan criteria have been adopted as the cornerstone of the selection policy. To allow more patients to benefit from LT, a number of expanded criteria have been proposed, many of which use radiologic morphological characteristics with larger and more tumors as surrogates to predict outcomes. Other groups developed indices incorporating biological variables and dynamic markers of response to locoregional treatment. These expanded selection criteria achieved satisfactory results with limited liver supplies. In addition, a number of prognostic models have been developed using clinicopathological characteristics, imaging radiomics features, genetic data, and advanced techniques such as artificial intelligence. These models could improve prognostic estimation, establish surveillance strategies, and bolster long-term outcomes in patients with HCC. In this study, we reviewed the latest findings and achievements regarding the selection criteria and post-transplant prognostic models for LT in patients with HCC.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated death globally. Liver transplantation (LT) has emerged as a key treatment for patients with HCC, and the Milan criteria have been adopted as the cornerstone of the selection policy. To allow more patients to benefit from LT, a number of expanded criteria have been proposed, many of which use radiologic morphological characteristics with larger and more tumors as surrogates to predict outcomes. Other groups developed indices incorporating biological variables and dynamic markers of response to locoregional treatment. These expanded selection criteria achieved satisfactory results with limited liver supplies. In addition, a number of prognostic models have been developed using clinicopathological characteristics, imaging radiomics features, genetic data, and advanced techniques such as artificial intelligence. These models could improve prognostic estimation, establish surveillance strategies, and bolster long-term outcomes in patients with HCC. In this study, we reviewed the latest findings and achievements regarding the selection criteria and post-transplant prognostic models for LT in patients with HCC.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated death globally. Liver transplantation (LT) has emerged as a key treatment for patients with HCC, and the Milan criteria have been adopted as the cornerstone of the selection policy. To allow more patients to benefit from LT, a number of expanded criteria have been proposed, many of which use radiologic morphological characteristics with larger and more tumors as surrogates to predict outcomes. Other groups developed indices incorporating biological variables and dynamic markers of response to locoregional treatment. These expanded selection criteria achieved satisfactory results with limited liver supplies. In addition, a number of prognostic models have been developed using clinicopathological characteristics, imaging radiomics features, genetic data, and advanced techniques such as artificial intelligence. These models could improve prognostic estimation, establish surveillance strategies, and bolster long-term outcomes in patients with HCC. In this study, we reviewed the latest findings and achievements regarding the selection criteria and post-transplant prognostic models for LT in patients with HCC.

Medical institutions, with their clinical practice foundation and abundant human use experience data, have become important carriers for the inheritance and innovation of traditional Chinese medicine(TCM) and the "cradles" of the preparation of new TCM. To effectively promote the transformation of new TCM originating from the TCM clinical practice in medical institutions and establish an effective evaluation index system for the transformation of new TCM conforming to the characteristics of TCM, consensus experts adopted the literature research, questionnaire survey, Delphi method, etc. By focusing on the policy and technical evaluation of new TCM originating from the TCM clinical practice in medical institutions, a comprehensive evaluation from the dimensions of drug safety, efficacy, feasibility, and characteristic advantages was conducted, thus forming a comprehensive evaluation system with four primary indicators and 37 secondary indicators. The expert consensus reached aims to encourage medical institutions at all levels to continuously improve the high-quality research and development and transformation of new TCM originating from the TCM clinical practice in medical institutions and targeted at clinical needs, so as to provide a decision-making basis for the preparation, selection, cultivation, and transformation of new TCM for medical institutions, improve the development efficiency of new TCM, and precisely respond to the public medication needs.
Medicine, Chinese Traditional/standards* ; Humans ; Consensus ; Drugs, Chinese Herbal/therapeutic use* ; Surveys and Questionnaires

