Objective To explore the value of the Accordion severity grading system (ASGS) in predicting short-term outcomes after orthotopic liver transplantation for severe hepatitis by classifying post-surgery complications.Methods The clinical documents of 159 patients were retrospectively analyzed who underwent orthotopic liver transplantation for severe hepatitis between Aug.1,2004 to Sept.1,2014 at our center.Complications were categorized according to the ASGS:grade 1 (mild),grade 2 (moderate),grade 3-5 (severe),and grade 6 (death).Outcome measures included ventilator support time,the length of ICU stay,postoperative recovery time.Spearman rank correlation analysis was used to test the correlation between the different grades with these outcome measures.1-year survival trends of different grade complication groups were demonstrated by Kaplan-Meier method and compared by Log-rank test.Results In total,43 (27.0％) patients had a grade 2 complication;41 (25.8％) grade 3;31 (19.5％) grade 4;9 (5.7％) grade 5;and 35 (22.0％) grade 6.There was no grade 1 patient.There was a significant correlation between the complication grades and the ventilator support time,the length of ICU stay and postoperative inpatient time (P＜0.01).With the increase of the complication grades,the outcome measures were even worse.Severe grade complication group had a longer ventilator support time,the length of ICU stay and postoperative inpatient time than the moderate grade complication group (P＜0.01).There was a significant downward trend in 1-year survival with the increase of the complication grade (P＜0.01).Conclusion The ASGS is helpful to assess risks and predict short-term outcomes after liver transplantation for severe hepatitis.Higher Accordion grades are correlated with even worse short-term outcomes.

Background In recent years, a growing number of studies have indicated that perfluorooctanoic acid (PFOA) exposure can impact heart development, though the specific mechanisms remain elusive. The aryl hydrocarbon receptor (AHR) is a critical environmental sensor capable of inducing oxidative stress and cell apoptosis. Objective To explore the role of AHR in the cardiac developmental toxicity of PFOA by using zebrafish embryo as an in vivo model. Methods Zebrafish embryos at 2 h post-fertilization (2 hpf) were exposed to dimethyl sulfoxide (DMSO) control, 1, 10, 100, and 1000 μg·L⁻¹ of PFOA. The AHR inhibitor CH223191 (CH) was added to the high-concentration group (1000 μg·L⁻¹) to form an intervention group. Under a dissecting microscope, the survival rate, mortality rate, heart rate, and heart malformation rate of 72 hpf zebrafish larvae were assessed. The activity of AHR was measured using 7-ethoxyresorufin-O-dealkylation (EROD) staining. The levels of intracellular and mitochondrial ROS in the heart of zebrafish larvae were assessed using dichloro-dihydro-fluorescein diacetate and MitoSOX™ Red, respectively. Apoptosis was examined using acridine orange (AO) staining and Immunofluorescence method. Total RNA was extracted from dissected hearts, and mRNA expression levels of oxidative stress-related genes (sod2, cat) and apoptosis-related gene (p53) were analyzed using quantitative PCR. Results Compared to the DMSO control group, PFOA at even the lowest concentration (1 μg·L⁻¹) increased heart malformation rate (P＜0.05) and reduced heart rate (P＜0.01) in the zebrafish larvae at 72 hpf, and the results showed a clear concentration-response relationship. Adding the AHR inhibitor CH significantly decreased heart malformation rate and restored heart rate to the control group level. The EROD results showed that PFOA at 1000 μg·L⁻¹ increased AHR activity (P＜0.001). Further studies revealed that PFOA caused a dose-dependent increase in intracellular ROS (P<0.001) and an increase in mitochondrial ROS (P<0.001) in the heart region of zebrafish larvae. A high dose of PFOA (1000 μg·L⁻¹) also induced elevated mRNA expression levels of oxidative stress-related genes sod2 and cat (P<0.05). Addition of the AHR inhibitor CH effectively antagonized PFOA-induced (1000 μg·L⁻¹) oxidative stress in the heart of zebrafish larvae (P<0.001). In addition, PFOA exposure induced a concentration-dependent increase in apoptotic bodies in the heart of zebrafish larvae (P<0.05). Moreover, PFOA at 1000 μg·L⁻¹ caused an increase in the cleaved-caspase 3 immunofluorescence signal (P<0.05) as well as overexpression of the apoptosis-associated gene p53 (P<0.001).which were attenuated by the CH supplementation. Conclusion PFOA triggers oxidative stress and apoptosis via AHR activation in the heart of zebrafish larvae, resulting in cardiac defects.

