ObjectiveTo investigate the diagnostic accuracy and grading capability of ultrasound-derived fat fraction （UDFF）， controlled attenuation parameter （CAP）， and hepatic/renal ratio （HRR） in assessing hepatic steatosis in metabolic associated fatty liver disease （MAFLD） with magnetic resonance imaging-proton density fat fraction （MRI-PDFF） as the gold standard. MethodsA total of 150 patients with MAFLD who attended The First Hospital of Hebei Medical University from January 2023 to December 2024 were enrolled， and 148 healthy volunteers were recruited. All subjects underwent MRI-PDFF， UDFF， CAP， and HRR examinations. Hepatic steatosis was graded based on MRI-PDFF （S0：148 cases； S1：92 cases； S2：21 cases； S3：37 cases）， and the MAFLD patients with different grades of hepatic steatosis were compared in terms of UDFF， CAP， HRR， and clinical features. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups and the Tukey HSD test was used for further comparision between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups， and the Mann-Whitney U test was used for further comparison between two groups； the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was used to investigate the correlation between UDFF， CAP， HRR， and MRI-PDFF in different grades of MAFLD； the receiver operating characteristic （ROC） curve was used to investigate the efficacy of UDFF， CAP， and HRR in the diagnosis of different degrees of hepatic steatosis in MAFLD； the Bland-Altman difference plot was used to analyze the consistency between UDFF and MRI-PDFF in different degrees of hepatic steatosis in MAFLD. ResultsUDFF measurement gradually increased with the increase in the grade of fatty liver （H=201.52，P0.001）. The Spearman correlation analysis showed that there was a strong correlation between any two indicators of UDFF， CAP， HRR， and MRI-PDFF in S1， S2， and S3 MAFLD （all P0.001）， with the strongest correlation between UDFF and MRI-PDFF （r_s1=0.884，r_s2=0.962，r_s3=0.929， all P0.001）. The ROC curve analysis showed that UDFF had a larger area under the ROC curve （AUC） than CAP and HRR in the graded diagnosis of S1 and S3 （all P0.05）， while in the diagnosis of S2 MAFLD， UDFF had a significantly larger AUC than HRR （P0.05） and a similar AUC to CAP （P0.05）. The Bland-Altman difference plot showed good consistency between UDFF and MRI-PDFF in different degrees of hepatic steatosis in MAFLD. ConclusionCompared with CAP and HRR， UDFF can accurately measure liver fat content and has good efficacy in identifying varying degrees of hepatic steatosis in MAFLD.

Objective To explore the application of painless diagnosis and treatment technology in children's peripherally inserted central catheter(PICC)guided by ultrasound.Methods Totally 82 children who planned to undergo PICC in the hospital from January 2021 to January 2023 were selected and randomly divided into a control group and an observation group using a random number table method,with 41 cases in each group;The control group underwent conventional ultrasound guided PICC catheterization,while the observation group underwent painless diagnostic and therapeutic techniques using ultrasound guided PICC catheterization;Compare the success rate of catheterization,completion time of catheterization,degree of pain in the child pain[children's pain behavior scale(FLACC)],tolerance[Houpt behavior scale(HBS)],compliance[Frankl scale(FCS)],and family satisfaction between the two groups.Results The success rate of catheterization in the observation group was higher than that in the control group,and the catheterization time was shorter than that in the control group,with a statistically significant difference(P<0.05).The FLACC score of the observation group was lower than that of the control group,while the HBS score and FCS score were higher than those of the control group,with a statistically significant difference(P<0.05);The total satisfaction of family members in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The use of painless diagnosis and treatment technology in ultrasound-guided PICC catheterization in children can improve the success rate of catheterization,shorten the catheterization time,reduce the degree of pain in children,enhance tolerance and compliance,and improve family satisfaction.

