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 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 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 promote the development of high-quality health standards in China and summarize the characteristics of global health standards management systems and development processes.  Methods  We conducted a systematic search of relevant databases and the websites of standardization institutions. A descriptive method was used to analyze the basic characteristics of the standard management systems and development processes.  Results  The majority of the investigated countries and organizations primarily implement voluntary standards, with the exception of Chinese and the European Committee for Standardization that enforce compulsory standards. All countries and organizations have health standards at the national, group, and enterprise levels. In China and Japan, standards authorities are subordinate to the government, while in other countries or organizations, they operate as independent civil societies. The development process for health standards generally involves five stages: "Project/Proposal → Draft → Enquiry → Review → Publication". However, the specific steps in the development of health standards vary across different countries and organizations. Furthermore, China ranks high in the number of both standards and health standards issued, but the proportion of health standards is only 2.06%.  Conclusions  There are significant differences between China and other countries in terms of the management system and development process of health standards. To promote the management and development of high-quality health standards in China, we recommend promoting the coordination mechanism for standard development, increasing efforts to publicize standards and evaluate the implementation effect, strengthening the construction of personnel for the development of health standards, optimizing the efficiency of standard development and improving the internationalization level of health standards.

The paper-based microfluidic chip,also known as a paper chip,uses paper as the substrate on which the sample processing,biochemical reactions and assay processes are performed.Com-pared to other microfluidic chips,the paper chip has the advantages of widely availability of raw materials,lower cost,and easier disposal after use and ease of operation,making it more suitable for rapid on-site testing.This study systematically summarizes the production technology of paper chip and its research progress in animal pathogen detection,analyzes the existing problems of pa-per chip technology,and looks forward to the future research direction,so as to provide reference for the improvement of paper chip technology and its popularization and application.

Humans ; Hypertension/therapy* ; Publications ; Research Design

Objective: To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO). Methods: A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n=20) and no weaning group (n=8). The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups. Results: Age, the peak of creatine kinase-MB levels(CK-MB), cardiac troponin I levels (cTnI), and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR=0.064, 95%CI: 0.008-0.527, P=0.011; OR=1.004, 95%CI: 1.002-1.108, P=0.039; OR=3.635, 95%CI: 1.320-9.740, P=0.020; OR=1.075, 95%CI: 1.045-1.286, P=0.013). In the weaning group, compared with pre-ECMO, mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO₂) were significantly increased at maximum flow on the first day during ECMO (all P<0.05), while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P<0.05). The values of MAP, StO₂, left ventricular ejection fraction (LVEF), velocity-time integral of left ventricular outflow tract (LVOT-VTI), velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P<0.05). Compared with the no weaning group, MAP, StO₂, LVEF, LVO-TVTI and LatSa increased significantly in the weaning group (all P<0.05), and the left ventricular end diastolic volume (LVEDV) decreased obviously after ECMO weaning(P<0.05). Conclusions Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO.

To follow up and analyze patients with ventricular septal rupture( VSR) after acute myocardial infarction ( AM I) w ho underwent VSR occlusion ,screen the main risk factors of survival in perioperative patients with VSR after AM I ,and observe the postoperative cardiac function and hemodynamic changes by echocardiography . Methods Seventeen VSR patients were divided into the survival group ( 11 cases) and the death group ( 6 cases) within 30 days according to the survival time . T he changes of cardiac ultrasound parameters before and after the operation of VSR survivors were compared , and the hemodynamic recovery characteristics of VSR survivors were analyzed . Results Age ,the time to VSR occlusion ,preoperative left ventricular ejection fraction ,cardiogenic shock ,and the size of VSR were all the factors that were closely related to the 30‐day mortality of VSR with odds ratio of 0 .90 ( 95% CI 0 .73 to 1 .14 , P ＝0 .045) ,1 .89( 95% CI 1 .35 to 2 .23 , P ＝0 .003) ,0 .89( 95% CI 0 .57 to 1 .24 , P ＝0 .039) ,1 .45 ( 95% CI 1 .12 to 1 .78 , P ＝0 .027) and 11 .45( 95% CI 7 .89 to 15 .56 , P ＝0 .012) ,respectively ( all P＜0 .05 ) . Compared with the preoperative measurements , the left ventricular end‐diastolic volume and pulmonary artery systolic pressure were significantly reduced in the VSR survival group ( P ＜ 0 .05 ) . Conclusions The decrease of left ventricular end diastolic volume and pulmonary artery systolic pressure after operation indicates a better prognosis in the short period . Echocardiography is a vital tool in preoperative screening ,intraoperative monitoring and postoperative follow‐up in VSR occlusion .

