Objective To explore the value of combined ultrasound parameters, including the hepatorenal index (HRI) and renal resistance index (RRI), with cystatin C (CysC) in monitoring early acute kidney injury (AKI) after liver transplantation. Methods Perioperative data from 121 liver transplant recipients who received organs from donation after brain death were collected. The HRI and RRI of the recipients were measured on postoperative days 1-7 and at 1 month, and the CysC levels were measured on postoperative day 1. The recipients were divided into the AKI group (n=53) and the non-AKI group (n=68) based on whether AKI occurred within 7 days after operation. The data of the two groups were compared, and the ultrasound parameters before and after recovery in the AKI group were analyzed. The value of combined HRI, RRI and CysC in monitoring AKI was also analyzed. Results AKI occurred in 53 recipients, with an incidence rate of 43.8%, including 30 cases of stage 1, 18 cases of stage 2, and 5 cases of stage 3. Among them, 49 cases occurred on postoperative day 1, and 4 cases occurred on postoperative day 2. Of these, 43 cases recovered within 7 days after surgery, 8 cases recovered within 2 months after surgery, 1 case was lost to follow-up, and 1 case received renal replacement therapy. The body mass index and preoperative CysC levels were higher in the AKI group than in the non-AKI group, and the operative time was longer in the AKI group than in the non-AKI group (all P < 0.05). The HRI on postoperative day 1 was lower in the AKI group than in the non-AKI group, while the RRI and CysC levels were higher (all P < 0.05). When AKI occurred, the HRI was lower than the baseline level, and the RRI was higher than the baseline level. As AKI recovered, the HRI gradually increased, and the RRI gradually decreased. The receiver operating characteristic curve analysis showed that the sensitivity and specificity of HRI ≤ 1.12 for predicting AKI were 0.623 and 0.878, respectively, with an area under the curve (AUC) of 0.801. The sensitivity and specificity of RRI ≥ 0.65 for predicting AKI were 0.878 and 0.676, respectively, with an AUC of 0.825. The sensitivity and specificity of CysC ≥ 1.38 mg/L for predicting AKI were 0.736 and 0.882, respectively, with an AUC of 0.851 (all P<0.01). The combination of HRI and CysC (AUC=0.897, P<0.01), RRI and CysC (AUC=0.910, P<0.01), and all three parameters combined (AUC=0.934, P<0.01) were more effective than using each parameter alone. Conclusions HRI and RRI may be used to monitor the occurrence and recovery of early AKI after liver transplantation. The combination of these two parameters with CysC has a high application value in monitoring early AKI after liver transplantation.

Peri-implant keratinized mucosa (PIKM) augmentation refers to surgical procedures aimed at increasing the width of PIKM. Consensus reports emphasize the necessity of maintaining a minimum width of PIKM to ensure long-term peri-implant health. Currently, several surgical techniques have been validated for their effectiveness in increasing PIKM. However, the selection and application of PIKM augmentation methods may present challenges for dental practitioners due to heterogeneity in surgical techniques, variations in clinical scenarios, and anatomical differences. Therefore, clear guidelines and considerations for PIKM augmentation are needed. This expert consensus focuses on the commonly employed surgical techniques for PIKM augmentation and the factors influencing their selection at second-stage surgery. It aims to establish a standardized framework for assessing, planning, and executing PIKM augmentation procedures, with the goal of offering evidence-based guidance to enhance the predictability and success of PIKM augmentation.
Humans ; Consensus ; Dental Implants ; Mouth Mucosa/surgery* ; Keratins

Objective To meet the treatment requirements for mitral regurgitation disease,this study designed a novel valve repair system and evaluated its hydrodynamic performance.Methods A mitral regurgitation model was created.The valve repair system was loaded onto the regurgitation model,and pulsatile flow tests and steady backflow leakage tests were conducted.Results The pulsatile flow test results indicated that the percentage of reflux after product implantation was lower than that before implantation under different concentric outputs and reverse pressures.The average cross-valve pressure difference after implantation was less than 5 mmHg.The steady backflow leakage test results showed that as the reverse pressure increased,the leakage amount of the valve repair system after implantation also increased.Conclusion The developed valve repair system exhibits excellent hydrodynamic performance,suggesting the feasibility of its application in the treatment of clinical mitral regurgitation.

