Objective To establish a predictive model for hepatic sinusoidal obstruction syndrome(HSOS)and Budd-Chiari syn-drome(BCS),and to evaluate the performance of the model.Methods From April 2016 to February 2024,20 patients with HSOS and 40 patients with BCS who were first discharged from the Beijing Friendship Hospital Affiliated to Capital Medical University hospital infor-mation system(HIS)system were retrospectively collected.The clinical data of all patients were extracted,and the independent risk fac-tors for HSOS were screened by multi-factor Logistic regression method,and the differential diagnosis model was established accordingly,and then the efficacy was evaluated by receiver operating characteristic(ROC)curve.Results Multivariate Logistic regression analysis showed that hepatic vein stenosis or unclear display(OR=39.441,95％CI:5.928-262.429)was an independent risk factor for HSOS,and paravertebral vein opening was an independent protective factor for HSOS(OR=0.026,95％CI:0.002-0.285).Based on the above two parameters,a prediction model for HSOS in patients with hepatic venous outlet tract obstruction was established.The ROC curve showed that the area under the curve(AUC)of the model was 0.922(95％CI:0.864-0.991),with the sensitivity of 85.0％and the specificity of 92.5％.Conclusion Hepatic vein stenosis or unclear display is an independent risk factor for HSOS in patients with hepatic vein outflow tract obstruction during hospitalization,and the model constructed can predict the risk of HSOS.

Purpose To compare the MRI features of hepatic sinusoidal obstruction syndrome(HSOS)and Budd-Chiari syndrome(BCS).Materials and Methods A total of 12 cases of HSOS and 12 cases of BCS diagnosed with liver biopsy or liver transplantation disease or digital subtraction angiography were retrospectively collected from April 2016 to November 2023 in Beijing Friendship Hospital,Capital Medical University.The clinical and MRI features of the two groups were analyzed,and the characteristic clinical and MRI features were summarized.Results The glutamic-oxaloacetic transaminase,total bilirubin and direct bilirubin in HSOS patients were significantly higher than those in BCS group,while albumin was significantly lower than that in BCS group,the difference was statistically significant(Z=-3.407,-2.078,-2.425,-2.252,all P<0.05).Of the 12 HSOS patients,ten patients with HSOS had a history of taking hebel medicine(gynura segetum),six patients with HSOS showed the second portal of liver characteristic trifolium-like enhancement,BCS features did not appear.Of the 12 BCS patients,ten had main portal vein widening,ten spleen enlargement,ten accessory hepatic vein,eight transverse hepatic vein,eleven perihepatic lateral branch and seven paravertebral varicose veins.In HSOS and BCS patients,the uneven proportion of liver parenchymal signals was identified by MRI plain scan(12 cases,10 cases,respectively),and the proportion of liver parenchymal signal mottle-like enhancement was also demonstrated in portal and delayed phases(12 cases,12 cases,respectively).Conclusion The characteristic MRI signs are helpful for the diagnosis of HSOS and BCS,and the history of taking hebel medicine(gynura segetum)is helpful for the differentiation of the two diseases.

Objective To establish a predictive model for hepatic sinusoidal obstruction syndrome(HSOS)and Budd-Chiari syn-drome(BCS),and to evaluate the performance of the model.Methods From April 2016 to February 2024,20 patients with HSOS and 40 patients with BCS who were first discharged from the Beijing Friendship Hospital Affiliated to Capital Medical University hospital infor-mation system(HIS)system were retrospectively collected.The clinical data of all patients were extracted,and the independent risk fac-tors for HSOS were screened by multi-factor Logistic regression method,and the differential diagnosis model was established accordingly,and then the efficacy was evaluated by receiver operating characteristic(ROC)curve.Results Multivariate Logistic regression analysis showed that hepatic vein stenosis or unclear display(OR=39.441,95％CI:5.928-262.429)was an independent risk factor for HSOS,and paravertebral vein opening was an independent protective factor for HSOS(OR=0.026,95％CI:0.002-0.285).Based on the above two parameters,a prediction model for HSOS in patients with hepatic venous outlet tract obstruction was established.The ROC curve showed that the area under the curve(AUC)of the model was 0.922(95％CI:0.864-0.991),with the sensitivity of 85.0％and the specificity of 92.5％.Conclusion Hepatic vein stenosis or unclear display is an independent risk factor for HSOS in patients with hepatic vein outflow tract obstruction during hospitalization,and the model constructed can predict the risk of HSOS.

