Objective:To construct a nomogram model for predicting the incidence of hepatocellular carcinoma based on serum abnormal prothrombin and alpha-fetoprotein and evaluate the predictive effect.Methods:Retrospective analysis of data from 351 patients with liver disease who received treatment at the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2023, including 285 males and 66 females, aged (52.9±11.9) years. Among the 351 patients, there were 229 cases (65.2%) of hepatocellular carcinoma, 87 cases (24.8%) of liver cirrhosis, and 35 cases (10.0%) of chronic hepatitis B. All patients were randomly divided into a training set ( n=245) and a testing set ( n=106) in a 7∶3 ratio without replacement sampling. The training set was used to construct the model, and the testing set was used to evaluate the model. At the same time, gender, age, disease type, and other indicators were compared between the two sets. The risk factors of hepatocellular carcinoma were analyzed by univariate and multivariate logistic regression based on the training set, and a nomogram was constructed to predict the incidence of hepatocellular carcinoma based on the multivariate results. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive performance of nomogram, and decision curve analysis was used to evaluate the clinical applicability of the model. Results:There was no statistically significant difference in age, gender, disease type, etc. between the training and testing sets of patients (all P>0.05). Univariate logistic regression analysis showed that age, abnormal prothrombin logarithm (LnPIVKA-Ⅱ), alpha-fetoprotein logarithm (LnAFP), and diabetes were associated with hepatocellular carcinoma (all P<0.05). Multivariate logistic regression analysis showed that older age ( OR=1.07, 95% CI: 1.03-1.12), higher LnPIVKA-Ⅱ ( OR=2.97, 95% CI: 1.97-4.46), higher LnAFP ( OR=1.43, 95% CI: 1.11-1.84) and diabetes ( OR=5.17, 95% CI: 1.02-26.17) were risk factors for hepatocellular carcinoma (all P<0.05). Based on the above variables, a nomogram model for predicting the incidence of hepatocellular carcinoma was constructed. The area under the ROC curve analysis of the nomogram for predicting the incidence of hepatocellular carcinoma was 0.920 (95% CI: 0.886-0.953) in the training set and 0.934 (95% CI: 0.891-0.977) in the testing set. The calibration curve fit well with the standard curve, and the prediction was basically consistent with the actual situation. The decision curve analysis showed that the net benefit of the model was greater than 0 under most thresholds (0.1-1.0). Conclusion:The nomogram constructed based on age, LnPIVKA-Ⅱ, LnAFP and diabetes can effectively predict the incidence of hepatocellular carcinoma and has clinical applicability.

Objective:To analyze the relationship between the growth and development of pump twin and the changes of blood flow parameters and the natural pregnancy outcome of pump twin after pontaneous cessation of blood flow in the umbilical artery of the acardiac twin with reverse arterial perfusion sequence（TRAPs）detected by prenatal ultrasound.Methods:From January 2001 to August 2023，a total of 23 cases of TRAPs diagnosed in Hubei Maternal and Child Health Hospital were retrospectively collected and detected by ultrasound follow-up. According to the pregnancy outcome of the pump twin，23 patients were divided into the poor pregnancy outcome group（6 cases）and the good pregnancy outcome group（17 cases）. The changes of ultrasound growth indexes and blood flow parameters of the pump twin and acardia twin were compared between the two groups. The hemodynamic parameters with statistically significant differences between the two groups were selected，and the diagnostic efficacy for TRAPs pregnancy outcomes was analyzed using ROC analysis.Results:There were no statistically significant differences in the structural development of acardiac fetus between the two groups，including skin edema，hemicardia，skull structure，trunk structure，upper and lower limbs，cardiothoracic ratio，amniotic fluid，sex and amniotic nature of twins（all P > 0.05）. The lower limbs of acardia twin was significantly higher in the poor pregnancy outcome group（6/6）than in the good pregnancy outcome group（7/17），and the difference was statistically significant（ P < 0.05）. The relevant parameters of ultrasound blood flow were shown in both groups，there were no significant differences in middle cerebral artery pulsation index（PI）and umbilical artery PI between the two groups before natural occlusion of fetal blood flow with TRAPs（all P > 0.05）. In the good pregnancy outcome group，the ratio of umbilical cord diameter between pump twin and acardia twin was higher than that in the poor pregnancy outcome group，the difference was statistically significant（ P < 0.05）. The scatter plot of the ratio of umbilical diameter between the two groups was drawn，and the cut-off value was 2.125 through ROC curve analysis，the area under the curve（AUC）was 0.961，the sensitivity was 94.10%，the specificity was 100%，and the Yoden index was 0.94. Conclusions:The ratio of umbilical cord diameter between pump twin and acardia twin in TRAPs is significant for predicting the pregnancy outcome of pump twin.