Objective:To establish a time control mode for component blood collection and to discuss its application value in the operation management of blood separator.Methods:The causes for delay in blood separation time in blood component collection were analyzed,the correlation between influencing factors and time control level was analyzed by using data mining algorithm,and time control management countermeasures were developed by running time prediction.A total of 600 blood donors and 17 blood separators in clinical use in Shanghai Xuhui District Central Hospital from 2019 to 2022 were selected and divided into a control group(300 blood donors,14 blood separators)and an observation group(300 blood donors,15 blood separators,including 12 of control groups and 3 newly added)according to different management modes.The control group adopted the quality control mode,the observation group adopted the time control mode.The number of problems,the proportion of delay,the number of satisfied people and the assessment results of relevant medical staff in the blood component collection process were compared between the two groups.Results:The number of blood donors with problems related to equipment,medical consumables,medical staff and blood donors during the blood component collection process in the observation group was 11(accounting for 3.7%),17(accounting for 5.7%),7(accounting for 2.3%)and 18(accounting for 6.0%),respectively,which were lower than those in the control group,the difference was statistically significant(x2=7.192,6.822,8.153,11.405,P<0.05).The number of blood donors whose blood separators were in normal operation,apparent delay and significant delay in the observation group were 236(accounting for 78.7%),46(accounting for 15.3%)and 18(accounting for 6.0%),respectively,and the proportions of normal operation were higher than those in the control group,the proportions of apparent delay and significant delay were lower than those in the control group,the difference was statistically significant(x2=17.821,7.131,8.549,P<0.05).The proportion of blood donors satisfied was 284(accounting for 94.7%)in the observation group,which was higher than that in the control group,the difference was statistically significant(x2=30.171,P<0.05).The assessment score of medical staff involved in blood donors in the observation group was(91.14±4.86),which was higher than that in the control group,the difference was statistically significant(t=4.587,P<0.05).Conclusion:Time control mode can control the probability of the problems in the operation of blood separator,shorten the delay time of blood separator operation,improve blood donation experience of blood donors and blood collection service quality,and improve the professional level of medical staff.

Objective: To evaluate the effectiveness and safety of modified Xiaoyao powder for postpartum depression (PPD) by conducting a systematic review of randomized controlled trials (RCTs). Methods: The Chinese National Knowledge Infrastructure Databases (CNKI), the Chinese Scientific Journals Database (VIP), Wanfang, Google Scholar, the SinoMed, Embase, Cochrane Library, and PubMed databases were searched from their inception to April 25, 2023. The Cochrane Risk of Bias tool was used to assess the quality of the trials. We applied the risk ratio to present dichotomous data and the mean difference to present continuous data. Data with similar characteristics were pooled for meta-analysis and heterogeneity was assessed using I2. Results: This review included 35 trials involving 2848 participants. The quality of the included studies was low (unclear randomization processes and insufficient reporting of blinding). Participants treated with modified Xiaoyao powder plus Western medicine showed lower Hamilton Depression Scale (HAMD) depression score than those who used Western medicine alone (mean difference = −2.15; 95% confidence interval:−2.52 to 1.78; P < .00001), and higher effective rate (relative risk = 1.19; 95% confidence interval: 1.15 to 1.24; P < .00001), When comparing modified Xiaoyao alone with Western medicine, the HAMD depression score remained low, however, the efficacy rate was higher in the modified Xiaoyao group. Regarding adverse events, the modified Xiaoyao group reported weight gain, nausea, and diarrhea, but no severe adverse events were reported. Conclusion Modified Xiaoyao may help relieve depression in PPD when used alone or in combination with Western medicine, with minor side effects. Therefore, future high-quality, large-sample size RCTs are warranted.

Objective To explore the value of CT enterography(CTE)in the clinical treatment efficacy evaluation of Crohn's disease(CD).Methods A total of 55 patients with CD confirmed by clinical and pathology were selected.All patients both underwent CTE and enteroscopy before and after treatment.After treatment,the patients were divided into the good curative effect group and the poor curative effect group according to Crohn's disease activity index(CDAI).The CT findings were both analyzed before and after treatment.Results There were significant differences in bowel wall thickness,bowel wall attenuation,bowel wall thickness type and"comb sign"of 55 CD patients before and after treatment(P＜0.05).After treatment,phlegmon,abscess,swollen lymph node enlargement,and intestinal fistula all decreased from 18％,7％,27％,and 2％to 2％,2％,9％,and 0％,respectively.Also,there were significant differences in bowel wall thickness,bowel wall attenuation,bowel wall thickness type and"comb sign"between the good curative effect group and the poor curative effect group(P＜0.05).Logistic regression analysis and receiver operating characteristic(ROC)curve analysis showed bowel wall thickness,bowel wall attenuation and bowel wall thickness type were the most valuable parameters for the treatment efficacy evaluation of CD patients.Conclusion CTE can fully show intestinal lesions and extrenteral complications,and is of great value in evaluating clinical treatment efficacy of patients.

