Objective:To summarize and investigate the ultrasound manifestations, clinical characteristics, causes, and prognosis of hepatic portal vein gas (HPVG) after liver transplantation in children.Methods:A case series study. Clinical data of 9 pediatric recipients diagnosed with HPVG by ultrasound after liver transplantation between January 2012 and August 2023 were collected, and the ultrasound manifestations, causes, clinical features, and prognosis of HPVG were analyzed.Results:A total of 1,850 pediatric liver transplantations were performed during the same period in Tianjin First Central Hospital, among which 9 cases (0.48%) developed HPVG; 6 cases occurred within 1 month after surgery, and 3 cases occurred more than 1 month after surgery; the duration ranged from 2 to 15 days, with a median of 7 (4.5, 9.0) days. HPVG was first detected by ultrasound in all cases, with common ultrasound manifestations including bubble-like or punctate strong echoes flowing with blood in the portal vein, and patchy strong echoes with unclear borders in the liver parenchyma. Among the 9 patients, 3 had diarrhea with intestinal flora imbalance, 2 had abdominal distension with incomplete intestinal obstruction, 1 had colonic fistula with repeated replacement of Li's tube and concurrent abdominal distension, 1 was experiencing acute T-cell-mediated rejection of the transplanted liver, and the remaining 2 were asymptomatic. Patients with diarrhea and intestinal dysbiosis were treated with Bifidobacterium Lactobacillus triple viable tablets to regulate flora and montmorillonite powder to relieve diarrhea, which gradually subsided. Patients with abdominal distension and incomplete intestinal obstruction were treated with fasting, intravenous nutrition, and enema, and the obstruction gradually resolved, along with disappearance of HPVG.Conclusion:HPVG after liver transplantation has characteristic ultrasound manifestations, and its occurrence may be related to intestinal gas, obstruction, dysbiosis, or mucosal damage. Treatment may be conservative or surgical depending on the underlying cause and severity.

Objective To establish dynamic nomogram models for postoperative recurrence and survival risk of patients with AFP-negative hepatocellular carcinoma(ANHC)based on multimodal clinical data,to identify ANHC-specific prognostic biomarker combinations by integrating tumor biological characteristics and treatment response parameters through machine learning,and to provide an individualized risk assessment tool for overcoming the limitations of traditional serum biomarkers.Methods A retrospective analysis was performed for 421 ANHC patients who underwent hepatectomy in Eastern Hepatobiliary Surgery Hospital from April 2012 to December 2018,and they were randomly divided into training group with 210 patients and validation group with 211 patients.The univariate and multivariate Cox proportional-hazards regression models were used to identify independent prognostic factors and establish a nomogram model,and the receiver operating characteristic(ROC)curve,the calibration curve,and the decision curve analysis were used to assess the performance of the model.Related indicators were measured,including prealbumin(PA),white blood cell count(WBC),tumor size,and microvascular invasion.The chi-square test or the Fisher's exact test was used for comparison of categorical variables between two groups,and the independent-samples t test or the Mann-Whitney U test was used for comparison of continuous variables between two groups.Results The multivariate analysis showed that multiple tumors(hazard ratio[HR]=3.30,P<0.001),WBC(HR=1.05,P=0.005),blood glucose(HR=1.15,P=0.026),CA19-9(HR=1.17,P=0.005),and tumor size(HR=1.17,P<0.001)were independent risk factors for disease-free survival(DFS),while PA(HR=0.99,P=0.022)was a protective factor.Incomplete tumor capsule(HR=0.60,P=0.009),age(HR=1.02,P=0.035),prothrombin time(PT)(HR=1.27,P=0.023),CA19-9(HR=1.01,P<0.001),and tumor size(HR=1.15,P<0.001)were independent risk factors for overall survival(OS).The DFS nomogram achieved an AUC of 0.74(95%confidence interval[CI]:0.64-0.84)in the training group and 0.67(95%CI:0.57-0.77)in the validation group,while the OS nomogram had an AUC of 0.76(95%CI:0.64-0.88)and 0.73(95%CI:0.60-0.87),respectively.The calibration curve and the decision curve analysis showed that the models had good predictive accuracy and clinical practicability.Conclusion Preoperative indicators,including tumor number,PA,WBC,and tumor size,can effectively predict postoperative recurrence in ANHC patients,while tumor capsule integrity,age,and PT are significantly associated with OS.The nomogram models established have good performance and can provide a basis for individualized prognostic assessment.

