Objective To evaluate cerebral parenchymal atrophy of patients with Alzheimer's disease(AD)through the compara-tive analysis of the volume and morphology of the brain ventricle between patients with AD and normal elderly.Methods 20 patients with AD and 20 normal elderly people were scanned at 3.0T MR,and lateral ventricle section images were achieved,and the lateral ventricle volume and the anterior horn,posterior horn and temporal horn of the lateral ventricle were calculated by analyzing the re-construction of section images with MIMICS software from Belgian.Results As compared with normal elderly group,the patients with AD exhibited significantly increased the volume of left ventricular volume(LV),right ventricular volume (RV)and total vol-ume (TV)(P<0.05).Angle of bilateral anterior horn and temporal horn but not posterior horn of the lateral ventricle in patients with AD were significantly higher than that in normal elderly (P<0.05).The volume of the left,right and total cerebral ventricle, the angle of the anterior horn of the left and right lateral ventricle and the angle of the temporal horn of the left and right lateral ven-tricle were negatively correlated with MMSE (P<0.05).Conclusion Patients with AD exhibites significantly greater volume and an-gle of the lateral ventricular than normal elderly people.These related data measured can predict brain parenchymal atrophy of pa-tients with AD more conveniently and accurately.

Objective To investigate the practical value of a logistic regression model of serum indexes in distinguishing between geriatric depression and geriatric depressive state. Methods A total of 160 patients were recruited from the outpatient department from January 2013 to January 2016 ,and were divided into a depression group (n= 80)and a depressive state group (n= 80) ,with retrospective diagnoses based on the Chinese Classification of Mental Disorders-Third-Edition(CCMD-3).Serum samples were collected and enzyme linked immunosorbent assays (ELISA)were used to determine the concentrations of brain-derived neurotrophic factor (BDNF ) ,glial cell line-derived neurotrophic factor(GDNF) ,fibroblast growth factor 2(FGF-2) ,vascular endothelial growth factor (VEGF) ,interleukin-1β(IL-1β) ,interleukin-6 (IL-6) ,interleukin-10 (IL-10) ,tumor necrosis factor-α(TNF-α) ,cortisol (CORT ) ,and platelet-derived growth factor (PDGF).Binary logistic regression analysis was used to establish the regression model ,and the ROC curve was drawn to explore its value of differentiating geriatric depression from depressive state. Results The levels of serum BDNF , GDNF and VEGF in the depression group were lower than those in the depressive state group (BDNF :208.7 ± 41.4 vs.262.9 ± 84.6 ng/L ,GDNF :92.3 ± 18.6 vs. 101.4 ± 30.9 ng/L ,VEGF :223.1 ± 98.2 vs. 257.8 ± 77.2ng/L) ,while the levels of IL-1βand CORT in the depression group were higher than in the depressive group(IL-1β:27.0 ± 4.9 vs.19.6 ± 5.7 μg/L ,CORT :96.3 ± 16.7 vs.83.0 ± 17.3 nng/L).In multivariate logistic regression analysis ,BDNF(OR = 0.987 ,P = 0.001) ,IL-1β(OR =1.29 ,P = 0.000)and CORT (OR = 1.065 ,P = 0.000)were selected to build the regression model. The regression equation was P=1/[1+e-(- 8.546 - 0.013(BDNF)+ 0.258(IL -1β)+ 0.063(CORT)) ]and the area under the ROC curve was 0.966.Compared with retrospective diagnoses made two weeks later ,the correct diagnosis rate of the logistic model was 90.47％. Conclusions The Logistic regression model of serum indexes can further differentiate between geriatric depression and depressive state which also offers additional benefits for the diagnosis ,differential diagnosis ,and treatment of depression.