Objective To explore the effect of controlled low central venous pressure(CLCVP)on venous congestion and postoperative acute kidney injury(AKI)in cardiac surgery under cardiopulmonary bypass(CPB).Methods A total of 137 patients scheduled for elective cardiac surgery under general anes-thesia with CPB were selected,including 73 males and 64 females,aged 18 to 70 years,with a BMI of 20 to 28 kg/m2,and ASA physical status Ⅱ or Ⅲ.The patients were randomly assigned into two groups:the controlled low central venous pressure group(group CL,n=68)and the control group(group C,n=69).In group CL,CLCVP was applied by pumping nitroglycerin to reduce CVP to below 10 mmHg after 20 minutes of CPB cessation until the end of surgery.If necessary,norepinephrine was applied to maintain MAP≥65 mmHg.Patients in group C received standardized anesthesia management.Urine samples were collected before anesthesia induction and 12 hours postoperatively to detect the concentration of kidney injury molecule-1(KIM-1).Urine samples were also collected before anesthesia induction and 2 hours postopera-tively to detect the concentration of neutrophil gelatinase-associated lipocalin(NGAL).Cumulative time a-bove 10,12,16,and 20 mmHg and time-weighted average CVP were used to assess venous congestion.The occurrence of postoperative AKI,stage 2 or above AKI,renal replacement therapy(CRRT),postoperative low cardiac output syndrome(LCOS),acute kidney injury following cardiac surgery(AKICS)score when arriving in ICU,in-hospital mortality,ICU stay,and postoperative hospital stay were recorded.Results Compared with group C,the cumulative time of CVP above 10,12,16,and 20 mmHg after CPB in group CL was significantly shorter,and the time-weighted average CVP was significantly lower(P＜0.05).AKI occurred in 9 patients(13.2%)in group CL and 15 patients(21.7%)in group C postoperatively,and there was no significant difference between the two groups.One case(1.5%)of stage 2 or above AKI oc-curred in group CL and 2 patients(2.9%)in group C,with one patient in group C requiring CRRT.Com-pared with group C,the concentrations of KIM-1 at 12 hours postoperatively and NGAL at 2 hours postoper-atively were significantly lower in group CL(P＜0.05).There were no statistically significant differences between the two groups in LCOS,AKICS score,in-hospital mortality,ICU stay,and postoperative hospital stay.Conclusion Controlled low central venous pressure in cardiac surgery under cardiopulmonary bypass can reduce venous congestion and decrease the occurrence of postoperative renal injury,thereby exerting a certain renal protective effect.

Objective To explore the changes and significane of USP20 and HIF-α expression in breast cancer.Methods Following transfection of shRNA-USP20 lentivirus into breast cancer MDA-MB-231 cells,the gene and protein expression levels of USP20 were detected using fluorescence quantitative PCR and Western Blot.Subsequently,the overexpression of USP20 was observed to determine its effect on HIF-α expression.Similarly,siRNA-USP20 was used to knock down USP20 in breast cancer MDA-MB-231 cells,followed by detection of gene and protein expression levels using fluorescence quantitative PCR and Western Blot.The subsequent changes in HIF-α expression were then examined.Rusults The positive expression rates of USP20 and HIF-α in breast cancer tissues were 69.6%and 46.83%,respectively,while they were negatively expressed in the adjacent normal tissues,with statistically significant differences(P＜0.01).The positive expressions of USP20 and HIF-α were predomi-nantly observed in the cytoplasm of breast cancer tissue,with a smaller amount present in the nucleus.There was a significant positive correlation between USP20 and HIF-α in breast cancer.Following transfection of shRNA-USP20 lentivirus into MDA-MB-231 cells,both the protein and gene expression levels of USP20 significantly increased(P＜0.01).Over-expression of USP20 did not affect HIF-α mRNA levels but led to a significant increase in HIF-α protein expression(P＜0.01).Conversely,siRNA-USP20 interference resulted in a significant decrease in both the protein and gene expression levels of USP20(P＜0.01),without affecting HIF-α mRNA levels;however,it caused a notable reduction in HIF-α protein expression(P＜0.01).Conclusion The expression of USP20 exhib-ited a significant positive correlation with HIF-α in breast cancer.Overexpression of USP20 led to a substantial increase in HIF-α protein expression,while knock-down of the USP20 gene resulted in a significant decrease in HIF-α protein levels.Therefore,it can be inferred that USP20 may exert its influence on the development of breast cancer through modulation of HIF-α expression,thereby providing crucial experimental evidence for clinical treat-ment,prognosis,and further investigations.