Purpose To compare the MRI features of hepatic sinusoidal obstruction syndrome(HSOS)and Budd-Chiari syndrome(BCS).Materials and Methods A total of 12 cases of HSOS and 12 cases of BCS diagnosed with liver biopsy or liver transplantation disease or digital subtraction angiography were retrospectively collected from April 2016 to November 2023 in Beijing Friendship Hospital,Capital Medical University.The clinical and MRI features of the two groups were analyzed,and the characteristic clinical and MRI features were summarized.Results The glutamic-oxaloacetic transaminase,total bilirubin and direct bilirubin in HSOS patients were significantly higher than those in BCS group,while albumin was significantly lower than that in BCS group,the difference was statistically significant(Z=-3.407,-2.078,-2.425,-2.252,all P<0.05).Of the 12 HSOS patients,ten patients with HSOS had a history of taking hebel medicine(gynura segetum),six patients with HSOS showed the second portal of liver characteristic trifolium-like enhancement,BCS features did not appear.Of the 12 BCS patients,ten had main portal vein widening,ten spleen enlargement,ten accessory hepatic vein,eight transverse hepatic vein,eleven perihepatic lateral branch and seven paravertebral varicose veins.In HSOS and BCS patients,the uneven proportion of liver parenchymal signals was identified by MRI plain scan(12 cases,10 cases,respectively),and the proportion of liver parenchymal signal mottle-like enhancement was also demonstrated in portal and delayed phases(12 cases,12 cases,respectively).Conclusion The characteristic MRI signs are helpful for the diagnosis of HSOS and BCS,and the history of taking hebel medicine(gynura segetum)is helpful for the differentiation of the two diseases.

Objective To explore the effect of atractylodes macrocephala lactone Ⅲ(AML Ⅲ)on nerve injury of rats with cerebral infarction.Methods The rats were randomly divided into sham operation group,model group(modified Longa thrombus method to prepare rat cerebral infarction model),low and high dose of AML Ⅲ group(AML Ⅲ-L,AML Ⅲ-H)and high dose AML Ⅲ+EX527(SIRT1 inhibitor)group(AMLⅢ-H-EX527).Neuro-logical function was assessed by Zea-Longa score.Serum tumor necrosis factor(TNF-α)and interleukin(IL-6,IL-1β)were measured by ELISA;The level of super oxide dismutase activity(SOD),malonaldehyde content(MDA),and catalase activity(CAT)in brain tissue was detected by commercially available kit;pathological changes of hippocampus tissue and the area of cerebral infarction were observed by HE staining and TTC staining microscopy respectively.Apoptosis of brain cells was identified by TUNEL staining;protein expression of Bax,Bcl-2,SIRT1,and Nrf2 in rat brain tissue was detected by Western blot assay.Results After the intervention by AML Ⅲ,the pathological injury of hippocampus neurons in rats was alleviated.The neurological function score,serum TNF-α,IL-6 and IL-1 β levels,apoptosis rate,cerebral infarction size,MDA level and Bax protein expression were all decreased.SOD and CAT activity,SIRT1,Nrf2,Bcl-2 and protein expression were all in-creased(P＜0.05);EX527 was able to alleviate the protective effect of AML Ⅲ on neural function damage in rats with cerebral infarction.Conclusions Atractylodes macrocephala lactone Ⅲ reduces the nerve function injury in rat models with cerebral infarction.

