The left triangular ligament of liver and its fibrous appendix(free border) was studied in 42 Chinese adult male cadavers. 37 fibrous appendices were further studied histologically.In order to prove the formation of the fibrous appendix 30 left triangular ligaments of new born cadavers were also studied. The average length of the left triangular ligament of adult cadavers was 13.91cm.,and that of their fibrous appendices was 6.86cm. Almost all of the left triangular ligaments were attached to the superior surface of the left lobe of liver,consequ- ently, the left suprahepatic space could be properly subdivided into anterior and posterior left suprahepatic spaces by the ligament. The forms of the fibrous appendices were classified into 5 types:triangular (23.8％), narrow band(14.3%), triangular-narrow band(50.0％),membranous (7.1%), and bifurcate type(4.8%).The left triangular ligaments of the 30 new born cadavers were devoid of fibrous appendix. Histological observations of the 37 fibrous appendices showed:aberrant bile ducts were found in 89% of the cases, rudimentory liver-cell cord 65％,nerves 78％, and blood vessels 100％.Their size and number diminished gradually from the pro- Kimal (hepatic) end of the fibrous appendix to the distalend. The authors agreed with Toldt and Zuckandl that the fibrous appendix might be the result of the retrogression of the left lobe and suggested that the occurrence of the fibrous appendix was after birth. The clinical importance of the fibrous appen- dix was discussed.

Objective:To investigate the correlation between subclinical hypothyroidism (SCH) and clinical outcomes of patients with acute ischemic stroke.Methods:From July 2014 to October 2017, patients with acute ischemic stroke admitted to Jiangsu Shengze Hospital Affiliated to Nanjing Medical University were enrolled retrospectively. Their demographic and baseline clinical and laboratory data were collected. The modified Rankin Scale was used to evaluate the clinical outcome at 3 months after the onset of symptoms. Multivariate logistic regression analysis was used to determine the independent correlation between SCH and clinical outcome of patients with acute ischemic stroke. Results:A total of 200 patients with acute ischemic stroke were enrolled, including 107 males (53.5%) and 93 females (46.5%). Their age was 69.67±11.38 years. There were 45 patients (22.5%) with SCH, 160 (80.0%) with good outcomes, and 40 (20.0%) had poor outcomes. Univariate analysis showed that there were significant differences in the baseline National Institutes of Health Stroke Scale (NIHSS) score, stroke etiology classification and the proportion of patients with SCH between the poor outcome group and the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that high NIHSS score (odds ratio 2.884, 95% confidence interval 2.005-4.147; P=0.001) and SCH (odds ratio 19.527, 95% confidence interval 2.334-163.386; P=0.006) were the independent risk factors for poor outcomes. Conclusion:High NIHSS score and SCH were associated with the poor outcomes at 3 months after the onset of acute ischemic stroke.

Objective: To investigate the degree and influencing factors of glycosylated hemoglobin ( HbA1c ) control among patients with type 2 diabetes ( T2DM ) living in rural communities of Zhejiang Province, so as to provide the reference for optimizing the management of diabetes patients in rural communities. Methods: Permanent adult patients with T2DM that were registered and received standardized management in all communities of Jiashan County and Suichang County, and 6 communities of Yongkang City, Zhejiang Province in 2016 were recruited, and their demographic characteristics were captured from the health record system and chronic disease management system. The height, body weight, waist circumstance and blood pressure were measured, and HbA1c and blood lipid parameters were detected. The degree of HbA1c control ( <7% ) was analyzed, and its influencing factors were identified using a multivariable logistic regression model. Results: A total of 10 339 patients with T2DM were enrolled, including 4 520 men ( 43.72% ) and 5 819 women ( 56.28% ), with a mean age of ( 63.54±9.78 ) years and the mean course of diabetes of ( 6.36±4.73 ) years. The rate of HbA1c control was 47.89%. Multivariable logistic regression analysis showed that males ( OR=1.123, 95%CI: 1.024-1.233 ), region ( Suichang, OR=2.413, 95%CI: 2.106-2.765; Yongkang, OR=2.460, 95%CI: 2.188-2.767 ), course of disease ( 5-9 years, OR=1.724, 95%CI: 1.504-1.977; 10 years and longer, OR=2.881, 95%CI: 2.477-3.351 ), use of hypoglycemic drugs ( OR=1.203, 95%CI: 1.089-1.329 ), development of chronic complications ( OR=1.190, 95%CI: 1.027-1.379 ), uncontrolled blood pressure ( OR=1.140, 95%CI: 1.030-1.261 ), uncontrolled blood lipid ( OR=1.258, 95%CI: 1.104-1.433 ), and smoking ( OR=1.318, 95%CI: 1.165-1.491 ) were statistically associated with HbA1c control among T2DM patients. Conclusion The rate of HbA1c control was 47.89% among T2DM patients in rural communities of Zhejiang Province. HbA1c control should be given a high priority among men living in low-economic-level regions with long course of disease, use of hypoglycemic drugs, chronic complications, smoking, uncontrolled blood pressure and lipid.