Hepatocellular carcinoma （HCC） with biliary duct tumor thrombus （BDTT） is currently not common in clinical practice and is easily misdiagnosed， and previously， it was often considered an advanced stage of the disease with a poor prognosis， making its treatment challenging. However， in-depth studies in recent years have gradually deepened our understanding of this disease， leading to significant changes in diagnostic and treatment concepts. Currently， comprehensive treatment， mainly surgery， is used for treatment， but there is still controversy over the selection of clinical treatment strategies. This article provides a detailed discussion on surgical methods and prognosis， in order to provide a reference for clinical treatment options.

Objective:To investigate microbial ecology in restored milk (RM) -donor human milk (DHM) supplemented with mother's own milk (MOM)-under varying MOM ratios, incubation temperatures, and durations. Methods:This in vitro controlled study utilized breast milk samples collected from mothers of preterm infants (<37 weeks) admitted to the Neonatal Intensive Care Unit of Chongqing Health Center for Women and Children between December 2024 and March 2025, including five MOM samples and one DHM sample. Each MOM sample was mixed with DHM at 10% (RM-10 group) or 30% (RM-30 group) volume ratios. Samples were incubated at room temperature (23-26 ℃) and 37 ℃ for 1 h and 4 h, followed by collection. Microbial α-diversity (Chao/Shannon indices), β-diversity (principal co-ordinates analysis), and taxonomic composition (phylum/genus) were analyzed via high-throughput sequencing. Statistical analysis included analysis of variance and the Kruskal-Wallis H test. Results:No statistically significant differences in the Chao index or Shannon index were observed between the RM-10 and RM-30 groups across different incubation times and temperatures ( H or F values=7.61 and 93.20, respectively; both P>0.05). At 37 ℃, the microbial composition of the RM-30 group at both 1 h and 4 h showed no significant difference compared to the initial MOM samples ( R=－0.018, P=0.540), with Firmicutes abundance restored to 65%-90% of the initial MOM level. At room temperature, incubation of the RM-30 group partially restored microbial communities (50%-60%), but induced overgrowth of Proteobacteria (e.g., Pseudomonas, Acinetobacter). Incubation of the RM-10 group at 37 ℃ for 1 h and 4 h also showed no significant difference in microbial composition compared to the initial MOM ( R=－0.004, P=0.442). However, at room temperature, Proteobacteria consistently increased in the RM-10 group samples, and significant differences in microbial composition compared to initial MOM were observed at both 1 h and 4 h ( R=0.179, P=0.027). Conclusion:Under the experimental conditions of this study, preliminary evidence suggests that incubating a blend of DHM and 30% MOM at 37 ℃ for 1 h or 4 h may modulate the microbial composition toward a potentially beneficial profile.

BACKGROUND:Iron overload is an independent factor inducing osteoporosis,but the action mechanism is currently unclear.Therefore,exploring the effects of iron overload on osteoblast-related cells will help to deeply understand the pathogenesis of osteoporosis and provide potential strategies for osteoporosis treatment.OBJECTIVE:To explore the effects of iron overload environment on osteoblast precursor cell activity,ferroptosis,and osteogenic differentiation.METHODS:Osteoblast precursor cells(MC3T3-E1 cells)were divided into blank group,iron overload group,fer-1 group,and deferoxamine group.The iron overload group was treated with 300 μmol/L ammonium ferric citrate in the culture medium for 48 hours to simulate the iron overload microenvironment.The cells in fer-1 group and deferoxamine group were pretreated with 5 μmol/L antioxidant fer-1 and 5 μmol/L deferoxamine for 8 hours,respectively,and then added with 300 μmol/L ammonium ferric citrate for 48 hours.CCK-8 assay was used to determine the cell viability.Intracellular reactive oxygen species levels were detected employing a reactive oxygen species fluorescent probe.Changes in mitochondrial membrane potential were monitored with a mitochondrial membrane potential fluorescent probe.Mitochondrial morphology was observed employing transmission electron microscopy.Cellular glutathione levels were measured with a reduced glutathione colorimetric assay kit.Lipid peroxidation levels were assessed with a malondialdehyde colorimetric assay kit.Cellular ferrous ion levels were determined with a ferrous ion colorimetric assay kit.The osteogenic and mineralization capabilities of the cells were verified by alkaline phosphatase staining and alizarin red staining.Collagen secretion ability was detected using Sirius Red staining.The expression of osteogenic/ferroptosis-related genes and proteins was examined through reverse transcription quantitative polymerase chain reaction and western blot analysis.RESULTS AND CONCLUSION:(1)In an iron-overload environment,the mitochondrial membrane potential of cells decreased and their structure was compromised,with an elevation in intracellular lipid peroxidation levels and a downregulation of genes and proteins associated with ferroptosis resistance.However,pretreatment with fer-1 and deferoxamine led to an increase in mitochondrial membrane potential and partial restoration of morphology,a reduction in intracellular lipid peroxidation levels,and an upregulation of genes and proteins related to ferroptosis resistance.(2)In an iron-overload environment,the levels of cellular alkaline phosphatase,the formation of mineralized nodules,and the synthesis of collagen fibers were all found to be decreased.Pretreatment with fer-1 and deferoxamine was observed to upregulate the expression of osteogenic differentiation in cells.(3)In summary,iron overload could increase intracellular oxidative stress levels,mediate ferroptosis in MC3T3-E1 cells and inhibit osteogenic differentiation,thereby inducing osteoporosis.Therefore,maintaining iron homeostasis and inhibiting osteogenesis-related ferroptosis may be potential strategies to prevent or treat osteoporosis.