Objective To analyze the application of dexmedetomidine in intracranial arterial stenting and its influence on the serum myocardial enzyme ,cardiac troponin I(cTnI) and left ventricular ejection fraction (LVEF). Methods From March 2015 to March 2017,94 cases with intracranial arterial stenting in the People's Hospital of Lishui were divided into control group and observation group by the random number table method ,with 47 cases in each group.The control group was treated with conventional anesthesia ,the observation group was treated with dexme-detomidine.The enzyme creatine phosphate kinase isoenzyme (CK -MB),creatine phosphate kinase (CK),cTnI, LVEF,inflammatory factor, neural function, brain oxygen metabolism and complications in the two groups were compared.Results After surgery,the CK-MB,CK,cTnI levels of the observation group were lower than those of the control group[(35.27 ±4.41) U/L,(488.30 ±61.03) U/L,(3.85 ±0.49) μg/L vs.(46.40 ±5.79) U/L, (611.21 ±76.40)U/L,(4.72 ±0.59)μg/L],the LVEF of the observation group was higher than that of the control group[(45.60 ±5.72)%vs.(43.12 ±5.39)%],the differences were statistically significant (t＝10.484,8.619, 7.777,2.163,all P＜0.05).The interleukin -6(IL-6) and interleukin -8(IL-8),tumor necrosis factor -α (TNF-α),S-100β,specificity enolization enzyme(NSE),cerebral metabolic rate of oxygen(ERO2),arterial blood oxygen saturation(PaO2),carotid venous blood oxygen saturation (SjvO2) of the observation group were better than those of the control group(t＝5.794,6.177,15.065,6.964,5.606,3.147,2.116,2.807,all P＜0.05).The inci-dence rate of complication of the observation group was lower than that of the control group (χ2＝17.091,P＜0.05). Conclusion Application of dexmedetomidine in intracranial arterial stenting can protect myocardium , inhibit the serum levels of myocardial enzyme ,cTnI rise,and is conducive to the recovery of LVEF.

Objective: To evaluate the ability of matrix-assisted laser desorption/ionization-time of flight mass spectrometry(MALDI-TOF MS) in the homology analysis of Carbapenems-resistant klebsiella pneumonia. Methods: Twenty-one non-duplicated strains of Carbapenems-resistant klebsiella pneumoniae were isolated from Shandong Provincial Hospital affiliated to Shandong University during April 2011 and October 2013 in this study. Twenty isolates were from neonatal unit and one from cardiac surgery. The homology analysis of Carbapenems-resistant klebsiella pneumoniae was performed with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and MALDI-TOF MS respectively. Results: The result of PFGE was consistent with MLST. The twenty-one CRKPN strains were divided into three groups by MALDI-TOF MS according to their relationship, 18 of them belonged to II group, and the homology was higher than 75%. From the analysis of protein mass spectra of 18 strains, the protein peaks were roughly the same. Thus, it was concluded that their relationship was close, and the results were basically consistent with the results of PFGE and MLST. The H13 strain with low homology (<60%) was different from the above strains, especially in the molecular weight 4365, 5381 and 6289.The PFGE analysis showed that the homology between H13 and other strains was 61%, and the MLST classification result was ST54. Conclusions MALDI-TOF MS can be used to identify CRKPN accurately and analyze its homology analysis more conveniently than other methods in clinical laboratory. MALDI-TOF MS has the potential to be used as an easy and rapid epidemiology typing tool for nosocomial infection investigation caused by drug-resistant bacteria.(Chin J Lab Med, 2018, 41: 589-595)