The ICR(Institute of Cancer Research)mouse infection model was constructed to study the pathogenicity of Sal-monella Telelkebir serotype,and the pathogenic identification of mouse isolates was carried out.Observe the bacterial excretion cycle,evaluate the pathogenicity of Salmonella serotype to mice,and calculate the LD50 by the changes in clinical characteris-tics,histopathology and tissue bacterial load of infected mice;by flight mass spectrometry,biochemical identification,serotype identification,molecular typing and other experiments,compared with human isolates;virulence gene analysis was carried out by PCR experiment and whole genome sequencing.The LD50 of Salmonella Telelkebir is 2.67 × 108 CFU/mL;curling and fluffing may occur 0.5 h after infection;autopsy of dead mice showed that the small intestine was severely congested,with more bubbles and fluid accumulation,cecal necrosis,liver apical degeneration and necrosis,necrotic foci on the surface of the kidney and spleen atrophy;the bacterial load of spleen,kidney,lung,liver and jejunum in mice reached its peak at 3 days after infection,while that of heart at 6 days;the bacterial excretion time of the high-dose group exceeded 100 days;The level of CD3 in tissues increased with increasing dose,with inflammatory cell infiltration,myocardial capillary dilation and hyperemia,large area of vacuoles,degeneration and necrosis of hepatocytes,obvious enlargement of splenic sinus,blurred zoning,thickening of glomerular basement membrane,partial exfoliation of ciliated epithelium,atrophy and exfoliation of jejunal villi;PCR and whole genome sequencing revealed Salmonella-related virulence genes such as cdtB,plt A and pltB.This study was the first to successfully establish the ICR mouse model of Salmonella Telelkebir,demonstrating that this serotype of Salmonella has some pathogenicity.

The central nervous system is susceptible to the modulation of various neurophysiological processes by the cytochrome P450 enzyme(CYP),which plays a crucial role in the metabolism of neurosteroids.The antiepileptic drug phenytoin(PHT)has been observed to induce neuronal side effects in patients,which could be attributed to its induction of CYP expression and testosterone(TES)metabolism in the hip-pocampus.While pregnane X receptor(PXR)is widely known for its regulatory function of CYPs in the liver,we have discovered that the treatment of mice with pregnenolone 16α-carbonitrile(PCN),a PXR agonist,has differential effects on CYP expression in the liver and hippocampus.Specifically,the PCN treatment resulted in the induction of cytochrome P450,family 3,subfamily a,polypeptide 11(CYP3A11),and CYP2B10 expression in the liver,while suppressing their expression in the hippocampus.Func-tionally,the PCN treatment protected mice from PHT-induced hippocampal nerve injury,which was accompanied by the inhibition of TES metabolism in the hippocampus.Mechanistically,we found that the inhibition of hippocampal CYP expression and attenuation of PHT-induced neurotoxicity by PCN were glucocorticoid receptor dependent,rather than PXR independent,as demonstrated by genetic and pharmacological models.In conclusion,our study provides evidence that PCN can negatively regulate hippocampal CYP expression and attenuate PHT-induced hippocampal neurotoxicity independently of PXR.Our findings suggest that glucocorticoids may be a potential therapeutic strategy for managing the neuronal side effects of PHT.

Objective:To summarize the complications and prevention after botulinum toxin type A(BTA) injection for masseter muscle hypertrophy(MMH).Methods:The clinical data of patients with masseter hypertrophy who received BTA injection in Shanxi Bethune Hospital from January 2019 to September 2021 were retrospectively analyzed. Injection method: 100 U BTA was prepared into a solution with a concentration of 50 U/ml with 2 ml 0.9% sodium chloride injection. The "safe injection zone" of the masseter muscle was marked. The anterior and posterior boundaries were the anterior and posterior edges of the masseter muscle, respectively. The upper boundary was the line from the corner of the mouth to the earlobe, and the lower boundary was the lower edge of the mandible. The injection points(3 or 4 points) were at least 1 cm away from the four borders, and 25-40 U was injected on each side. The patients were followed up after treatment, the types of complications were recorded, and the treatment measures were summarized.Results:A total of 160 patients were enrolled, including 8 males and 152 females, with a mean age of (30.6±6.2) years. All patients were followed up for 1 to 6 months. The masseter muscle of all patients was reduced to varying degrees, the lower facial lines were softer, and the facial contour was improved. The incidence of complications was 81.3%(130/160). There were four main types of complications: (1) Complications with a nonmuscular etiology include ecchymosis in 5 cases (3.1%) which resolved spontaneously in 5 to 7 days and headache occurred in 2 cases (1.3%) which disappeared in 2-3 days with proper rest. (2) The complication related to the toxin effect mainly was the decrease of masticatory power in 86 cases (53.8%), which gradually recovered with the drug metabolism for 3-12 weeks. (3) Dose-related complications include facial ptosis in 4 cases (2.5%) with 30-40 U dose per side. 2 cases without special treatment, gradually recovered in about 8-12 weeks. One patient underwent the BTA injection to raise the mandibular margin and gradually recovered about 2 weeks later. One patient recovered gradually with the treatment by Thermage in another hospital. There were 9 cases (5.6%) of paradoxical rigid masseter muscle bulge. 5 cases resolved within 1 week after supplementary injection of 4 U botulinum toxin, and the other 4 cases resolved spontaneously within 1 to 2 weeks without special treatment. (4) Complications related to the injection site include abnormal smiles in 3 cases (1.9%). Patients were instructed to practice the smile correctly and gradually recovered in 4-12 weeks. Twenty-one patients (13.1%) had sunken cheeks. One patient improved by injection of hyaluronic acid, and the other patients recovered gradually within 8-12 weeks without special treatment.Conclusion:The incidence of complications after BTA injection for MMH is high, and the manifestations are diverse. The injection should be performed in the recommended safe area of the masseter muscle. A reasonable dose and depth of injection can reduce the occurrence of complications.