Objective To explore the application value of ultrasound radiomics technology based on grayscale ultrasound images in the differential diagnosis of histological classification of glomerulonephritis.Methods A total of 204 patients with renal biopsy were selected from our hospital,and according to pathological results,they were divided into the membranous nephropathy group(n=133)and the mesangial proliferative glomerulonephritis group(n=71).The ultrasound images were sketched and the image omics features were extracted by two physicians.The pathological results and ultrasound data of renal biopsy were collected from the two groups,and the ultrasound radiomics features were preliminarily screened by the maximum correlation and minimum redundancy algorithm(mRMR)algorithm for all the obtained omics feature data.Then the optimal effective features were selected from the screened features by minimum absolute shrinkage and selection operator(LASSO)algorithm,and random forest(RF),support vector machine(SVM),logistic regression(LR),four kinds of classifiers of K-nearest neighbor(KNN)method were used to establish a prediction model.All cases were randomly divided into the training set and the validation set according to the ratio of 7∶3,and the four models were trained by the training set,and then validated in the validation set,and the best prediction model was selected by comparing the receiver operating characteristic(ROC)curve,Delong test and GiViTI calibration curve.Decision curve analysis(DCA)was used to evaluate the clinical utility of the model.Results The radiomics method was used to extract 837 radiomics features per image,and 16 meaningful features were finally screened out by using the mRMR+LASSO algorithm.Among the four prediction models of RF,SVM,LR and KNN,the best performing model was LR model,with the AUC of 0.944,the specificity of 0.867 and the sensitivity of 0.878.The GiViTI calibration curve showed that the model had good accuracy(P＞0.05),and the decision curve showed that the prediction model had good clinical practical value.Conclusion Ultrasound radiomics has a good ability to distinguish the more common histological types of glomerulonephritis,and is a non-invasive method with good application prospects.

Objective To explore the relationship between serum Visfatin,pentraxin 3(PTX3),and carbo-hydrate antigen 19-9(CA19-9)levels and prognosis in patients with acute cholecystitis.Methods A total of 228 patients with acute cholecystitis admitted to a hospital from September 2020 to September 2023 were se-lected as the study objects.According to the severity of the patients,228 patients were divided into mild group(n=81),moderate group(n=102)and severe group(n=45).The patients were divided into good prognosis group(n=186)and bad prognosis group(n=42).General data of patients were collected,serum Visfatin and PTX3 levels were detected by enzyme linked immunosorbent assay,and serum CA19-9 levels were determined by chemiluminescence immunoassay.Univariate and multivariate analysis of prognostic factors in patients with acute cholecystitis was performed,and the diagnostic value of serum Visfatin,PTX3 and CA19-9 levels in patients with acute cholecystitis was analyzed by drawing receiver operating characteristic curve.Results Ser-um Visfatin,PTX3 and CA19-9 in moderate and severe groups were significantly different from those in mild group(P＜0.05).There were significant differences in serum Visfatin,PTX3 and CA19-9 between severe group and moderate group(P＜0.05).Gallbladder thickness,long diameter and short diameter of gallbladder,serum Visfatin,PTX3 and CA19-9 levels in the poor prognosis group were significantly different from those in the good prognosis group(P＜0.05).Multivariate Logistic regression analysis showed that serum Visfatin,PTX3 and CA19-9 levels were the influential factors for poor prognosis of patients(P＜0.05).The area under the curve of serum Visfatin,PTX3 and CA19-9 combined diagnosis was significantly larger than that of Visfa-tin alone diagnosis(Z=4.577,P＜0.001)and PTX3 alone diagnosis(Z=3.132,P=0.002)and the area un-der the curve of CA19-9 diagnosis alone(Z=2.766,P=0.006).Conclusion Serum Visfatin,PTX3 and CA19-9 are elevated in patients with acute cholecystitis,which is related to the patient's condition.The combi-nation of the three is of better value in the diagnosis of poor prognosis.