Objective: To learn the prevalence of dyslipidemia and its influencing factors among patients with type 2 diabetes mellitus (T2DM) in rural areas of Zhejiang Province, and to provide evidence for dyslipidemia control. Methods: A sample of 10 343 patients with T2DM managed by communities from three counties (Jiashan,Suichang and Yongkang) were recruited. Through the residents’ health record system and specific investigation, demographic features,physical examination results of blood pressure,height, weight, waist circumstance (WC), glycated hemoglobin (HbA1c),total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were collected to analyze the spectrum of dyslipidemia. A logistic regression model was established to explore the associated factors of dyslipidemia. Results : The prevalence rate of dyslipidemia among the patients with T2DM in rural communities was 66.91%. The prevalence rates of higher level of TC, TG, LDL-C were 41.76%, 41.28%, 15.89%, respectively, while the prevalence rateof lower level of HDL-C was 16.92%. The prevalence rates of purely high TC,high TC with TG and purely high TG were 11.84%,11.75% and 11.47%,respectively. Higher level of TG with lower level of HDL-C was common in males (11.32%) and higher level of TC with TG was common in females (14.60%). The results from multivariate logistic regression analysis indicated that females(OR=1.499,95%CI:1.352-1.663),age(OR=0.992,95%CI:0.988-0.996),poor control of HbA1c(OR=1.241,95%CI:1.141-1.351), abdominal obesity(OR=1.169,95%CI:1.064-1.285),overweight(OR=1.384,95%CI:1.257-1.524)and obesity(OR=1.582,95%CI:1.352-1.852)were associated with dyslipidemia. Conclusions The prevalence of dyslipidemia is relatively higher among the patients with T2DM in rural communities of Zhejiang Province. Higher level of TC and TG contributed to most dyslipidemia. The patients with T2DM who are females,have poor control of plasma glucose and suffer from obesity should be under surveillance.

Objective To evaluate the values of bilateral inferior petrosal sinus sampling ( BIPSS),high dosage dexamethasone suppression test (HDDST) and pituitary image in the differential diagnosis of ACTH-dependent Cushing's syndrome. Methods Totally 87 patients with confirmed pathological diagnosis were recruited in the study.All received the procedure of BLPSS,HDDST,and pituitary MRI with dynamic enhancement.The diagnostic performances of three differential diagnosis methods in ACTH-dependent Cushing's syndrome were evaluated.Results Seventy-eight patients were diagnosed as cases of pituitary ACTH adenoma,and the remaining 9 were confirmed cases of ectopic ACTH syndrome due to the thymic carcinoid.The sensitivity and specificity of HDDST,pituitary MRI,and BIPSS for the diagnosis of ACTH-dependent Cushing's syndrome were 82.1％ and 100％,79.5％ and 44.4％,92.3％ and 100％,respectively.In Cushing's disease,the diagnostic accuracy was 83.9％ with HDDST,77.0％with pituitary MRI,and93.1％ with BIPSS.In those patients with Cushing's disease,the coincidence of lateralization was 83.9％ with BIPSS and 64.5％ with MRII.Conclusion BIPSS was better than the other two methods in differential diagnosis of ACTH-dependent Cushing's syndrome.Compared with the pituitary MRI,the concordant rate of BIPSS in lateralization of the tumor is higher,and it is more reliable.

