Objective:To explore the ultrasonic hemodynamic characteristics of early allograft dysfunction after left lateral lobe liver transplantation in children with biliary atresia.Methods:A total of 546 children with biliary atresia who underwent related left lateral lobe liver transplantation at Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, according to the early functional recovery of the transplanted liver, it was divided into a normal function recovery group (non-EAD group) and an early allograft dysfunction group (EAD group). The hepatic artery peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), resistance index (RI), portal vein diameter (PVD), portal vein flow velocity (PVV), portal vein flow (PVF), left hepatic vein diameter (LHVD) and left hepatic vein velocity (LHVV) were measured 1 to 7 days after surgery (a total of 3 703 ultrasound examination results), and the differences in ultrasound hemodynamic parameters between the two groups were compared. Binary logistic regression analysis was used to determine the correlation between hepatic artery RI=1.0, PSV<25 cm/s, PVV<15 cm/s, LHVV<15 cm/s and the occurrence of EAD within 7 days after surgery.Results:① Among the 546 children with biliary atresia, 262 children developed EAD after liver transplantation, and 284 children did not develop EAD. ②The portal vein flow of children in the EAD group was lower than that of the non-EAD group on 3 days, 4 days, 6 days and 7 days after surgery [3 days: 783 (560, 1 170) ml/(min·100 g) vs 942 (597, 1 381) ml/(min·100 g), P=0.006; 4 d: 862(594, 1 443) ml/(min·100 g) vs 1 068(748, 1 606) ml/(min·100 g), P=0.001; 6 d: 1 024 (631, 1 447) ml/(min·100 g) vs 1 141 (777, 1 709) ml/(min·100 g), P=0.005; 7 d: 937 (619, 1 408) ml/(min·100 g) vs 1 066 (670, 1 557) ml/(min·100 g), P=0.018]. The hepatic artery blood flow parameter RI was higher than that in the non-EAD group 7 days after surgery [0.72 (0.65, 0.79) vs 0.70 (0.63, 0.76), P=0.025]. There were no statistically significant differences in hepatic venous blood flow parameters between the two groups from 1 to 7 days (all P>0.05). ③Both the PVV and PVF in the EAD group and the non-EAD group showed an overall upward trend over time from 1 to 7 days after surgery, but compared with the non-EAD group, the portal vein flow in the EAD group increased more slowly from 3 to 7 days [PVF change rate: 0.01 (-0.25, 0.62)% vs 0.06 (-0.41, 0.41)%, P=0.003], while PSV, EDV and LHVV had no significant fluctuations. ④In the ultrasound hemodynamic abnormality index, the EAD group has a higher probability of transplanted hepatic artery RI=1.0 than the non-EAD group. Binary logistic regression analysis showed that hepatic artery RI=1.0 within 7 days after surgery was correlated with the occurrence of EAD [Exp(B)=2.413, P=0.005]. Conclusions:After left lateral lobe liver transplantation in children with biliary atresia, the portal vein of children with EAD showed a relatively low flow state.Abnormal ultrasound hemodynamic index hepatic artery RI=1.0 in children within 7 days after surgery can indicate the occurrence of EAD. Ultrasound examination can provide hemodynamic basis for early clinical detection of the presence of EAD.

Objective It aims to construct an evaluation index system for the development level of intelligent health insurance,which can serve as a reference for health insurance management departments in assessing the develop-ment level of intelligent health insurance and the implementation of health insurance informatization.Methods Key events in intelligent health insurance were identified based on event system theory and text analysis.The evaluation index system was determined through a combination of expert interviews and Delphi expert consultations.The entro-py method was used to calculate the weights of each index,followed by the assessment of the current and ideal de-velopment levels.Results A total of 16 experts were consulted.After two rounds of Delphi expert consultation,two first-level indicators and 18 second-level indicators were finally included in the system.The current development level of intelligent health insurance in China is at the intelligent development stage(2.524 points),while the ideal de-velopment level is at the intelligent improvement stage(4.073 points).The positivity coefficient of both rounds of Del-phi expert consultation was 100%,with an authority coefficient of 0.842,and the degree of expert coordination im-proved with each round.Conclusion The constructed evaluation index system exhibits high scientificity,stability,and generalizability.It can provide an effective evaluation tool for the development of intelligent health insurance in various pooled areas.