Objective To investigate the variation of serum fibroblast growth factor-22 (FGF-22) of first episode depressive patients before and after treatment,and its relations with serotonin (5-HT) and interleukin-1[β (IL-1β) levels and Hamilton's depression scale (HAMD) scores to provide assistance for further study of pathogenesis of depression.Methods Ninety patients with first episode depression accepted treatment in our hospital from June 2015 to June 2016 and 90 healthy controls were enrolled.The serum FGF-22 level was detected and Hamilton's depression scale (HAMD) was performed before and after drug treatment.The relations of FGF-22 level with 5-hydroxytryptamine (5-HT) and interleukin (IL)-1[β levels were analyzed.Results (1) Before treatment,the first episode depressive patients had significantly lower scrum FGF-22 level ([180.44±17.02] ng/mL) and statistically higher HAMD scores (17.84±5.92) as compared with the healthy controls ([200.74±16.63] ng/mL,1.88±2.67,P＜0.05).(2) The serum FGF-22 level after treatment ([195.74+19.57] ng/mL) was significantly higher than that before treatment,and the HAMD scores after treatment (7.64±4.09) were significantly lower than those before treatment (P＜0.05).(3) In the patient group,serum FGF-22 level and HAMD scores were negatively correlated (r=-0.644,P=0.000);serum FGF-22 level had positive correlation with 5-HT level (r=0.718,P=0.000),and negative correlation with IL-1β level (r=-0.763,P=0.000).Conclusion The serum FGF-22 level is abnormal in first episode depressive patients,and it could be a good indicator of peripheral blood in response to depression,which plays an important role in the pathogenesis of depression.

In this paper, cobalt chloride was used to stimulate human umbilical vein endothelial cells (HUVEC) to establish a model of abnormal hypoxic injury, to investigate the effect of heparin-derived oligosaccharides (HDO) on glycolysis in HUVEC cells and its molecular mechanism.The experiment was divided into the control group (FBS-free DMEM medium), the model group (FBS-free DMEM medium +50 μmol/L CoCl2), and the HDO group (modeling+0.01, 0.1, 1 μmol/L HDO).Firstly, a biochemical kit was used to detect the effects of HDO on glucose uptake and lactic acid accumulation in HUVEC cells, then Western blot and qPCR were used to detect the effects of HIF-1α, GLUT-1 and LDHA gene transcription and protein expression, and finally, PI3K/Akt signaling pathway was detected.The results showed that HDO inhibited glucose uptake and lactate production, down-regulated the expression of HIF-1α, GLUT-1, and LDHA, and affected the activation of the PI3K/Akt signaling pathway.HDO could regulate the glycolysis level of HUVEC cells by inhibiting the activation of the PI3K/Akt/HIF-1α signaling axis.

The European Association for the Study of Liver Diseases issued the "Clinical Practice Guidelines for the Management of Hepatic Encephalopathy" in 2022, which included recommendations for clinical diagnosis, assessment, treatment, management, and prevention. The Society’s "Hepatic Encephalopathy Clinical Practice Guidelines in Chronic Liver Disease," which was last published in 2014, and the "Guidelines for the Diagnosis and Treatment of Hepatic Encephalopathy in Cirrhosis," which the Chinese Society of Hepatology, Chinese Medical Association, released in 2018, have certain differences and updates in terms of comparison to terminology, grading and classification, diagnosis, clinical evaluation and treatment, management, and prevention. Herein, the updated points of this guideline and the differences between it and our nation’s guidelines are summarized in order to refine and understand the guiding role of the new version of the guideline for the clinical treatment of hepatic encephalopathy and provide aid for standardizing clinical diagnosis and treatment.