Objective:Exploring the value of contrast enhanced ultrasound (CEUS) plus transient elastography in evaluating donor livers for C-I donors and predicting the occurrence of early allograft dysfunction (EAD).Methods:Between September 1, 2022 and August 31, 2023, the relevant clinical data were retrospectively reviewed for 75 pairs of donors and recipients. Based upon whether or not there was a postoperative onset of EAD, the recipients were assigned into two groups of EAD (16 cases) and non-EAD (59 cases) . All donors were examined by contrast-enhanced ultrasonography and FibroScan. QLAB analysis software was utilized for analyzing the results of contrast-enhanced ultrasound. Liver parenchyma at 3 cm below liver capsule was selected as a region of interest for plotting the time-intensity curve (TIC) . And the contrast-enhanced ultrasonic parameters of two groups were recorded. FibroScan transient elastography instrument was employed for quantifying liver stiffness 12 times in right lobe of donor liver and recording quantitative parameters of liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) .Results:Inter-group comparison of gender, age, body mass index (BMI) and ICU length of stay showed no statistically significant differences ( P>0. 05) . However, significant differences existed in the levels of platelet [ (122. 44±85. 82) vs (197. 22± 140. 93) ×10 9/L]and cholinesterase [ (3 473. 44±1 368. 54) vs (4 252. 93±1 365. 37) U/L]within the first 24h pre-operation ( P=0. 047, P=0. 047) . Peak intensity (PKI) and area under the curve (AUC) were lower in EAD group than those in non-EAD group [ (16. 44±4. 70) dB vs 19. 85±4. 39 dB, P=0. 009; (1 366. 76±508. 10) dB·s vs (1 675. 23±498. 77) dB·s, P=0. 014]. There were statistically significant differences ( P=0. 009, P=0. 032) . Arterial-portal arrival interval (APAI) and LSM were higher in EAD group than those in non-EAD group[6. 50 (5. 00, 10.75) s vs 5. 00 (4. 00, 7. 00) s, P =0. 24; 8. 60 (6. 32, 11. 65) kPa vs 6. 10 (5. 40, 7. 90) kPa, P=0. 014]. Receiver operating characteristic (ROC) curve analysis revealed that PKI, AUC, APAI and LSM had AUC values of 0. 703, 0. 664, 0. 683 and 0. 702, respectively in predicting postoperative EAD. And combined prediction of EAD occurrence based upon these parameters had an AUC of 0. 776, a Youden index of 0. 508 with cutoff values, sensitivity and specificity of 0. 800, 0. 813 and 0. 695 respectively. Spearman' s correlation analysis revealed a negative correlation between APAI and AUC values ( r= -0. 404, P<0. 001) . Conclusions:The combination of CEUS and transient elastography can comprehensively evaluate the status of microcirculatory perfusion, fibrosis and steatosis of liver grafts from brain death donors. It offers a great predictive value for postoperative occurrence of EAD.

Objective To analyze Professor Zhang Binghou's medication experience in the treatment of diabetic kidney disease using data mining methods;To screen the core medicinal pairs and medicinal groups.Methods Prescriptions of diabetic kidney disease of Professor Zhang Binghou from the outpatient department of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University were selected from January 2014 to December 2021.TCM Inheritance Platform System 2.5,SPSS Modeler 18 and SPSS Statistics 21 software were used for association rules,clustering analysis and factor analysis to summarize the medication frequency,properties and tastes and meridians,and medicinal pairs and combinations.Results A total of 161 prescriptions were included,involving 188 kinds of Chinese materia medica,with a total frequency of 2 220 time.The kinds of Chinese materia medica with higher frequency were Rehmannize Radix et Praeparata,Testudinis Carapax et Plastrum,Astragali Radix,Rehmannine Radix,etc.The main properties were cold and warm,the main tastes were sweet and bitter,and the main meridians were kidney,liver and spleen meridians.A total of 14 drug pair association rules were obtained,with 27 commonly used drug combinations.Clustering analysis extracted 10 combinations based on the spectrum,and factor analysis extracted 14 common factors.Conclusion Professor Zhang Binghou's treatment for diabetic kidney disease takes nourishing the true yin and clearing away damp-heat as the main treatment method,and at the same time,it pays attention to tonifying kidney,consolidating essence,nourishing yin and containing yang,promoting blood circulation and removing blood stasis,etc.,which embodies Professor Zhang Binghou's unique academic thought of treating diabetic kidney disease.

