Objective To establish an animal model of dampness-syndrome in mice (single model) and evaluate its characteristics of dampness-syndrome. The above-mentioned mice with dampness syndrome were used to construct mice model of ischemic stroke (double model) and observe the effect of dampness-pathogenic on the outcome of stroke. Methods Healthy C57BL/6J male mice were randomly divided into dampness-syndrome (including sham-surgery group and ischemic stroke group,with 10 mice in each group) and non dampness-syndrome groups (including sham-surgery group and ischemic stroke group,with 10 mice in each group). The dampness-syndrome group was fed with high-fat diet and the non dampness-syndrome group was fed with normal diet for 12 weeks. After the mice model of dampness-syndrome was successfully established,transient middle cerebral artery occlusion/reperfusion (tMCAO/R) surgery was used to replicate an ischemic stroke mice model. Evaluation indicators for dampness-syndrome mice model:the general status including body weight,morphology,posture,activity status,and physical characteristics,the histopathological observation of the aorta (oil red O staining,Masson-trichrome staining) and liver (HE staining,oil red O staining),electron microscopic observation of the tongue tissue (scanning electron microscopy,electron microscopy),blood lipid levels[total cholesterol(TC),triglycerides(TG)]and liver coefficient. Evaluation indicators for ischemic stroke mice model:neurological function score and the cerebral infarction volume ratio. Results Compared with the non dampness-syndrome group,the mice in the dampness-syndrome group showed an increased in body weight,poor hair color,sparse hair,fatigue and laziness,mental atrophy,anorexia and lethargy. It was observed that the aortic lumen was narrowed,the intima was significantly thickened,lipid plaque deposition was increased,and foam cells were visible. A large amount of red lipid droplets appeared in liver cells. There were obvious lipid infiltration and diffuse steatosis. Increased keratosis of the mucosal layer of tongue tissue,the thicker stratum corneum,lipofuscin,and bacteria on the tongue surface were found. Serum TG and TC levels significantly increased(P<0.01),and the liver coefficient significantly decreased (P<0.001). Compared with non dampness-syndrome group (sham-surgery group),neurological function score and the cerebral infarction volume ratio in dampness-syndrome ischemic stroke group obviously increased (P<0.001). Conclusion High-fat feeding for 12 weeks combined with tMCAO/R modeling can successfully establish a mice model with dampness-syndrome ischemic stroke,and the neurological function score and cerebral infarction volume in the dampness-syndrome ischemic stroke group was more severe than that in the non dampness-syndrome ischemic stroke group.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective:To investigate the effect of transconjunctival lower blepharoplasty combined with stromal vascular fraction-gel (SVF-gel) transplantation in suborbital rejuvenation.Methods:The clinical data of patients with suborbital rejuvenation who were admitted to the Department of Plastic Surgery, Wuhan No.1 Hospital from April 2019 to April 2021 were retrospectively analyzed. Hirmand classification of tear trough deformity was performed based on preoperative photographs. The expanded orbital septum fat was removed through the conjunctival approach, and the SVF-gel was extracted from the fat which was harvested from abdomen or thigh. The tear trough or suborbital depression was corrected by SVF-gel injection. The patients were followed up and the complications related to the operation were recorded. According to tear trough rating scale (TTRS), the depth of tear trough depression, the degree of pigmentation, the sagging degree of zygomatic fat pad and the degree of lower eyelid skin fold were scored before and after operation. The higher the total score indicates the greater severity of the lacrimal groove deformity. The morphology of the orbital-buccal junction was rated (0 to 3) according to the Barton aesthetic rating criteria. The aesthetic effects of lower eyelid bag and tear trough correction were comprehensively analyzed based on the satisfaction