Objective:To assess the prognostic impact of frailty on elderly inpatients with heart failure.Methods:This prospective cohort study enrolled 121 in elderly patients with heart failure from Beijing Hospital, the General Hospital of the People's Liberation Army, and Beijing Tsinghua Changgung Hospital between September 2018 and April 2019.Patients were assessed for frailty using the Fried frailty phenotype and categorized into frail and non-frail groups.Follow-ups were conducted at 3-, 6-, and 12-months post-enrollment through clinic visits or phone calls to record adverse events.Composite endpoints include all-cause mortality and rehospitalization duo to deterioration of heart failure.Results:The study included 121 patients with an average age of 78.0±7.4 years, of whom 71(58.7%)were male and 57(47.1%)were classified as frail.Compared to the non-frail group, the frail group had lower estimated glomerular filtration rates[49.5±20.7 ml/(min·1.73m 2) vs.(64.0±27.1)ml/(min·1.73m 2)], lower scores in Basic Activities of Daily Living[5.0(4.0, 6.0) vs.6.0(5.0, 6.0)], Instrumental Activities of Daily Living[2.0(1.3, 7.8) vs.7.0(5.0, 8.0)], and Mini-Mental State Examination[26.0(16.0, 28.0) vs.27.0(22.3, 29.0)], all P<0.05.They also experienced longer hospital stays[10.5(6.0, 18.8)days vs.8.0(6.0, 11.8)days, P=0.008].During the follow-up period, the incidence of composite endpoint events was significantly higher in the frail group(43.9% vs.25.0%, P=0.029).Kaplan-Meier survival analysis demonstrated that the one-year incidence of composite endpoint events was significantly higher in the frail group( P=0.013).Multivariable Cox regression analysisindicated that frailty was an independent risk factor for composite endpoint events( HR=2.201, 95% CI: 1.089-4.447, P=0.028). Conclusions:Frailty is an independent risk factor for poor outcomes in elderly hospitalized patients with heart failure and should be considered a crucial factor in clinical assessment and treatment strategies.

In 2022, the European Association for the Study of the Liver issued Clinical practice guidelines on sclerosing cholangitis. With reference to the 2017 edition of Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline (2017) and in comparison to the corresponding contents in Guidelines on the diagnosis and management of primary sclerosing cholangitis (2021) issued by Chinese Society of Hepatology, Chinese Medical Association, in 2021, this article summarizes the updates in diagnosis, treatment, monitoring, and management of special populations and analyzes the basis for updated recommendations and their guiding significance in optimizing the clinical management of primary sclerosing cholangitis (PSC). The comparative analysis shows that the new version of the guidelines is similar to the Chinese guidelines in terms of diagnosis, treatment, and follow-up, and it is worth learning from the technical details such as the recommended dose of ursodeoxycholic acid and long-term follow-up plan. Since PSC is a chronic refractory disease, the drugs recommended by current guidelines cannot delay or reverse disease progression, and there is still a lack of consensus statements on immunotherapy and screening protocols for end-stage complications, which might be the directions for further research.

Proton pump inhibitors (PPIs) are commonly used in clinical practice and are currently widely used in people with acute-on-chronic liver failure (ACLF). However, such medication is still not supported by the recommendations in the latest version of Clinical guidelines for acute-on-chronic liver failure issued by American College of Gastroenterology. With reference to the guidelines or consensus statements in China and globally and the latest research advances, this article elaborates on the indications, possible benefits, and potential risks of PPIs used in people with ACLF, in order to provide a reference for the standardized use of PPIs in the population with ACLF in clinical practice.

Objective To review and analyze the effect of probiotics in preventing the overt hepatic encephalopathy (OHE) in patients with minimal hepatic encephalopathy (MHE). Methods Studies about this subject were searched in PubMed, Web of Science, Cochrane Library, Chinese journal full-text database (CNKI), WanFang data knowledge service platform (WanFang Data) from their establishment to November 2021. Meta-analysis was performed using RevMan 5.4. Description analysis was used for data that could not be pooled. The relative risk ( RR ) and 95% confidence interval ( CI ) were used to present pooled data. Results Six RCT studies with a total of 404 patients were included in this meta-analysis. The results showed probiotics users had a significant reduction of the OHE incidence, as compared with the controls ( RR =0.46, 95% CI : 0.26 - 0.81; P =0.007), but an increase in the reversal MHE rate ( RR =4.94, 95% CI : 2.82-8.66; P < 0.000 01). Conclusion This finding demonstrated that probiotics were able to effectively reduce the OHE incidence and improve the reversal MHE rate in the patients with MHE. This study could provide novel evidence for probiotics treatment of MHE.