Objective:To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) in AIDS patients complicated with Pneumocystis jirovecii ( P. jirovecii) infection. Methods:This is a retrospective study. From January 2019 to June 2021, the respiratory tract and other body fluid samples of 236 cases of AIDS co-infected patients diagnosed in the AIDS Department of Changsha First Hospital were collected, along with corresponding medical histories. Traditional etiological hexamine silver staining and serum 1,3-β-D glucan (BDG) were performed simultaneously with mNGS detection, and Fisher′s exact test was used to analyze the results and compare the diagnostic performances of mNGS with those of hexamine silver staining and serum G test.Results:A total of 236 cases of AIDS patients with pulmonary infection were collected and tested. Seventy-seven cases were clinically diagnosed with Pneumocystis jiroveci pneumonia and 159 cases with non- Pneumocystis jiroveci pneumonia. Among the 236 AIDS patients with pulmonary infection, mNGS detected 77 [32.63%(77/236)] positive cases of Pneumocystis jiroveci, while hexamine silver staining detected 10[4.24%(10/236)] and serum BDG detected 146 [61.86% (146/236). Based on these clinical diagnostic results, the sensitivity of mNGS detection was 100% (77/77) for the 77 patients with Pneumocystis pneumoniae, significantly higher than that of silver hexamine staining [12.99% (10/77), P=0.046] and serum BDG [58.44% (45/77), P=0.038]. The mNGS showed good specificity, which was the same as that of hexamine silver staining [100% (159/159)] and significantly higher than that of serum BDG [36.48% (58/159), P=0.026]. With therapeutic clinical diagnosis as the reference method, the accuracy of mNGS detection was 100% (236/236). Conclusions:This study evaluated the diagnostic value of mNGS detection in AIDS patients with Pneumocystis jirovecii infection. The results showed that the sensitivity and specificity of mNGS detection were high, and it had exceptional clinical application value in the pathogenic detection of infectious diseases.

【Objective】 To supervise the clinical blood use of 19 hospitals, covering a district of Shanghai, during two years, and discover the problems in the process of blood transfusion, so as to put forward suggestions for corrective methods in grades and promote continuous improvement of clinical transfusion management. 【Methods】 A total of 19 hospitals were supervised in terms of hardware facilities, management level, professional and technical level, and blood typing test on the site, according to the Administrative Blood Management Measures for Medical Institutions, Technical Specification for Clinical Transfusion and Shanghai Medical Quality Supervision Score Statistical Table.All data were analyzed. 【Results】 These hospitals can properly perform clinical blood transfusion, but there were obvious differences.Tertiary hospitals were relatively better, yet need to strengthen the management of medical documents.Secondary hospitals remained to be improved, mainly in insufficient construction of Blood Transfusion Department (blood bank), the lack of management and maintenance of key equipment and the lack of standardization in medical documents writing.However, flaws in the supervision were general in private hospitals (most of which were affiliated hospitals), so the management of clinical blood use should be further strengthened. 【Conclusion】 For secondary hospitals or above, routinized writing of medical documents and promoted construction of Blood Transfusion Department (blood bank) should be strengthened.For private hospitals, especially affiliated hospitals, the management of clinical blood use should be further improved, including the examination rules corresponding to the blood use process and strict access and exit mechanism, so as to improve the overall management level of clinical blood use and ensure the safety of clinical blood use.