questionnaire (very satisfied, satisfied, dissatisfied 3 grades). SPSS 22.0 software was used for statistical analysis, and the normally distributed measurement data were represented by Mean±SD. Paired sample t-test was used to compare preoperative and postoperative TTRS scores, and P<0.05 was considered statistically significant. Results:A total of 92 patients with bilateral lower eyelid bag accompanied by tear trough or middle facial depression were included. There were 15 males and 77 females, aged (38.8±9.6) years (21-55 years). Preoperative Hirmand tear trough classification was performed as type Ⅱ in 37 cases, as type Ⅲ in 55 cases. All patients had conjunctival edema and lower eyelid swelling of different degrees 3 days after surgery, among which 35 patients had skin ecchymosis of different degrees, which recovered spontaneously 1 to 2 weeks after surgery, and no complications such as hematoma, diplopia, fat liquefaction, fat nodule and fat embolism occurred. Postoperative follow-up was conducted for 6 to 12 months. Comparison of preoperative and postoperative TTRS scores: compared with preoperative results, the TTRS scores of Hirmand type Ⅱ patients [(2.37±0.78) points vs. (4.83±0.98) points, t=36.54, P<0.001] and type Ⅲ patients [(2.61±0.60) points vs. (5.38±0.93) points, t=55.20, P<0.001] were significantly decreased after surgery, and the differences were statistically significant. Comparison of Barton aesthetic rating before and after surgery: for Hirmand type Ⅱ patients, preoperative rating was grade 1 in 7 cases, grade 2 in 19 cases, grade 3 in 11 cases, and postoperative improvement was grade 0 in 36 cases and grade 1 in 1 case; for Hirmand type Ⅲ patients, preoperative ratings were grade 2 in 20 cases, grade 3 in 35 cases, and postoperative improvement was grade 0 in 50 cases, grade 1 in 5 cases. Postoperative patient satisfaction survey: 85 cases (92.4%) were very satisfied, 5 cases (5.4%) were satisfied, 2 cases (2.2%) were dissatisfied. For the 2 patients who were not satisfied, one patient had no obvious improvement due to tear trough deformity, and was filled with SVF-gel for the second time 3 months later, achieving satisfactory results. One patient still had baggy eye on the outer side of the lower eyelid after surgery, which was corrected again 3 months later and achieved satisfactory results. Conclusion:For patients with lower eyelid bag with tear trough or suborbital depression without obvious skin relaxation, lower eyelid bag correction through conjunctival approach combined with SVF-gel transplantation can achieve the effect of rejuvenation of the suborbital region.

Objective:To investigate the effect of transconjunctival lower blepharoplasty combined with stromal vascular fraction-gel (SVF-gel) transplantation in suborbital rejuvenation.Methods:The clinical data of patients with suborbital rejuvenation who were admitted to the Department of Plastic Surgery, Wuhan No.1 Hospital from April 2019 to April 2021 were retrospectively analyzed. Hirmand classification of tear trough deformity was performed based on preoperative photographs. The expanded orbital septum fat was removed through the conjunctival approach, and the SVF-gel was extracted from the fat which was harvested from abdomen or thigh. The tear trough or suborbital depression was corrected by SVF-gel injection. The patients were followed up and the complications related to the operation were recorded. According to tear trough rating scale (TTRS), the depth of tear trough depression, the degree of pigmentation, the sagging degree of zygomatic fat pad and the degree of lower eyelid skin fold were scored before and after operation. The higher the total score indicates the greater severity of the lacrimal groove deformity. The morphology of the orbital-buccal junction was rated (0 to 3) according to the Barton aesthetic rating criteria. The aesthetic effects of lower eyelid bag and tear trough correction were comprehensively analyzed based on the satisfaction questionnaire (very satisfied, satisfied, dissatisfied 3 grades). SPSS 22.0 software was used for statistical analysis, and the normally distributed measurement data were represented by Mean±SD. Paired sample t-test was used to compare preoperative