BACKGROUND:Iron overload is an independent factor inducing osteoporosis,but the action mechanism is currently unclear.Therefore,exploring the effects of iron overload on osteoblast-related cells will help to deeply understand the pathogenesis of osteoporosis and provide potential strategies for osteoporosis treatment.OBJECTIVE:To explore the effects of iron overload environment on osteoblast precursor cell activity,ferroptosis,and osteogenic differentiation.METHODS:Osteoblast precursor cells(MC3T3-E1 cells)were divided into blank group,iron overload group,fer-1 group,and deferoxamine group.The iron overload group was treated with 300 μmol/L ammonium ferric citrate in the culture medium for 48 hours to simulate the iron overload microenvironment.The cells in fer-1 group and deferoxamine group were pretreated with 5 μmol/L antioxidant fer-1 and 5 μmol/L deferoxamine for 8 hours,respectively,and then added with 300 μmol/L ammonium ferric citrate for 48 hours.CCK-8 assay was used to determine the cell viability.Intracellular reactive oxygen species levels were detected employing a reactive oxygen species fluorescent probe.Changes in mitochondrial membrane potential were monitored with a mitochondrial membrane potential fluorescent probe.Mitochondrial morphology was observed employing transmission electron microscopy.Cellular glutathione levels were measured with a reduced glutathione colorimetric assay kit.Lipid peroxidation levels were assessed with a malondialdehyde colorimetric assay kit.Cellular ferrous ion levels were determined with a ferrous ion colorimetric assay kit.The osteogenic and mineralization capabilities of the cells were verified by alkaline phosphatase staining and alizarin red staining.Collagen secretion ability was detected using Sirius Red staining.The expression of osteogenic/ferroptosis-related genes and proteins was examined through reverse transcription quantitative polymerase chain reaction and western blot analysis.RESULTS AND CONCLUSION:(1)In an iron-overload environment,the mitochondrial membrane potential of cells decreased and their structure was compromised,with an elevation in intracellular lipid peroxidation levels and a downregulation of genes and proteins associated with ferroptosis resistance.However,pretreatment with fer-1 and deferoxamine led to an increase in mitochondrial membrane potential and partial restoration of morphology,a reduction in intracellular lipid peroxidation levels,and an upregulation of genes and proteins related to ferroptosis resistance.(2)In an iron-overload environment,the levels of cellular alkaline phosphatase,the formation of mineralized nodules,and the synthesis of collagen fibers were all found to be decreased.Pretreatment with fer-1 and deferoxamine was observed to upregulate the expression of osteogenic differentiation in cells.(3)In summary,iron overload could increase intracellular oxidative stress levels,mediate ferroptosis in MC3T3-E1 cells and inhibit osteogenic differentiation,thereby inducing osteoporosis.Therefore,maintaining iron homeostasis and inhibiting osteogenesis-related ferroptosis may be potential strategies to prevent or treat osteoporosis.