Objective:To obtain the normal reference range of hemodynamic ultrasound parameters after pediatric liver transplantation through big data query and statistical analysis, and compare their changes with age.Methods:The clinical liver transplantation ultrasound imaging database software V1.0 independently developed by Tianjin First Central Hospital was used to query the ultrasound hemodynamic parameters of 0-14 years old pediatric patients after parental liver transplantation from December 2012 to December 2022, including portal vein diameter (PVD) on the 1st day, 7th day, 1st month, 6th month, 1st year, 5th year, and 10th year after surgery. The changes in ultrasound blood flow parameters such as portal vein velocity (PVV), hepatic artery peak velocity (S), hepatic artery end diastolic velocity (D), and left hepatic vein velocity (LHVV) with postoperative time in different age groups were analyzed, the differences between age groups were compared, and statistical analysis was perform to obtain the 95% reference value range for each parameter.Results:A total of 731 pediatric patients aged 0-14 years who underwent parental liver transplantation were included in this study, with a total of 5 283 monitoring results. The ultrasound hemodynamic parameters PVV, hepatic artery S, D, and LHVV were highest at 7th day after surgery, and gradually showed a sustained and slightly decreasing trend with the prolongation of postoperative time. At the same time, there was no statistically significant difference in PVV, hepatic artery S, D, and LHVV among different age groups (all P>0.05). Conclusions:This study obtains the trend of ultrasound hemodynamic parameters after pediatric liver transplantation with prolonged follow-up time, and compared them among different age groups.After pediatric liver transplantation, there is no significant change in liver hemodynamic parameters with increasing age. Obtaining reference value ranges for various parameters in different age groups is of great clinical significance for early detection and diagnosis of postoperative vascular complications. Pediatric liver transplantation is more complex than adult liver transplantation, and in clinical monitoring, more attention should be paid to the dynamic changes of transplanted liver blood flow, combining with individual patient status, to provide imaging support for clinical diagnosis.

Androgenetic alopecia (AGA) is currently the most common hair loss disease, which is the result of a combination of genetic and environmental factors, and manifests itself as miniaturization of hair follicles around the top of the head and frontotemporal region, which eventually leads to hair reduction or disappearance. The pathogenesis of AGA is closely related to a variety of signaling pathways, which include the Wnt/β-catenin signaling pathway, bone-forming protein (BMP) signaling pathway, insulin-like growth factor (IGF) signaling pathway, fibroblast growth factor (FGF) signaling pathway, hedgehog (SHH) signaling pathway, and so on. Several cytokines are involved in these signaling pathways, including β-catenin, BMP2, IGF-1, and FGF5. An in-depth study of AGA-related signaling pathways and related cytokines can help to provide a comprehensive understanding of the pathogenesis of AGA, provide a certain theoretical basis for the discovery of new signaling pathways, and provide a new research direction for the treatment of AGA.