and postoperative TTRS scores, and P<0.05 was considered statistically significant. Results:A total of 92 patients with bilateral lower eyelid bag accompanied by tear trough or middle facial depression were included. There were 15 males and 77 females, aged (38.8±9.6) years (21-55 years). Preoperative Hirmand tear trough classification was performed as type Ⅱ in 37 cases, as type Ⅲ in 55 cases. All patients had conjunctival edema and lower eyelid swelling of different degrees 3 days after surgery, among which 35 patients had skin ecchymosis of different degrees, which recovered spontaneously 1 to 2 weeks after surgery, and no complications such as hematoma, diplopia, fat liquefaction, fat nodule and fat embolism occurred. Postoperative follow-up was conducted for 6 to 12 months. Comparison of preoperative and postoperative TTRS scores: compared with preoperative results, the TTRS scores of Hirmand type Ⅱ patients [(2.37±0.78) points vs. (4.83±0.98) points, t=36.54, P<0.001] and type Ⅲ patients [(2.61±0.60) points vs. (5.38±0.93) points, t=55.20, P<0.001] were significantly decreased after surgery, and the differences were statistically significant. Comparison of Barton aesthetic rating before and after surgery: for Hirmand type Ⅱ patients, preoperative rating was grade 1 in 7 cases, grade 2 in 19 cases, grade 3 in 11 cases, and postoperative improvement was grade 0 in 36 cases and grade 1 in 1 case; for Hirmand type Ⅲ patients, preoperative ratings were grade 2 in 20 cases, grade 3 in 35 cases, and postoperative improvement was grade 0 in 50 cases, grade 1 in 5 cases. Postoperative patient satisfaction survey: 85 cases (92.4%) were very satisfied, 5 cases (5.4%) were satisfied, 2 cases (2.2%) were dissatisfied. For the 2 patients who were not satisfied, one patient had no obvious improvement due to tear trough deformity, and was filled with SVF-gel for the second time 3 months later, achieving satisfactory results. One patient still had baggy eye on the outer side of the lower eyelid after surgery, which was corrected again 3 months later and achieved satisfactory results. Conclusion:For patients with lower eyelid bag with tear trough or suborbital depression without obvious skin relaxation, lower eyelid bag correction through conjunctival approach combined with SVF-gel transplantation can achieve the effect of rejuvenation of the suborbital region.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Child ; Humans ; Malacoplakia/pathology* ; Intestines/pathology*

Objective:To investigate the diagnostic value of independent and combined subtests of the psychometric hepatic encephalopathy score (PHES) in mild hepatic encephalopathy(MHE) of patients with liver cirrhosis, so as to optimize the PHES.Methods:This was a prospective, multicenter and real-world study which was sponsored by the National Clinical Research Center of Infectious Diseases and the Portal Hypertension Consortium. Twenty-six hospitals from 13 provinces, autonomous regions and municipalities countrywide participated in this study, induding Tianjin Third Central Hospital, the Fourth People′s Hospital of Qinghai Province, the Second Affiliated Hospital of Baotou Medical College, the Third People′s Hospital of Taiyuan, the Fifth Medical Center of PLA General Hospital and so on. From October 2021 to February 2022, outpatients and hospitalized patients with liver cirrhosis and no obvious hepatic encephalopathy were consecutively enrolled. All patients received 5 PHES subjects in the same order: number connection test(NCT)-A, NCT-B, digit symbol test(DST), line tracing test(LTT) and serial dotting test(SDT), and the scores were calculated. The total score of PHES <-4 was taken as the cut-off value for diagnosing MHE. Compare the differences in each subtest between MHE group and non-MHE group. Receiver operating characteristic curve(ROC) and area under the curve(AUC) was performed to assess the diagnostic value of independent and combined subtests in MHE. Mann-Whitney U test and DeLong test were used for statistical analysis. Results:A total of 581 patients with liver cirrhosis were enrolled, 457 were diagnosed as MHE, and the incidence of MHE was 78.7%. The results of NCT-A, NCT-B, SDT, LTT, DST of MHE group were 60.00 s(47.01 