Objective:To analyze hepatic hemodynamic parameters detected by Doppler ultrasound (DU) of uncomplicated children who underwent left lateral segment(LLS) LDLT (LLS-LDLT), explore their change trends over time and determine the normal reference intervals.Methods:This retrospective study involved the data from 261 pediatric LLS-LDLT cases in Tianjin First Central Hospital from June 2014 to January 2018. Hemodynamic parameters included peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and pulsation index (PI) of hepatic artery (HA), and portal vein velocity (PVV) during intra-operative and on the 1st, 3rd, 5th and 7th days after operation were collected. Among whom, 232 cases with uncomplicated and normal recovery were finally involved in our study, with 200 cases who were collected from June 2014 to August 2017 as test group. Those collected from September 2017 to January 2018, totally 32 cases were set as validation group. The change trends and normal ranges of hemodynamic parameters over time were analyzed in test group, and the results were further tested in the validation group.Results:In the test group, PSV HA, EDV HA showed a similar change trend at one week after surgery, with an overall decrease-rise trend; RI HA, PI HA also changed similarly with an overall rise-decrease trend. PVV at surgery was lower than at all time points after surgery. In addition, this study provided the normal reference intervals of hemodynamic parameters for LDLT patients at early postoperative period, which at intra-operation they were PSV HA 18.4-98.3 cm/s, EDV HA 0-43.3 cm/s, RI HA 0.41-1.0, PI HA 0.51-2.0, PVV 19.0-83.7 cm/s. Within 1 week after surgery: PSV HA 21.0-97.7 cm/s, EDV HA 0-32.7 cm/s, RI HA 0.47-1.0, PI HA 0.62-2.0, PVV 23.0-92.0 cm/s. By using those results, the coincidence rate of Doppler parameter change trend was 84.3%(27/32), 84.3%(27/32), 78.1%(25/32), 78.1%(25/32), 87.5%(28/32) for PSV HA, EDV HA, RI HA, PI HA, PVV in the validation group, respectively. As for the normal reference intervals of blood flow parameters, RI HA and PI HA in one case in the validation group were lower than the lower limits of the normal reference intervals, accounting for 3.1% of the total. PSV HA in two cases was lower than the lower limit of normal reference interval, accounting for 6.2% of the total. Conclusions:The hepatic hemodynamic in post-transplanted children detected by DU has specific changing trends and normal ranges, which provides valuable reference values for ultrasonologists and pediatric transplant clinicians.

Objective:To explore the characteristics of postoperative hemodynamic changes in patients with early allograft dysfunction (EAD), and to provide clinical imaging support for the early diagnosis of EAD.Methods:A total of 907 patients who underwent liver transplantation in Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, and they were divided into EAD group (361 cases) and non-EAD group (546 cases) according to EAD diagnostic criteria. The peak systolic velocity(PSV) of the hepatic artery, end-diastolic velocity(EDV) of the hepatic artery, resistance index(RI), S/D(PSV/EDV), diameter of the portal vein(PVD), velocity of the portal vein(PVV), diameter of the middle hepatic vein(MHVD), velocity of the middle hepatic vein(MHVV), the diameter of the right hepatic vein(RHVD), and the velocity of the right hepatic vein (RHVV) were collected from 1 to 7 days after operation (a total of 5 573 ultrasound examination results), and the differences in ultrasound hemodynamic parameters were compared between the two groups. The correlation of S/D<2, PSV<25 cm/s, PVV<15 cm/s, MHVV or RHVV<15 cm/s within 3 days after operation with the occurence of EAO were analyzed by multivariate Logistic regression analysis.Results:①The PSV and EDV of the hepatic artery in the EAD group and the non-EAD group showed a slow upward trend at 1-7 days after operation, while the hepatic artery RI and PVV showed a downward trend, the MHVV and RHVV did not fluctuate significantly. ②The hepatic artery in the EAD group showed low-resistance blood flow in the early postoperative period, and the EDV were significantly higher than that in the non-EAD group on 1 d, 2 d, 3 d and 5 d, RI was significantly lower than that of the non-EAD group (all P<0.05); At 4 d, 6 d and 7 d, there was no significant differences of EDV and RI between the two groups(all P>0.05). The PSV of the EAD group was higher than that of the non-EAD group on 3 d ( P<0.05). Among the parameters of portal vein blood flow, the PVV in the EAD group was significantly higher than that in the non-EAD group on 1 d ( P<0.05), and there was no significant difference of PVD between the two groups at day 1-7. Among the parameters of hepatic venous blood flow, the MHVV and RHVV in the EAD group were significantly lower than those in the non-EAD group (all P<0.05), there was no significant difference between the two groups of MHVD and RHVD at 1-7 days. ③The incidence of grafted hepatic artery S/D<2 within 3 days after operation in EAD group was higher than that in non-EAD group. Binary Logistic regression multivariate analysis showed that the occurrence of grafted hepatic artery S/D<2 within 3 days after operation was significantly correlated with the occurrence of EAD[Exp(B)=1.878, P<0.05]. Conclusions:Patients who develop EAD after liver transplantation show low-resistance blood flow in the hepatic artery during the perioperative period, and the occurrence of hepatic artery S/D<2 within 3 days after operation can early predict the occurrence of EAD.