Objective To investigate the fluctuation of kynuridine/tryptophan ratio and its relation-ship with short-term prognosis in hospitalized patients with HF.Methods A total of 150 elderly HF patients admitted to our hospital from December 2020 to December 2022 were enrolled,and according to their clinical outcomes in 6 months after discharge,they were divided into poor prog-nosis group(n=48)and good prognosis group(n=102).The concentrations of kynurenine and tryptophan in serum were determined by liquid chromatography-tandem mass spectrometry.The kynuridine/tryptophan ratio at admission and discharge was compared between the two groups.ROC curve was plotted to evaluate the value of the ratio in predicting the short-term prognosis in the patients.Logistic regression analysis was used to identify the influencing factors for adverse events in these inpatients in 6 months after discharge.Results The poor prognosis group had sig-nificantly lower levels of TC,BNP and BUN than the good prognosis group(P＜0.05).The kynuridine/tryptophan ratio was obviously lower at discharge than at admission in both groups(P＜0.01),and the ratio in the poor prognosis group at discharge was notably higher than that in the good prognosis group(P＜0.01).ROC curve analysis showed that the AUC value of kynuri-dine/tryptophan ratio at admission and discharge in predicting short-term prognosis of the HF in-patients was 0.863(95％CI:0.803-0.924)and 0.701(95％CI:0.602-0.801),respectively,with the predictive performance of the ratio at discharge higher than that at admission(P＜0.05).Mul-tivariate logistic regression analysis indicated that TC(OR=0.696,95％CI:0.501-0.965),BNP(OR=1.530,95％CI:1.092-2.143),BUN(OR=1.740,95％CI:1.077-2.813)and the kynuri-dine/tryptophan ratio at discharge(OR=2.280,95％CI:1.093-4.754)were the influencing fac-tors of adverse events in the elderly HF inpatients in 6 months after discharge(P＜0.05).Conclu-sion Kynurenine/tryptophan ratio is an independent risk factor for short-term poor prognosis in hospitalized HF patients,and it can effectively predict short-term prognosis of the patients.

Objective: To compare and analyze patient’s general condition, changes in laboratory parameters, and the spectrum of UGT1A1 mutations in patients with inherited non-hemolytic unconjugated hyperbilirubinemia. Methods: A retrospective study was conducted at Nanjing Second Hospital from January 2015 to July 2018 and patients’ demographic characteristics, liver function test, and UGT1A1 gene were analyzed. The categorical variable data were compared by χ ² test. The normal distribution continuous variable data were compared by t-test and the non-normal distribution continuous variable data were compared using Mann-Whitney U test. Results: Of the 51 patients with inherited non-hemolytic unconjugated hyperbilirubinemia, 44 (86.3%) were Gilbert’s syndrome (GS) and seven (13.7%) were Crigler-Najjar syndrome type II (CNS- II). The male to female ratio was 2.9:1 and the average age was 36.11 ± 13.17 years. Six variant types were detected: C. -40_-39insTA, C. -3279T > G, c.211G > A (p.G71R), c.686C > A (p.P229Q), c.1091C > T (p.P364L), c.1456T > G (P.Y486D). Among them, c.211G > A accounted for 58.82% (30/51), c.-40_-39insTA accounted for 27.5% (14/51), and c.1456T > G accounted for 25.5% (13/51). The total bilirubin(TB) and unconjugated bilirubin (UCB) in CNS-II patients were significantly higher than GS patients[155.91 (130 ~ 207) vs. 38.25(29 ~ 52.15) μmol/L, U = 0, P < 0.01; 144.13 (120.8 ~ 197) vs. 30.00 (21.7 ~ 46.75) μmol/L, U = 0.00, P < 0.01, respectively]. Exon mutations of c.1091C > T and c.1456T > G were statistically significant(P < 0.01).There were no differences in age, TB, UCB, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) between the c.211G > A homozygous variants and heterozygous variants (P > 0.05). Conclusion The common pathogenic mutations of UGT1A1 gene were c.211G > A, c.-40_-39insTA, c.1456T > G. c.211G > A. The mutation has little effect on the level of total bilirubin, but c.1091C > T, c.1456T > G mutations has great influence on the level of total bilirubin.

Objective To investigate the risk factors for acute ischemic stroke in patients with lower extremity atherosclerosis (LEA).Methods The consecutive patients with acute ischemic stroke admitted to hospital within 7 d after onset were enrolled retrospectively.Color Doppler flow imaging was used to detect LEA.The demographic characteristics,vascular risk factors,and laboratory parameters were identified and analyzed.Results A total of 156 patients with acute ischemic stroke were enrolled,including 138 with LEA.Univariate analysis showed that age (69.5± 11.8 years vs.60.4± 11.5 years;t =3.063,P =0.003) and the proportion of patients with hypertension (81.1％ vs,55.6％;x2 =2.467,P =0.014) in the LEA group were significantly higher than those in the non-LEA group.Multivariate logistic regression analysis showed that after adjustment for confounders such as gender,baseline systolic blood pressure,diabetes mellitus,and ischemic heart disease,age (odds ratio [OR] 1.059,95％ confidence interval [CI] 1.016-1.105;P=0.007),and hypertension (OR 3.128,95％ CI 1.084-9.026,P =0.035) were the independent risk factors for acute ischemic stroke complicated with LEA.Conclusions Age and hypertension are associated with acute ischemic stroke complicated with LEA.