OBJECTIVE To investigate the pathogens of pulmonary infection and their influencing factors in patients with initially treated pulmonary tuberculosis(PTB),and to analyze the diagnostic efficacy of systemic inflamma-tory response index(SIRI)for pulmonary infection.METHODS The clinical data of 459 patients with initially trea-ted PTB admitted to Changsha Central Hospital from Jan.to Dec.2023 were retrospectively analyzed,and they were divided into the combined group(n=90)and the non-combined group(n=369)according to the combina-tion of other pulmonary infections at the time of consultation.The pathogens of pulmonary infection,as well as the levels of monocytes(MN),neutrophils(NE),and lymphocytes(LYM),were analyzed,and the SIRI was calculated.The risk factors of pulmonary infection in initially treated PTB patients were explored by multivariate logistic regression analysis,and the diagnostic value of SIRI for pulmonary infection in initially treated PTB pa-tients was evaluated by receiver operating characteristic(ROC)curve.RESULTS The rate of pulmonary infection in 459 initially treated PTB patients was 19.61％(90/459),and a total of 103 pathogens were detected,of which 64 strains of gram-negative bacteria accounted for 62.14％,followed by 28 strains of gram-positive bacteria ac-counting for 27.18％,and 11 strains of fungi accounting for 10.68％,with Pseudomonas aeruginosa,Klebsiella pneumoniae and Staphylococcus aureus being predominant.Age(OR=1.908,95％CI:1.375-2.647),comor-bid diabetes(OR=2.073,95％CI:1.462-2.938),pulmonary cavities(OR=2.323,95％CI:1.588-3.398),delayed medical treatment(OR=2.024,95％CI:1.467-2.791)and elevated SIRI(OR=2.855,95％CI:1.851-4.402)were risk factors for pulmonary infection in initially treated PTB patients(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of SIRI for diagnosing pulmonary infection in initially treated PTB cases was 0.876(0.824-0.928),with a cut-off value of 4.96×109/L,a specificity of 85.91％,and a sen-sitivity of 86.67％.CONCLUSIONS The main pathogens in patients with initially treated PTB complicated with pulmonary infection are Pseudomonas aeruginosa and Klebsiella pneumoniae.Age,comorbid diabetes mellitus,pulmonary cavity,delayed medical treatment and elevated SIRI are all influencing factors for pulmonary infection in patients with initially treated PTB,and monitoring of SIRI can to some extent assist in diagnosis of whether pa-tients with initial treatment PTB are complicated with other pulmonary infections.

OBJECTIVE To investigate the pathogens of pulmonary infection and their influencing factors in patients with initially treated pulmonary tuberculosis(PTB),and to analyze the diagnostic efficacy of systemic inflamma-tory response index(SIRI)for pulmonary infection.METHODS The clinical data of 459 patients with initially trea-ted PTB admitted to Changsha Central Hospital from Jan.to Dec.2023 were retrospectively analyzed,and they were divided into the combined group(n=90)and the non-combined group(n=369)according to the combina-tion of other pulmonary infections at the time of consultation.The pathogens of pulmonary infection,as well as the levels of monocytes(MN),neutrophils(NE),and lymphocytes(LYM),were analyzed,and the SIRI was calculated.The risk factors of pulmonary infection in initially treated PTB patients were explored by multivariate logistic regression analysis,and the diagnostic value of SIRI for pulmonary infection in initially treated PTB pa-tients was evaluated by receiver operating characteristic(ROC)curve.RESULTS The rate of pulmonary infection in 459 initially treated PTB patients was 19.61％(90/459),and a total of 103 pathogens were detected,of which 64 strains of gram-negative bacteria accounted for 62.14％,followed by 28 strains of gram-positive bacteria ac-counting for 27.18％,and 11 strains of fungi accounting for 10.68％,with Pseudomonas aeruginosa,Klebsiella pneumoniae and Staphylococcus aureus being predominant.Age(OR=1.908,95％CI:1.375-2.647),comor-bid diabetes(OR=2.073,95％CI:1.462-2.938),pulmonary cavities(OR=2.323,95％CI:1.588-3.398),delayed medical treatment(OR=2.024,95％CI:1.467-2.791)and elevated SIRI(OR=2.855,95％CI:1.851-4.402)were risk factors for pulmonary infection in initially treated PTB patients(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of SIRI for diagnosing pulmonary infection in initially treated PTB cases was 0.876(0.824-0.928),with a cut-off value of 4.96×109/L,a specificity of 85.91％,and a sen-sitivity of 86.67％.CONCLUSIONS The main pathogens in patients with initially treated PTB complicated with pulmonary infection are Pseudomonas aeruginosa and Klebsiella pneumoniae.Age,comorbid diabetes mellitus,pulmonary cavity,delayed medical treatment and elevated SIRI are all influencing factors for pulmonary infection in patients with initially treated PTB,and monitoring of SIRI can to some extent assist in diagnosis of whether pa-tients with initial treatment PTB are complicated with other pulmonary infections.

