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.

Objective:To study the role of indocyanine green(ICG)fluorescence imaging in laparoscopic partial splenectomy (LPS).Methods:The data of 4 patients who underwent ICG fluorescence imaging technology for LPS at Beijing Luhe Hospital Affiliated to Capital Medical University from May 2017 to May 2020 were retrospectively analyzed. There were 3 females and 1 male, aged 46, 41, 27 and 12 years respectively. The extents of spleen preservation were compared between ICG fluorescence imaging with ordinary white light during operation. The residual splenic remnants were tested with fluorescence imaging after splenectomy, which showed fluorescence fading indicating good vascular perfusion.Results:ICG fluorescence imaging was performed on 4 patients. The operation time ranged from 180.0 to 250.0 min, and the intraoperative blood loss ranged from 40.0 to 200.0 ml. The postoperative hospital stay ranged from 4 to 14 days. There were no serious complications. Postoperative histopathology showed: splenic cyst ( n=1), splenic hemangioma ( n=2), and splenic laceration ( n=1). Conclusions:ICG fluorescence imaging technology had a significant role to play in partial splenectomy. This study showed this technique to improve safety of laparoscopic partial splenectomy.

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 investigate the value of brain functional connectivity density (FCD) derived from resting-state functional magnetic resonance imaging (rs-fMRI) in differentially diagnosing 2 subtypes of Parkinson's disease (PD): tremor dominant (TD) and non-tremor dominant (nTD), as well as its correlation with clinical symptom scores.Methods:A retrospective analysis was performed; 45 PD patients (25 with TD and 20 with nTD), admitted to Department of Neurology, Drum Tower Hospital Affiliated to Medical School of Nanjing University were chosen; and 24 middle-aged and elderly volunteers matched in age, gender and years of education at the same time were chosen as normal controls (NCs). The rs-fMRI data were collected and FCD map of the whole brain was computed. The FCD differences in whole brain and brain regions enjoying different FCD were compared among the 3 groups. ROC curve was used to analyze the differential diagnostic efficacy of FCD in brain regions enjoying different FCD in TD and nTD. Correlations of FCD in brain regions enjoying different FCD with disease course, Hoehn-Yahr (H-Y) grading, unified Parkinson's disease rating scale (UPDRS) III scores, tremor scores and non-tremor scores were analyzed by Pearson or Spearman correlation analyses.Results:Brain regions enjoying different FCD among the TD, nTD, and NC groups were the right lingual gyrus, right orbital medial frontal gyrus, right insula, left superior temporal gyrus, left insula, right anterior central gyrus, left posterior central gyrus, right medial and paracingulate gyrus, and left angular gyrus. FCD in the right orbital medial frontal gyrus and left angular gyrus of TD group was significantly higher than that in the nTD group ( P<0.05); while FCD in the right insula, right anterior central gyrus, left posterior central gyrus and right medial and paracingulate gyrus of TD group was significantly lower than that in the nTD group ( P<0.05). Area under the curve of combined application of FCD in brain regions enjoying different FCD in differentially diagnosing TD and nTD was 0.842, with sensitivity and specificity of 80.0%. FCD in the left superior temporal gyrus and left posterior central gyrus was positively correlated with H-Y grading ( P<0.05), while FCD in the left angular gyrus was negatively correlated with H-Y grading ( P<0.05). FCD in the left superior temporal gyrus was positively correlated with UPDRS III scores ( P<0.05). FCD in the right lingual gyrus, right insula, left insula, right anterior central gyrus, left posterior central gyrus, right medial and paracingulate gyrus was negatively correlated with tremor scores ( P<0.05). FCD in the left superior temporal gyrus, right medial and paracingulate gyrus was positively correlated with non-tremor scores ( P<0.05), whereas that in the left angular gyrus was negatively correlated with non-tremor scores ( P<0.05). Conclusion:Abnormalities in FCD exist in certain brain regions of PD patients, with disparities between TD and nTD. Combined application of FCD in brain regions enjoying different FCD can effectively differentiate TD and nTD, and this FCD is also partially correlated with the symptom scores of PD patients.

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 analyze the association between the triglyceride-glucose(TyG)index and the risk of nephrolithiasis across various demographic and clinical subgroups,aiming to enhance early di-agnosis and treatment of nephrolithiasis and promote personalized care in diverse populations.Methods:This cross-sectional study analyzed the medical records of 84 968 adults,stratified into three categories(low,middle,high)according to their TyG index scores.To evaluate the association between the TyG index and nephrolithiasis risk,multivariable Logistic regression models were employed,adjusting for po-tential confounders.Additionally,piecewise linear regression models were used to investigate the non-linear dynamics of the TyG index's relationship with nephrolithiasis risk.Subgroup analyses were per-formed to explore variations in the effects of the TyG index across different demographic and clinical populations.Results:Increasing TyG index was associated with a higher risk of nephrolithiasis,rising from 4.36％in the low group to 8.96％in the high group(P＜0.001).In adjusted models,males in the middle and high TyG index categories demonstrated significantly elevated risks of nephrolithiasis,with odds ratios of 1.18(95％CI:1.07-1.31,P=0.002)and 1.29(95％CI:1.15-1.45,P＜0.001),respectively.Conversely,in females,the association was not statistically significant post-adjustment(OR=0.98,95％CI:0.82-1.16,P=0.778).Among males,for each unit increment in the TyG index be-low the critical threshold of 8.98,there was a notable 40％escalation in the risk of developing nephroli-thiasis(OR=1.40,95％CI:1.24-1.58,P＜0.001).Surpassing this threshold,the TyG index no longer conferred a significant increase in risk(OR=0.91,95％CI:0.78-1.06,P=0.24).Subgroup analyses indicated that this association remained stable regardless of age,BMI,or hypertension status.Conclusion:The TyG index is positively associated with the risk of nephrolithiasis in males,demonstra-ting a nonlinear dose-response relationship that becomes especially pronounced at certain index levels.This biomarker could potentially serve as a valuable clinical tool for identifying males who are at a high risk of developing nephrolithiasis,thereby enabling targeted preventive strategies.Further research is urgently needed to explore the underlying mechanisms and to verify the applicability of these results across different populations.

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.

With the continuous advancement of the deepening reform of the medical security system, the medical insurance payment method, as an important part of it, has become the focus of the reform. As one of the main types of innovative payment methods, payment for performance combines payment and medical service quality to improve the efficiency of medical and health services and patient satisfaction. In order to accelerate the clinical application of new medical technologies, improve patients′ access to innovative technologies, and reduce the disease economic burden of patients, Shanghai has carried out a pilot reform of paying for performance for three new technologies including Cryoablation in the treatment of cancer, Da Vinic Robotic Surgical System and Plasma MicroRNA Panel detection. Through multiple rounds of expert consultation and on-the-spot investigation, the positive detection rate, complication rate and tumor reduction rate were finally determined as the performance evaluation indicators of the three technologies, and the corresponding payment standards were defined. The pilot reform in Shanghai could provide reference for other regions to carry out performance based payment.

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.

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.