OBJECTIVE: To meet the treatment requirements for mitral regurgitation disease, this study designed a novel valve repair system and evaluated its hydrodynamic performance. METHODS: A mitral regurgitation model was created. The valve repair system was loaded onto the regurgitation model, and pulsatile flow tests and steady backflow leakage tests were conducted. RESULTS: The pulsatile flow test results indicated that the percentage of reflux after product implantation was lower than that before implantation under different concentric outputs and reverse pressures. The average cross-valve pressure difference after implantation was less than 5 mmHg. The steady backflow leakage test results showed that as the reverse pressure increased, the leakage amount of the valve repair system after implantation also increased. CONCLUSION The developed valve repair system exhibits excellent hydrodynamic performance, suggesting the feasibility of its application in the treatment of clinical mitral regurgitation.
Hydrodynamics ; Mitral Valve Insufficiency/surgery* ; Mitral Valve/surgery* ; Heart Valve Prosthesis ; Pulsatile Flow ; Heart Valve Prosthesis Implantation

Irinotecan is an anticancer topoisomerase I inhibitor that acts as a prodrug of the active metabolite, SN-38. Unfortunately, the limited utility of irinotecan is attributed to its pH-dependent stability, short half-life and dose-limiting toxicity. To address this problem, a novel trivalent PEGylated prodrug (PEG-[Irinotecan]₃) has been synthesized and its full-profile pharmacokinetics, antitumor activity and toxicity compared with those of irinotecan. The results show that after intravenous administration to rats, PEG-[Irinotecan]₃ undergoes stepwise loss of irinotecan to form PEG-[Irinotecan]_3‒x (x = 1,2) and PEG-[linker] during which time the released irinotecan undergoes conversion to SN-38. As compared with conventional irinotecan, PEG-[Irinotecan]₃ displays extended release of irinotecan and efficient formation of SN-38 with significantly improved AUC and half-life. In a colorectal cancer-bearing model in nude mice, the tumor concentrations of irinotecan and SN-38 produced by PEG-[Irinotecan]₃ were respectively 86.2 and 2293 times higher at 48 h than produced by irinotecan. In summary, PEG-[Irinotecan]₃ displays superior pharmacokinetic characteristics and antitumor activity with lower toxicity than irinotecan. This supports the view that PEG-[Irinotecan]₃ is a superior anticancer drug to irinotecan and it has entered the phase II trial stage.

Posttransplant lymphoproliferative disorder(PTLD)is one of the more serious complications of organ transplantation.From October 2021 to December 2022, 3 patients with hepatic portal PTLD were hospitalized.Conventional ultrasonography hinted at hypoechoic area in porta hepatis.Enhanced CT revealed heterogeneous enhancement of soft tissue density in porta hepatis.PET/CT indicated higher metabolism of hilar mass.Two patients underwent contrast-enhanced ultrasound. "Fast-in-and-fast-out" sign(n=1)and no enhancement in all stages(n=1)were noted.Pathological examination revealed T/NK cell lymphoma(n=2)and B cell lymphoma(n=1). In conjunctions with previous literature reports, conventional ultrasound is frequently employed for detecting early cases of PTLD during clinical follow-ups.Contrast-enhanced ultrasound and enhanced CT may aid in making a differential diagnosis of PTLD.And PET/CT has high diagnostic accuracy for PTLD.