Objective:To construct a nomogram model for predicting the incidence of hepatocellular carcinoma based on serum abnormal prothrombin and alpha-fetoprotein and evaluate the predictive effect.Methods:Retrospective analysis of data from 351 patients with liver disease who received treatment at the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2023, including 285 males and 66 females, aged (52.9±11.9) years. Among the 351 patients, there were 229 cases (65.2%) of hepatocellular carcinoma, 87 cases (24.8%) of liver cirrhosis, and 35 cases (10.0%) of chronic hepatitis B. All patients were randomly divided into a training set ( n=245) and a testing set ( n=106) in a 7∶3 ratio without replacement sampling. The training set was used to construct the model, and the testing set was used to evaluate the model. At the same time, gender, age, disease type, and other indicators were compared between the two sets. The risk factors of hepatocellular carcinoma were analyzed by univariate and multivariate logistic regression based on the training set, and a nomogram was constructed to predict the incidence of hepatocellular carcinoma based on the multivariate results. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive performance of nomogram, and decision curve analysis was used to evaluate the clinical applicability of the model. Results:There was no statistically significant difference in age, gender, disease type, etc. between the training and testing sets of patients (all P>0.05). Univariate logistic regression analysis showed that age, abnormal prothrombin logarithm (LnPIVKA-Ⅱ), alpha-fetoprotein logarithm (LnAFP), and diabetes were associated with hepatocellular carcinoma (all P<0.05). Multivariate logistic regression analysis showed that older age ( OR=1.07, 95% CI: 1.03-1.12), higher LnPIVKA-Ⅱ ( OR=2.97, 95% CI: 1.97-4.46), higher LnAFP ( OR=1.43, 95% CI: 1.11-1.84) and diabetes ( OR=5.17, 95% CI: 1.02-26.17) were risk factors for hepatocellular carcinoma (all P<0.05). Based on the above variables, a nomogram model for predicting the incidence of hepatocellular carcinoma was constructed. The area under the ROC curve analysis of the nomogram for predicting the incidence of hepatocellular carcinoma was 0.920 (95% CI: 0.886-0.953) in the training set and 0.934 (95% CI: 0.891-0.977) in the testing set. The calibration curve fit well with the standard curve, and the prediction was basically consistent with the actual situation. The decision curve analysis showed that the net benefit of the model was greater than 0 under most thresholds (0.1-1.0). Conclusion:The nomogram constructed based on age, LnPIVKA-Ⅱ, LnAFP and diabetes can effectively predict the incidence of hepatocellular carcinoma and has clinical applicability.

Objective:To analyze the relationship between the growth and development of pump twin and the changes of blood flow parameters and the natural pregnancy outcome of pump twin after pontaneous cessation of blood flow in the umbilical artery of the acardiac twin with reverse arterial perfusion sequence（TRAPs）detected by prenatal ultrasound.Methods:From January 2001 to August 2023，a total of 23 cases of TRAPs diagnosed in Hubei Maternal and Child Health Hospital were retrospectively collected and detected by ultrasound follow-up. According to the pregnancy outcome of the pump twin，23 patients were divided into the poor pregnancy outcome group（6 cases）and the good pregnancy outcome group（17 cases）. The changes of ultrasound growth indexes and blood flow parameters of the pump twin and acardia twin were compared between the two groups. The hemodynamic parameters with statistically significant differences between the two groups were selected，and the diagnostic efficacy for TRAPs pregnancy outcomes was analyzed using ROC analysis.Results:There were no statistically significant differences in the structural development of acardiac fetus between the two groups，including skin edema，hemicardia，skull structure，trunk structure，upper and lower limbs，cardiothoracic ratio，amniotic fluid，sex and amniotic nature of twins（all P > 0.05）. The lower limbs of acardia twin was significantly higher in the poor pregnancy outcome group（6/6）than in the good pregnancy outcome group（7/17），and the difference was statistically significant（ P < 0.05）. The relevant parameters of ultrasound blood flow were shown in both groups，there were no significant differences in middle cerebral artery pulsation index（PI）and umbilical artery PI between the two groups before natural occlusion of fetal blood flow with TRAPs（all P > 0.05）. In the good pregnancy outcome group，the ratio of umbilical cord diameter between pump twin and acardia twin was higher than that in the poor pregnancy outcome group，the difference was statistically significant（ P < 0.05）. The scatter plot of the ratio of umbilical diameter between the two groups was drawn，and the cut-off value was 2.125 through ROC curve analysis，the area under the curve（AUC）was 0.961，the sensitivity was 94.10%，the specificity was 100%，and the Yoden index was 0.94. Conclusions:The ratio of umbilical cord diameter between pump twin and acardia twin in TRAPs is significant for predicting the pregnancy outcome of pump twin.