Objective:To investigate the expression of activator of basal transcription 1 (ABT1) protein in gastric cancer tissue and its relationships with the clinical parameters and prognosis of gastric cancer patients, and to clarify the role of ABT1in the occurrence and development of gastric cancer.Methods:A total of 100cases of cancer tissue of the gastric cancer patients and 80pairs of adjacent tissue were selected.The expressions of ABT1in cancer tissue and adjacent tissue were detected by immunohistochemistry and the proportion of stained cells and the degree of staining in the immunohistochemistry results were analyzed using semi-quantitative analysis.The relationships between the semi-quantitative analysis results and the clinical parameters of gastric cancer patients were statistically analyzed.Kaplan-Meier method was used to analyze the correlation between the ABT1 protein expression level and the survival of gastric cancer patients.Results:ABT1-positive staining was observed in the nucleus and cytoplasm of gastric cancer tissue and adjacent gastric tissue.The expression level of ABT1in gastric cancer tissue was lower than that in adjacent tissue (P=0.021) .The ABT1protein expression level in gastric cancer tissue was significantly negatively correlated with the pathological grade (r=-0.224, P=0.026) .The Kaplan-Meier analysis results of the survival curve showed that the high expression of ABT1was associated with good prognosis in the gastric cancer patients (HR=1.483, P＜0.01) .The survival rate of gastric cancer patients with high ABT1expression was significantly higher than that of the patients with low ABT1expression (HR=2.411, P=0.0272) .Conclusion:The expression of ABT1in gastric cancer tissue is lower, indicating that ABT1can be used one of the markers of good prognosis of gastric cancer.

Objective To investigate the relationship between insomnia,gastrointestinal symptoms,and glycosylated hemoglobin(HbA1c)levels in individuals diagnosed with type 2 diabetes mellitus(T2DM),as well as the related influencing factors.Methods A total of 910 T2DM patients treated in our multicenter from January 2022 to December 2022 were enrolled in this study.General information(gender,age,smoking and drinking history,exercise,course of disease,treatment and complications),HbA1c,Athens Insomnia Scale(AIS)scores and Gastrointestinal Symptoms Rating Scale(GSRS)scores of patients were collected.The differences of sleep and gastrointestinal symptoms between groups were analyzed,and the correlation between the differences and HbA1c was analyzed.Furthermore,the risk factors for non-standard HbA1c were analyzed.Results The AIS score and GSRS score in the HbA1c control group were less than those in the non-standard group(P＜0.01).Insomnia was reported by 37.0％of T2DM patients,and the HbA1c level in the insomnia group was significantly higher than that in the non-insomnia group(10.00％±2.38％vs.8.26％±1.73％,P＜0.01).Gastrointestinal symptoms were present in 57.5％of T2DM patients,and the HbA1c levels in the group with gastrointestinal symptoms were significantly higher than those in the group without gastrointestinal symptoms(9.26％±2.23％vs.8.43％±1.98％,P＜0.01).Furthermore,26.3％of T2DM patients experienced both insomnia and gastrointestinal symptoms.Remarkably,the HbA1c levels in the group with both insomnia and gastrointestinal symptoms were significantly higher than those in the group without either condition(10.18％±2.44％vs.8.45％±1.86％,P＜0.01).Correlation analysis demonstrated a significant association between sleep quality,gastrointestinal function,and HbA1c levels(P＜0.01).The logistic regression analysis result revealed that age,GSRS score,AIS score,and the presence of insomnia combined with gastrointestinal symptoms were independent risk factors for predicting HbA1c≥6.5％(P＜0.01).Having both insomnia and gastrointestinal symptoms concurrently was the strongest risk factor for substandard HbA1c control,and the risk of blood sugar control may increase about 5 times when both appear together.Conclusion Insomnia and gastrointestinal symptoms are common comorbidities in T2DM patients,showing a cross-interfering relationship,and they appear together with poor blood sugar control,interact causally,and amplify each other.