Objective To analyze the differences in the initial stability of an acetabular cup with a Voronoi polyhedral porous structure and a solid acetabular cup and to explore the impact of the Voronoi polyhedral porous layer on the initial stability of the acetabular cup,as well as its role in preventing loosening and dislocation.Methods Voronoi polyhedral porous scaffold structures with 60％and 70％porosities were designed using the Grasshopper software.Specimens of porous acetabular cups with 60％and 70％porosities and solid acetabular cups were manufactured using selective laser melting technology.Lever tests on the acetabular cups were conducted using polyurethane block models under identical conditions,and the maximum lever-out moment,angular displacement,and interface stiffness of the three groups of specimens were analyzed and compared.Results Under the condition of no significant differences in the compression force,for porous acetabular cups with porosities of 60％and 70％,the maximum lever-out moment increased by 278.82％and 320.56％,the angular displacement increased by 194.04％and 269.23％,respectively,and the interface stiffness increased by 18.58％and 7.88％,respectively,compared with that of solid acetabular cups.After the lever-out tests were completed,significant wear was observed within the polyurethane block hemisphere cavity using the porous acetabular cups.Conclusions The initial stability indicators of acetabular cups with a Voronoi polyhedral porous structure were higher than those of solid acetabular cups,indicating that the Voronoi polyhedral porous layer can enhance the initial stability of the acetabular cup.These results provide a reference for designing and selecting acetabular components.

Mycoplasma pneumoniae ( Mp) is an important pathogen causing community-acquired pneumonia. Macrolide is the first choice for the treatment of Mycoplasma pneumoniae pneumonia (MPP), while second-line drugs like tetracyclines or quinolones will be considered for pneumonia caused by macrolide-resistant Mycoplasma pneumoniae (MRMP). The isolation rate of MRMP has increased dramatically worldwide. Data from domestic and abroad indicate that MRMP is highly prevalent in Asian regions such as Japan, China, and Korea. The main mechanism of drug resistance in Mp is mutation A2063G of 23S rRNA V. In addition, mutations in the ribosomal protein L4 and L22 genes, ribosomal methylation modifications and the formation of efflux pumps are also significant drug resistance mechanisms. In this study, we summarize the treatment of MPP, the epidemiology of MRMP and the research progress of its mechanisms systematically.

OBJECTIVE: To explore the clinical characteristics and genetic basis of two brothers featuring X-linked alpha thalassemia mental retardation (ATR-X) syndrome. METHODS: An infant who had presented at the Qilu Children's Hospital in 2020 for unstable upright head and inability to roll over and his family were selected as the study subjects. The clinical features of the child and one of his brothers were summarized, and their genomic DNA was subjected to targeted capture and next generation sequencing (NGS). RESULTS: The brothers had presented with mental retardation and facial dysmorphisms. NGS revealed that they had both harbored a hemizygous c.5275C>A variant of the ATRX gene located on the X chromosome, which was inherited from their mother. CONCLUSION The siblings were diagnosed with ATR-X syndrome. The discovery of the c.5275C>A variant has enriched the mutational spectrum of the ATRX gene.
Humans ; Infant ; Male ; alpha-Thalassemia/diagnosis* ; Ataxia Telangiectasia Mutated Proteins/genetics* ; East Asian People ; Intellectual Disability/genetics* ; Mental Retardation, X-Linked/diagnosis* ; Pedigree ; X-linked Nuclear Protein/genetics*