Objective:To explore the ultrasonic hemodynamic characteristics of early allograft dysfunction after left lateral lobe liver transplantation in children with biliary atresia.Methods:A total of 546 children with biliary atresia who underwent related left lateral lobe liver transplantation at Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, according to the early functional recovery of the transplanted liver, it was divided into a normal function recovery group (non-EAD group) and an early allograft dysfunction group (EAD group). The hepatic artery peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), resistance index (RI), portal vein diameter (PVD), portal vein flow velocity (PVV), portal vein flow (PVF), left hepatic vein diameter (LHVD) and left hepatic vein velocity (LHVV) were measured 1 to 7 days after surgery (a total of 3 703 ultrasound examination results), and the differences in ultrasound hemodynamic parameters between the two groups were compared. Binary logistic regression analysis was used to determine the correlation between hepatic artery RI=1.0, PSV<25 cm/s, PVV<15 cm/s, LHVV<15 cm/s and the occurrence of EAD within 7 days after surgery.Results:① Among the 546 children with biliary atresia, 262 children developed EAD after liver transplantation, and 284 children did not develop EAD. ②The portal vein flow of children in the EAD group was lower than that of the non-EAD group on 3 days, 4 days, 6 days and 7 days after surgery [3 days: 783 (560, 1 170) ml/(min·100 g) vs 942 (597, 1 381) ml/(min·100 g), P=0.006; 4 d: 862(594, 1 443) ml/(min·100 g) vs 1 068(748, 1 606) ml/(min·100 g), P=0.001; 6 d: 1 024 (631, 1 447) ml/(min·100 g) vs 1 141 (777, 1 709) ml/(min·100 g), P=0.005; 7 d: 937 (619, 1 408) ml/(min·100 g) vs 1 066 (670, 1 557) ml/(min·100 g), P=0.018]. The hepatic artery blood flow parameter RI was higher than that in the non-EAD group 7 days after surgery [0.72 (0.65, 0.79) vs 0.70 (0.63, 0.76), P=0.025]. There were no statistically significant differences in hepatic venous blood flow parameters between the two groups from 1 to 7 days (all P>0.05). ③Both the PVV and PVF in the EAD group and the non-EAD group showed an overall upward trend over time from 1 to 7 days after surgery, but compared with the non-EAD group, the portal vein flow in the EAD group increased more slowly from 3 to 7 days [PVF change rate: 0.01 (-0.25, 0.62)% vs 0.06 (-0.41, 0.41)%, P=0.003], while PSV, EDV and LHVV had no significant fluctuations. ④In the ultrasound hemodynamic abnormality index, the EAD group has a higher probability of transplanted hepatic artery RI=1.0 than the non-EAD group. Binary logistic regression analysis showed that hepatic artery RI=1.0 within 7 days after surgery was correlated with the occurrence of EAD [Exp(B)=2.413, P=0.005]. Conclusions:After left lateral lobe liver transplantation in children with biliary atresia, the portal vein of children with EAD showed a relatively low flow state.Abnormal ultrasound hemodynamic index hepatic artery RI=1.0 in children within 7 days after surgery can indicate the occurrence of EAD. Ultrasound examination can provide hemodynamic basis for early clinical detection of the presence of EAD.

Androgenetic alopecia (AGA) is currently the most common hair loss disease, which is the result of a combination of genetic and environmental factors, and manifests itself as miniaturization of hair follicles around the top of the head and frontotemporal region, which eventually leads to hair reduction or disappearance. The pathogenesis of AGA is closely related to a variety of signaling pathways, which include the Wnt/β-catenin signaling pathway, bone-forming protein (BMP) signaling pathway, insulin-like growth factor (IGF) signaling pathway, fibroblast growth factor (FGF) signaling pathway, hedgehog (SHH) signaling pathway, and so on. Several cytokines are involved in these signaling pathways, including β-catenin, BMP2, IGF-1, and FGF5. An in-depth study of AGA-related signaling pathways and related cytokines can help to provide a comprehensive understanding of the pathogenesis of AGA, provide a certain theoretical basis for the discovery of new signaling pathways, and provide a new research direction for the treatment of AGA.

Objective:To explore the characteristics of postoperative hemodynamic changes in patients with early allograft dysfunction (EAD), and to provide clinical imaging support for the early diagnosis of EAD.Methods:A total of 907 patients who underwent liver transplantation in Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, and they were divided into EAD group (361 cases) and non-EAD group (546 cases) according to EAD diagnostic criteria. The peak systolic velocity(PSV) of the hepatic artery, end-diastolic velocity(EDV) of the hepatic artery, resistance index(RI), S/D(PSV/EDV), diameter of the portal vein(PVD), velocity of the portal vein(PVV), diameter of the middle hepatic vein(MHVD), velocity of the middle hepatic vein(MHVV), the diameter of the right hepatic vein(RHVD), and the velocity of the right hepatic vein (RHVV) were collected from 1 to 7 days after operation (a total of 5 573 ultrasound examination results), and the differences in ultrasound hemodynamic parameters were compared between the two groups. The correlation of S/D<2, PSV<25 cm/s, PVV<15 cm/s, MHVV or RHVV<15 cm/s within 3 days after operation with the occurence of EAO were analyzed by multivariate Logistic regression analysis.Results:①The PSV and EDV of the hepatic artery in the EAD group and the non-EAD group showed a slow upward trend at 1-7 days after operation, while the hepatic artery RI and PVV showed a downward trend, the MHVV and RHVV did not fluctuate significantly. ②The hepatic artery in the EAD group showed low-resistance blood flow in the early postoperative period, and the EDV were significantly higher than that in the non-EAD group on 1 d, 2 d, 3 d and 5 d, RI was significantly lower than that of the non-EAD group (all P<0.05); At 4 d, 6 d and 7 d, there was no significant differences of EDV and RI between the two groups(all P>0.05). The PSV of the EAD group was higher than that of the non-EAD group on 3 d ( P<0.05). Among the parameters of portal vein blood flow, the PVV in the EAD group was significantly higher than that in the non-EAD group on 1 d ( P<0.05), and there was no significant difference of PVD between the two groups at day 1-7. Among the parameters of hepatic venous blood flow, the MHVV and RHVV in the EAD group were significantly lower than those in the non-EAD group (all P<0.05), there was no significant difference between the two groups of MHVD and RHVD at 1-7 days. ③The incidence of grafted hepatic artery S/D<2 within 3 days after operation in EAD group was higher than that in non-EAD group. Binary Logistic regression multivariate analysis showed that the occurrence of grafted hepatic artery S/D<2 within 3 days after operation was significantly correlated with the occurrence of EAD[Exp(B)=1.878, P<0.05]. Conclusions:Patients who develop EAD after liver transplantation show low-resistance blood flow in the hepatic artery during the perioperative period, and the occurrence of hepatic artery S/D<2 within 3 days after operation can early predict the occurrence of EAD.