Objective:To investigate the application value of magnetic resonance (MR) diffusion tensor imaging (DTI) automatic fiber quantification (AFQ) in the diagnosis and prediction of Alzheimer's disease (AD).Methods:Clinical and MR data of 21 patients with AD (AD group) and 33 normal controls (NC group) were collected.AFQ software was used to analyze DTI data, track 20 white matter fiber bundles in the brain, and compare the differences of fractional anisotropy (FA) and mean diffusivity (MD) value of each bundle between groups.Each fiber bundle was divided into 100 equal parts along the direction of travel, and the FA or MD value of each part was taken as a characteristic.Screening the characteristics with statistic differences between groups for classification of AD and NC by support vector machine (SVM) with leave one method for cross validation.Classification effectiveness was evaluated using the receiver operating characteristic (ROC) curve.Results:Eleven (left/right anterior thalamic radiation (ATR), left/right corticospinal tract (CST), genu of corpus callosum (CC Genu), right inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus (SLF), left/right uncinated fasciculus (UF), and left/right arcuate fasciculus (AF)) of the 20 fiber bundles were successfully tracked in all subjects.Compared with NC group, the FA values of 2 fiber bundles (left/right UF) in AD group were significantly decreased( t=-2.532, -2.391, both P<0.05), and the MD values of 7 fiber bundles (left ATR, left/right CST, right ILF, left/right UF, and left AF) were significantly increased ( t=2.569, 2.411, 2.108, 2.357, 3.773, 3.796, 3.492, all P<0.05). Among the 2 200 characteristics of 11 fiber bundles, 412 classification characteristics with inter-group differences were selected.Among which, 78 FA characteristics were distributed in 7 fiber bundles (left ATR, left/right CST, CC Genu, right ILF, left/right UF), and 334 MD characteristics were distributed in 9 fiber tracts (left/right ATR, left/right CST, CC Genu, right ILF, left/right UF, and left AF). The accuracy of SVM classification was 85.19%, sensitivity was 80.95%, specificity was 87.88%, and area under ROC curve was 0.894 7. Conclusion:AFQ analysis based on DTI has a high application value in the diagnosis and prediction of AD.

BACKGROUND:Bone relies on the close connection between blood vessels and bone cells to maintain its integrity.Bones are in a physiologically hypoxic environment.Therefore,the study of angiogenesis and osteogenesis in hypoxic environment is closer to the microenvironment in vivo. OBJECTIVE:To explore the influence of Wenshen Tongluo Zhitong(WSTLZT)formula on H-type bone microvascular endothelial cell/bone marrow mesenchymal stem cell co-culture system in hypoxia environment and its related mechanism. METHODS:Enzyme digestion method and flow sorting technique were used to isolate and identify H-type bone microvascular endothelial cells.Mouse bone marrow mesenchymal stem cells were isolated and obtained by bone marrow adhesion method.H-type bone microvascular endothelial cell/bone marrow mesenchymal stem cell hypoxic co-culture system was established using Transwell chamber and anoxic culture workstation.WSTLZT formula powder was used to intervene in each group at a mass concentration of 50 and 100 μg/mL.The angiogenic function of H-type bone microvascular endothelial cells in the co-culture system was evaluated by scratch migration test and tube formation test.The osteogenic differentiation ability of bone marrow mesenchymal stem cells in the co-cultured system was evaluated by alkaline phosphatase staining and alizarin red staining.The protein and mRNA expression changes of PDGF/PI3K/AKT signal axis related molecules in H-type bone microvascular endothelial cells in the co-cultured system were detected by Western Blotting and q-PCR,respectively. RESULTS AND CONCLUSION:(1)Compared with the normal oxygen group,the scratch mobility and new blood vessel length of H-type bone microvascular endothelial cells were significantly higher(P<0.05);the osteogenic differentiation capacity of bone marrow mesenchymal stem cells was higher(P<0.05);the expression of PDGF/PI3K/AKT axis-related molecular protein and mRNA increased(P<0.05)in the hypoxia group.(2)Compared with the hypoxia group,scratch mobility and new blood vessel length were significantly increased in the H-type bone microvascular endothelial cells(P<0.05);bone marrow mesenchymal stem cells had stronger osteogenic function(P<0.05);the expression of PDGF/PI3K/AKT axis-related molecular proteins and mRNA further increased(P<0.05)after treatment with different dose concentrations of WSTLZT formula.These findings conclude that H-type angiogenesis and osteogenesis under hypoxia may be related to the PDGF/PI3K/AKT signaling axis,and WSTLZT formula may promote H-type vasculo-dependent bone formation by activating the PDGF/PI3K/AKT signaling axis,thereby preventing and treating osteoporosis.