Objective:To summarize the complications and prevention after botulinum toxin type A(BTA) injection for masseter muscle hypertrophy(MMH).Methods:The clinical data of patients with masseter hypertrophy who received BTA injection in Shanxi Bethune Hospital from January 2019 to September 2021 were retrospectively analyzed. Injection method: 100 U BTA was prepared into a solution with a concentration of 50 U/ml with 2 ml 0.9% sodium chloride injection. The "safe injection zone" of the masseter muscle was marked. The anterior and posterior boundaries were the anterior and posterior edges of the masseter muscle, respectively. The upper boundary was the line from the corner of the mouth to the earlobe, and the lower boundary was the lower edge of the mandible. The injection points(3 or 4 points) were at least 1 cm away from the four borders, and 25-40 U was injected on each side. The patients were followed up after treatment, the types of complications were recorded, and the treatment measures were summarized.Results:A total of 160 patients were enrolled, including 8 males and 152 females, with a mean age of (30.6±6.2) years. All patients were followed up for 1 to 6 months. The masseter muscle of all patients was reduced to varying degrees, the lower facial lines were softer, and the facial contour was improved. The incidence of complications was 81.3%(130/160). There were four main types of complications: (1) Complications with a nonmuscular etiology include ecchymosis in 5 cases (3.1%) which resolved spontaneously in 5 to 7 days and headache occurred in 2 cases (1.3%) which disappeared in 2-3 days with proper rest. (2) The complication related to the toxin effect mainly was the decrease of masticatory power in 86 cases (53.8%), which gradually recovered with the drug metabolism for 3-12 weeks. (3) Dose-related complications include facial ptosis in 4 cases (2.5%) with 30-40 U dose per side. 2 cases without special treatment, gradually recovered in about 8-12 weeks. One patient underwent the BTA injection to raise the mandibular margin and gradually recovered about 2 weeks later. One patient recovered gradually with the treatment by Thermage in another hospital. There were 9 cases (5.6%) of paradoxical rigid masseter muscle bulge. 5 cases resolved within 1 week after supplementary injection of 4 U botulinum toxin, and the other 4 cases resolved spontaneously within 1 to 2 weeks without special treatment. (4) Complications related to the injection site include abnormal smiles in 3 cases (1.9%). Patients were instructed to practice the smile correctly and gradually recovered in 4-12 weeks. Twenty-one patients (13.1%) had sunken cheeks. One patient improved by injection of hyaluronic acid, and the other patients recovered gradually within 8-12 weeks without special treatment.Conclusion:The incidence of complications after BTA injection for MMH is high, and the manifestations are diverse. The injection should be performed in the recommended safe area of the masseter muscle. A reasonable dose and depth of injection can reduce the occurrence of complications.