Postoperative thyroid scar not only causes itching, pain, and pulling, but also seriously affects the patient’s aesthetics, so it is important to study the prevention and treatment of postoperative thyroid scar. In the past 20 years, clinicians have made many innovative researches to alleviate postoperative thyroid scar growth, and the following progresses have been made: firstly, thyroid surgery methods and surgical accesses have been improved to a certain extent, resulting in more concealed and less traumatic accesses; secondly, the use of lasers and silicone and other drugs has significantly improved the scar treatment effect; thirdly, the concept of "cosmetic" is gradually gaining popularity, and related technical means are used throughout the treatment of postoperative scarring of the thyroid gland, and multiple treatment modalities are used "early" and "in combination" to "prevent" scar growth after surgery. The use of multiple treatment modalities to prevent scar growth in the early postoperative period has achieved twice the result with half the effort.

Arginine vasopressin （AVP），also known as antidiuretic hormone，is a highly conserved neuropeptide secreted by the supraoptic or paraventricular nucleus of the hypothalamus and has complex physiological functions. This article reviews the physiological properties of AVP and elaborates on the possible involvement of AVP in sleep-arousal regulation via the hypothalamic orexinergic and noradrenergic systems and the role of AVP in maintaining circadian homeostasis by facilitating intercellular coupling of suprachiasmatic nucleus neurons，as well as the potential role of AVP in the regulation of anxiety and depression.

Objective : To establish the liver conditional knockout mouse model ofNod2gene infected byKlebsiella pneumoniae(K.pneumoniae),and to explore the role and mechanism ofNod2gene in the process of liver abscess caused byK.pneumoniaeinfections. Methods : Nod2flox/floxmice were obtained by self-crossing ofNod2flox/+mice, andAlb-Cre+mice were hybridized withNod2flox/+to obtainNod2flox/+;Alb-Cre+mice, then the above two genotypes mice were crossed to obtain liver conditional knockout mice ofNod2gene(Nod2flox/flox;Alb-Cre+) and negative control mice in the same litter(Nod2flox/flox).The genomic DNA of mice toe was extracted and amplified by polymerase chain reaction(PCR).The genotypes of offspring were identified by agar-gel electrophoresis and the livers of mice were extracted.Real-time fluorescence quantitative PCR(RT-qPCR) and Western blot were used to verify the knockout efficiency ofNod2gene in the liver.Both experimental group and control group mice were infected withK.pneumoniae,and the survival rate and pathological changes of livers were observed at different time points, and mRNA expression levels of Tumor necrosis factor α(TNF-α),interleukin 1β(IL-1β) and C-X-C motif chemokine ligand 1(CXCL1) in the livers of experimental group and control group were detected by RT-qPCR 24 h postK.pneumoniaeinfections. Results : The expression of NOD2 mRNA in the liver ofNod2flox/flox;Alb-Cre+mice decreased, and the Western blot results showed that the expression of NOD2 protein decreased.Compared with the control group, the survival rate of mice infected withK.pneumoniaein the experimental group decreased(median survival time=60.5 h,P=0.046 9) and the liver tissue showed more serious pathological damage, furthermore the mRNA expression levels of TNF-α,IL-1β and CXCL1 in the livers of experimental group were lower than those of the control group, and the difference was statistically significant(P<0.05). Conclusion NOD2 plays a protective role in the process of liver abscess induced byK.pneumoniaeinfections.