Objective:To investigate the clinical efficacy of using INFIX combined with hollow nail in the treatment of anterior pelvic ring injury with symphyseolysis.Methods:Data of 12 patients with anterior pelvic ring injury and symphyseolysis who were treated from January 2016 to December 2018 were retrospectively analyzed. They were 8 males and 4 females with an average age of 39.5 years (range, 23-64 years). There were 4 cases of traffic injury, 3 cases of falling injury and 5 cases of crush injury; all the cases were combined with front and rear crush injury. According to Tile classification for pelvic fractures, there were 6 cases of type B1 , 3 cases of type B3, 1 case of type C1 and 2 cases of type C2. Six cases of B1 and 3 cases of B3 patients used percutaneous inter fixation with sacroiliac joint cannulated screw in posterior ring; 1 case of C1 and 2 cases of C2 used spinal-pelvic fixation. Every patients' operating time of INFIX combined with the pubic symphysis hollow nail , amount of hemorrhage, length of incisions and number of X-ray projections were recorded. Pelvic X-ray and CT scan were taken postoperatively to observe the reduction and screw position. Postoperative reduction quality was assessed using Matta radiological criteria and Majeed criteria was used at the final follow-up to evaluate the pelvic function.Results:The average operating time for 12 patients was 42 min (range, 35-56 min) ; the average amount of hemorrhage was 28 ml (range, 15-40 ml); the average length of incision at INFIX nail placement on both sides were 2.7 cm (range, 2.2-3.5 cm); the average length of incisions at the pubic symphysis hollow nail placement was 0.8 cm (range, 0.6-1.2 cm) and the average number of X-ray projections was 38 times (range, 26-55 times). Postoperative X-ray and CT scan showed that all the hollow screws are located accurately and firmly, and pubic symphysis had good reduction and no infection occurred in the surgical incision at the screw placement site. Postoperative reduction quality was evaluated according to Matta radiological criteria, and there were excellent in 10 and good in 2, giving an excellent to good rate of 100% (12/12). The average follow-up time for the 12 patients was 12 months (range, 6-15 months). At the final follow-up, all patients showed fine fracture union and no looseness of pubic symphysis occurred according to imaging test. According to the Majeed criteria, the pelvic function was excellent in 8 cases, good in 3 cases and fair in 1 case, giving a good to excellent rate of 91.7% (11/12). One case developed symptoms of femoral nerve compression after surgery and returned to normal after removal of the INFIX. Another case had damage to the lateral femoral cutaneous nerve and the symptoms disappeared after three months.Conclusion:Using INFIX combined with hollow nail in the treatment of symphyseolysis can lead to more minimally invasive with excellent postoperative efficacy and markedly reduced the morbidity of complication.

Objective To explore the influencing factors of the vaginal birth after cesarean section (VBAC), and establish a model for predicting the risk of trial of the trial of labor after cesarean section (TOLAC). Methods From January 2016 to December 2018, total 694 pregnant women who underwent TOLAC in Northwest Women's and Children's Hospital were retrospectively analyzed. Those cases were divided into two groups according to the mode of delivery: the VBAC group and the failed TOLAC group. At the same time, 700 cases in the elective repeat cesarean section (ERCS) group were randomly selected as control group. The influencing factors of VBAC were analyzed by univariate and multivariate logistic regression, and the pregnancy outcomes between the three groups were compared. Results (1) The VBAC rate was 76.1% (528/694) and 166 women underwent the failed TOLAC (23.9%, 166/694). (2) Univariate analysis found that, the pre-pregnancy body mass index (BMI) [(22.0±3.0),(23.3±2.7) kg/m2], the previous vaginal delivery history [10.4%(55/528),3.6%(6/166)], the cervical score (5.2±1.9,4.3±1.6) and the neonatal birth weight [(3 315 ± 468), (3 484 ± 274) g] of the VBAC group were significantly different from the failed TOLAC group (P<0.05). (3) The comparison of pregnancy outcomes: the neonatal birth weight was (3 315± 468) g, and the intrapartum hemorrhage volume was (255 ± 121) ml in the VBAC group, which were significantly lower than those in the failed TOLAC group [intrapartum hemorrhage (325 ± 173) ml] and the ERCS group [(3 572±344) g, (281±125) ml], there were statistically significant differences in the comparison among the three groups (all P<0.05). Two cases of bladder injury occurred during cesarean section in the TOLAC failure group (1.2%,2/166). The rates of the blood transfusion, puerperal infection, 5-minute Apgar score and neonatal ICU admission among the three groups were no statistically significantly different (all P>0.05). There was no maternal or perinatal death. (4) Multivariate logistic regression analysis showed that the delivery age of pregnant women ( OR=0.92, 95% CI : 0.87-0.98), pre-pregnancy BMI ( OR=0.92, 95% CI :0.86-0.98), vaginal delivery history ( OR=3.31, 95% CI : 1.35-8.01), cervical score ( OR=1.29, 95% CI :1.13-1.42) and the birth weight of the neonates <3 300 g ( OR=3.15, 95% CI : 2.02-4.90) were independent influencing factors for VBAC. The area under curve of the receiver operating characteristic curve was 0.74. Conclusions The influencing factors of VBAC are delivery age, pre-pregnancy BMI, vaginal delivery history, cervical score and neonatal birth weight <3 300 g. The adequate individualized management and assessment of the TOLAC may be helpful to improve the VBAC rate.