Objectives:To investigate the association between body mass index (BMI) changes and other risk factors for cardiovascular disease in patients with type 2 diabetes mellitus (T2DM).Methods:Based on the T2DM cohort in rural communities of Zhejiang province, baseline and follow up information of height, weight, blood pressure, glycated hemoglobin (HbA1c), TC, TG, LDL-C and HDL-C of the T2DM patients were collected. After excluding those who died during the follow-up period, lost follow-up or had incomplete information, a total of 8 953 T2DM patients were included in the final analysis. Multiple linear regression and Cox proportional hazards regression models were used for analysis.Results:At baseline survey, 40.97% of the T2DM patients were overweight and obese. Compared with those with normal BMI, the SBP, DBP and TG level were significantly higher, while HDL-C level was significantly lower in the overweight and obese T2DM patients ( P<0.01). During the follow-up period, the blood glucose control rate in the patients increased by 15%, and the levels of HbA1c decreased in the patients with different BMI changes at different degrees. Compared with the patients who kept normal BMI, the HbA1c level decrease had a smaller range, while the SBP and DBP increase had a larger range in the patients with persistent overweight and obesity, and their substandard rates of HbA1c, SBP, DBP, TG, HDL-C levels were 1.142 (1.057-1.233) times, 1.123 (1.055-1.196) times, 1.220 (1.128-1.320) times, 1.400 (1.282-1.528) times and 1.164 (1.069-1.267) times higher. The changes of blood pressure, blood lipids and other related indicators in the patients whose BMI became abnormal were similar to those of the patients with persistent overweight and obesity; Compared with the patients whose BMI were kept normal, the differences in changes and substandard rate of blood glucose level, blood pressure level in the patients whose BMI became normal were not significant ( P>0.05). The change value of BMI was positively correlated with the change value of SBP, DBP, TG and LDL-C, while negatively correlated with the change value of HDL-C ( P<0.05). Conclusions:Abnormal changes in BMI are associated with the adverse changes of blood glucose level, blood pressure, and blood lipids level and other cardiovascular disease risk factors. Keeping normal BMI would benefit the positive outcome of cardiovascular adverse factors.

Objective:To investigate the association between obesity and the risk for all-cause mortality in type 2 diabetes (T2DM) patients.Methods:The participants were from a rural community-based T2DM patient cohort in Zhejiang Province. The study used the data collected from baseline survey in 2016 and follow-up until December 31, 2021. A total of 10 310 participants were included, excluding those who were lost in follow-up or had incomplete data in follow-up. According to BMI and waist circumference, the study subjects were divided into 6 groups: low body weight, normal body weight, simple abdominal obesity, simple body obesity, complex overweight and complex obesity. Cox proportional hazards regression model was used to analyze hazard ratios ( HRs) of all-cause mortality and their 95% CIs in T2DM patients with different obesity status. Results:The cumulative follow-up period was 57 049.47 person-years with an average follow-up of (5.53±0.89) person-years. During this period, 971 subjects died. The death density was 1 702.03/100 000 person-years. After adjusting for confounders, low-weight patients had a 104% increased risk for all-cause death compared with normal-weight patients ( HR=2.04, 95% CI:1.42-2.92). The risk for all-cause death decreased by 34% ( HR=0.66, 95% CI: 0.53-0.82), 22% ( HR=0.78,95% CI: 0.66-0.92), 38% ( HR=0.62, 95% CI: 0.49-0.78) in the patients with simple body obesity, complex overweight and complex obesity, respectively, there was no significant difference for all-cause death in the patients with simple abdominal obesity alone. In subgroup analysis, the risk of all-cause mortality increased in low-weight T2DM patients of different sexes and ages, the mortality risk in women with complex obesity was 50% lower than that in the women with normal body weight, but there was no significant difference in men in the comparison between complex obesity group and normal body weight group. The risk for all-cause mortality was significantly lower in ≥65 years old patients with simple body obesity, complex overweight and complex obesity than in patients with normal body weight ( HR=0.61, 95% CI: 0.48-0.78; HR=0.76, 95% CI: 0.63-0.91; HR=0.56,95% CI: 0.42-0.73), there was no significant difference in the patients aged <65 years. There was no significant change in sensitivity analysis. Conclusions:There was an "obesity paradox" in the risk for all-cause mortality in T2DM patients. The risk of all-cause mortality in the low-weight patients was significantly higher than that in normal-weight patients, and the risk for death in the patients with simple body obesity or complex overweight and obesity were significantly lower.