s, 88.00 s), 90.45 s(69.32 s, 125.35 s), 74.00 s(57.65 s, 96.60 s), 74.72(60.00, 98.61) and 27.00(20.00, 36.00), respectively. Compared those of non-MHE group(34.00 s(29.15 s, 44.48 s), 50.00 s(40.98 s, 60.77 s), 50.00 s(41.07 s, 63.03 s), 46.23(38.55, 59.42) and 42.00(34.00, 50.75)), the differences were statistically significant( Z=12.37, 12.98, 9.83, 11.56, 10.66; all P<0.001). The AUC(95% confidence interval(95% CI)) of subtests of PHES NCT-B, NCT-A, LTT, DST and SDT alone in MHE diagnosis were 0.880(0.849 to 0.910), 0.862(0.828 to 0.896), 0.838(0.799 to 0.877), 0.812(0.772 to 0.851) and 0.788(0.743 to 0.832), respectively. The combination of 2 PHES subtests significantly increased the diagnostic efficacy. Among them the diagnostic efficacy of the combination of NCT-B and LTT was the best, the AUC(95% CI) was 0.924(0.902 to 0.947), the specificity was 91.9% and the sensitivity was 79.2%, which was better than a single PHES subtest (NCT-A, NCT-B, SDT, LTT and DST) and the combination of NCT-A and DST(AUC was 0.879, 95% CI0.847 to 0.910) which was recommended by guidelines on the management of hepatic encephalopathy in cirrhosis, the differences were statistically significant ( Z=3.78, 3.83, 5.57, 5.51, 5.38, 2.93; all P<0.01). Furthermore, compared between the combination of NCT-B and LTT and the combination of 3 subests of PHES, only the diagnostic efficacy of combination of NCT-B, LTT and SDT (AUC was 0.936, 95% CI 0.916 to 0.956) was better than that of the combination of NCT-B and LTT, the difference was statistically significant( Z=2.32, P=0.020). Conclusion:Based on the diagnostic efficacy and clinical feasibility of PHES subtests and their combinations, the combination of NCT-B and LTT is recommended for the diagnosis of MHE.

Child ; Consensus ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional ; Respiratory System

Objective:To evaluate partial ventral hepatectomy in the treatment of patients with complicated iatrogenic high bile duct injury.Methods:The clinical data of 8 cases of complicated iatrogenic high bile duct injury treated with the assistance of hepatic ventral segmentectomy from Mar 2013 to May 2020 at Hunan Provincial People's Hospital was retrospectively analyzed.Results:Among the 8 patients, 5 patients underwent partial Ⅳb lobectomy, and 3 patients received partial Ⅳb and Ⅴ segmentectomy of the liver. All the operation was successful without death in hospital. One case developed subphrenic infection and seroperitoneum, which was healed by anti-infection treatment and abdominocentesis. The postoperative follow-up time was 5-90 months, and all of patients are doing well. There was no stenosis in intrahepatic bile duct by postoperative cholangiography or MRI.Conclusions:Quadrate lobe hepatectomy provides a wide view for the treatment of complicated iatrogenic high bile duct injury by fully opening the first porta hepatis and exposing the primary and secondary bile duct branch helping establish a wide patent tension free bile duct-jejunostomy.

OBJECTIVES: To study the effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia. METHODS: A retrospective analysis was performed on the medical data of the neonates with asphyxia who were admitted to 52 hospitals in Hubei Province of China from January to December, 2018 and had blood glucose data within 12 hours after birth. Their blood glucose data at 1, 2, 6, and 12 hours after birth (with an allowable time error of 0.5 hour) were recorded. According to the presence or absence of brain injury and/or death during hospitalization, the neonates were divided into a poor prognosis group with 693 neonates and a good prognosis group with 779 neonates. The two groups were compared in the incidence of glucose metabolism disorders within 12 hours after birth and short-term prognosis. RESULTS: Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of neonates from secondary hospitals (48.5% vs 42.6%, CONCLUSIONS Recurrent hyperglycemia in neonates with asphyxia may suggest poor short-term prognosis, and it is necessary to strengthen the early monitoring and management of the nervous system in such neonates.
Asphyxia ; Asphyxia Neonatorum/epidemiology* ; Humans ; Hyperglycemia ; Infant, Newborn ; Prognosis ; Retrospective Studies