Thoracoscopic mitral valve replacement is a common minimally invasive cardiac surgery procedure. However, small annulus, severe calcification of the annulus, and severe thickening of the posterior valve leaflet or sub valvular structure are the difficulties of thoracoscopic mitral valve replacement. Improper treatment can easily lead to left ventricular rupture or prosthesis-patient mismatch. This paper reports a thoracoscopic mitral bioprosthesis replacement case using the chimney technique in Guangdong Provincial People's Hospital and summarizes its operating key points. The patient was a 68-year-old female, weighing 36 kg. The preoperative diagnosis was rheumatic mitral stenosis and atrial fibrillation, the preoperative transthoracic echocardiogram showed the left ventricular end-diastolic diameter was 39 mm. The surgical effect was satisfactory. The patient was in good condition at the follow-up 2 months after the operation.

Objective To investigate the clinical characteristics and outcomes of Coronavirus Dis-ease 2019 in immunocompromised hosts.Methods A retrospective analysis was conducted on the clinical data of 230 hospitalized patients diagnosed with Coronavirus Disease 2019 at Nanjing Yimin Hospital from December 2022 to November 2023.The patients were divided into three groups based on their immune status:immunocompromised group(n=59),relatively immunocompromised group(n=129),and immunocompetent group(n=42).The clinical characteristics(such as clinical manifesta-tions,imaging features,and laboratory examinations)and outcomes(such as length of hospital stay and in-hospital mortality)were compared among three groups.Results Compared with there latively immunocompromised and immunocompetent groups,the immunocompromised group showed no obvious specific clinical manifestations.However,the proportions of patients with symptoms such as cough and expectoration were lower,and the occurrences of symptoms such as myalgia and fatigue were less fre-quent in the immunocompromised group(P＜0.05).The chest CT findings in the immunocompro-mised group also lacked specific changes,mainly presenting as subpleural ground-glass opacities and consolidations with multilobar distribution,but fibrotic changes were more common(P＜0.05).The proportion of patients with decreased absolute lymphocyte counts in the immunocompromised group was higher than that in the immunocompetent group,and the proportion of patients with elevated procalcitonin levels was higher than that in the other two groups(P＜0.05).The proportion of severe case sand the length of hospital stay in the immunocompromised group were higher and longer than those in the relatively immunocompromised and immunocompetent groups(P＜0.05).The in-hospital mortality rates in the immunocompromised,relatively immunocompromised,and immunocompetent groups were 10.17％,6.98％,and 2.38％,respectively,with no statistically significant difference(P＞0.05).Conclusion After Coronavirus Disease 2019,immunocompromised hosts do not show obvi-ous clinical and imaging features.However,they have a prolonged length of hospital stay,a signifi-cantly higher proportion of severe cases,and a tendency towards increased in-hospital mortality,which should be given high clinical attention.

Objective To establish dynamic nomogram models for postoperative recurrence and survival risk of patients with AFP-negative hepatocellular carcinoma(ANHC)based on multimodal clinical data,to identify ANHC-specific prognostic biomarker combinations by integrating tumor biological characteristics and treatment response parameters through machine learning,and to provide an individualized risk assessment tool for overcoming the limitations of traditional serum biomarkers.Methods A retrospective analysis was performed for 421 ANHC patients who underwent hepatectomy in Eastern Hepatobiliary Surgery Hospital from April 2012 to December 2018,and they were randomly divided into training group with 210 patients and validation group with 211 patients.The univariate and multivariate Cox proportional-hazards regression models were used to identify independent prognostic factors and establish a nomogram model,and the receiver operating characteristic(ROC)curve,the calibration curve,and the decision curve analysis were used to assess the performance of the model.Related indicators were measured,including prealbumin(PA),white blood cell count(WBC),tumor size,and microvascular invasion.The chi-square test or the Fisher's exact test was used for comparison of categorical variables between two groups,and the independent-samples t test or the Mann-Whitney U test was used for comparison of continuous variables between two groups.Results The multivariate analysis showed that multiple tumors(hazard ratio[HR]=3.30,P<0.001),WBC(HR=1.05,P=0.005),blood glucose(HR=1.15,P=0.026),CA19-9(HR=1.17,P=0.005),and tumor size(HR=1.17,P<0.001)were independent risk factors for disease-free survival(DFS),while PA(HR=0.99,P=0.022)was a protective factor.Incomplete tumor capsule(HR=0.60,P=0.009),age(HR=1.02,P=0.035),prothrombin time(PT)(HR=1.27,P=0.023),CA19-9(HR=1.01,P<0.001),and tumor size(HR=1.15,P<0.001)were independent risk factors for overall survival(OS).The DFS nomogram achieved an AUC of 0.74(95%confidence interval[CI]:0.64-0.84)in the training group and 0.67(95%CI:0.57-0.77)in the validation group,while the OS nomogram had an AUC of 0.76(95%CI:0.64-0.88)and 0.73(95%CI:0.60-0.87),respectively.The calibration curve and the decision curve analysis showed that the models had good predictive accuracy and clinical practicability.Conclusion Preoperative indicators,including tumor number,PA,WBC,and tumor size,can effectively predict postoperative recurrence in ANHC patients,while tumor capsule integrity,age,and PT are significantly associated with OS.The nomogram models established have good performance and can provide a basis for individualized prognostic assessment.