Objective:To evaluate the correlation between brain-derived neurotrophic factor (BDNF) and inflammatory markers in rheumatoid arthritis (RA) patients with depressive symptoms.Methods:This study was a cross-sectional study. RA patients' medical history were recorded and disease activity was evaluated. Serum BDNF, interleukin (IL)-6, tumor necrosis factor (TNF)-α were tested and clinical inflammatory indicators such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen (FIB), serum amyloid A (SAA) were recorded. RA patients were instructed to fill in the patient health Questionnaire-9 (PHQ-9) scale by themselves. Patients with a score greater than or equal to 5 were included in the RA with depressive symptoms group, and patients with a score of 4 or less were included in the RA without depressive symptoms group. The changes in BDNF and inflammatory indexes were compared between the two groups. Correlation analysis of PHQ-9, BDNF, inflammatory markers and DAS28 was performed. Logistic regression analysis was performed to find the risk factors of depression in RA.Results:A total of 140 RA patients were enrolled in this study, and 66 patients (47.1%) with a PHQ-9 score greater than or equal to 5 were included in the RA with depressive symptoms group. Compared with the RA without depressive symptoms group, RA patients with high disease activity, single and living alone, poor economic self-awareness and unemployed were more likely to have depressive symptoms. The serum level of BDNF[(2 276±333) pg/ml vs (1 367±431) pg/ml, t=13.91, P<0.001], IL-6[(39±28) pg/ml vs (27±8) pg/ml, t=3.66, P<0.001], TNF-α[(9.0±7.2) pg/ml vs (6.6±3.9)pg/ml, t=2.43, P=0.035], CRP[(25±13) mg/L vs (17±11) mg/L, t=3.94, P<0.001], ESR[(48±18) mm/1 h vs (34±21) mm/1 h, t=4.14, P=0.024], Fib[(3.8±1.1) g/L vs (3.0±0.5) g/L, t=5.92, P=0.023], SAA[(64±39) mg/L vs (37±19) mg/L, t=5.32, P<0.001] in RA with depressive symptoms group were significantly higher than those in RA without depressive symptoms group. Serum BDNF was significantly positively correlated with PHQ-9 score ( r=0.66, P<0.001), IL-6( r=0.20, P=0.019), TNF-α ( r=0.14, P=0.090), CRP ( r=0.32, P<0.001), ESR ( r=0.20, P= 0.001), Fib ( r=0.28, P=0.001), SAA( r=0.28, P=0.001) and DAS28 ( r=0.37, P<0.001) . BDNF [ OR (95% CI) =1.578(1.257, 2.354), P=0.001], IL-6[ OR (95% CI) =1.073(1.012, 1.075), P=0.006], CRP[ OR(95% CI)=1.085(1.045, 1.178), P=0.001], SAA[ OR(95% CI)=1.125(1.004, 1.198), P=0.018] and unemployment were risk factors for depressive symptoms in RA. Conclusion:Serum BDNF is positively correlated with PHQ-9 scores, inflammatory markers and disease activity in RA patients. BDNF, IL-6, CRP, SAA and unemployment are risk factors for depressive symptoms in RA. Effective treatment of RA can reduce the occurrence of depression symptoms.

Objective:To evaluate the clinical characteristics and identify potential factors of the early-stage hip involvement in patients with ankylosing spondylitis (AS) based on the magnetic resonance imaging (MRI).Methods:A retrospective group control study was carried out in 570 AS patients who were consecutively admitted to our hospital from 2014 to 2018. Patients with hip pain or hip function limitation but lacking definitive evidence of hip involvement on radiography were underwent hip MRI. Patients were divided into three groups: no hip involvement, early-stage hip involvement (hip involvement detected by MRI but with negative radiographs) and advanced-stage hip involvement (Bath Ankylosing Spondylitis Radiology Index-hip score ≥2). The study factors included demographic, laboratory, clinical and radiographic data. Simple and multiple ordinal logistic regression analysis were used to identify factors associated with the early-stage hip involvement and advanced-stage hip involvement.Results:A total of 236 patients (41.4%) presented with hip involvement, in which 146 cases (25.6%) were diagnosed with early-stage hip involvement, while 90 cases (15.8%) were diagnosed with advanced-stage hip involvement. Multivariate logistic regression analysis demonstrated that older age at onset [ OR=0.80, 95% CI (0.72, 0.90), P<0.01], more active inflammation in the sacroiliac joints [ OR=1.13, 95% CI(1.07, 1.18), P<0.01] and worse BASMI score [ OR=3.06, 95% CI(2.14, 4.13), P<0.01] were associated with the occurrence of early-stage hip involvement. Conclusion:MRI is superior to radiography in detecting early-stage hip involvement. MRI is more suitable for hip involvement assessment in AS patients with suspected symptoms or risk factors of hip involvement.