OBJECTIVE: To investigate the factors related to renal impairment in patients with diabetic kidney disease (DKD) from the perspective of integrated Chinese and Western medicine. METHODS: Totally 492 patients with DKD in 8 Chinese hospitals from October 2017 to July 2019 were included. According to Kidney Disease Improving Global Outcomes (KDIGO) staging guidelines, patients were divided into a chronic kidney disease (CKD) 1-3 group and a CKD 4-5 group. Clinical data were collected, and logistic regression was used to analyze the factors related to different CKD stages in DKD patients. RESULTS: Demographically, male was a factor related to increased CKD staging in patients with DKD (OR=3.100, P=0.002). In clinical characteristics, course of diabetes >60 months (OR=3.562, P=0.010), anemia (OR=4.176, P<0.001), hyperuricemia (OR=3.352, P<0.001), massive albuminuria (OR=4.058, P=0.002), atherosclerosis (OR=2.153, P=0.007) and blood deficiency syndrome (OR=1.945, P=0.020) were factors related to increased CKD staging in patients with DKD. CONCLUSIONS Male, course of diabetes >60 months, anemia, hyperuricemia, massive proteinuria, atherosclerosis, and blood deficiency syndrome might indicate more severe degree of renal function damage in patients with DKD. (Registration No. NCT03865914).
Humans ; Male ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Hyperuricemia ; Kidney ; Proteinuria ; Renal Insufficiency, Chronic/complications*

Objective: To evaluate the clinical characteristics and prognostic factors of patients with Philadelphia-negative myeloproliferative neoplasm-accelerated phase/blast phase (MPN-AP/BP) . Methods: A total of 67 patients with MPN-AP/BP were enrolled from February 2014 to December 2021 at the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences. Their clinical features and prognostic factors were analyzed retrospectively. Results: ① Sixty-seven patients with MPN-AP/BP with a median age of 60 (range, 33-75) years, including 31 males (46.3% ) and 36 females (53.7% ) , were analyzed. Forty-eight patients progressed from primary myelofibrosis (PMF) , and 19 progressed from other myeloproliferative neoplasms (MPNs) , which included polycythemia vera, essential thrombocythemia, and MPN unclassifiable. Patients who progressed from PMF had higher lactate dehydrogenase (LDH) levels than those who progressed from other MPNs (925.95 vs. 576.2 U/L, P=0.011) , and there were higher proportions of patients who progressed from PMF with splenomegaly (81.4% vs. 57.9% , P=0.05) , a myelofibrosis grade of ≥2 (93.6% vs. 63.2% , P=0.004) , and a shorter duration from diagnosis to the transformation to AP/BP (28.7 vs. 81 months, P=0.001) . ② JAK2V617F, CALR, and MPLW515 were detected in 41 (61.2% ) , 13 (19.4% ) , and 3 (4.5% ) patients, respectively, whereas 10 (14.9% ) patients did not have any driver mutations (triple-negative) . Other than driver mutations, the most frequently mutated genes were ASXL1 (42.2% , n=27) , SRSF2 (25% , n=16) , SETBP1 (22.6% , n=15) , TET2 (20.3% , n=13) , RUNX1 (20.3% , n=13) , and TP53 (17.2% , n=11) . The ASXL1 mutation was more enriched (51.1% vs. 21.1% , P=0.03) , and the median variant allele fraction (VAF) of the SRSF2 mutation (median VAF, 48.8% vs. 39.6% ; P=0.008) was higher in patients who progressed from PMF than those who progressed from other MPNs. ③ In the multivariate analysis, the complex karyotype (hazard ratio, 2.53; 95% confidence interval, 1.06-6.05; P=0.036) was independently associated with worse overall survival (OS) . Patients who received allogeneic stem cell transplantation (allo-HSCT) (median OS, 21.3 vs. 3 months; P=0.05) or acute myeloid leukemia-like (AML-like) therapy (median OS, 13 vs. 3 months; P=0.011) had significantly better OS than those who received supportive therapy. Conclusion: The proportions of patients with PMF-AP/BP with splenomegaly, myelofibrosis grade ≥2, a higher LDH level, and a shorter duration from diagnosis to the transformation to AP/BP were higher than those of patients with other Philadelphia-negative MPN-AP/BP. The complex karyotype was an independent prognostic factor for OS. Compared with supportive therapy, AML-like therapy and allo-HSCT could prolong the OS of patients with MPN-AP/BP.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Blast Crisis/drug therapy* ; Primary Myelofibrosis/genetics* ; Prognosis ; Splenomegaly ; Retrospective Studies ; Myeloproliferative Disorders/genetics* ; Mutation ; Leukemia, Myeloid, Acute ; Janus Kinase 2/genetics*