Objective:To summarize and investigate the ultrasound manifestations, clinical characteristics, causes, and prognosis of hepatic portal vein gas (HPVG) after liver transplantation in children.Methods:A case series study. Clinical data of 9 pediatric recipients diagnosed with HPVG by ultrasound after liver transplantation between January 2012 and August 2023 were collected, and the ultrasound manifestations, causes, clinical features, and prognosis of HPVG were analyzed.Results:A total of 1,850 pediatric liver transplantations were performed during the same period in Tianjin First Central Hospital, among which 9 cases (0.48%) developed HPVG; 6 cases occurred within 1 month after surgery, and 3 cases occurred more than 1 month after surgery; the duration ranged from 2 to 15 days, with a median of 7 (4.5, 9.0) days. HPVG was first detected by ultrasound in all cases, with common ultrasound manifestations including bubble-like or punctate strong echoes flowing with blood in the portal vein, and patchy strong echoes with unclear borders in the liver parenchyma. Among the 9 patients, 3 had diarrhea with intestinal flora imbalance, 2 had abdominal distension with incomplete intestinal obstruction, 1 had colonic fistula with repeated replacement of Li's tube and concurrent abdominal distension, 1 was experiencing acute T-cell-mediated rejection of the transplanted liver, and the remaining 2 were asymptomatic. Patients with diarrhea and intestinal dysbiosis were treated with Bifidobacterium Lactobacillus triple viable tablets to regulate flora and montmorillonite powder to relieve diarrhea, which gradually subsided. Patients with abdominal distension and incomplete intestinal obstruction were treated with fasting, intravenous nutrition, and enema, and the obstruction gradually resolved, along with disappearance of HPVG.Conclusion:HPVG after liver transplantation has characteristic ultrasound manifestations, and its occurrence may be related to intestinal gas, obstruction, dysbiosis, or mucosal damage. Treatment may be conservative or surgical depending on the underlying cause and severity.

Iron is an indispensable nutritional element for human growth and development. It has a protective effect on cardiovascular. The changes and metabolism of iron can affect the physiological and pathological state of the body. Current research has confirmed that iron overload will promote the synthesis of cholesterol and increase lipid metabolism disorders. Lipid metabolic disorders in the body easily induce the occurrence and development of related metabolic diseases, and increase the hidden dangers of the outbreak of relevant risk factors. This article reviews iron and lipid metabolic and other metabolic diseases and natural products to prevent diseases through iron metabolic pathway, which aims to provide more powerful references for in-depth research on the mechanism of metabolic diseases and related diseases and target drug research and development.

Objective:To study the effects of the combined application of NaF and Nisin on Streptococcus mutans(S.mutans).Meth-ods:The minimum inhibitory concentration(MIC)of Nisin and NaF against S.mutans was determined by microdilution method respec-tively.The fractional inhibitory concentration(FIC)was calculated by checkerboard method.The inhibition effect of the combination of NaF and Nisin at(NF)the same MIC concentration on acid production and acid resistance of S.mutans was detected.Crystal violet staining was used to detect the effects of NF in the inhibition of the biofilm formation,and the damage and dispersion of the established biofilms.The changes of the biofilms were observed by CLSM.Results:The MIC of NaF and Nisin was 0.6 mg/mL and 20 mg/mL re-spectively.The FIC was 0.75.The 1/8×MIC NF showed significantly higher inhibition on acid production and biofilm formation than 1/4×MIC NaF or Nisin(P＜0.05),but it has no obvious dispersion effect on established biofilms.The 1/2×MIC NF showed stronger in-hibition effect on the acid resistance of S.mutans in the membrane than 1×MIC NaF or Nisin(P＜0.05).At the concentration of 2x MIC,any component didn't cause obvious damage on the established biofilm structure.Conclusion:Nisin and NaF have synergistic in-hibitory effects on the proliferation,acid production,acid resistance and biofilm formation of S.mutans.

Objective To investigate the relationship between the level of secretory curl related protein(SFRP)and the therapeutic effect of sodium hyaluronate in patients with knee osteoarthritis(KOA).Methods A total of 89 patients with KO A from May 2021 to June 2023 in Wenzhou Traditional Chinese Medicine Hospital were selected as observation group.All patients were treated with sodium hyaluronate.According to the treatment effect,they were divided into obvious/improved group and poor effect group.67 healthy examinees were selected as control group during the same period..The levels of SFRP1,SFRP2 and SFRP5 in each group were determined by enzyme linked immunosorbent assay,and the therapeutic effect of sodium hyaluronate in patients with KOA was analyzed by multivariate Logistic regression.Receiver operating characteristic(ROC)curve was drawn to analyze the evaluation efficiency of SFRP level in the treatment effect of patients with KOA.Results SFRP1,SFRP2 and SFRP5 in observation group were lower than those in control group(P＜0.05);89 patients were treated with sodium hyaluronate,and 67 patients showed good treatment outcomes(75.28％),and SFRP1,SFRP2 and SFRP5 in obvious/improved group were higher than those in poor effect group(P＜0.05).Multivariate results showed that SFRP1,SFRP2,SFRP5 and the Western Ontario and MeMaster Universities osteoarthritis index were the influential factors for the treatment effect of patients with KOA(P＜0.05).ROC curve results showed that the sensitivity and specificity of SFRP1,SFRP2 combined with SFRP5 in the treatment of KOA patients was higher than that of a single index(P＜0.05).Conclusion The levels of SFRP1,SFRP2 and SFRP5 are low in patients with KOA,and their expression levels are closely related to the therapeutic effect of sodium hyaluronate.The combined determination of different indicators can improve the sensitivity and specificity of prognosis.

Objective To analyze the correlation between NOD like receptor pyrin domain containing 3(NLRP3)inflammasome and pro-inflammatory factors interleukin(1L)-1 β and tumor necrosis factor(TNF)-α in the pathogenesis of acute gouty arthritis.Methods From June 2023 to July 2024,76 patients in Wenzhou Hospital of Traditional Chinese Medicine with acute gouty arthritis were selected as case group,and 53 healthy individuals as control group.The mRNA expression levels of NLRP3 inflammasome,apoptosis-associated speck-like protein(ASC),Caspase-1,IL-1β,IL-18,TNF-α were monitored using real-time fluorescence quantitative real-time fluorescence quantitative(PCR),and concentrations of these proteins were determined using enzyme-linked immunosorbent assay(ELISA).Results Age,gender,and other data were similar between both groups(P＞0.05).levels of uric acid,C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)in case group were higher than those in control group(P＜0.001).Expression of NLRP3,ASC,and Caspase-1 were also higher(P＜0.001).Serum levels of IL-1β,IL-18,and TNF-α were higher in case group(P＜0.05).NLRP3 inflammasome activity correlated positively with IL-1β and TNF-α.Multivariate Logistic regression showed uric acid,CRP,ESR,NLRP3,ASC,Caspase-1,IL-1 β,IL-18,and TNF-α were important factors for acute gouty arthritis attacks(P＜0.05).Conclusion By inhibiting activation of NLRP3 inflammasome or release of downstream inflammatory factors,inflammatory response of gouty arthritis can be effectively reduced,thereby alleviating symptoms and preventing joint damage.